Us Army Medical Course Md0550-100 - Return To Duty

U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL FORT SAM HOUSTON, TEXAS 78234-6100

RETURN TO DUTY

SUBCOURSE MD0550

EDITION 100

DEVELOPMENT This subcourse is approved for resident and correspondence course instruction. It reflects the current thought of the Academy of Health Sciences and conforms to printed Department of the Army doctrine as closely as currently possible. Development and progress render such doctrine continuously subject to change.

ADMINISTRATION For comments or questions regarding enrollment, student records, or shipments, contact the Nonresident Instruction Branch at DSN 471-5877, commercial (210) 2215877, toll-free 1-800-344-2380; fax: 210-221-4012 or DSN 471-4012, e-mail [email protected], or write to: COMMANDER AMEDDC&S ATTN MCCS HSN 2105 11TH STREET SUITE 4192 FORT SAM HOUSTON TX 78234-5064 Approved students whose enrollments remain in good standing may apply to the Nonresident Instruction Branch for subsequent courses by telephone, letter, or e-mail. Be sure your social security number is on all correspondence sent to the Academy of Health Sciences.

CLARIFICATION OF TRAINING LITERATURE TERMINOLOGY When used in this publication, words such as "he," "him," "his," and "men" are intended to include both the masculine and feminine genders, unless specifically stated otherwise or when obvious in context. .

TABLE OF CONTENTS Lesson

Paragraphs

INTRODUCTION 1

PERFORM A BASIC PHYSICAL ASSESSMENT Exercises

1-1--1-7

2

TREAT COMMON HEADACHES AND TOOTHACHES Exercises

2-1--2-3

3

PROVIDE SYMPTOMATIC RELIEF FOR COMMON COLD Exercises

3-1--3-8

4

TREAT COMMON SKIN PROBLEMS Exercises

4-1--4-4

5

INITIATE MEASURES TO PREVENT THE SPREAD OF COMMUNICABLE DISEASES Section I. SEXUALLY TRANSMITTED DISEASES (STD) Section II. RESPIRATORY DISEASES--UPPER RESPIRATORY INFECTIONS (URI) Section III. GASTROINTESTINAL DISEASES Exercises

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5-1--5-5 5-6--5-10 5-11--5-15

CORRESPONDENCE COURSE OF THE ACADEMY OF HEALTH SCIENCES, UNITED STATES ARMY SUBCOURSE 550 RETURN TO DUTY INTRODUCTION At any level of medical treatment, evaluation of the patient must come before treatment. A good evaluation should be used to discover a condition rather than to confirm it. Identify treatment and preventive measures are key words in this subcourse. You, as a medical specialist, will become involved with the many diseases as mentioned in this subcourse. Subcourse Components: The subcourse instructional material consists of the following: Lesson 1, Perform a Basic Physical Assessment. Lesson 2, Treat Common Headaches and Toothaches. Lesson 3, Provide Symptomatic Relief for Common Cold. Lesson 4, Treat Common Skin Problems. Lesson 5, Initiate Measures to Prevent the Spread of Common, Communicable Diseases.

Study Suggestions: Here are some suggestions that may be helpful to you in completing this subcourse: --Read and study each lesson carefully. --Complete the subcourse lesson by lesson. After completing each lesson, work the exercises at the end of the lesson, marking your answers in this booklet. --After completing each set of lesson exercises, compare your answers with those on the solution sheet that follows the exercises. If you have answered an exercise incorrectly, check the reference cited after the answer on the solution sheet to determine why your response was not the correct one. Credit Awarded: To receive credit hours, you must be officially enrolled and complete an examination furnished by the Nonresident Instruction Branch at Fort Sam Houston, Texas. Upon successful completion of the examination for this subcourse, you will be awarded 7 credit hours. You can enroll by going to the web site http://atrrs.army.mil and enrolling under "Self Development" (School Code 555). MD0550

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A listing of correspondence courses and subcourses available through the Nonresident Instruction Section is found in Chapter 4 of DA Pamphlet 350-59, Army Correspondence Course Program Catalog. The DA PAM is available at the following website: http://www.usapa.army.mil/pdffiles/p350-59.pdf.

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LESSON ASSIGNMENT

LESSON 1

Perform a Basic Physical Assessment.

LESSON ASSIGNMENT

Paragraphs 1-1 through 1-7.

LESSON OBJECTIVES

After completing this lesson, you should be able to:

SUGGESTION

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1-1.

Identify general techniques of physical assessment.

1-2.

Identify the procedures and factors involved with inspection of major body systems.

1-3.

Record findings during a physical assessment.

After completing the assignment, complete the exercises at the end of this lesson. These exercises will help you to achieve the lesson objectives.

1-1

LESSON 1 PERFORM A BASIC PHYSICAL ASSESSMENT 1-1.

GENERAL

As a medical specialist, there will be many times when you will be confronted to physically evaluate a patient. This type of evaluation is called performing a basic physical assessment, which is considered the first step in patient care. Procedures to perform a standardized physical examination in a logical sequence will be presented in this lesson. It will be to your advantage, as well as the patient and the medical staff, to develop the techniques that will enable you to provide quality patient care. 1-2.

ASSESSMENT TOOLS/EQUIPMENT

A penlight, stethoscope, blood pressure cuff, wrist watch with second hand, your eyes for inspection, your ears for hearing, and your hands for palpation will be needed to perform a complete physical assessment. 1-3.

ENVIRONMENT CONDITIONS ON ASSESSMENT

a. Clinical (Hospital,Medical Treatment Facility, Troop Medical Clinic, and so forth). A complete examination is possible in a clinical environment. The degree of injury, illness, or condition will determine the extent of the examination. b. Field. In a field setting, or environment, complete examination may not be possible, therefore, some situations may necessitate incomplete or quick physical examinations. Examples are as follows: (1)

Initial evaluation of front line battlefield casualties under fire.

(2)

Initial evaluation of a casualty in mass casualty situations.

(3) Conditions of inadequate light or environment, such as power failure at night, or tropical rains. NOTE:

If any of the above or similar situations prohibit a complete physical evaluation, remember to document or inform your supervisor of the situations. These situations may affect the physical findings or decisions.

NOTE:

All data (what you see, feel, and/or hear) must be as objective as possible and documented over a period of time so that changes in a patient's status are readily observed and identified.

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1-4.

GENERAL TECHNIQUES OF PHYSICAL ASSESSMENT

The general techniques of physical assessment are inspection, auscultation, palpation, and percussion. a. Inspection. This involves seeking of physical signs by observing the patient. Inspection depends entirely upon the knowledge of the observer; we tend to see things that have meaning for us. The two processes that are associated with inspection in this lesson are general and local inspections. (1) General inspection involves the initial inspection of the body as a whole. In looking at the body as a whole, many facts may be noted about the patient's motor activity, body build, outstanding anatomic malformation, behavior, speech, nutrition, and appearance of illness (a complex defying description). (2) Local inspection involves focusing a single anatomic region (head, chest, abdomen, and so forth). This process of inspection can lead to many physical signs; for example, a dermatologist relies entirely on the appearance of a wart to make a decision. b. Auscultation. This involves the process of listening with a stethoscope to obtain a patient's physical signs. You will be mainly listening for vascular and breath sounds. (1) Vascular sounds. These sounds are caused by the heartbeat or flow of blood. The heartbeat is normally heard and described as a "lubb-dubb" sound. (2) Breath sounds. These sounds are respiratory sounds that are transmitted through the lungs and chest wall. The sounds may be "low or "high-pitched" and "soft" or "loud," depending on the location. A crackling or a raspy type sound may also be heard. c. Palpation. This involves the act of examination by using the sense of touch. (1)

Perceived signs. Signs are perceived by:

(a) Tactile sense. The tips of the fingers are used. They are sensitive for fine tactile discriminations. (b) Temperature sense. The back of the hand is used. The skin is much thinner than elsewhere on the hand. (c)

Vibratory sense. The upper palm (the area just below the fingers)

is used.

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(d) Position and consistency sense. The grasping fingers are used. You perceive from your joints and muscles. (2) Structures examined by palpation. This includes every part of the body accessible to the examining fingers. (a) All external structures (that is, hair, extremities, and so forth). (b) Internal structures. These may be felt beneath exterior covering (for example, spleen, liver, bladder, testes, ribs, bones, masses, and so forth). (3)

Qualities elicited by palpation. (a) Texture of skin and hair. (b) Moisture of skin and mucosa. (c)

Skin temperature, various levels of the body.

(d) Masses (shape, size, consistency, motility, pulsatility). (e) Tenderness of all accessible tissues. (f)

Crepitus (a crackling sound or grating/grinding sensation perceived

(g)

Unusual vibrations, (for example, some heart murmurs produce

upon touch).

"thrills"). (h) Hydration. 1 Dehydration of tissues is described as loss of skin turgor (when the skin does not resume its natural shape after pinching). 2 Overhydration of tissues (presence of edema) is demonstrated by pressing your thumb into swollen skin (if indentation persists for a short time, it is termed "pitting edema"). d. Percussion. This is a method of examination by which the surface of the body is struck by one or more fingers to emit sounds that vary in quality according to the density of underlying tissue. (1) Example: Tap a hallow object and listen to the sound as opposed to tapping a solid object.

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(2) Percussion is used during physical assessment to determine fluid content in the abdomen, the lungs, and other body parts. NOTE:

1-5.

Percussion can be a difficult skill to master, it requires a great deal of practice and experience.

PROCEDURES TO PERFORM A PHYSICAL ASSESSMENT

a. Primary Survey. This is the first step taken to perform a patient assessment. It is done to detect life-threatening problems and if any problems are detected, lifesaving measures should be taken immediately. You will be concerned with the following areas in performing a primary survey. (1) Level of consciousness. Remember that consciousness may be lost quickly, breathing may change, and circulation may stop. Shake the patient at his shoulders and shout to him, "Are you okay?"..."Are you okay?"..."Are you okay?"...Ask the patient what is his name? What is today's date? These questions are asked to check the patient's orientation. (2) Patient airway. Check for an opened airway. If the patient's airway is closed, you should open it with manual maneuvers. (a) Head tilt-chin lift. This technique provides a consistently more effective method of opening the airway in the unconscious patient and is less tiring than other methods. (See figure 1-1.)

Figure 1-1. Head tilt-chin lift. (b) Jaw thrust. This technique is the safest first approach to opening the airway of a patient who has a suspected neck injury; in most cases, it can be accomplished without extending the neck. (See figure 1-2.)

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Figure 1-2. Jaw thrust. NOTE:

If the patient is making respiratory efforts, his airway may still be obstructed. Many times opening the airway is all that is needed.

(3) Breathing. Look, listen, and feel for adequate breathing. (See figure 1-3.) Place your ear close to the patient's mouth and: (a)

Look for chest movements that are associated with breathing.

(b) Listen for air moving at the patient's mouth and nose. (c)

Feel for air being expired through the patient's mouth and nose.

Figure 1-3. Check for breathing. (4) Circulation. Check for a carotid pulse. (See figure 1-4.) The carotid pulse is the most accessible, most reliable, and most easily learned and remembered. You should begin cardiac compressions if there is no carotid pulse.

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Figure 1-4. Carotid pulse site. (5) Bleeding (major hemorrhaging). Check for persistent, external bleeding. If there is profuse bleeding, STOP bleeding by applying a field dressing, direct pressure, elevation, tourniquet, and so forth. b. Summary. Now that you have assured that the patient has an open airway, adequate breathing, a carotid pulse, and any profuse bleeding is controlled, you are ready to begin the secondary survey. 1-6.

SECONDARY SURVEY

The secondary survey is performed to discover medical and injury-related problems that do not pose an immediate threat to survival, but may, if allowed to go untreated. You will begin by checking/examining the following areas: a. Vital Signs. Measure and record the patient's pulse, respiration, blood pressure, and temperature. (1) Pulse. Normal pulse for adults is 60-80 heartbeats per minute, for children 80-100, and for infants 120-160. Also observe for regularity and strength. (See figure 1-5.) (2) Respiration. Normal respiratory rates for adults are 12-20 per minute, a higher rate for children is normal. Also observe for rhythm and depth. (3) Blood pressure. Normal blood pressure for an adult is 110-146 mm/Hg systolic and 60-90 mm/Hg diastolic. Infant readings are 50-80 mm/Hg systolic and 4058 mm/Hg diastolic. (4) NOTE:

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Temperature. Normal temperature is 98.6ºF (37.0ºC).

Conduct the remainder of the secondary survey in an orderly pattern from head to toe. Be sure to record all pertinent findings; for example, abnormal vital signs, obvious fractures, profuse bleeding, and so forth.

1-7

Figure 1-5. Sites for taking a pulse. b. Head. (1) Scalp. Examine the scalp for presence of bleeding or contusions (bruises) and palpate for tenderness or depressions. CAUTION.

Do not move the patient's neck.

(2) Forehead. Touch (palpate) the forehead with the back of your hand to check for temperature and moisture. (3)

Eyes. (a) Check the eyelids for swelling and discoloration.

(b) Check the pupils for dilation, constriction, equality or inequality, roundness, eye movement, and gross activity (have the patient to follow you finger).

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(c) Check the conjunctiva. Pull the lower eyelids down to check the color on the inside of the lid, (color should be reddish pink). (4)

Nose. Check the nose for deformity, bleeding, or discharge.

(5) Ears. Inspect for drainage, bleeding, or torn tissue without turning the patient's head. (6) Mastoids (bony prominence of the skull directly behind the ears). Check the mastoids for bruising or discoloration. (See figure 1-6.) This may indicate a skull fracture. (7) Facial bones. Check for lacerations or contusions. Palpate the zygomatic arches, maxilla, and mandible for tenderness. (See figures 1-7 and 1-8.)

Figure 1-6. Looking for discoloration.

Figure 1-7. Palpating zygoma for fractures.

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Figure 1-8. Palpating mandible for fractures.

1-9

(8) Mouth. Examine for loose teeth, bleeding, and abnormal alignment. The oral mucosa should be pink and surfaces moist. NOTE:

The mucosa membranes should be pink, regardless of skin color.

c. Neck. (1) Trachea. Check for midline position, presence of a stoma and/or Medic Alert "dog tags." (See figure 1-9.)

Figure 1-9. Midline position. (2) for crepitus.

Suprasternal area (area above sternum). Check for retractions and feel

(3) Neck veins. Check for distension (swelling or bulging). (See figure 1-10.) This may be a sign of heart failure. (4) Cervical spine. Check for deformity or midline point tenderness without moving the patient. (See figure 1-11.)

Figure 1-10. Check neck veins for distension.

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Figure 1-11. Palpating the cervical spine.

1-10

d. Chest. (1)

Chest wall. Examine for paradoxical breathing.

(a) Flail chest. A portion of the chest wall goes in on inspiration and out on expiration. (See figure 1-12.)

Figure 1-12. Checking for flail chest. (b) Splinting. A patient uses his own muscles to immobilize an injured area. (c) Retraction. A patient's respiratory effort is great. This may be seen by the pulling back of tissue between the ribs when the patient inspires. (2) Ribs. Examine for bruises and tenderness during chest compression. (See figure 1-13.) CAUTION:

Do not push/compress over any abrasive bruise.

Figure 1-13. Examining for rib tenderness.

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(3)

Thoracic spine. Palpate for deformity or tenderness without moving the

(4)

Breath sounds. Listen to both front and back of chest and both sides.

patient.

(5) Apical pulse. This can be taken by listening to the patient's heartbeat and counting the rate. e. Abdomen. (1) tenderness.

External. Observe for sounds and/or distension, palpate lightly for

(2) Lumbar spine. Palpate for deformity or tenderness without moving the patient or risking spinal injury. (3) Pelvis. Gently compress the pelvis with your hands covering the patient's hip joint and iliac crest, inspect for tenderness, discoloration, and incontinence. (See figure 1-14.)

Figure 1-14. Testing pelvis for compression pain. (4)

Femoral pulse. Check for presence and bilateral equality.

f. Lower Extremities. (1) Legs. Inspect and palpate for bleeding, tenderness, deformity, discoloration, contusions, etc. (2) Pedal pulses. Palpate both feet for either dorsalis pedis pulse or posterior tibial pulse. (See figures 1-15, 1-16, and 1-17.)

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Figure 1-15. Palpating for pedal pulses.

Figure 1-16. Palpating for dorsalis pedis pulse.

Figure 1-17. Palpating for posterior tibial pulse.

(3) Foot movement. Examine the feet for movement and sensation by having the patient demonstrate his ability to move both feet. (4)

Foot sensation. Ask the patient to determine which toes are touched.

g. Upper Extremities. (1)

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Clavicles. Palpate both clavicles for tenderness and deformity.

1-13

(2) Arms and forearms. Inspect and palpate both arms for bleeding, tenderness, and deformity. (3) Radial pulses. Compare radial pulses for presence and equality (if unequal, compare blood pressure bilaterally). (4) Hand movement. Instruct patient to move both hands to confirm flexion (bending) and extension; check for movement of the fingers. (5)

Hand sensation. Ask patient to determine which finger(s) is touched by

you. h. Posterior Wound. Logroll the patient (unless spinal injury is suspected) and observe for any posterior wounds. 1-7.

RECORDING PERTINENT FINDINGS

Record all pertinent findings as accurately as possible on DD Form 1380 (U.S. Field Medical Card) or SF 600 (Chronological Record of Medical Care).

Continue with Exercises

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EXERCISES, LESSON 1 INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the question or best completes the incomplete statement or by writing the answer in the space provided. After you have completed all the exercises, turn to "Solutions to Exercises" at the end of the lesson and check your answers..

1.

Which of the following conditions would NOT prohibit a complete physical assessment? a. Frontline battlefield injuries. b. Screening patient's at local TMC. c.

Light failure during a tropical storm.

d. Initial evaluation during a mass casualty situation.

2.

List the two types of inspections. ________________________________. ________________________________.

3.

______________________, __________________, __________________, and _________________ are considered general techniques of physical assessment.

4.

What sounds are you listening for during auscultation? _______________________ and __________________________.

5.

What sounds are transmitted through the lungs and chest wall? ________________________________.

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6.

During palpation, signs are percieved by your ______________________, _________________, ___________________, and ___________________.

7.

What three methods are used when checking a patient for breathing? ___________________, ___________________, and ____________________.

8.

What patient areas would you check during a primary survey? ________________________________. ________________________________. ________________________________. ________________________________. ________________________________.

9.

List the major areas to check/observe during the secondary survey. ________________________________. ________________________________. ________________________________. ________________________________. ________________________________. ________________________________. ________________________________.

10.

____________________ ___________________ is a condition when a portion of a patient's chest wall goes in on inspiration and out on expiration.

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SPECIAL INSTRUCTIONS FOR EXERCISES 11 THROUGH 19. Match the areas examined in Column A to what you would be checking for as listed in Column B. Mark your answers in the blanks in Column A.

COLUMN A

COLUMN B

____11. Arms and forearms

a.

Temperature, moisture

____12. Pelvis

b.

Posterior wounds

____13. Ribs

c.

Bleeding, tenderness, deformity

____14. Hand movement

d.

Stoma, Medic Alert "dog tags"

____15. Back logroll

e.

Bruises, tenderness

____16. Ears

f.

Bleeding, torn tissue, drainage

____17. Eyelids

g.

Tenderness, discoloration, incontinenc

____18. Forehead

h.

Swelling, discoloration

____19. Trachea

i.

Confirm flexion, extension

Check Your Answers on Next Page

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SOLUTIONS TO EXERCISES, LESSON 1

1.

b

(para 1-3b)

2.

General, local (para 1-4a)

3.

Inspection, auscultation, palpations, percussion (para 1-4)

4.

Vascular, breath (para 1-4b)

5.

Breath (para 1-4b(2))

6.

Tactical sense, temperature sense, vibratory sense, position and consistency sense (para 1-4c(1))

7.

Look, listen, feel (para 1-5a(3))

8.

Level of consciousness, patient airway, breathing, circulation, bleeding (para 1-5a)

9.

Vital signs, head, neck, chest, abdomen, lower extremities, upper extremities, back logroll (para 1-6)

10.

Flail chest (para 1-6d(1)(a))

11.

c

(para 1-6g(2))

12.

g

(para 1-6e(3))

13.

e

(para 1-6d(2))

14.

i

(para 1-6g(4))

15.

b

(para 1-6h)

16.

f

(para 1-6b(5))

17.

h

(para 1-6b(3a))

18.

a

(para 1-6b(2))

19.

d

(para 1-6c(1)) End of Lesson 1

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LESSON ASSIGNMENT

LESSON 2

Treat Common Headaches and Toothaches.

LESSON ASSIGNMENT

Paragraphs 2-1 through 2-3.

LESSON OBJECTIVES

After completing this lesson, you should be able to:

SUGGESTION

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2-1.

Identify the various types of headaches.

2-2.

Identify the signs and symptoms associated with headaches.

2-3.

Identify the treatment provided for headaches.

2-4.

Identify the signs and symptoms associated with toothaches.

2-5.

Identify the treatment provided for toothaches.

After completing the assignment, complete the exercises of this lesson. These exercises will help you to achieve the lesson objectives.

2-1

LESSON 2 TREAT COMMON HEADACHES AND TOOTHACHES 2-1.

GENERAL

Headaches and toothaches are also common ailments and complaints by patients. They both can be very disturbing and might cause a person to not function as he normally would. It is your duty to assess these ailments and provide treatment for relief. 2-2.

HEADACHES

This section of the lesson will present the etiology of the different types of vascular and sinus headaches, signs and symptoms, and treatment for the headaches. a. Vascular Headaches. A term applied to a variety of entities produced by reversible, segmental, arterial constriction and dilation; vascular headaches are all characterized by their intermittence and throbbing pain. The components of the group are distinguished by differences in cause, temporal sequences, and the location of the affected blood vessels. Vascular headaches include migraine, cluster, muscle tension, and hypertensive headaches. (1)

Types of vascular headaches.

(a) Migraine. A recurrent, intense headache usually confined to one side of the head and associated with nausea, vomiting, and visual disturbances. 1 Etiology. The exact cause of a migraine is not known, it may be hereditary; triggered by emotional stress, physical activity, fatigue, smoking, consumption of certain foods, and excess of alcohol intake. NOTE:

The nature of attacks varies between persons and from time to time in the same person. 2 Classic symptoms of migraines may appear in the following

sequence: a Inability to see clearly, followed by seeing bright spots and zigzag patterns. Visual disturbances may last several minutes or several hours, but disappear once headache begins. b Dull, boring pain in temple that spreads to entire side of head. Pain becomes intense and throbbing (sometimes pain may affect both temples simultaneously). c MD0 550

Nausea and vomiting, sweating. 2-2

NOTE:

In some cases, the classic symptoms, may be absent, or other symptoms may be present; for example, dizziness, hypersensitivity to light and sound, runny nose and/or eyes, and bloodshot eyes.

3 Treatment. The importance of early medication during an attack cannot be overemphasized. The patient should be given mild analgesics, aspirin, or acetaminophen. Additionally, the patient should: a Lie down in a quiet, darkened room; decrease external stimulation as much as possible; relax, but do not read. b Apply a cold cloth or ice pack to the forehead and back of neck until headache is completely relieved. c

Cover both eyes with cloth.

d Immobilize head by placing blankets or towels on each side of the head. e If available, drink hot liquids (such as tea) only if there is no nausea and/or vomiting. NOTE:

Instruct patient to keep a record of activity or food eaten prior to a migraine, this may indicate the cause of the headache.

4 Refer patient to a physician if the migraine attack persists longer than 24 hours, despite treatment. Recurrent migraine headaches will, most likely, interfere with duty performance. NOTE:

A more extensive work-up (tests) may be required.

(b) Cluster headache. This type of headache occurs in clusters of several times a day or week for several weeks, with long intermissions between clusters. The headache is unilateral, severe, boring, and throbbing. It occurs consistently on the same side, usually in the orbital region, the temple, or on the side of the face; it may spread to the neck and shoulder. 1 Etiology. Similar to the migraine headache. The exact cause is unknown 2 Signs and symptoms: a Severe and frequent attacks of short duration usually in "cluster or groups"; sometimes as often as 20 or more per week followed by remission for an indefinite period.

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b Often occurs at same time of day and on same side behind one eye. c

Described as "knifelike" or "like a hot poker in the eye."

d Pain is accompanied by tugging, pulling, or pressing sensation behind one eye (unilateral). e Other signs include nasal congestion, tearing; may have one "bloodshot" eye. f Duration ranges from few minutes to hours; rarely more than 2 hours; usual range is 30-90 minutes. g Commonly precipitated by ingesting alcohol, oversleeping or napping, but may occur without these triggers. 3 Treatment. Acetaminophen or Aminosalicylic Acid (ASA) given as soon as the headache begins. (c) Hypertensive headache. These headaches are related to high blood pressure. They may be muscular contraction type or vascular. 1 Etiology. Increased blood pressure. 2 Signs and symptoms. a Throbbing, suddenly increasing in intensity, frequently located at top of head; may be generalized. b Elevated blood pressure. 3 Treatment. Give mild analgesia, aspirin, or acetaminophen. Also involves lowering the patient's blood pressure. Inform the patient to: a Decrease stress, stress-producing situations. b Maintain minimal ideal body weight. c

Rest if headache begins.

d Limit use of nicotine and caffeine (they cause vasoconstriction and heart stimulation).

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4 Referral. Refer patient to a physician if the headache increases in severity, or lasts longer than 24 hours. If a patient has no history of high blood pressure, refer him to a physician. (d) Muscle tension headache. These headaches involve contraction of the muscles of the neck, head, and shoulders causing fatigue and pain. 1 Etiology. Tension and emotional stress contribute greatly towards these headaches. Pain results from constricted blood vessels in the head that cause pressure on the walls of the blood vessels (dilated blood vessels in the brain). 2 Signs and symptoms. a Pain is usually steady, over temples with feeling often stated "a vise is over the back of my head." b Unilateral or bilateral, often suboccipital by referring pain to frontal region of face. c Moderate pain in the front or back of the head, accompanied by tight muscles in the neck or scalp. d Throbbing pain all over the head. NOTE:

Persistent headaches may be a sign of pending combat stress reaction in combat situations. 3 Associated causes. a Overexertion. b Tension-producing strain on muscles of neck, scalp, face,

and jaw. c

Sleep disturbances.

d Anxiety, depression. e Low blood sugar. f

Allergic reactions.

g An environment that is noisy, stuffy, hot, poorly lit, or has irritating odors.

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4 Treatment. a Mild analgesic, aspirin, or acetaminophen. b Rest, relax in quiet room. c

Removal of anxiety-producing situation.

d Massage shoulders, neck, jaw, scalp. e Take a hot bath or shower, allow water to massage tense muscles. f Have patient lie down, place warm or cold cloth, whichever feels better, over painful area. 5 Referral. Refer patient to a physician if headache is accompanied by: a Fever 101º F (38.3ºC) or higher. b Recent head injury. c

Drowsiness.

d Nausea and/or vomiting. e Pain in one eye. f

Blurred vision.

g High blood pressure. h Pain and tenderness around eyes and cheekbones that worsens when leaning forward--may indicate sinus infection.

(2)

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i

Vision disturbances and vomiting prior to headache.

j

Persistent headache pain longer than 24 hours.

See figure 2-1 for the types of headaches.

2-6

Figure 2-1. Types of headaches. b. Sinus Headache. This type of headache is frontal, dull, or severe; usually worse in the morning, improved in the afternoon; and worse in cold, damp weather. (1) Etiology. The sinus headache is caused by acute infection of the sinuses. Pain radiation is associated with the affected sinus, and nasal congestion, followed by gradual buildup of pressure in the affected sinus. (2)

Signs and symptoms. (a)

Aching pain, usually on face, that worsens when bending over.

(b) Possibly thick, yellow or green nasal discharge (may be associated with sinusitis). (c)

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Face extremely tender to touch over location of the affected sinus.

2-7

(3)

Treatment.

(a) Alternate warm and cool compresses on forehead and cheeks; keep alternating warm and cool compresses for 10 minutes.

(b) If available, give decongestant, such as Dristan, Contac, or Sudafed, as directed on package. (c) (4)

Repeat warm and cool compresses in an hour, as necessary.

Referral. Refer patient to a physician if: (a)

Temperature is 101ºF (38.3º) or greater.

(b) Increased severity or intensity of the headache. (c)

Repeated visit to sick call is within 24 hours with same complaint.

NOTE:

A sinus headache may be a symptom of sinusitis, the inflammation of the mucous membranes that line the sinuses. Referral is necessary for this condition.

NOTE:

There are other headaches. However, vascular and sinus headaches are the most common that will concern you.

2-3.

TOOTHACHES

a. Pain from a toothache may be characterized in many ways, that is, dull and throbbing, burning, piercing, and sharp. This pain could involve the teeth, obviously, the bones of the mandible and maxilla (jawbones) that hold the teeth, and the gums and soft tissue surrounding the tooth, including the nerves, blood vessels, and the periosteum (covering of the bone). b. Toothaches can occur, from exposed gum, a missing tooth, pain and/or bleeding from tooth site, and swelling (edema) of gums with or without a history of injury. c. An abscess can also cause great pain. They are characterized by redness, pain, swelling, warmth, or hardened area along the gum line near the affected tooth. NOTE:

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An abscess is an accumulation of pus in an area where healthy tissue has been invaded and broken down by bacteria. The pain caused by inflammation of gum tissues and an accumulation of pus pressing against adjoining nerves.

2-8

d. Treatment. (1)

Loose fillings and toothache. (a)

Mild analgesics (aspirin or acetaminophen).

(b) Warm packs to side of face to lessen pain. (c)

Soak tip of cotton swab in oil of cloves or whiskey and apply to

tooth. (d) Have patient to rest in a comfortable position. Lying flat may increase the pain. Use pillows or rolled blankets behind the head and shoulders. (e) If dental care is not immediately available, melt or rub between your palms a piece of paraffin or candle; mix in some strands of cotton--when wax mixture begins to cool, apply to tooth as temporary filling. (f) Have the patient to seek dental care to avoid the possibility of infection developing or progressing. (2)

Lost or broken tooth. (a) Do not throw tooth or tooth part away.

(b) Rinse tooth in water and wrap in wet gauze or plastic wrap and submerge in cold water or ice. NOTE:

When a tooth falls out, a lot of the membrane to the tooth is still attached. Keeping the tooth damp will provide a connection for what is remaining in the bone to make reattachment possible.

(c) If patient is awake and has partial loss of tooth, place moistened gauze on his tooth--can also place tooth in moistened gauze between his jaw and cheek. (d) Put moist gauze in empty socket and have patient bite on the guaze. NOTE:

If the tooth is kept damp and protected, and the patient can get to a dentist within three hours of the injury, there is a 60—75 percent success rate in reimplanting the tooth.

(3) Abscess. Place warm packs to the patient's face to lessen the pain and refer to a physician immediately.

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e. Refer the patient to a physician if: (1)

There is increased mouth pain, swelling, redness, drainage, or bleeding.

(2)

Signs of infection, (headache, muscle aches, dizziness, or general ill

(3)

Temperature, of 101ºF (38.3ºC) or higher.

feeling).

Continue with Exercises

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EXERCISES, LESSON 2 INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the question or best completes the incomplete statement or by writing the answer in the space provided. After you have completed all the exercises, turn to "Solutions to Exercises" at the end of the lesson and check your answers..

1.

Vascular headaches are characterized by ____________________ and ___________________________ pain.

2.

List the four types of vascular headaches. _________________________________________ _________________________________________ _________________________________________ _________________________________________

3.

The inability to see clearly, followed by seeing bright spots and zigzag patterns is one of the ________________ symptoms of a __________________ headache.

4.

The ___________________ headache may be hereditary; triggered by emotional stress, physical activity, fatigue, smoking, consumption of certain foods, and excess of alcohol intake.

5.

The ________________________ headache is unilateral, severe, boring, and throbbing.

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6.

What is the usual range for a cluster headache? a. 1 to 2 days. b. 5 to 15 minutes. c. 30 to 90 minutes. d. 60 to 120 minutes.

7.

_____________________headaches are closely related to high blood pressure.

8.

Throbbing pain all over the head is one of the symptoms for ________________ headaches.

9.

What headache usually affects a person in the morning and improves in the afternoon? _______________________________________.

10.

Mild analgesics are given to a patient who has loose fillings and/or a _________.

11.

An __________________________ is characterized by redness, pain, swelling, warmth, or hardened areas along the gum line near the affected tooth.

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12.

Label the following types of headaches:

A. _________________________________________________ B. _________________________________________________ C, _________________________________________________ D. _________________________________________________ E. _________________________________________________

Check Your Answers on Next Page

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SOLUTIONS TO EXERCISES, LESSON 2 1.

Intermittence, throbbing (para 2-2a)

2.

Migraine, cluster, hypertensive, muscle tension (para 2-2a)

3.

Classic, migraine (para 2-2a(1)(a)2a)

4.

Migraine (para 2-2a(1)(a)1)

5.

Cluster (para 2-2a(1)(b))

6.

c (para 2-2a(1)(b)2f)

7.

Hypertensive (para 2-2a(1)(c))

8.

Muscle tension (para 2-2a(1)(d)2d)

9.

Sinus (para 2-2b)

10.

Toothache (para 2-3d(1)(a))

11.

Abscess (para 2-3c)

12.

A. B. C. D. E.

Migraine Cluster Paranasal sinus Muscle contraction headache Hypertension (figure 2-1)

End of Lesson 2

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LESSON ASSIGNMENT

LESSON 3

Provide Symptomatic Relief for Common Cold.

LESSON ASSIGNMENT

Paragraphs 3-1 through 3-8.

LESSON OBJECTIVES

After completing this lesson, you should be able to:

SUGGESTION

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3-1.

Define a common cold.

3-2.

Identify signs and symptoms of a common cold and modes of transmission.

3-3.

Identify the methods, treatment, and preventive measures of a common cold.

3-4.

Identify when a patient with a common cold will be referred to a medical physician.

After completing the assignment, complete the exercises at the end of this lesson. These exercises will help you achieve the lesson objectives.

3-1

LESSON 3 PROVIDE SYMPTOMATIC RELIEF FOR COMMON COLD 3-1.

GENERAL

The common cold is one of the most common infectious diseases among people of all ages. This will probably be the most frequent complaint that you will encounter as you perform your duties as a medical specialist. More serious infectious respiratory diseases may occur if treatment is not given in a timely and professional manner. 3-2.

DEFINITION

The common cold is an acute, usually afebrile (no fever) viral infection that causes inflammation of the upper respiratory system. 3-3.

BACKGROUND INFORMATION a. The common cold is more prevalent in children than adults. b. It affects more boys than girls among teenagers and more women among

adults. c. The common cold occurs more often in colder months in temperate zones, and more often during rainy seasons in tropical zones. d. There are over 100 different viruses that may be responsible for the common cold. This makes the development of an effective vaccine highly unlikely. e. Neither fatigue nor exposure to drafts increases susceptibility. 3-4.

MODES OF TRANSMISSION The common cold can be transmitted by: a. Airborne respiratory droplets--most often. b. Objects contaminated with respiratory droplets--less frequently. c. Hand-to-hand--less often.

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3-5.

SIGNS AND SYMPTOMS a. Malaise. b. Fever/chills. c. Headache. d. Nasal congestion/nasal discharge. e. Hacking, nonproductive cough. f. Burning, watery eyes. g. "Stuffed up" feeling may persist for one week. h. Sneezing. i.

3-6.

Sore throat.

TREATMENT

There are no cures for the common cold. These are purely symptomatic treatments. a. Rest--logical response to fatigue and weakness. b. Fluid--helps maintain hydration and loosen accumulated respiratory secretions. c. Aspirin--eases headache and muscle soreness. d. Decongestants--relieve "stuffed up" feeling (for example, Sudafed, Contac, Dristan). e. Throat lozenges--relieves soreness. NOTE:

3-7.

Many individuals advocate doses of vitamin C to help treat and/or prevent the common cold. The role vitamin C plays remains controversial.

PREVENTION a. Minimize contact with people who have colds.

b. Avoid spreading colds by washing hands often, cover coughs and sneezes, and avoid sharing towels and drinking glasses.

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3-8.

REFERRAL

The patient should be referred to a physician when he has or complains of the following conditions: a. Temperature 101ºF (38.3ºC) or greater. b. Productive cough. c. Dyspnea. d. Tachycardia. e. Loss of appetite. NOTE:

Remember to record all pertinent findings.

Continue with Exercises

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EXERCISES, LESSON 3 INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the question or best completes the incomplete statement or by writing the answer in the space provided. After you have completed all the exercises, turn to "Solutions to Exercises" at the end of the lesson and check your answers..

1.

List the modes of transmission of a common cold. ______________________________________. ______________________________________. ______________________________________.

2.

The use of decongestants for a common cold relieves _______________feeling.

3.

List six of the signs and symptoms of a common cold. ______________________________________. ______________________________________ . ______________________________________. ______________________________________. ______________________________________. ______________________________________.

4.

_____________________ helps maintain hydration and loosen accumulated respiratory secretions.

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5.

Which of the following conditions of a common cold would you refer to a physician? a. Dyspnea. b. Tachycardia. c.

Loss of appetite.

d. All of the above.

6.

Minimizing contact with individuals who have colds is known as a ____________ measure.

Check Your Answers on Next Page

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SOLUTIONS TO EXERCISES, LESSON 3

1.

Airborne respiratory droplets Objects contaminated with respiratory droplets Hand-to-hand (para 3-4)

2.

Stuffed up (para 3-6d)

3.

Any of the following: (para 3-5) Malaise Burning, watery eyes Fever/chills "Stuffed up" feeling Headache Sneezing Nasal congestion/nasal discharge Sore throat Hacking, nonproductive cough

4.

Fluids (para 3-6b)

5.

d (para 3-8)

6.

Preventive (para 3-7a)

End of Lesson 3

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LESSON ASSIGNMENT

LESSON 4

Treat Common Skin Problems.

LESSON ASSIGNMENT

Paragraphs 4-1 through 4-4.

LESSON OBJECTIVES

After completing this lesson, you should be able to:

SUGGESTION

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4-1.

Identify types and effects of skin lessons.

4-2.

Identify signs, symptoms, and treatment of common skin disorders/diseases.

4-3.

Identify medications used to treat common skin disorders/diseases.

After completing the assignment, complete the exercises of this lesson. These exercises will help you to achieve the lesson objectives.

4-1

LESSON 4 TREAT COMMON SKIN DISORDERS 4-1.

GENERAL

a. As we all know, the skin covers the entire body, protecting the underlying tissues from injury, infection, and dehydration. However, there are times when the skin is affected by many common disorders causing some unsightly shapes and arrangements on the surface of the skin. Your knowledge of recognition and identification of common skin disorders will enable you to provide quality patient care. b. A brief review of the layers of skin will help you throughout this lesson (see figure 4-1). The skin is made up of the following three layers: (1) Epidermis. The outer, thinner layer of skin. It has no blood vessels, but, contains a limited distribution of nerve endings. The epidermis is made up of several layers of cells. The outermost cells are flat and resemble scales. These dead cells are constantly flaking off the surface, as this happens, inner epidermal cells are growing, pushing up towards the surface to replace outer cells. (2) Dermis or Corium. The inner layer of skin found beneath the epidermis. It is rich in blood vessels and nerves. (3)

Subcutaneous tissues. The layer of fat and soft tissues found below the

dermis.

Figure 4-1. Principal parts of the skin.

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4-2.

LESIONS

Lesions are any morbid changes in the structure or function of tissues due to injury or disease. They may be life-threatening; that is, indicating tuberculosis, cancer, or other diseases. They can cause disturbances of normal skin functions; represent findings that are significant of internal diseases such as hepatitis or endocrine problems; can cause severe itching and/or pain; and can cause psychological distress and social problems because of unsightly appearance. a. Primary Lesions. These are the most important to recognize and if necessary, to biopsy. They are also the earliest changes that appear. Macule, papule, nodule, tumor, wheal, plaque, vesicle, bulla, and pustule are all considered primary lesions. (1) Macule (see figure 4-2). This is a flat, localized change in the skin's color. The area may be small or large, less than 1 cm in diameter. Macules occur in many shapes and colors and is nonpalatable. Some examples of macules are freckles, flat moles, tattoos, and the rashes of rubella and rubeola.

Figure 4-2. Macule. (2) Papule (see figure 4-3). This is a solid, elevated lesion, about 0.5 cm to 1 cm or less in diameter. Their borders and tops may assume various forms. Some papule lesions can occur in insect bites, acne, psoriasis, and atopic eczema.

Figure 4-3. Papule.

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(3) Nodule (see figure 4-4). This is a palpable solid, rounded or elevated lesion extending deeper into the dermis than papule and greater than 0.5 cm but less than 2 cm in diameter. Some typical nodules are keratinous cysts, small lipomas, and a variety of neoplasms. Larger nodules are classified as tumors, benign or malignant.

Figure 4-4. Nodule. (4)

Tumor. This is an elevated, solid lesion greater than 2 cm in diameter.

(5) Wheal (see figure 4-5). An elevated lesion with increased tissue fluid usually associated with itching. These are known as common allergic reactions from drug eruptions, insect stings or bits, or sensitivity to cold, heat, pressure, or sunlight.

Figure 4-5. Wheal. (6) Plaque. A collection of wheals that joined (coalesced) together to form a larger area. The skin appears thickened, and the skin markings are accentuated. (7) Vesicle (see figure 4-6). An elevated, fluid-filled lesion less than 0.5 cm in diameter (small blister). Some examples of vesicles are found in acute eczematous dermatitis and second degree burns.

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Figure 4-6. Vesicle/Bulla. (8) Bulla (see figure 4-6). A fluid-filled elevation greater than 0.5 cm in diameter (a burn blister). (9) Pustule (see figure 4-7). A pus-filled lesion, which may have resulted from infection of vesicles or bullae and may have had many forms and origins.

Figure 4-7. Pustule. b. Secondary Lesions. These are the result of, or completion of, a primary lesion. This can be caused by natural evolution of primary lesions (a vesicle bursts, leaving an eroded area), or from the patients' manipulation of the primary lesion (scratching a vesicle, leaving an eroded or ulcerated area). (1) Crust (see figure 4-8). A dried residue of serous fluid, blood, or pus overlying an area of lost or damaged epidermis. Crusting is the result in a wide variety of inflammatory and infectious diseases.

Figure 4-8. Crust.

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(2) Scale (see figure 4-9). A buildup of dry cells (horny layer), higher than normal; may be caused by excessive oils or disease processes. Some of the scaling rashes are psoriasis, dermatitis, and superficial fungus infections.

Figure 4-9. Scale. (3) Fissure (see figure 4-10). A crack in the epidermis that extends into the dermis. This commonly occurs from trauma to thickened, dry, or inelastic skin.

Figure 4-10. Fissure. (4) Erosion (see figure 4-11). A loss of the epidermis but does not extend into the dermis.

Figure 4-11. Erosion.

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(5) Ulcer (see figure 4-12). An excavation into the dermis or deeper, always results in a scar.

Figure 4-12. Ulcer. (6)

Scar. The result of healing after destruction of some of the dermis.

(7) Keloid. A sharply elevated, irregular-shaped, progressively enlarging scar caused by the formation of excessive amounts of collagen in the corium during connective tissue repair. c. Special Lesions. (1) Sebaceous cyst. A blocked sebaceous duct, where by the gland continues with its activity. (2)

Folliculitis. An inflammation or infection of the hair follicles.

(3) Boil (furuncle). A well-localized staph infection of the hair follicle, epidermis, and/or dermis. (4)

Abscess. A localized collection of pus.

(5)

Petechiae. A ruptured capillary (micro-sized bruise).

(6)

Ecchymosis. A ruptured vein (large bruise).

(7) Maceration. A softening of solid tissue by soaking; the tissue turns white and breaks down easily.

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4-3.

GENERAL METHODS TO HELP PREVENT SKIN DISEASES

a. Keep Skin Clean. Bathing removes dirt, decreases the number of microorganisms, and body odors. (1)

Use soap and water when bathing; bathe no more than twice a day.

(2) Wash out helmet. If no shower facilities are available, use cold water to wash helmet. b. Keep Skin Dry. Keeping the skin dry in tropical regions helps decrease the incidence of tropical skin diseases. (1)

Remove wet socks and boots as frequently as possible.

(2)

Rinse mud off boots--mud prevents drying.

(3) Keep skin fold areas dry--underarms, groin, buttocks, and area between toes; use talcum powder sparingly.

NOTE: 4-4.

(4)

Don't starch battle dress uniform (BDU's).

(5)

Do not wear underwear if it aggravates an existing skin condition

The above preventive measures applie to all patients/soldiers.

COMMON SKIN DISEASES

a. Eczema. This is the general name for a group of noncontagious, inflammatory skin diseases that have a tendency toward erythema (redness), swelling (edema), oozing, weeping, and crusting. (1)

Signs and symptoms. Includes scaling, crusting, and fissuring.

(2) Treatment. Apply cold, wet compresses, anti-itching medications and air dry the affected area. b. Contact Dermatitis. An inflammation to the skin produced by substances in contact with the skin--may be acute or chronic, and is often sharply defined. This may be caused by plants (that is, poison ivy, oak, or sumac), chemicals, cosmetics, fabrics, and household items (that is, detergents, waxes, polish). (1) Signs and symptoms. Includes itching, redness, burning, blisters, oozing, crusty areas, and secondary bacterial infections.

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NOTE:

Reaction is usually immediate, but may be delayed due to hypersensitivity allergic reaction.

(2) Treatment. Remove offending agent immediately (that is, wash it off), cool soak affected area; bathe affected area in lukewarm water. (3) Referral. Refer patient to a physician if fever is more than 101ºF, or signs of infection (smelling, tenderness, redness, or warmth) develops at site of irritation. c. Blisters. These are a collection of elevated fluids between the epidermis and the dermis. They are caused by repeated friction and pressure against the skin, cold injuries, and burns. (1)

Treatment.

(a) Blisters should be opened routinely unless there is severe pain or infection. For blisters on the toe or foot, cover with petroleum jelly and adhesive tape or moleskin wrapped completely around the toe or foot. (b) Blisters on the heel can be protected with a donut-shaped piece of felt or moleskin taped in place around margin of blister. (2)

Prevention. (a) Wear properly fitted footgear, and wear gloves to protect hands. (b) Avoid walking long distances in new shoes/boots.

(c) Wear cotton or cotton wool socks. They are less likely to cause blisters than synthetic materials. (d) Avoid tube socks. (e) Put tape on vulnerable areas prior to exercise/use. (3)

Refer patient to a physician if: (a) Signs of infection occur (increased heat, redness, swelling, or pus

in the blister). (b) Patient is incapacitated, unable to perform mission.

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d. Callus. A usually painless thickening of skin caused by repeated pressure or irritation. This is caused by repeated injury to skin, particularly on the feet and may be caused by excessive perspiration, increased heat, friction of clothing, or poorly fitting shoes. (1) Signs and symptoms. A rough, thickened area of skin that appears after repeated pressure or irritation. (2)

Treatment. (a)

Soften callus in warm water.

(b) Rub thickened area with pumice stone, sandstone, or sandpaper. (c) (3)

Use callus pads to reduce pressure on irritated area.

Prevention. (a)

Do not wear shoes that fit poorly.

(b) Avoid activities that create constant pressure on specific skin areas. (c)

Use callus pads to reduce pressure on irritated areas.

e. Chafing. A superficial inflammation which develops when skin is subjected to friction from clothing or adjacent skin--may occur at underarm, groin, anal region, or between digits of hands and feet, or at the neck or wrists. Chafing is caused by friction from contact with another surface such as tight-fitting clothing, shoes, or another area of body skin. (1) Signs and symptoms. Include local pain, tenderness, and/or redness of skin at areas of friction. (2) Treatment. Relief may be obtained by liberal application of petroleum jelly to the affected area. (3)

Prevention. (a) Eliminate potential causes such as tight-fitting shoes, shorts, or

shirts. (b) Prior to beginning activity, apply petroleum jelly to parts of the body which may be most likely to become chafed (areas include inside of thighs, groin, and feet).

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f. Prickly Heat. A noncontagious eruption of red pimples with itching and tingling of the affected parts, usually seen in hot weather-- (also called miliaria). This is caused by inflammation of the skin around the sweat glands. (1)

Signs and symptoms. (a)

Itching, burning, or stinging of skin.

(b) Small red bumps or blisters suddenly develop during exercise in hot, humid weather. (2) Treatment. There is no specific treatment. Conditions are seldom severe enough to cause major problems. (3)

Prevention. (a)

Minimize exercise and work on hot, humid days.

(b) Wear well ventilated clothing to minimize accumulation of sweat on skin. g. Psoriasis. Common genetically determined dermatitis consisting of discrete pink or dull-red lesions. The cause is unknown. (1) Signs and symptoms. Patches of thick skin with red base and whitesilvery scales/flakes usually on the elbows, knees, scalp, back, and penis. NOTE:

Psoriasis can become worse if exposed to sunshine TOO LONG; a small amount of sun is good. (2)

Treatment. There is no known cure. Temporary relief can be obtained

by: (a) Applying hydrocortisone cream 1/2 percent to skin four times a day. (b) Being exposed to mild sun--warm climates seem to exert a favorable effect, humidity often aggravates. h. Acne. This is a chronic inflammatory disease of the sebaceous glands and hair follicles of skin. Acne is caused by excessive oils due to hormone stimulations and bacteria that may be hereditary, and prime bacteria--staph and/or strep. Common affected areas are the face, back, and chest.

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(1)

Signs and symptoms. (a) Multiple spreading of pimples, cysts, and/or nodules with pain. (b) Development of pus in many cases.

(2)

Treatment.

(a) There are pros and cons about a number of foods contributing to the severity of acne; those most often agreed upon are chocolates, nuts, and carbonated cola beverages. Do not consume these foods or other foods if they are suspected. (b) Drying lotions such as white lotion or commercially prepared lotions containing sulfur and resorcinol may be used. i. Urticaria (hives). This is an acute or chronic inflammatory skin reaction of allergic origin-eruptions of wheals or hives. It can be caused by ingestion of food or drugs. Acute inflammation is less than 6 weeks duration. Chronic inflammation is longer that 6 weeks duration. Common causes of the acute form are shellfish, strawberries, eggs, chocolate, penicillin, and serum vaccines. (1)

Signs and symptoms. (a) Intolerable itching. (b) Slight fever and malaise may be present.

(c) Wheals may vary in size, shape, and amount of swelling; morphology of lesions may vary over period of minutes to hours. CAUTION: Observe for laryngeal obstruction. Death could occur. (2)

Treatment. (a) Avoid exposure to sensitizing drugs or foods.

1. Look for cause. A careful history may reveal recent prescription of antibiotics, or a new food introduced into diet. 2. Eliminate cause. The cause may be antibiotics or other medications; therefore, one would go back to the prescriber to change medication. (b) Give epinephrine 1:1000 0.3-1.0 ml subcataneous (SQ), if laryngeal spasm is suspected.

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(c) Give antihistamines. They often give prompt and sustained symptomatic relief. (d) Urticaria is usually self-limiting, lasting only a few days. j. Tinea Pedis (Athlete's Foot). A common, contagious fungus infection of the skin on the feet between the toes (usually the 4th and 5th toes). (1)

Causes. (a)

Infection by fungus or yeast.

(b)

Infrequent washing of feet.

(c)

Infrequent changes of shoes or socks.

(d)

Hot, humid weather.

(e) Use of locker rooms and public showers. (2)

Signs and symptoms. (a)

Moist, soft, gray-white or red scales on feet, especially between

toes. (b) Dead skin between toes. (c)

Damp, musty foot odor.

(d) Small blisters on feet, caused by hypersensitivity to fungus (this symptom is not always present). (3)

Treatment. (a) Remove scales and material between toes daily.

(b) Keep affected areas cool and dry--go barefoot or wear sandals as much as possible during treatment. (c)

Use nonprescription antifungal powders, creams, or ointments after

each bath.

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(4)

Prevention. (a) Observe good locker room hygiene. (b) Bathe feet daily, and dry thoroughly. (c)

Wear socks made of cotton, wool, or other natural absorbent fibers.

k. Tinea Cruris (Jock Itch). Infection of the skin in the groin with one of several fungus germs--these fungi thrive in the groin where darkness, warmth, and moisture stimulate their growth. (1)

Causes and risk factors. (a) Athlete's foot can spread to the groin. (b) Contact with infected surfaces, such as towels and benches. (c)

Excessive sweating.

(d) Friction of skin against skin from constant movement. (2)

Signs and symptoms.

(a) Scaling patches on skin of groin, thighs, and buttocks (patches have well-defined edges).

(3)

(b)

Occasionally small, pus-filled blisters appear.

(c)

Itching of involved areas.

(d)

Pain (if skin becomes secondarily infected with bacteria).

Treatment. (a)

Bathe with clear water only. Soap irritates infected skin.

(b) Wear loose, cotton underwear. (c) Use topical antifungal medications. They may be purchased over the counter (jock itch powders or sprays).

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(4)

Refer to physician: (a) If symptoms do not improve after five days.

(b) If, after receiving prescription treatment, new unexplained symptoms develop (drugs used in treatment may produce side effects). (5)

Prevention. (a) Dry thoroughly after bathing. (b) Wear clean, dry athletic supporters and underwear.

Continue with Exercises

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EXERCISES, LESSON 4 INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the question or best completes the incomplete statement or by writing the answer in the space provided. After you have completed all the exercises, turn to "Solutions to Exercises" at the end of the lesson and check your answers..

1.

_________________, _______________ , and__________________ tissues are the three layers of skin.

2.

Freckles, flat moles, and tattoos are examples of _______________________.

3.

Define "lesion." ___________________________________________________ ________________________________________________________________

4. List the three types of lesions. ______________________________________. ______________________________________. ______________________________________.

5. Which of the following lesions is the result of healing after destruction of some of the dermis? a. Boil. b. Scar. c.

Abscess.

d. Keloid.

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6.

Categorize the following lesions according to their group. Use the chart below: Keloid Folliculitis Crust Bulla Abscess

Maceration Scale Boil Ulcer Vesicle

Macule Ecchymosis Plague Erosion Wheal

______ Primary______________ Secondary_________________ Special__________ _______________________

_____________________

____________________

_______________________

_____________________

____________________

_______________________

_____________________

____________________

_______________________

_____________________

____________________

_______________________

_____________________

____________________

7.

What general methods are used to help prevent skin diseases? _____________________________________________________. _____________________________________________________.

8.

What are the signs and symptoms of eczema? _____________________________________________________. _____________________________________________________. _____________________________________________________.

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SPECIAL INSTRUCTIONS FOR EXERCISES 9 THROUGH 17. Match the name of the common disease in Column A to its definition as listed in Column B.

COLUMN A ____ 9. Callus

COLUMN B a.

Dermatitis consisting of discrete pink or dull-red lesions.

b.

Superficial inflamation that develops when skin is subjected to friction from clothing or adjacent skin.

c.

Chronic inflammatory diseases of the sebaceous glands and hair follicles of the skin.

d.

Painless thickening of skin caused by repeated pressure or irritation.

e.

Athletes' foot (contagious fungus infection of the skin between the toes.

f.

Jock itch (infection of the skin in the groin).

g.

Noncontagious eruption of red pimples with itching and tingling of the affected parts.

h.

Acute or chronic inflammatory skin reaction of allergic origin.

i.

Collection of elevated fluid between the epidermis and the dermis.

____10. Blister ____11. Prickly heat ____12. Chafing ____13. Psoriasis ____14. Acne ____15. Tinea pedis ____16. Urticaria ____17. Tinea cruris

Check Your Answers on Next Page

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4-18

SOLUTIONS TO EXERCISES, LESSON 4

1.

Epidermis, dermis or corium, subcutaneous (para 4-1b)

2.

Macule (para 4-2a(1)(a))

3.

Any morbid change in the structure or functioning tissues due to injury or disease. (para 4-2)

4.

Primary, secondary, special para 4-2a, b, c)

5.

b

6.

Primary

Secondary

Special

Bulla Vesicle Wheal Plaque Macule

Erosion Ulcer Scale Crust Keloid

Folliculitis Abscess Boil Ecchymosis Maceration (paras 4-2))

(para 4-2a(2)(f))

7.

Keep skin clean, keep skin dry (paras 4-3a, b)

8.

Scaling, crusting, fissuring (para 4-4a (1))

9.

d

(para 4-4d)

10.

i

(para 4-4c)

11.

g

(para 4-4f)

12.

b

(para 4-4e)

13.

a

(para 4-4g)

14.

c

(para 4-4h)

15.

e

(para 4-4j)

16.

h

(para 4-4i)

17.

f

(para 4-4k)

End of Lesson 4

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LESSON ASSIGNMENT

LESSON 5

Initiate Measures to Prevent the Spread of Communicable Diseases.

LESSON ASSIGNMENT

Paragraphs 5-1 through 5-15.

LESSON OBJECTIVES

After completing this lesson, you should be able to:

SUGGESTION

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5-1.

Identify signs, symptoms, and procedures to prevent spread of sexually transmitted diseases.

5-2.

Identify signs, symptoms, and procedures to prevent the spread of communicable respiratory diseases: upper respiratory infection (URI); influenza; pneumonia; tonsillitis; mononucleosis.

5-3.

Identify signs, symptoms, and procedures to prevent the spread of communicable gastrointestinal diseases: diarrhea; dysentery.

5-4.

Identify signs, symptoms, and procedures in preventing the spread of hepatitis, malaria, rabies, and meningitis.

After completing the assignment, complete the exercises of this lesson. These exercises will help you to achieve the lesson objectives.

5-1

LESSON 5 INITIATE MEASURES TO PREVENT THE SPREAD OF COMMUNICABLE DISEASES SECTION I. SEXUALLY TRANSMITTED DISEASES 5-1.

GENERAL

Sexually transmitted diseases (STD) (commonly known as venereal diseases) are the most known common communicable diseases in the world and have steadily increased in incidence for the past two decades. Although, progress has been made in diagnosis and treatment of STD, factors responsible include changes in sexual behavior (that is, widespread use of contraceptive pills and devices, the greater variety of sexual practices; the increase of sexual activity; the infection of homosexual men, and ignorance of the facts by doctors and educational materials). Sexually transmitted diseases are almost always acquired by sexual contact with an infected individual. Of the many STD, the Army is greatly concerned about gonorrhea, syphilis, herpes, and acquired immunodeficiency syndrome (AIDS). 5-2.

GONORRHEA

Gonorrhea is commonly known as clap, the drip, gleet, gonorrhea culture (GC), strains, or running. This is the most prevalent reported disease among the STD cases in the United States (US). It is spread by sexual intercourse and the highest incidence ranges between the ages of 15 to 29 years old. Signs and symptoms for gonorrhea in males and females may be similar, yet the appearance of the symptoms will differ. Males will show symptoms where as 60 percent of females may show no symptoms. a. Signs and Symptoms. (1)

Male. (a)

Usually starts 2 to 8 days after sexual exposure.

(b) Dysuria (painful or difficult urination). 1 Initially--tingling or burning on urination. 2 Hours to 3 days later pain is more pronounced. (c)

Purulent (pus-like) discharge from the penis. 1 May be milky in character. 2 Progresses to yellow-creamy discharge, sometimes blood-

tinged. MD0550

5-2

(d) Area surrounding meatus may be red and swollen. (e) Frequency in voiding/urination. (2)

Female. (a)

Usually starts 7 to 21 days after sexual exposure.

(b) Dysuria (painful or difficult urination). (c) Frequency and increase in vaginal discharge, purulent (pus-like) discharge from the urethra. b. Preventive Measures. (1) Report to the local health authority (Preventive Medicine Office for the military and the Community Health Office for the civilian population). (a) The infected person should identify and report all infected sexual partners, if possible. (b) He should also report visible signs of infection. 1 For males--sores on genitalia or discharge from penis. 2 For females--increased vaginal discharge, lesions of skin and mucous membranes. Ask the female if she has burning during urination. (2)

Isolation not required.

(3)

Quarantine not required.

(4)

Refer infected person to a physician for treatment.

(5)

Educate the public through health and sex education classes.

(6) Protect the community by control of prostitution (advise against prostitution) and discourage sexual promiscuity. (7)

Use of personal prophylaxis; that is., condoms.

(8)

Avoid sexual intercourse until released/okayed by doctor; (usually 6 to 8

weeks).

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5-3

NOTE:

5-3.

The medic should gain the patient's confidentiality and ensure his privacy. Only tell those persons who have a need to know for all STD cases; that is, doctor, local health authority, and so forth.

SYPHILIS

Of all sexually transmitted diseases, syphilis is potentially one of the most destructive. Early symptoms disappear spontaneously and yet, years later, can return with devastating consequences. Syphilis is a highly infectious disease and is spread by sexual intercourse. It usually involves persons between 15 to 30 years old, and is more prevalent in males than females. a. Signs and Symptoms. (1) Purulent (pus-like) discharge from moist lesions of skin and mucous membranes--lesions occur on lips, tongue, breast, fingers, and anal region. (2)

No pain is associated with syphilis.

(3)

Patient may develop fever caused by infected lesions.

(4) If early signs and symptoms of syphilis are not treated appropriately and immediately, more life-threatening conditions may occur. (a) Blindness. (b)

Severe heart disease.

(c)

Altered neurological status.

b. Preventive Measures. (1) Report to the local health authority (Preventive Medicine Office for the military and the Community Health Office for the civilian population). (a) The affected person should identify and report all infected sexual partners. (b) He should also report visible signs of infection.

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(2)

Isolation not required.

(3)

Quarantine not required.

5-4

(4) Educate the public through health and sex education classes; for example, preparation for marriage and general physical examination includes having a blood serology test. (5) Protect the community by control of prostitution (advise against prostitution) and discourage sexual promiscuity.

5-4.

(6)

Use of personal prophylaxis; that is, condoms.

(7)

Avoid sexual intercourse until released/okayed by doctor.

HERPES SIMPLEX (FEVER BLISTER, COLD SORE) a. General. (1)

Viral infection marked by its repeated recurrence of lesions.

(2)

Lesions, after healing, are reactivated by: (a) Trauma. (b) Occurrence of infection.

(3)

Location of lesions. (a) Lips. (b)

Gums.

(c)

Mouth area.

(d) Occasionally affects genitals. (4)

Two types of herpes simplex.

(a) Herpes Simplex Virus Type I (HSV-I)--usually occurs in childhood; virus remain in body for life until triggered by infection. (b) Herpes Simplex Virus Type II (HSV-II)--genital herpes; usually occurs in adults; transmitted by some form of sexual contact. b. Signs and Symptoms.

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(1)

Very small, painful blisters grouped together and surrounded by red ring.

(2)

Fever.

5-5

(3)

Malaise.

(4)

Experience pain or difficulty in voiding/urinating.

(5)

Headache.

c. Causes. Herpes simplex virus may be triggered by: (1)

Injury to skin from friction with clothing or protective gear.

(2)

Previous eczema.

(3)

Illness that may lower individual's resistance.

(4) Some form of sexual contact--kissing an individual infected with the herpes simplex virus. d. Preventive Measures. (1) (2) the infection. (3)

Personal hygiene--bathing; wash you hands often during flare-up. Health and sex education classes directed toward minimizing transfer of

Avoid physical contact with others who have active lesions.

(4) Isolation--individuals with Herpes simplex virus lesions should be kept away from patients with burns. NOTE:

5-5.

Patients with burns are more prone to development of infections because of an altered state in resistance to illnesses and/or infections.

Acquired Immune Deficiency Syndrome a. Terminology.

(1) HTLV-III--Human T-cell Lymphotrophic Virus Type III--this virus attacks certain white blood cells called the T-helper cells that regulate our immune system and protect us from various infectious agents. (2) Acquired Immune Deficiency Syndrome --AIDS—is a disease at least moderately predictive of a defect in the immune system, occurring in a person with no known cause for diminished resistance to that disease.

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5-6

NOTE:

HTLV-III infection means that a person has been exposed to and infected with the virus. Acquired immune deficiency syndrome means that the infection has progressed to the point that the body's immune system has been attacked and the person shows signs and symptoms of illness.

b. Background. (1)

HTLV-III--traced back to African Green Monkey--transmitted by scratch

(2)

Acquired immune deficiency syndrome --found and named coincidentally--first seen as pneumonia of a rare type--in primarily, but not limited to homosexual men.

or bite.

c. Transmission of HTLV-III Virus. (1)

Sexual contact--heterosexual and/or homosexual.

(2)

Sharing of needles—interveinous (IV) drug users.

(3)

Contaminated blood--less of a problem now that blood is being tested for

(4)

Maternal-child transmission--in uterus.

HTLV-III.

d. Signs and Symptoms of HTLV-III Virus. Signs and symptoms of HTLV-III virus may range from no symptoms at all to symptoms of AIDS. NOTE:

There has been no cure found for the HTLV-III infection.

e. Signs and Symptoms of AIDS. (1) Fever of unknown origin--fever may be low grade and persistent or it may be episodic and spiking. (2)

Weight loss--can amount from 20 to 30 percent of body weight.

(3)

Malaise.

(4)

Diarrhea.

(5) Opportunistic infections—that is, Candida, Pneumocystis pneumonia, toxoplasmosis, cytomegalovirus. (6)

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Kaposils sarcoma.

5-7

f. Treatment. There is no cure; the patient is treated to alleviate whatever signs and symptoms, which is causing them to suffer. g. Problems Unique to Military Personnel. (1)

Deployment--ready fighting force cannot be deployed worldwide.

(2) Battlefield injuries and transfusions if wounded, they can develop infections, cannot fight, cannot give blood to others. (3) Live virus inoculations, if given a live virus inoculation, they will become infected with the virus and will not be able to fight. h. Prevention. (1)

Avoid sexual contact with those at risk. (a) Prostitutes. (b) Drug users. (c)

Homosexuals.

(d) Bisexuals. (e) Promiscuous individuals.

NOTE:

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(2)

Use a condom if you or your partner may be carrying the virus

(3)

Limit number of sexual partners.

(4)

Do not use IV drugs.

Women who have the virus or think they may have the virus, should be cautioned to avoid pregnancy. The virus can be transmitted to their unborn child.

5-8

SECTION II. RESPIRATORY DISEASES--UPPER RESPIRATORY INFECTIONS 5-6.

GENERAL

There are many acute respiratory infections that are grouped together and given a general title of Acute Viral Respiratory Diseases. They are associated with a large number of viruses and each virus is capable of producing a wide variety of acute respiratory illnesses. The greatest incidence of upper respiratory infections (URI)occurs during the fall and winter months. a. Signs and Symptoms. Upper respiratory infections are usually associated with fever, chills, headaches, generalized body aches and pain (to include facial and tooth pain), malaise, loss of appetite, possibly nasal congestion, sneezing, sore throat, and coughing. The signs and symptoms may last from 2 to 5 days. b. Common Treatment. Treatment includes mild analgesic--acetylsalicyclic acid (ASA) (asprin), rest, fluids, and light diet. c. Preventive Measures. (1) Isolation. Infected persons should avoid direct or indirect exposure of others, particularly patients with other illness. Avoid crowding in living and sleeping quarters, especially in the barracks. NOTE:

In some cases of mild upper respiratory infections, soldiers will not be isolated from their barracks. If a soldier's condition deteriorates and hospitalization is required, isolate IAW STP-8-91A12-TQ-SM, 081-833-0009, Identify Basic Principles of Isolation Techniques.

(2) Oral vaccines. This has been proven effective against type-specific (oral polio) infections in military recruits. (3) Education. Inform individuals on personal hygiene (that is, covering mouth when coughing, cover nose when sneezing). (4) Disposal. Dispose of discharge from mouth and nose. Get rid of tissues or whatever else is used to hold discharge. 5-7.

INFLUENZA (FLU)

Influenza is a highly contagious, acute disease caused by a virus. Recovery time is between 2 to 7 days. Its mode of transmission is through direct contact--someone coughing, failing to cover mouth or nose in crowded areas, or being in confined places such as the barracks.

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5-9

a. Signs and Symptoms. Includes a slight fever that may last from 1 to 7 days (usually 3 to 5 days), nonproductive and dry cough, headache, nasal stuffiness/congestion, chills, generalized body aches and pain, and occasionally nausea and diarrhea. b. Treatment. Includes mild analgesic--ASA for aches, pains, and headaches; fluids and bedrest. c. Preventive Measures. (1)

Immunization. Flu vaccine.

(2)

Isolation. Recommended for highly susceptible patients.

(3) Referral. Refer patient to higher level of medical care if condition deteriorates (same complaint or no improvement upon return visit). 5-8.

TONSILLITIS AND STREP THROAT a. Definitions.

(1) Tonsillitis. A painful inflammatory disease caused by bacteria or viruses that infect one or both of the tonsils. The highest incidence is people between the ages of 10 to 40 years old. (2) Strep throat (septic sore throat, acute streptococcal pharyngitis, and acute streptococcal tonsillitis). An infectious disease that affects the membranes of the throat and tonsils. It spreads from person to person through droplets of moisture sprayed from the nose and mouth. b. Signs and Symptoms. (1)

Sore throat--classic symptom.

(2)

Pain while swallowing.

c. Treatment. Includes rest, fluids, mild analgesic--ASA, light diet--mostly liquids.

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(3)

Fever/chills.

(4)

Headache.

5-10

(5)

Malaise.

(6)

Red or swollen tonsils on examination.

d. Preventive Measures. None. 5-9.

PNEUMONIA

Pneumonia is an acute infection of the air sacs in the lungs. It usually occurs as a result from other infections (that is, injury to the respiratory mucosa with pneumonia as a secondary infection, influenza, common cold, and bronchitis). NOTE:

Patients who are hospitalized and confined to the bed, post-operative patients or patients with chest or abdominal trauma injuries, have a tendency not to take deep breaths and cough due to pain associated with these procedures. It would be better if the patient would cough or try to cough to loosen some of the congestion and to expel it from the chest and mouth.

a. Signs and Symptoms. (1)

Runny nose, sore throat several days before onset.

(2)

Severe chest pain when coughing.

(3)

Productive cough when able to cough--sputum slightly blood-tinged.

(4)

Fever (103ºF or higher).

(5)

Chills.

(6)

Shortness of breath.

b. Treatment. Includes bedrest and fluids. c. Referral. Refer patient to higher level of medical care if the patient's condition deteriorates. If the patient has a severe case of pneumonia, refer to a physician immediately. d. Preventive Measures. (1) (2) bedridden. (3)

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Good personal hygiene. Strongly encourage patients to cough and deep breathe when

Avoid crowded living quarters.

5-11

(4)

Avoid contact with patients infected with upper respiratory infections.

(5)

Immunization with flu vaccine.

5-10. MONONUCLEOSIS Mononucleosis is an acute infectious disease. Its mode of transmission is through close contact, kissing is the common route of transmission. The infection is most common among college students. It usually occurs between the ages of 15 to 25 years old. a. Signs and Symptoms. Includes fever, sore throat, and malaise. b. Treatment. There is no specific treatment, however, rest and nourishment are recommended. c. Preventive Measures. Avoid contact with persons infected with other respiratory diseases. d. Referral. Refer to higher level of medical care if the patient's condition worsens. SECTION III. GASTROINTESTINAL DISEASES 5-11. DIARRHEA, DYSENTERY a. Definition. (1)

Diarrhea. An abnormal frequency and liquidity of fecal discharges.

(2) Dysentery. A term given to a number of disorders marked by inflammation of the intestines, especially the colon, and attended by pain in the abdomen, tenesmus (straining), and frequent stools containing blood and mucus. b. Mode of Transmission. Includes contaminated food and water, flies, and infected individuals. c. Signs and Symptoms. (1)

Frequent liquid or semi-liquid stools.

(2) May lead to dehydration (dry mouth and skin, failure to urinate, sunken eyes, drowsiness).

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5-12

(3)

Severe abdominal pain or cramps.

(4)

Severe cases--stools contain blood, pus, and mucous.

d. Preventive Measures. (1)

Eat only approved food and drink (only treated water).

(2)

Dispose of waste matter properly.

(3)

Maintain good personal hygiene.

(4)

Practice insect and rodent control.

(5)

Thorough terminal cleaning--to specifically include bathroom facilities.

5-12. HEPATITIS Hepatitis is defined as inflammation of the liver. It is divided into two types: Hepatitis Type A and Hepatitis Type B. The signs and symptoms for both types are the same, the only difference is the mode of transmission. a. Mode of Transmission. (1)

Type A--common vehicle outbreaks related to contaminated water and

food. (2) Type B--common vehicle by parental route (intravenous, intramuscular, or subcutaneous routes)--using contaminated needle and syringes. b. Signs and Symptoms.

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(1)

Fever.

(2)

Malaise.

(3)

Loss of appetite.

(4)

Nausea, vomiting.

(5)

Abdominal discomfort.

(6)

Headache.

5-13

(7)

Skin, sclera of eyes become yellowish-tinged.

(8)

Urine becomes dark yellow; may look brown.

c. Treatment. Involves bedrest, restricted activities, and a diet high in protein and carbohydrates. d. Preventive Measures. (1)

Education to public directed toward good sanitation and good personal

(2)

Special emphasis on sanitary disposal of feces/stools.

(3)

Proper disposal of contaminated/used needles and syringes.

hygiene.

(4) Isolation--definitely--enteric precautions (good hand washing and wearing gloves when handling the patients waste matter, feces, needles and syringes). (5) Individuals who have history of hepatitis should be identified and properly screened prior to blood donations. NOTE:

All military personnel PCS to Korea as of 1 October 1983 will receive the Immune Serum Globulin Hepatitis B Antibody (Anti-BHs).

5-13. MALARIA Malaria is an infectious, febrile disease caused by protozoa of the genus plasmodium, which are parasites in the red blood cells, and are transmitted by bites of infect mosquitoes of the genus anopheles. a. Signs and Symptoms. (1)

Fever.

(2)

Chills and sweating.

(3)

Headache.

(4)

Shock, if the condition worsens.

b. Preventive Measures.

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(1)

Keep immunizations current.

(2)

Take prescribed prophylaxis (malaria pills).

5-14

(3)

Bathe daily and change clothing daily. (a)

Tuck your pants into boots.

(b) Button your shirt up entirely. (c) (4)

Button you shirtsleeves.

Use insect repellent; spray pesticides to eliminate or control insects.

(5) Blood donors should be question for history of malaria or possible exposure to the disease. (a) May not donate blood up to 6 months after return from a susceptible area, if patient has not taken anti-malarial drugs, or has been symptom-free. (b) If anti-malarial drugs are taken, definitely identified as having malaria, individuals may be accepted as blood donors after three years. 5-14. RABIES a. Rabies is an acute, infectious disease of the central nervous system to which all warm-blooded animals and humans are susceptible. (1)

Wild animals include skunks, foxes, raccoons, and bats.

(2)

Domestic animals include dogs, cats, pigs, horses, and mules.

b. Mode of Transmission. Bites from affected animals. c. Signs and Symptoms. (1)

Slight temperature elevation.

(2)

Headache.

(3)

Malaise.

(4)

Nervousness.

d. Treatment. (1)

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Immediately wash wound with large amount of saline.

5-15

(2)

Cleanse with large amounts of soap.

(3)

Debride wound if necessary.

e. Preventive Measures. (1) Report to local health authority--date, time, type of animal; you must bring animal with you, if possible. (2)

Isolation--strict isolation during time of illness.

(3)

Wearing of gloves and protective gown required when handling infected

individual. CAUTION: NOTE:

The infected individual's saliva/secretions are potentially hazardous.

Vaccination of a person is NOT a preventive measure.

(4) The public should be instructed to have proper administration of vaccines given to all domestic animals. (6) State establishes source of preventive measures for appropriate wildlife conservation. 5-15. MENINGITIS Meningitis is an acute inflammation of the meninges of the brain or spinal cord. The actual cause is not known. a. Signs and Symptoms. NOTE:

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The signs and symptoms in most cases are related to an upper respiratory type of infection. (1)

Headache.

(2)

Back pain.

(3)

Stiff neck.

(4)

Chills.

(5)

Fever, extremely high on some occasions.

(6)

Loss of appetite.

5-16

(7)

Confusion.

(8)

Drowsiness.

c. Treatment. Treat symptomatically and provide life-support, as necessary d. Preventive Measures. (1) Report to local authority--community Health Nurse or Infection Control Department must be notified. (2)

Isolation--isolate all patients during febrile (fever) period.

(3) Disinfect all eating and drinking utensils soiled by secretions and waste matter of patients. (4)

Patients need to be treated for more definitive care in medical treatment

facility.

Continue with Exercises

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5-17

EXERCISES, LESSON 5 INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the question or best completes the incomplete statement or by writing the answer in the space provided. After you have completed all the exercises, turn to "Solutions to Exercises" at the end of the lesson and check your answers..

1.

What is the most prevalent reported STD in the world? a. AIDS. b. Syphilis. c.

Gonorrhea.

d. Herpes simplex.

2.

Signs and symptoms of gonorrhea usually start in women within _________ after sexual exposure. a. 1 to 2 hours. b. 8 to 12 hours. c.

1 to 6 days.

d. 7 to 21 days.

3.

___________________ is the STD that is more prevalent in men than in women.

4.

There is no pain associated with syphilis. a. True. b. False.

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5-18

5.

Which of the following incidents could trigger the herpes simplex virus? a. Previous eczema. b. Vascular headaches. c.

Pain while urinating.

d. Previous aches and pains.

6.

Which of the following modes of transmission are related to the HTLV-III virus? a. Sexual contact, both hetero and/or homosexual. b. Sharing of needles-IV drug users. c.

Contaminated blood.

d. All of the above.

7.

__________________ is a highly contagious, acute disease caused by a virus.

8.

Tonsillitis only affects one tonsil. a. True. b. False.

9.

What is known as a classic symptom for strep throat? a. Fever. b. Chills. c.

Sore throat.

d. Pain while swallowing.

10.

______________________ is an acute infection of the air sacs in the lungs.

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5-19

11.

Which of the following diseases common route of transmission is by kissing? a. Meningitis. b. Influenza. c.

Dysentery.

d. Mononucleosis.

12.

What are two gastrointestinal diseases as listed below? a. Pneumonia, diarrhea. b. Diarrhea, dysentery. c.

Influenza, meningitis.

d. Herpes, hepatitis.

13.

What are the signs and symptoms of malaria? a. Headache, malaise, nervousness. b. Fever, chills and sweating, headache. c.

Lost of appetite, nausea, abdominal pain.

d. Dryness of the mouth, fever, headache.

14.

________________ is an acute infectious disease of the central nervous system.

Check Your Answers on Next Page

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5-20

SOLUTIONS TO EXERCISES, LESSON 5

1.

c

(para 5-2)

2.

d

(para 5-2a(2))

3.

Syphilis (para 5-3)

4.

a

(para 5-3a(2))

5.

a

(para 5-4c)

6.

d

(para 5-5c)

7.

Influenza (para 5-7)

8.

b

(para 5-8a(1))

9.

c

(para 5-8b(1))

10.

Pneumonia (para 5-9)

11.

d

(para 5-10)

12.

b

(para 5-11)

13.

b

(para 5-13a)

14.

Rabies (para 5-14a)

End of Lesson 5

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5-21