Gastrointestinal Communicable Diseases

GASTROINTESTINAL communicable diseases LEPTOSPIROSIS/WEILS DISEASE/CANICOLA FEVER/MUD FEVER/ SWINEHERD’S DISEASE Causative Agent: Leptospira interrogans Mode of Transmission: Inoculation into broken skin, mucous membrane ingestion of urine/fecally contaminated food and water Source of Infection Urine and excreta of rodents, infected farm and pet animals Incubation Period: 7 – 13 days LEPTOSPIROSIS Signs and Symptoms: Septicimic Stage - High remittent fever, myalgia/myosites, particularly calf pain, abdominal pain Anicteric Stage – conjuctival suffusion, disorientation Icteric Stage - acute renal failure Diagnostic Examination: 1. Blood culture 2. Leprospira agglutination test LAT) Treatment: Penicillin or Tetracycline Nursing Care: 1. Symptomatic 3. Environmental Sanitation 2. Urine precaution Prevention: Eradication of rodents TYPHOID FEVER/ENTERIC FEVER Causative Agent: Salmonella Typhosa Mode of Transmission: Fecal – oral, Principle vehicle is food and water. Direct/Indirect contact Incubation: 7-14 days Source of infection: Feces and urine of infected Period of communicability – first week throughout the convalescence. TYPHOID FEVER Signs and Symptoms: 1. Prodromal: headache, fever, anorexia, lethargy, constipation or diarrhea, vomiting abdominal pain, feeling of unwellness 2. Fastigial: ladder-like curve of temperature, rose spots, spleenomegaly, typhoid state 3. Defervescence: fever gradually subsides, severity of previous conditions onset of complications: 1) Hemorrhage and 2) Peritonitis 4. Lysis/Convalescence: signs and symptoms gradually disappear TYPHOID FEVER Diagnostic Examinations: Hemoculture Widal’s test/Typhidot

Stool exam Rectal swab Treatment: Chloramphenicol Nursing Care: 1. Enteric precaution 2. Observe character of stool Prevention: Avoid MOT Handwashing Immunization TYHPHOD FEVER Prevention: Sanitary disposal of feces, handwashing, fly control to protect foods, isolation, avoid eating, raw, unpeeled, uncooked foods Nursing Responsibility: Teach family, guide and supervise members of the family. CHOLERA Causative Agent: Vibrio-Cholerae (El Tor); vibrio comma Mode of Transmission: Fecal – oral Incubation: 1 – 3 days Signs and Symptoms: rapid onset characterized by explosive or watery diarrhea and vomiting symptoms of severe dehydration: washer woman’s hand, etc. stool: rice-water stool CHOLERA Treatment: IVF Tetracycline, Cotrimoxazole Nursing Care: Enteric Precaution Prevention: 5 F (Feces, Flies, Food, fluids, fomites) DYSENTERY/SHIGELLOSIS Causative Agent: Shigella Dysenteriae Mode of Transmission: Fecally contaminated food and water Incubation: 3 – 4 days Signs and Symptoms: High grade fever colicky abdominal pain with tenderness diarrhea with tenesmus-straining (watery, mucoid, with blood streaks) DYSENTERY Diagnostic Examination: Stool exam Treatment: Co-trimoxazole, Chloramphenicol Nursing Care: Monitor I and O – frequency and amount, consistency of stool Replacement of fluids and electrolytes lost with IVF as ordered, ORESOL, oral fluids Enteric precaution Peri-anal care Prevention: Immunization

Good sanitation/hygienic practices Safe water supply Handwashing Avoid 5 F’s – feces, fomites, flies, food, fluids HEPATITIS A Synonyms – Infectious HEPA Causative Agent – HAV Source of Infection - Feces Mode of Trans. - Fecal – oral Incubation period- 2 – 7 weeks TYPES OF HEPATITIS TYPE SOURCE TRANSMISSION OTHER NAME ANTIBODY HbsAg RISK PERSONS COMPLICATIONS

HEPATITIS A Risk - food handlers, poor sanitation, unsafe water supply Prevention - Proper handwashing, sanitation, screen food handlers, enteric precautions HEPA B Synonyms- Serum hepatitis Causative Agent- HBV Source of Infection -Blood, semen, cervical secretions Mode of Trans. - Person to person parenteral/percutaneous, placental Incubation period- 6 wks – 6 mos. HEPA B Risk - Multiple sex partners, members of medical team, blood, drug addicts, Screen blood donors Immunization Use of sterile disposal needles Prevention - Monogamous sex HEPA C Synonyms- Post-transfusion,

Causative Agent- HCV Source of Infection - blood Mode of Trans. – Percutaneous, BT Incubation period- 5 wks-6 wks. HEPA C Risk - Blood recipients Drug addicts Prevention – Screen blood donors HEPATITIS Signs and Symptoms: Pre-icteric: flu-like symptoms, Slight RUQ pain Icteric: Jaundice, Tea-colored urine, Alcoholic stool, Pruritus Post-icteric: Symptoms gradually subsides Diagnostic Examinations: Liver function test Hemagglutination test Ultrasound of liver Liver biopsy Treatment: no specific supportive Nursing Care: Bed rest, High CHO, high CHON, low fat diet, Oral skin care, Psychological support SCHISTOSOMIASIS Shistosomiasis (Snail Fever) Agent: Schistosoma Japonicum by snail (oncomelania quadrasi) Areas: Bicol, Samar, Leyte, Davao Dx Test: Stool exam Shistosomiasis (Snail Fever) Signs: Diarrhea, Bloody stool, Anemia Weakness Inflamed liver Enlargement of the Abdomen Spleenomegaly Shistosomiasis (Snail Fever) Treatment Praziquantel (Biltricide) – drug of choice Oxamniquine – S. Mansoni & metrifonate, S. haematobium Shistosomiasis (Snail Fever) Prevention Health Education

Dispose feces and urine, Proper irrigation of all stagnant bodies of water Prevent exposure to contaminated water (rubber boots) Treat Patient in endemic areas ENTEROBIASIS/OXYURIASIS Causative Agent: Enterobius vermicularis/ human pinworm or seatworm Sx/Symptoms: perianal itching-disturbed sleep & nervousness, irritability Source – overcrowding & water supply is inadequate for personal hygiene, eggsfingernail cuttings Mode of Trans – ingestion or inhalation of eggs Incubation – 4 to 6 hours ENTEROBIASIS Dx – Scotch tape swab (perianal region) done in the morning prior to bath Prevention – personal hygiene, handwashing, keeping fingernails short Control – sterilization of contaminated linens, clothing Treatment – Mebendazole 100mg single dose repeated once at 2nd week for effectivity ASCARIASIS Causative Agent: Ascaris lumbricoides (round worm) Source – soil (no sanitary toilets) Mode of Trans – fecal oral Diagnostic – Fecalysis, Kato Katz ASCARIASIS Sx – pulmonary symptoms like cough and fever, abdominal pain, vomiting of worms (erratic) Treatment – antihelminthic (Mebendazole 100mg BID for 3 days Prevention – Proper disposal of feces-not used as fertilizer, handwashing, washing of vegetables before consumption. ANCYLOSTOSOMIASIS Causative Agent: Necator americanus (found in the Philippines) and Ancylostoma duodenale – blood sucking roundworms of the intestine Source – Soil Mode of Trans – direct contact (skin) ANCYLOSTOSOMIASIS Symptoms – Ground/Dew itch dermatitis, pulmonary symptoms (coughing & wheezing), abdominal pain, anemia Dx – Fecalysis, FECT (direct fecal smear) Tx – antihelminthic Mebendazole 100mg BID for 3 days, Iron supplementation, diet, health education, use of footwear Diarrhea Is the passage of loose watery stools at least 3 times a day First time of loose stool: Tx – oral rehydration Goal of management: maintenance and restoration of fluid and electrolyte balance because diarrheal disorders are self limiting

*cholera- warrants the use of antibiotics Antihelminthic is required if there is: Amoebiasis Giardiasis First Level Assessment initial action- assess for dehydration: eyes-absence for tears mouth and tongue level of thirst skin turgor Second Level Assessment Problems to look out for: 1. Presence of blood in the stools- shigellosis/ bacillary dysentery. If antibiotics are given, expect improvement after 2 days Chronic diarrhea- check the onset Diarrhea that has lasted for 14 days or 2 weeks, if this happens consider the following: Hospitalization if: Chronic diarrhea in a point younger than 6 months Chronic diarrhea (+) plus signs of dehydration Home management- provide adequate nutrition Home management for chronic diarrhea is only 5 days, if still without improvement, hospitalization is needed. Second Level Assessment Severe under nutrition- warrants hospitalization Check for why? because it is a complication of diarrhea Check out for body temperature -if a point younger than 2 months and has a temperature of 38.5 Celsius or higher refer the patient to the hospital – give antipyretic Take note: In the community- antipyretics is the answer and never use cooling measures for this is done only in the hospital Treatment plan A – Home Management Main task: Give instruction to the mother regarding the following: 1. Increase fluids of the child Give oral: KCl, K citrate, NaCO3, C6H12O6, constituted in 1L H2O Home made oresol A mixture of 1 tsp. of rock salt, 8 tsp. or 2 tbsp of sugar dissolve in 1L H2O Treatment plan A – Home Management 2. Give adequate food

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