Communicable Disease Nursing (part Ii: Diseases)

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Communicable Disease Nursing

I. EPI DISEASES DISEASE 1. Tuberculosis Other names: Koch’s Disease Consumption Phthisis Weak lungs

CAUSATIVE AGENT Mycobacterium tuberculosis TB bacillus Koch’s bacillus Mycobacterium bovis (rod-shaped)

MODE OF TRANSMISSION Airborne-droplet Direct invasion through mucous membranes and breaks in the skin (very rare)

Most hazardous period for development of clinical Incubation period : 4 – 6 weeks disease is the first 6-12 months after infection Highest risk of developing disease is children under 3years old

PATHOGNOMONIC SIGN 1. Usually asymptomatic 2. Low-grade afternoon fever 3. Night sweating 4. Loss of appetite 5. Weight loss 6. Easy fatigability – due to increased oxygen demand 7. Temporary amenorrhea 8. Productive dry cough 9. Hemoptysis

TREATMENT: SCC/Short Course Chemotherapy, Direct –observed treatment short course/DOTS; Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E), Streptomycin (S) CATEGORY 1: 6 months SCC Indications: > new (+) smear > (-) smear PTB with extensive parenchymal lesions on CXR > Extrapulmonary TB > severe concominant HIV disease Intensive Phase: 2 months R&I : 1 tab each; P&E 2 tabs each Continuation Phase: 4 months R&I : 1 tab each

CATEGORY 2: 8 months SCC Indications: > treatment failure > relapse > return after default Intensive Phase:3 mos R&I 1 tab each; P&E 2 tabs each Streptomycin – 1 vial/day IM for first 2 months = 56 vials (if given for > 2mos can cause nephrotoxicity Continuation Phase: 5 months R&I : 1 tab each E : 2 tabs

CATEGORY 3: 6 months SCC Indications: > new (-) smear PTB with minimal lesions on CXR Same meds with Category 1 Intensive Phase: 2 months R&I 1 tab each; P&E 2 tabs each Continuation Phase: 4 months R&I 1 tab each CATEGORY 4: Chronic (*Referral needed)

SIDE EFFECTS: Rifampicin • body fluid discoloration • hepatotoxic • permanent discoloration of contact lenses Isoniazid • Peripheral neuropathy (Give Vit B6/Pyridoxine) Pyrazinamide • hyperuricemia /gouty arthritis (increase fluid intake)

MANAGEMENT/TREATMENT

PREVENTION

Diagnostic test: • Sputum examination or the Acid-fast bacilli (AFB) / sputum microscopy 1. Confirmatory test 2. Early morning sputum about 3-5 cc 3. Maintain NPO before collecting sputum 4. Give oral care after the procedure 5. Label and immediately send to laboratory 6. If the time of the collection of the sputum is unknown, discard • Chest X-ray is used to: 1. Determine the clinical activity of TB, whether it is inactive (in control) or active (ongoing) 2. To determine the size of the lesion: a. Minimal – very small b. Moderately advance – lesion is < 4 cm c. Far advance – lesion is > 4 cm • Tuberculin Test – purpose is to determine the history of exposure to tuberculosis Other names: Mantoux Test – used for single screening, result interpreted after 72 hours Tine test – used for mass screening read after 48 hours Interpretation: 0 - 4 mm induration – not significant 5 mm or more – significant in individuals who are considered at risk; positive for patients who are HIV-positive or have HIV risk factors and are of unknown HIV status, those who are close contacts with an active case, and those who have chest x-ray results consistent with tuberculosis. 10 mm or greater – significant in individuals who have normal or mildly impaired immunity

• Respiratory precautions • Cover the mouth and nose when sneezing to avoid mode of transmission • Give BCG BCG is ideally given at birth, then at school entrance. If given at 12 months, perform tuberculin testing (PPD), give BCG if negative. • Improve social conditions SIDE EFFECTS: Ethambutol • Optic neuritis • Blurring of vision (Not to be givento children below 6 y.o. due to inability to complain blurring of vision) • Inability to recognize green from blue Streptomycin • Damage to 8th CN • Ototoxic • Tinnitus • nephrotoxic

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NATIONAL TB CONTROL PROGRAM: Vision: A country where TB is no longer a public health problem Mission: Ensure that TB DOTS Services are available, accessible, and affordable to the communities in collaboration with LGUs and others Goal: To reduce prevalence and mortality from TB by half by the year 2015 (Millennium Development Goal) Targets: 1. Cure at least 85% of the sputum smear (+) patients discovered 2. Detect at least 70% new sputum smear (+) TB cases Objectives: 1. Improve access to and quality of services 2. Enhance stakeholder’s health-seeking behavior 3. Increase and sustain support for TB control activities 4. Strengthen management of TB control activities at all levels KEY POLICIES: *Case finding: - DSSM shall be the primary diagnostic tool in NTP case finding - No TB Dx shall be made based on CXR results alone - All TB symptomatic shall be asked to undergo DSSM before treatment - Only contraindication for sputum collection is hemoptysis - PTB symptomatic shall be asked to undergo other tests (CXR and culture), only after three sputum specimens yield negative results in DSSM - Only trained med techs / microscopists shall perform DSSM - Passive case finding shall be implemented in all health stations

Communicable Disease Nursing

s MANAGEMENT OF CHILDREN WITH TUBERCULOSIS - for TB symptomatic children *a TB symptomatic child with either known or Prevention: BCG immunization to all infants (EPI) unknown exposure to a TB case shall be referred for tuberculin testing Casefinding: * (+) contact but (-) tuberculin test and unknown - cases of TB in children are reported and identified in 2 contact but (+) tuberculin test shall be referred for instances: (a) patient was screened and was found symptomatic CXR examination of TB after consultaion (b) patient was reported to have been *(-) CXR, repeat tuberculin test after 3 months exposed to an adult TB patient * INH chemoprophylaxis for three months shall be - ALL TB symptomatic children 0-9 y.o, EXCEPT sputum given to children less than 5y.o. with (-) CXR; after positive child shall be subjected to Tuberculin testing (Note: which tuberculin test shall be repeated Only a trained PHN or main health center midwife shall do tuberculin testing and reading which shall be conducted once a Treatment (Child with TB): week either on a Monday or Tuesday. Ten children shall be Short course regimen gathered for testing to avoid wastage. PULMONARY TB Intensive: 3 anti-TB drugs (R.I.P.) for 2 months - Criteria to be TB symptomatic (any three of the following:) Continuation: 2 anti-TB drugs (R&I) for 4 months * cough/wheezing of 2 weeks or more * unexplained fever of 2 weeks or more EXTRA-PULMONARY TB * loss of appetite/loss of weight/failure to gain weight/weight Intensive: 4 anti-TB drugs (RIP&E/S) for 2 months faltering Continuation: 2 anti-TB drugs (R&I) for 10 months * failure to respond to 2 weeks of appropriate antibiotic therapy for lower respiratory tract infection *Treatment: Domiciliary treatment – preferred mode of care * failure to regain previous state of health 2 weeks after a viral DSSM – basis for treatment of all TB cases infection or exanthem (e.g. measles) PERIOD OF COMMUNICABILITY OF *Hospitalization is recommended: massive hemoptysis, pleural effusion, TUBERCULOSIS: military TB, TB meningitis, TB pneumonia, & surgery is needed or with -Conditions confirming TB diagnosis (any 3 of the following:)  as long as bacillus is contained in the complications * (+) history of exposure to an adult/adolescent TB case sputum *All patients undergoing treatment shall be supervised * (+) signs and symptoms suggestive of TB  Primary complex in children is NOT *National & LGUs shall ensure provision of drugs to all smear (+) TB cases * (+) tuberculin test contagious *Quality of fixed-dose combination (FDC) must be ensured * abnormal CXR suggestive of TB  Good compliance to regimen renders *Treatment shall be based on recommended category of treatment regimen * Lab findings suggestive or indicative of TB person not contagious 2-4 weeks after initiation of treatment DOTS Strategy – internationally-recommended TB control strategy - for children with exposure to TB Five Elements of DOTS: (RUSAS) Recording & reporting system enabling outcome assessment of all patients * a child w/ exposure to a TB registered adult patient shall undergo physical exam and tuberculin testing Uninterrupted supply of quality-assured drugs * a child with productive cough shall be referred for sputum Standardized SCC for all TB cases exam, for (+) sputum smear child, start treatment immediately Access to quality-assured sputum microscopy * TB asymptomatic but (+) tuberculin test and TB symptomatic Sustained political commitment but (-) tuberculin test shall be referred for CXR examination

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2. Diphtheria Types: > nasal > pharyngeal – most common > laryngeal – most fatal due to proximity to epiglottis

3. Pertussis Whooping cough Tusperina No day cough

Corynebacterium diphtheria Klebbs-loffler

***Diphtheria transmission is increased in hospitals, households, schools, and other crowded areas. Bordetella pertussis Hemophilus pertussis Bordet-gengou bacillus Pertussis bacillus

Communicable Disease Nursing

Droplet especially secretions from mucous membranes of the nose and nasopharynx and from skin and other lesions Milk has served as a vehicle Incubation Period: 2 – 5 days Droplet especially from laryngeal and bronchial secretions Incubation Period: 7 – 10 days but not exceeding 21 days

Pseudomembrane – mycelia of the oral mucosa causing formation of white membrane on the oropharynx Bull neck Dysphagia Dyspnea

Complication: MYOCARDITIS (Encourage bed rest) Catarrhal period: 7 days paroxysmal cough followed by continuous nonstop accompanied by vomiting Complication: abdominal hernia

Incidence: highest under 7 years of age Mortality: highest among infants (<6 months) One attack confers definite and prolonged immunity. Second attack occasionally occurs

4. Tetanus Other names: Lock jaw

Clostridium tetani – anaerobic spore-forming heat-resistant and lives in soil or intestine Neonate: umbilical cord Children: dental caries Adult: punctured wound; after septic abortion

Indirect contact – inanimate objects, soil, street dust, animal and human feces, punctured wound

Incubation Period: Varies from 3 days to 1 month, falling between 7 – 14 days

Diagnostic test: • Nose/throat swab • Moloney’s test – a test for hypersensitivity to diphtheria toxin • Schick’s test – determines susceptibility to bacteria Drug-of-Choice: Erythromycin 20,000 - 100,000 units IM once only

Risus sardonicus (Latin: “devil smile”) – facial spasm; sardonic grin Opisthotonus – arching of back For newborn: 1. Difficulty of sucking 2. Excessive crying 3. Stiffness of jaw 4. Body malaise

Plan nursing care to improve respiration. Diagnostic: • Bordet-gengou agar test Management: 1. DOC: Erythromycin or Penicillin 20,000 100,000 units 2. Complete bed rest 3. Avoid pollutants 4. Abdominal binder to prevent abdominal hernia

No specific test, only a history of punctured wound Treatment: Antitoxin antitetanus serum (ATS) tetanus immunoglobulin (TIG) (if the patient has allergy, should be administered in fractional doses) Pen G Diazepam – for muscle spasms Note: The nurse can give fluid provided that the patient is able to swallow. There is risk of aspiration. Check first for the gag reflex

DPT immunization Pasteurization of milk Education of parents ***Infants born to immune mothers maybe protected up to 6-9 months. Recovery from clinical attack is always followed by a lasting immunity to the disease. DPT immunization Booster: 2 years and 4-5 years Patient should be segregated until after 3 weeks from the appearance of paroxysmal cough

DPT immunization Tetanus toxoid (artificial active) immunization among pregnant women Training and Licensing of midwives/”hilots” Health education of mothers Puncture wounds are best cleaned by thorough washing with soap and water.

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5. Poliomyelitis Other name: Infantile paralysis

Legio debilitans Polio virus Enterovirus

Communicable Disease Nursing

Fecal – oral route Incubation period: 7 – 21 days

Attacks the anterior horn of the neuron, motor is affected Man is the only reservoir 6. Measles Other names: Morbilli Rubeola

7. Hepatitis B Other names: Serum Hepatitis

RNA containing paramyxovirus Period of Communicability: 4 days before and 5 days after the appearance of rash

Hepatitis B virus

Droplet secretions from nose and throat Incubation period: 10 days – fever 14 days – rashes appear (8-13 days)

Blood and body fluids Placenta Incubation period: 45 – 100 days

Paralysis Muscular weakness Uncoordinated body movement Hoyne’s sign – head lag after 4 months (!Safety) 1. Koplik’s spots – whitish/bluish pinpoint patches on the buccal cavity 2. cephalocaudal appearance of maculopapular rashes 3. Stimson’s line – bilateral red line on the lower conjunctiva

1. Right-sided Abdominal pain 2. Jaundice 3. Yellow-colored sclera 4. Anorexia 5. Nausea and vomiting 6. Joint and Muscle pain 7. Steatorrhea 8. Dark-colored urine 9. Low grade fever

Diagnostic test:

OPV vaccination Frequent hand washing

• CSF analysis / lumbar tap • Pandy’s test Management: Rehabilitation involves ROM exercises No specific diagnostic test Management: Supportive and symptomatic

Diagnostic test: • Hepatitis B surface agglutination (HBSAg) test Management: > Hepatitis B Immunoglobulin Diet: high in carbohydrates

Hepatitis A – infectious hepatitis; oral-fecal Hepatitis B – serum hepatitis; blood and body fluids Hepatitis C – non-A non-B, post-transfusion hepatitis; blood and body fluids Hepatitis D – Delta hepatitis or dormant hepatitis; blood and body fluids; needs past history of infection to Hepatitis B Hepatitis E – oral-fecal

Measles vaccine Disinfection of soiled articles Isolation of cased from diagnosis until about 5-7 days after onset of rash

-Hepatitis B immunization -Wear protected clothing -Hand washing -Observe safe-sex -Sterilize instruments used in minor surgical-dental procedures -Screening of blood products for transfusion

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Communicable Disease Nursing

II. DISEASES TRANSMITTED THROUGH FOOD AND WATER DISEASE 1. Cholera Other names: El tor

CAUSATIVE AGENT Vibrio cholera Vibrio coma Ogawa and Inaba bacteria

MODE OF TRANSMISSION Fecal-oral route

PATHOGNOMONIC SIGN Rice watery stool

5 Fs

Period of Communicability: 7-14 days after onset, occasionally 2-3 months

Incubation Period: Few hours to 5 days; usually 3 days 2. Amoebic Dysentery

Entamoeba histolytica

Fecal-oral route

Protozoan (slipper-shaped body) 3. Shigellosis

Shigella bacillus

Fecal-oral route

Other names: Bacillary dysentery

Sh-dysenterae – most infectious Sh-flesneri – common in the Philippines Sh-connei Sh-boydii

5 Fs: Finger, Foods, Feces, Flies, Fomites

4. Typhoid fever

Salmonella typhosa (plural, typhi)

Incubation Period: 1 day, usually less than 4 days Fecal-oral route 5 Fs

5. Hepatitis A Other names: Infectious

Hepatitis A Virus

Incubation Period: Usual range 1 to 3 weeks, average 2 weeks Fecal-oral route 5 Fs

• Abdominal cramping • Bloody mucoid stool • Tenesmus - feeling of incomplete defecation (Wikipedia) • Abdominal cramping • Bloody mucoid stool • Tenesmus - feeling of incomplete defecation (Wikipedia)

• Rose Spots in the abdomen – due to bleeding caused by perforation of the Peyer’s patches

MANAGEMENT/TREATMENT Diagnostic Test: Stool culture Treatment: Oral rehydration solution (ORESOL) IVF Drug-of-Choice: tetracycline (use straw; can cause staining of teeth). Oral tetracycline should be administered with meals or after milk. Treatment: Metronidazole (Flagyl) * Avoid alcohol because of its Antabuse effect can cause vomiting Drug-of-Choice: Co-trimoxazole

PREVENTION Proper handwashing Proper food and water sanitation Immunization of Chole-vac

Proper handwashing Proper food and water sanitation

Diet: Low fiber, plenty of fluids, easily digestible foods

Proper handwashing Proper food and water sanitation Fly control

Diagnostic Test: Typhi dot – confirmatory test; specimen is feces Widal’s test – agglutination of the patient’s serum

Proper handwashing Proper food and water sanitation

Drug-of-Choice: Chloramphenicol

• Ladderlike fever • Fever • Anorexia (early sign) • Headache • Jaundice (late sign)

Prophylaxis: “IM” injection of gamma globulin Hepatitis A vaccine Hepatitis immunoglobulin Avoid alcohol

Proper handwashing Proper food and water sanitation Proper disposal of urine

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Hepatitis / Epidemic Hepatitis / Catarrhal Jaundice 6. Paralytic Shellfish Poisoning (PSP I Red tide poisoning)

Communicable Disease Nursing

Incubation Period: 15-50 days, depending on dose, average 20-30 days Dinoflagellates Phytoplankton

Ingestion of raw of inadequately cooked seafood usually bivalve mollusks during red tide season Incubation Period: 30 minutes to several hours after ingestion

• Clay-colored stool • Lymphadenopathy

Complete bed rest – to reduce the breakdown of fats for metabolic needs of liver Low-fat diet; increase carbohydrates (high in sugar)

In convalescent period, patient may have difficulty with maintaining a sense of well-being. Treatment: • Numbness of face 1. No definite treatment especially around the 2. Induce vomiting mouth 3. Drink pure coconut milk – weakens the • Vomiting and dizziness toxic effect • Headache 4. Sodium bicarbonate solution (25 grams in ½ • Tingling glass of water) sensation/paresthesia and Advised only in the early stage of illness eventful paralysis of because paralysis can lead to aspiration hands NOTE: Persons who survived the first 12 hours after • Floating sensation and ingestion have a greater chance of survival. weakness • Rapid pulse • Dysphonia • Dysphagia • Total muscle paralysis leading to respiratory arrest and death

and feces Separate and proper cleaning of articles used by patient 1. Avoid eating shellfish such as tahong, talaba, halaan, kabiya, abaniko during red tide season 2. Don’t mix vinegar to shellfish it will increase toxic effect 15 times greater

ROBERT C. REÑA, BSN Death from diarrhea is usually due to dehydration. Food recall is the basis for the diagnosis of food poisoning.

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Communicable Disease Nursing

III. SEXUALLY TRANSMITTED DISEASES DISEASE 1. Syphilis Other names: Sy Bad Blood The pox Lues venereal Morbus gallicus

CAUSATIVE AGENT Treponema pallidum (a spirochete) Incubation Period: 10 to 90 days (3 months); average of 21 days

MODE OF TRANSMISSION Direct contact Transplacental (after 16th week AOG) Through blood transfusion Indirect contact with contaminated articles

PATHOGNOMONIC SIGN Primary stage (4-6 weeks): painless chancre at site of entry of germ with serous exudates Tertiary stage (one to 35 years) : Gumma, syphilitic endocarditis and meningitis

Other names: GC, Clap, Drip, Stain, Gleet, Flores Blancas

Primary and secondary sores will go even without treatment but the germs continue to spread throughout the body. Latent syphilis may continue 5 to 20+ years with NO symptoms, but the person is NO longer infectious to other people. A pregnant mother can transmit the disease to her unborn child (congenital syphilis). Neiserria gonorrheae Direct contact – Thick purulent yellowish genitals, anus, discharge mouth Burning sensation upon urination / dysuria Incubation Period: 2 – 10 days

3. Trichomoniasis

Trichomonas vaginalis

2. Gonorrhea

Other names: Vaginitis Trich

4. Chlamydia

Direct contact Incubation Period: 4 – 20 days; average of 7 days

Chlamydia trachomatis (a rickettsia)

Direct contact

Females: white or greenish-yellow odorous discharge vaginal itching and soreness painful urination Males: Slight itching of penis Painful urination Clear discharge from penis Females: Asymptomatic

MANAGEMENT/TREATMENT Diagnostic test: Dark field illumination test Fluorescent treponemal antibody absorption test – most reliable and sensitive diagnostic test for Syphilis; serologic test for syphilis which involves antibody detection by microscopic flocculation of the antigen suspension VDRL slide test, CSF analysis, Kalm test, Wasseman test

PREVENTION Abstinence Be faithful Condom Secondary syphilis (6-8 weeks: generalized rashes, generalized tender discrete lymphadenopathy, mucus patches, flu-like symptoms, condylomata, patchy alopecia

Treatment: Drug of Choice: Penicillin (Tetracycline if resistant to Penicillin)

Latent stage (one to two to 50 years): non-infectious

Diagnostic test: Culture of urethral and cervical smear Gram staining

Abstinence, Be faithful Condom

Treatment: Drug of Choice: Penicillin

Diagnostic Test: Culture

Prevention of gonococcal ophthalmia is done through the prophylactic use of ophthalmic preparations with erythromycin or tetracycline Abstinence Be faithful Condom

Treatment: Drug of Choice: Metronidazole (Flagyl)

Personal Hygiene

Diagnostic Test: Culture

Abstinence Be faithful

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Communicable Disease Nursing

Incubation Period: 2 to 3 weeks for males; usually no symptoms for females

5. Candidiasis

Candida albicans

Direct contact

Other names: Moniliasis Candidosis

6. Acquired immune deficiency syndrome (AIDS)

Retrovirus (Human T-cell lymphotrophic virus 3 or HTLV 3)

Direct contact Blood and body fluids Transplacental

Attacks the T4 cells: Thelper cells; Tlymphocytes, and CD4 lymphocytes

Incubation period: 3-6 months to 8-10 years

The major route of HIV transmission to adolescent is SEXUAL TRANSMISSION. French kissing brings low risk of HIV transmission.

Variable. Although the time from infection to the development of detectable antibodies is generally 1-3 months, the time from HIV infection to diagnosis of AIDS has an observed range of less than 1 year to

Dyspareunia Fishy vaginal discharge Males: Burning sensation during urination Burning and itching of urethral opening (urethritis) White, cheese-like vaginal discharges Curd like secretions

1. Window Phase a. initial infection b. lasts 4 weeks to 6 months c. not observed by present laboratory test (test should be repeated after 6 months) 2. Acute Primary HIV Infection a. short, symptomatic period b. flu-like symptoms c. ideal time to undergo screening test (ELISA) 3. Asymptomatic HIV Infection a. with antibodies against HIV but not protective

Condom Treatment: Drug of Choice: Tetracycline

Diagnostic Test: Culture Gram staining Treatment: Nystatin for oral thrush Cotrimazole, fluconazole for mucous membrane and vaginal infection Fluconazole or amphotericin for systemic infection Diagnostic tests: Enzyme-Linked Immuno-Sorbent Assay (ELISA) - presumptive test Western Blot – confirmatory Treatment: 1. Treatment of opportunistic infection 2. Nutritional rehabilitation 3. AZT (Zidovudine) – retards the replication of retrovirus; must be taken exactly as ordered 4. PK 1614 – mutagen Major signs of Pediatric AIDS:  Chronic diarrhea > 1 month  Prolonged fever > 1 month  Weight loss or abnormally slow growth Breastmilk is important in preventing intercurrent infection in HIV infected infants and children.

Abstinence Be faithful Condom

Abstinence Be faithful Condom Sterilize needles, syringes, and instruments used for cutting operations Proper screening of blood donors Rigid examination of blood and other blood products Avoid oral, anal contact and swallowing of semen Avoid promiscuous sexual contact Avoid sharing of

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Communicable Disease Nursing

15 years or longer. (PHN Book)

b. lasts for 1-20 years depending upon factors 4. ARC (AIDS Related Complex) a. a group of symptoms indicating the disease is likely to progress to AIDS b. fever of unknown origin c. night sweats d. chronic intermittent diarrhea e. lymphadenopathy f. 10% body weight loss 5. AIDS a. manifestation of severe immunosuppression b. CD4 Count: <200/dL c. presence of variety of infections at one time: oral candidiasis leukoplakia AIDS dementia complex Acute encephalopathy Diarrhea, hepatitis Anorectal disease Cytomegalovirus Pneumonocystis carinii pneumonia (fungal) TB Kaposi’s sarcoma (skin cancer; bilateral purplish patches) Herpes simplex Pseudomonas infection Blindness Deafness

toothbrushes. The care of HIV patients is similar to the routine care given to cases of other diseases. Not everybody is in danger of becoming infected with HIV through sex. Never give live attenuated (weakened) vaccines e.g. oral polio vaccine. HIV positive pregnant women and their partner must be informed of the potential risk to the fetus.

HIV/AIDS Prevention and Control Program: Goal: Contain the transmission of HIV /AIDS and other reproductive tract infections and mitigate their impact LECTURE DISCUSSION – best method to use in teaching about safe sex Priority intervention when caring for AIDS patient: Use disposable gloves when in contact with nonintact skin.

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Communicable Disease Nursing

IV. ERUPTIVE DISEASES DISEASE 1. Chickenpox Other names: Varicella

CAUSATIVE AGENT Human (alpha) herpes virus 3 (varicella-zoster virus), a member of the Herpesvirus group

Period of Communicability: From as early as 1 to 2 days before the rashes appear until the lesions have crusted. 2. German Measles Other Names: Rubella Three-day Measles

3. Herpes Zoster Other names: Shingles Cold sores 4. Dengue Hemorrhagic Fever

Rubella virus or RNAcontaining Togavirus (Pseudoparamyxovirus)

MODE OF TRANSMISSION Droplet spread

PATHOGNOMONIC SIGN Vesiculo-pustular rashes

Direct contact

Centrifugal appearance of rashes – rashes which begin on the trunk and spread peripherally and more abundant on covered body parts

Indirect through articles freshly soiled by discharges of infected persons

No specific diagnostic exam Treatment is supportive. Drug-of-choice: Acyclovir / Zovirax ® (orally to reduce the number of lesions; topically to lessen the pruritus)

Incubation Period: 2-3 weeks, commonly 13 to 17 days

Pruritus

NEVER give ASPIRIN. Aspirin when given to children with viral infection may lead to development of REYE’S SYNDROME.

Droplet

Forscheimer spots – red pinpoint patches on the oral cavity

Nursing Diagnoses: Disturbance in body image Impairment of skin integrity Diagnostic Test: Rubella Titer (Normal value is 1:10); below 1:10 indicates susceptibility to Rubella.

Incubation Period: Three (3) days

German measles is teratogenic infection, can cause congenital heart disease and congenital cataract. Herpes zoster virus (dormant varicella zoster virus)

Droplet Direct contact from secretion

Dengue virus 1, 2, 3, and 4 and Chikungunya virus

Bite of infected mosquito (Aedes Aegypti) - characterized by black and white

Types 1 and 2 are

MANAGEMENT/TREATMENT

Maculopapular rashes Headache Low-grade fever Sore throat Enlargement of posterior cervical and postauricular lymph nodes Painful vesiculo-pustular lesions on limited portion of the body (trunk and shoulder)

Instruct the mother to avoid pregnancy for three months after receiving MMR vaccine. MMR is given at 15 months of age and is given intramuscularly. Treatment is supportive and symptomatic

PREVENTION Case over 15 years of age should be investigated to eliminate possibility of smallpox. Report to local authority Isolation Concurrent disinfection of throat and nose discharges Exclusion from school for 1 week after eruption first appears Avoid contact with susceptibles MMR vaccine (live attenuated virus) - Derived from chick embryo Contraindication: - Allergy to eggs - If necessary, given in divided or fractionated doses and epinephrine should be at the bedside. Avoidance of mode of transmission

Acyclovir to lessen the pain

Low-grade fever Classification (WHO):

Diagnostic Test:

4 o’clock habit

Grade I: a. flu-like symptoms

Torniquet test (Rumpel Leads Test / capillary fragility test) – PRESUMPTIVE; positive when 20

Chemically treated mosquito net

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Other names: H-fever

common in the Philippines Period of communicability: Unknown. Presumed to be on the 1st week of illness up to when the virus is still present in the blood Occurrence is sporadic throughout the year Epidemic usually occur during the rainy seasons (June to November) Peak months: September and October

Communicable Disease Nursing

stripes Daytime biting Low flying Stagnant clear water Urban Incubation Period: Uncertain. Probably 6 days to 1 week

b. Herman’s sign c. (+) tourniquet sign

or more oetechiae per 2.5 cm square or 1 inch square are observed

Grade II: a. manifestations of Grade I plus spontaneous bleeding b. e.g. petechiae, ecchymosis purpura, gum bleeding, hematemesis, melena

Platelet count – CONFIRMATORY; (Normal is 150 - 400 x 103 / mL)

Manifestations: First 4 days: Febrile/Invasive Stage - starts abruptly as fever - abdominal pain - headache - vomiting - conjunctival infection -epistaxis 4th – 7th days: Toxic/Hemorrhagic Stage - decrease in temperature - severe abdominal pain - GIT bleeding - unstable BP (narrowed pulse pressure) - shock - death may occur 7th – 10th days: Recovery/Convalescent Stage - appetite regained - BP stable

Grade III: a. manifestations of Grade II plus beginning of circulatory failure b. hypotension, tachycardia, tachypnea Grade IV: a. manifestations of Grade III plus shock (Dengue Shock Syndome)

Larva eating fish Environmental sanitation Antimosquito soap Neem tree (eucalyptus) Eliminate vector

Treatment: Supportive and symptomatic Paracetamol for fever Analgesic for pain Rapid replacement of body fluids – most important treatment

Avoid too many hanging clothes inside the house Residual spraying with insecticide Daytime fumigation

ORESOL Use of mosquito repellants Blood tansfusion Diet: low-fat, low-fiber, non-irritating, noncarbonated. Noodle soup may be given. ADCF (Avoid Dark-Colored Foods) ALERT! No Aspirin

Wear long sleeves, pants, and socks For the control of H-fever, knowledge of the natural history of the disease is important. Environmental control is the most appropriate primary prevention approach and control of Hfever.

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Communicable Disease Nursing

V. VECTOR-BORNE DISEASES DISEASE 1. Malaria

CAUSATIVE AGENT Plasmodium Parasites: Vivax Falciparum (most fatal; most common in the Philippines) Ovale Malariae -attacks the red blood cells

MODE OF TRANSMISSION Bite of infected anopheles mosquito Night time biting High-flying Rural areas Clear running water

PATHOGNOMONIC SIGN Cold Stage: severe, recurrent chills (30 minutes to 2 hours) Hot Stage: fever (4-6 hours) Wet Stage: Profuse sweating Episodes of chills, fevers, and profuse sweating are associated with rupture of the red blood cells. - intermittent chills and sweating - anemia / pallor - tea-colored urine - malaise - hepatomegaly - splenomegaly - abdominal pain and enlargement - easy fatigability NURSING CARE: 1. TSB (Hot Stage) 2. Keep patent warm (Cold Stage) 3. Change wet clothing (Wet Stage) 4. Encourage fluid intake 5. Avoid drafts

MANAGEMENT/TREATMENT

PREVENTION

Early Diagnosis and Prompt Treatment Early diagnosis – identification of a patient with malaria as soon as he is seen through clinical and/or microscopic method Clinical method – based on signs and symptoms of the patient and the history of his having visited a malaria-endemic area Microscopic method – based on the examination of the blood smear of patient through microscope (done by the medical technologist)

*CLEAN Technique *Insecticide – treatment of mosquito net *House Spraying (night time fumigation) *On Stream Seeding – construction of bio-ponds for fish propagation (2-4 fishes/m2 for immediate impact; 200-400/ha. for a delayed effect) *On Stream Clearing – cutting of vegetation overhanging along stream banks

QBC/quantitative Buffy Coat – fastest Malarial Smear – best time to get the specimen is at height of fever because the microorganisms are very active and easily identified Chemoprophylaxis Only chloroquine should be given (taken at weekly intervals starting from 1-2 weeks before entering the endemic area). In pregnant women, it is given throughout the duration of pregnancy. Treatment: Blood Schizonticides - drugs acting on sexual blood stages of the parasites which are responsible for clinical manifestations 1. QUININE – oldest drug used to treat malaria; from the bark of Cinchona tree; ALERT: Cinchonism – quinine toxicity 2. CHLOROQUINE 3. PRIMAQUINE – sometimes can also be given as chemoprophylaxis 4. FANSIDAR – combination of pyrimethamine and sulfadoxine

*Avoid outdoor night activities (9pm – 3am) *Wearing of clothing that covers arms and legs in the evening *Use mosquito repellents *Zooprophylaxis – typing of domestic animals like the carabao, cow, etc near human dwellings to deviate mosquito bites from man to these animals Intensive IEC campaign

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2. Filariasis Other names: Elephantiasis

Wuchereria bancrofti Brugia malayi Brugia timori

Communicable Disease Nursing

Bite of Aedes poecillus (primarily) Aedes flavivostris (secondary)

– nematode parasites Endemic in 45 out of 78 provinces

Incubation period: 8 – 16 months

Highest prevalence rates: Regions 5, 8, 11 and CARAGA

3. Shistosomiasis Other Names: Snail Fever Bilharziasis Endemic in 10 regions and 24 provinces

Schistosoma mansoni S. haematobium S. japonicum (endemic in the Philippines)

Contact with the infected freshwater with cercaria and penetrates the skin Vector: Oncomelania Quadrasi

Asymptomatic Stage: Presence of microfilariae in the blood but no clinical signs and symptoms of disease Acute Stage: Lymphadenitis Lymphangitis Affectation of male genitalia Chronic Stage: (10-15 years from onset of first attack) Hydrocele Lymphedema Elephantiasis Diarrhea Bloody stools (on and off dysentery) Enlargement of abdomen Splenomegaly Hepatomegaly Anemia / pallor weakness

Diagnosis Physical examination, history taking, observation of major and minor signs and symptoms Laboratory examinations Nocturnal Blood Examination (NBE) – blood are taken from the patient at his residence or in hospital after 8:00 pm Immunochromatographic Test (ICT) – rapid assessment method; an antigen test that can be done at daytime

Use of mosquito repellents Anytime fumigation Wear a long sleeves, pants and socks

Treatment: Drug-of-Choice: Diethylcarbamazine Citrate (DEC) or Hetrazan

Diagnostic Test: COPT or cercum ova precipitin test (stool exam) Treatment: Drug-of-Choice: PRAZIQUANTEL (Biltracide) Oxamniquine for S. mansoni Metrifonate for S. haematobium *Death is often due to hepatic complication

High prevalence: Regions 5, 8, 11

CLEAN Technique

Dispose the feces properly not reaching body of water Use molluscides Prevent exposure to contaminated water (e.g. use rubber boots) Apply 70% alcohol immediately to skin to kill surface cercariae Allow water to stand 48-72 hours before use

ROBERT C. REÑA, BSN REFERENCES:  THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN  CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10th EDITION  DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph  CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov

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Communicable Disease Nursing

VI. DISEASES TRANSMITTED BY ANIMALS DISEASE 1. Leptospirosis Other Names: - Weil’s Disease - Mud Fever - Trench Fever - Flood Fever - Spirochetal Jaundice - Japanese Seven Days fever

2. Rabies Other Names: Lyssa Hydrophobia Le Rage

CAUSATIVE AGENT Leptospira interrogans – bacterial spirochete RAT is the main host. Although pig, cattle, rabbits, hare, skunk, and other wild animals can also serve as reservoir Occupational disease affecting veterinarians, miners, farmers, sewer workers, abattoir workers, etc

MODE OF TRANSMISSION Through contact of the skin, especially open wounds with water, moist soil or vegetation infected with urine of the infected host Incubation Period: 7-19 days, average of 10 days

Bite or scratch (very rare) of rabid animal

Degeneration and necrosis of brain – formation of negri bodies

Non-bite means: leaking, scratch, organ transplant (cornea), inhalation/airborne (bats) Source of infection: saliva of infected animal or human

b. Sylvatic – disease of wild animals and bats which sometimes spread to dogs, cats, and livestock

MANAGEMENT/TREATMENT Diagnosis Clinical manifestations Culture of organism Examination of blood and CSF during the first week of illness and urine after the 10th day Leptospira agglutination test Treatment: Penicillins and other related B-lactam antibiotics Tetracycline (Doxycycline) Erythromycin Most common complication: kidney failure

Rhabdovirus of the genus lyssavirus

Two kinds of Rabies: a. Urban or canine – transmitted by dogs

PATHOGNOMONIC SIGN Leptospiremic Phase - leptospires are present in blood and CSF - onset of symptoms is abrupt - fever - headache - myalgia - nausea - vomiting - cough - chest pain

Incubation period: 2 – 8 weeks, can be years depending on severity of wounds, site of wound as distance from brain, amount of

Immune Phase - correlates with the appearance of circulating IgM Sense of apprehension Headache Fever Sensory change near site of animal bite Spasms of muscles of deglutition on attempts to swallow Fear of water/hydrophobia Paralysis Delirium Convulsions “FATAL once signs and symptoms appear”

Diagnosis: history of bite of animal culture of brain of rabid animal demonstration of negri bodies Management: *Wash wound with soap immediately. Antiseptics e.g. povidone iodine or alcohol may be applied *Antibiotics and anti-tetanus immunization *Post exposure treatment: local wound treatment, active immunization (vaccination) and passive immunization (administration of rabies immunoglobulin) *Consult a veterinarian or trained personnel to observe the pet for 14 days *Without medical intervention, the rabies victim would usually last only for 2 to 6 days. Death is

PREVENTION Protective clothing, boots and gloves Eradication of rats Segregation of domestic animals Awareness and early diagnosis Improved education of people Avoid wading or swimming in water contaminated with urine of infected animals. Concurrent disinfection of articles soiled with urine. Have pet immunized at 3 months of age and every year thereafter Never allow pets to roam the streets Take care of your pet National Rabies Prevention and Control Program Goal: Human rabies is eliminated in the Philippines and the country is declared rabiesfree

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3. Bubonic Plague

Bacteria (Yersinia pestis) Vector: rat flea

Communicable Disease Nursing

virus introduced, and protection provided by clothing Direct contact with the infected tissues of rodents

often due to respiratory paralysis. Fever and lyphadenitis

Streptomycin, tetracycline, chloramphenicol

Environmental Sanitation

VII. DISEASES OF THE SKIN DISEASE 1. Leprosy Other names: Hansenosis Hansen’s disease

CAUSATIVE AGENT Mycobacterium leprae

MODE OF TRANSMISSION Airborne-droplet Prolonged skin-toskin contact

-an ancient disease and is a leading cause of permanent physical disability among the communicable diseases

PATHOGNOMONIC SIGN

MANAGEMENT/TREATMENT

PREVENTION

Early signs: Change in skin color – either reddish or white Loss of sensation on the skin lesion Loss of sweating and hair growth Thickened and painful nerves Muscle weakness or paralysis or extremities Pin and redness of the eyes Nasal obstruction or bleeding Ulcers that do not heal

Diagnostic Test: Slit Skin Smear - determines the presence of M. leprae; optional and done only if clinical diagnosis is doubtful to prevent misclassification and wrong treatment Lepromin Test – determines susceptibility to leprosy

Avoid prolonged skin-toskin contact

Treatment: Ambulatory chemotherapy through use of MDT Domiciliary treatment as embodied in RA 4073 which advocates home treatment

Good personal hygiene

Late Signs: Madarosis Loss of eyebrows Inability to close eyelids (lagophthalmos) Clawing of fingers and toes Contractures Chronic ulcers Sinking of the nosebridge Enlargement of the breast (gynecomastia)

PAUCIBACILLARY (tuberculoid and indeterminate); noninfectious type Duration of treatment: 6 to 9 months Procedure: Supervised: Rifampicin and Dapsone once a month on the health center supervised by the rural health midwife Self-administered: Dapsone (side effect: itchiness of the skin) everyday at the client’s house

BCG vaccination – practical and effective preventive measure against leprosy

Adequate nutrition Health education

MDT Facts: It reduces communicability period of leprosy in 4-6 weeks time. It prevents development of resistance to drugs. It shortens the duration of treatment.

MULTIBACILLARY (lepromatous and borderline); infectious type Duration of treatment: 24-30 months Procedure: Supervised: Rifampicin, Dapsone, and Lamprene

Major activity of leprosy control program: casefinding and treatment with effective drugs Prevent deformities by self-care, exercise, and physical therapy.

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2. Anthrax Other names: Malignant pustule Malignant edema Woolsorter disease Ragpicker disease Charbon

3. Scabies

Bacillus anthracis

Incubation period: few hours to 7 days most cases occur within 48 hours of exposure

Sarcoptes scabiei - An itch mite parasite

Communicable Disease Nursing

Contact with a. tissues of animals (cattle, sheep, goats, horses, pigs, etc.) dying of the disease b. biting flies that had partially fed on such animals c. contaminated hair, wool, hides or products made from them e.g. drums and brushes d. soil associated with infected animals or contaminated bone meal used in gardening Direct contact with infected individuals Incubation Period: 24 hours

1. Cutaneous form – most common - itchiness on exposed part - papule on inoculation site - papule to vesicle to eschar - painless lesion

(Clofazimine; side effect: dryness or flaking of the skin) once a month on the health center supervised by the rural health midwife Self-administered: Dapsone and Lamprene everyday at the client’s house Treatment: Penicillin

Immunize with cell-free vaccine prepared from culture filtrate containing the protection antigen

2. Pulmonary form – contracted from inhalation of B. anthracis spores - at onset, resembles common URTI - after 3-5 days, symptoms become acute, with fever, shock, and death 3. Gastrointestinal anthrax – contracted from ingestion of meat from infected animal - violent gastroenteritis - vomiting - bloody stools Itching When secondarily infected: Skin feels hot and burning When large and severe: fever, headache, and malaise

Proper handwahing

Control dust and proper ventilation

Diagnosis: Appearance of the lesion Intense itching Finding of causative mite Treatment: (limited entirely to the skin) Examine the whole family before undertaking treatment Benzyl benzoate emulsion (Burroughs, Welcome) – cleaner to use and has more rapid effect Kwell ointment

Personal hygiene Avoid playing with dogs Laundry all clothes and iron Maintain the house clean Environmental sanitation Eat the right kind of food Regular changing of clean clothing, beddings and towels

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4. Pediculosis Other name: Phthipiasis

Pediculosis Capitis (head lice) Corporis (body lice) Pubis (crab lice)

Communicable Disease Nursing

Direct contact

Itchiness of the scalp

Common in school age

Kwell shampoo

Proper hygiene

One tbsp water + one tbsp vinegar VIII. INTESTINAL PARASITISM

DISEASE

CAUSATIVE AGENT

MODE OF TRANSMISSION Fecal-oral route

1. Ascariasis

Ascaris lumbricoides

Other names: Roundworm Giant worms 2. Taeniasis

(nematode)

5 Fs: Finger, Foods, Feces, Flies, Fomites Eating inadequately cooked pork or beef

Other name: Tape worm

Taenia solium – pork Taenia saginata – beef Dyphyllobotruim latum – fish

3. Capillariasis

Trichuris trichuria

Eating inadequately cooked seafood

Other name: Whip worm

Capillararia Philippinensis

4. Enterobiasis

Enterobium vermicularis

Other name: Pinworm 5. Ancyloclostomiasis

Ancyclostoma duodenal Necatur americanus

Other name: Hookworm

PATHOGNOMONIC SIGN Pot-bellied Voracious eater Thin extremities Muscle soreness Scleral hemorrhage

5 Fs: Finger, Foods, Feces, Flies, Fomites Walking barefooted 5 Fs: Finger, Foods, Feces, Flies, Fomites

Diagnostic Test: Fecalysis

PREVENTION Proper handwahing

Treatment: Antihelminthic: Mebendazole / Pyrantel Pamoate Diagnostic Test: Fecalysis

Proper handwahing

Treatment: Antihelminthic: Mebendazole / Pyrantel Pamoate

Cook pork and beef adequately

Abdominal pain Diarrhea borborygmi

Diagnostic Test: Fecalysis

Proper handwahing

Treatment: Antihelminthic: Mebendazole / Pyrantel pamoate

Cook seafoods adequately

Nocturnal anal itchiness

Diagnostic Test: Fecalysis / tape test

Proper handwahing

Treatment: Antihelminthic: Mebendazole / Pyrantel pamoate

Proper disinfection of beddings

Dermatitis

Diagnostic Test: Fecalysis

Proper handwahing

Anemia

Treatment: Antihelminthic: Mebendazole / Pyrantel pamoate

Avoid walking barefooted

5 Fs: Finger, Foods, Feces, Flies, Fomites

5 Fs: Finger, Foods, Feces, Flies, Fomites Inhalation of ova Toilet seat Infected bedsheets

MANAGEMENT/TREATMENT

Black fishy stool

ROBERT C. REÑA, BSN

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Communicable Disease Nursing

IX. OTHER COMMUNICABLE DISEASES DISEASE 1. Pneumonia Types: a. Community Acquired Pneumonia (CAP) b. Hospital / Nosocomial c. Atypical

CAUSATIVE AGENT Bacteria: Pneumococcus, streptococcus pneumoniae, staphylococcus aureus, Klebsiella pneumonia (Friedlander’s bacilli)

MODE OF TRANSMISSION Droplet Incubation Period: 2 – 3 days

Virus: Haemophilus influenzae Fungi: Pneumonocystis carinii pneumonia

2. Mumps Other name: Epidemic Parotitis

Mumps virus, a member of family Paramyxoviridae

Direct contact Source of infection: Secretions of mouth and nose Incubation Period: 12 to 26 days, usually 18 days

3. Influenza Other name: La Grippe

Influenza virus A – most common B – less severe C – rare

Direct contact Droplet infection or by articles freshly soiled with nasopharyngeal discharges

PATHOGNOMONIC SIGN Rusty sputum Fever and chills Chest pain Chest indrawing Rhinitis/common cold Productive cough Fast respiration Vomiting at times Convulsions may occur Flushed face Dilated pupils Highly colored urine with reduced chlorides and increased urates

Painful swelling in front of the ear, angle of the jaws and down the neck Fever Malaise Loss of appetite Swelling of one or both testicles (orchitis) in some boys Sudden onset Fever with chills Headache Myalgia / arthralgia

MANAGEMENT/TREATMENT Diagnosis: Based on signs and symptoms Dull percussion on affected lung Sputum examination – confirmatory Chest x-ray

PREVENTION Avoid mode of transmission Build resistance Turn to sides

Management: Bedrest Adequate salt, fluid, calorie, and vitamin intake Tepid sponge bath for fever Frequent turning from side to side Antibiotics based on CARI of the DOH Oxygen inhalation Suctioning Expectorants / mucolytics Bronchodilators Oral/IV fluids CPT Supportive and symptomatic Sedatives – to relieve pain from orchitis Cortisone – for inflammation

Proper care of influenza cases

MMR vaccine Isolate mumps cases

Diet: Soft or liquid as tolerated Support the scrotum to avoid orchitis, edema, and atrophy Dark glasses for photophobia Supportive and symptomatic Keep patient warm and free from drafts TSB for fever Boil soiled clothing for 30 minutes before

Avoid use of common towels, glasses, and eating utensils Cover mouth and nose during cough and sneeze

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Period of Communicability: Probably limited to 3 days from clinical onset 4. Streptococcal sore throat

Group A beta hemolytic streptococcus

Other name: Pharyngitis Tonsillitis

Other diseases: Scarlet fever St. Anthony fire Puerperal sepsis Imoetigo Acute glomerulonephritis Rheumatic Heart Disease Meningococcus Neisseria meningitides

5. Meningitis Other name: Cerebrospinal fever

Communicable Disease Nursing

Airborne Incubation Period: Short, usually 24 – 72 hours Droplet Complication: Rheumatic Heart Disease

Direct (Droplet) Incubation Period: 2 - 10 days

Sudden onset High grade fever with chills Enlarged and tender cervical lymph nodes Inflamed tonsils with mucopurulent exudates Headache dysphagia A. Sudden Onset - high fever accompanied by chills - sore throat, headache, prostration (collapse) B. entrance into the bloodstream leading to septicemia (meningococcemia) a. rash, petchiae, purpura C. Symptoms of menigeal irritation - nuchal rigidity (stiff neck) – earliest sign - Kernig’s sign – when knees are flexed, it cannot be extended - Brudzinski signs – pain on neck flexion with automatoc flexion of the knees - convulsion

laundering

Immunization: Flujob/Flushot – effective for 6 months to 1 year

Diagnosis: Throat swab and culture

Avoid mode of transmission

Treatment: erythromycin Care: Bed rest Oral hygiene with oral antiseptic or with saline gargle (1 glass of warm water + 1 tsp rock salt) Ice collar Diagnostic Test: Lumbar puncture or Lumbar tap - reveals CSF WBC and protein, low glucose; contraindicated for increased ICP for danger of cranial herniation Hemoculture – to rule out meningococcemia Treatment: Osmotic diuretic (Mannitol) – to reduce ICP and relieve cerebral edema; Alert: fastdrip to prevent crystallization Anti-inflammatory (Dexamethasone) – to relieve cerebral edema Antimicrobial (Penicillin) Anticonvulsany (Diazepam / Valium) Complications: Hydrocephalus Deafness (Refer the child for audiology testing) and mutism Blindness

Respiratory Isolation

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Communicable Disease Nursing

- poker soine (poker face / flat affect) - Increased ICP (Cushing’s triad: hypertension, bradycardia, bradypnea) and widening pulse pressure IX. KILLER DISEASES OF THE NEW MILLENNIUM DISEASE 1. Meningococcemia

CAUSATIVE AGENT Neisseria meningitides

MODE OF TRANSMISSION Direct contact with respiratory droplet from nose and throat of infected individuals Incubation Period: 2 – 10 days

2. Severe Acute Respiratory Syndrome / SARS Earliest case: Guangdong Province, China in November 2002 Global outbreak: March 12, 2003 First case in the Philippines: April 11, 2003

Coronavirus

Close contact with respiratory droplet secretion from patient Incubation Period: 2 – 10 days

PATHOGNOMONIC SIGN High grade fever in the first 24 hours Hemorrhagic rash – petechiae nuchal rigidity Kernig’s sign Brudzinski sign Shock Death Prodromal Phase: Fever (>38 0C) Chills Malaise Myalgia Headache Infectivity is none to low Respiratory Phase: Within 2-7 days, dry nonproductive cough progressing to respiratory distress

MANAGEMENT/TREATMENT

PREVENTION

Respiratory isolation within 24 hours

Universal precaution

Drug-of-Choice: Penicillin

Chemoprophylaxis with Rifampicin to protect exposed individual from developing the infection Proper hand washing

No specific treatment PREVENTIVE MEASURES and CONTROL 1. Establishment of triage 2. Identification of patient 3. Isolation of suspected probable case 4. Tracing and monitoring of close contact 5. Barrier nursing technique for suspected and probable case

Utilize personal protective equipment (N95 mask) Handwashing Universal Precaution The patient wears mask Isolation

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3. Bird Flu

Influenza Virus H5N1

Other Name: Avian Flu

Influenza Virus A H1N1

Other Name: Swine Flu

This new virus was first detected in people in April 2009 in the United States.

June 11, 2009 - The WHO raises its Pandemic Alert Level to Phase 6, citing significant transmission of the virus.

Contact with infected birds Incubation Period: 3 days, ranges from 2 – 4 days

4. Influenza A (H1N1)

May 21, 2009 – first confirmed case in the Philippines

Communicable Disease Nursing

Influenza A (H1N1) is fatal to humans

Exposure to droplets from the cough and sneeze of the infected person Influenza A (H1N1) is not transmitted by eating thoroughly cooked pork. The virus is killed by cooking temperatures of 160 F/70 C. Incubation Period: 7 to 10 days

Fever Body weakness and body malaise Cough Sore throat Dyspnea Sore eyes

- similar to the symptoms

of regular flu such as • Fever • Headache • Fatigue • Lack of appetite • Runny nose • Sore throat • Cough - Vomiting or nausea - Diarrhea

Control in birds: 1. Rapid destruction (culling or stamping out of all infected or exposed birds) proper disposal of carcasses and quarantining and rigorous disinfection of farms 2. Restriction of movement of live poultry In humans: 1. Influenza vaccination 2. Avoid contact with poultry animals or migratory birds Diagnostic: Nasopharyngeal (throat) swab Immunofluorescent antibody testing – to distinguish influenza A and B Treatment: Antiviral medications may reduce the severity and duration of symptoms in some cases: Oseltamivir (Tamiflu) or zanamivir

Isolation technique Vaccination Proper cooking of poultry

- Cover your nose and mouth when coughing and sneezing - Always wash hands with soap and water - Use alcohol- based hand sanitizers - Avoid close contact with sick people - Increase your body's resistance - Have at least 8 hours of sleep - Be physically active - Manage your stress - Drink plenty of fluids - Eat nutritious food

ROBERT C. REÑA, BSN REFERENCES:  THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN  CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10th EDITION  DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph  CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov