COMMUNICABLE DISEASE NURSING

SUMMER REVIEW
CHAIN OF INFECTION
COMMUNICABLE DISEASE
 Disease caused by an infectious agent that are transmitted
directly or indirectly to a well person through an agency, vector or
inanimate object

CONTAGIOUS DISEASE
 Disease that is easily transmitted from one person to
another
INFECTIOUS DISEASE
 Disease transmitted by direct inoculation through a break in
the skin INFECTIOUS AGENT
INFECTION
 Any microorganism capable of producing a disease
RESERVOIR
-Entry and multiplication of an infectious agent into the tissue of the
host  Environment or object on which an organism can survive
INFESTATION and multiply
- Lodgement and development of arthropods on the surface of the PORTAL OF EXIT
body  The venue or way in which the organism leaves the
reservoir
ASEPSIS MODE OF TRANSMISSION
- Absence of disease – producing microorganisms  The means by which the infectious agent passes from the
SEPSIS portal of exit from the reservoir to the susceptible host
- The presence of infection PORTAL OF ENTRY
 Permits the organism to gain entrance into the host
MEDICAL ASEPSIS SUSCEPTIBLE HOST
- Practices designed to reduce the number and transfer of  A person at risk for infection, whose defense mechanisms
pathogens are unable to withstand invasion of pathogens
- Clean technique
SURGICAL ASEPSIS STAGES OF THE INFECTIOUS PROCESS
- Practices that render and keep objects and areas free from  Incubation Period – acquisition of pathogen to the onset of
microorganisms signs and symptoms
- Sterile technique  Prodromal Period – patient feels “bad” but not yet
experiencing actual symptoms of the disease
 CARRIER – an individual who harbors the organism and is
 Period of Illness – onset of typical or specific signs and
symptoms of a disease
capable of transmitting it without showing manifestations of the
disease  Convalescent Period – signs and symptoms start to abate
and client returns to normal health
 CASE – a person who is infected and manifesting the signs
and symptoms of the disease MODE OF TRANSMISSION
CONTACT TRANSMISSION
 SUSPECT – a person whose medical history and signs and  Direct contact – involves immediate and direct transfer
symptoms suggest that such person is suffering from that particular from person-to-person (body surface-to-body surface)
disease  Indirect contact – occurs when a susceptible host is
 CONTACT – any person who had been in close association exposed to a contaminated object
DROPLET TRANSMISSION
with an infected person
 Occurs when the mucous membrane of the nose, mouth or
HOST conjunctiva are exposed to secretions of an infected person within a
- A person, animal or plant which harbors and provides nourishment distance of three feet
for a parasite VEHICLE TRANSMISSION
RESERVOIR  Transfer of microorganisms by way of vehicles or
- Natural habitat for the growth, multiplication and reproduction of contaminated items that transmit pathogens
microorganism AIRBORNE TRANSMISSION
 Occurs when fine particles are suspended in the air for a
ISOLATION long time or when dust particles contain pathogens
- The separation of persons with communicable diseases from other VECTOR-BORNE TRANSMISSION
persons  Transmitted by biologic vectors like rats, snails and
QUARANTINE mosquitoes
- The limitation of the freedom of movement of persons exposed to
communicable diseases TYPES OF IMMUNIZATION
 ACTIVE – antibodies produced by the body
 STERILIZATION – the process by which all microorganisms  NATURAL – antibodies are formed in the presence of
including their spores are destroyed active infection in the body; lifelong
 ARTIFICIAL – antigens are administered to stimulate
 DISINFECTION – the process by which pathogens but not
antibody production
their spores are destroyed from inanimate objects
 PASSIVE – antibodies are produced by another source
 CLEANING – the physical removal of visible dirt and debris  NATURAL – transferred from mother to newborn through
by washing contaminated surfaces placenta or colostrum
 ARTIFICIAL – immune serum (antibody) from an animal or
CONCURRENT human is injected to a person
- Done immediately after the discharge of infectious materials /
secretions SEVEN CATEGORIES OF ISOLATION
TERMINAL  STRICT- prevent highly contagious or virulent infections
- Applied when the patient is no longer the source of infection  Example: chickenpox, herpes zoster
 CONTACT – spread primarily by close or direct contact
BACTERICIDAL
- A chemical that kills microorganisms
 Example: scabies, herpes simplex
BACTERIOSTATIC  RESPIRATORY – prevent transmission of infectious
- An agent that prevents bacterial multiplication but does not kill distances over short distances through the air
microorganisms  Example: measles, mumps, meningitis

CD-Bucud 1
 TUBERCULOSIS – indicated for patients with positive
smear or chest x-ray which strongly suggests tuberculosis
 ENTERIC – prevent transmission through direct contact with SIGNS AND SYMPTOMS OF MENINGOCOCCEMIA
feces
 Example: poliomyelitis, typhoid fever
 DRAINAGE – prevent transmission by direct or indirect
contact with purulent materials or discharge DIC
 Ex. Burns URTI:
Vasculitis: Micro-
 UNIVERSAL – prevent transmission of blood and body-fluid cough, sore
borne pathogens petechial thrombosis
 Example: AIDS, Hepatitis B throat,
rash in the Purpura
fever,
trunk and
CENTRAL NERVOUS SYSTEM headache, Hypotension
extremities
nausea and
vomiting Shock
ENCEPHALITIS MENINGITIS MENINGO-
COCCEMIA Death
MAIN PROBLEM
- Acute infection of
- Inflammation of - Inflammation of the bloodstream and
the brain the meninges
ENCEPHALITIS MENINGITIS MENINGO-
developing vasculitis COCCEMIA
ETIOLOGIC AGENT - Streptococcus
SIGNS AND SYMPTOMS Vasculitis
- Arboviruses - Staphylococcus
- Pneumococcus Stiff neck Nuchal rigidity Waterhouse-
- Tubercle bacillus
Photophobia Opisthotonus Friderichsen
INCUBATION PERIOD - Neisseria meningitides
syndrome
5-15 days 1-10 days 3-4 days Lethargy Brudzinski’s
MODE OF TRANSMISSION
Petechiae with
Convulsions Kernig’s sign the development
Bite of infected
mosquito Respiratory droplets of hemorrhage
INCIDENCE
SIGNS AND SYMPTOMS OF ENCEPHALITIS 5-10 years old < 5 years old 6 months–5
Virus enters neural cells years old

DIAGNOSTIC EXAM
 Informed consent
Disruption in Perivascular Inflammatory  Empty bowel and bladder
cellular congestion reaction  Fetal, shrimp or “C” position
functioning  Spinal canal, subarachnoid space between L3-L4 or L4- L5
 After: bedrest
 Flat on bed to prevent spinal headache
Lethargy Headache Fever ENCEPHALITIS MENINGITIS MENINGO-
Convulsions Photophobia Sore throat COCCEMIA
Seizures Vomiting TREATMENT MODALITIES
Stiff neck
Dexamethasone Ceftriaxone

Mannitol Penicillin
Anticonvulsants Chloramphenicol
SIGNS AND SYMPTOMS OF MENINGITIS
Antipyretics

PREVENTION

1. Japanese 1. HiB vaccine Rifampicin

encephalitis
Ciprofloxacin
VAX
ENCEPHALITIS MENINGITIS MENINGO-
COCCEMIA
NURSING MANAGEMENT
1. Side boards
1. Comfort: quiet, 1. Respiratory 2. Close contacts
well-ventilated isolation 24-72
room hours after onset H – ouse
of antibiotic I – nfected person
THREE SIGNS OF MENINGEAL IRRITATION 2. Skin care:
therapy kissing
OPISTHOTONUS cleansing bath,
State of severe hyperextension and spasticity in which an individual’s change in 2. Room protected S – ame daycare
head, neck and spinal column enter into a complete arching position position against bright center
BRUDZINSKI’S SIGN lights
Place the patient in a dorsal recumbent position and then put hands 3. Eliminate S – hare mouth
behind the patient’s neck and bend it forward. mosquito instruments
3. Safety: side-lying
If the patient flexes the hips and knees in response to the breeding sites:
position and 3. Antibiotics as
manipulation, positive for meningitis CULEX
raised side rails prophylaxis
KERNIG’S SIGN mosquito
Place the patient in a supine position, flex his leg at the hip and knee
then straighten the knee; pain and resistance indicates meningitis
CD-Bucud 2
 POLIOMYELITIS RABIES TETANUS PRODROMAL/INVASION PHASE
 Fever
 Anorexia
MAIN PROBLEM  Sore throat
 Pain and tingling at the site of bite
Acute infection of Acute viral disease Acute infectious  Difficulty swallowing
the CNS – muscle of the CNS – by disease with systemic EXCITEMENT OR NEUROLOGICAL PHASE
spasm, paresis and saliva of infected neuromuscular  Hydrophobia (laryngospasm)
paralysis animals effects  Aerophobia (bronchospasm)
 Delirium
ETIOLOGIC AGENT Rhabdovirus Clostridium tetani  Maniacal behavior
Legio debilitans Bullet-shaped Anaerobic  Drooling
TERMINAL OR PARALYTIC PHASE
Affinity to CNS Gram positive  Patient becomes unconscious
Killed by sunlight, Drumstick  Loss of urine and bowel control
UV light, formalin appearance  Progressive paralysis
 Death
Resistant to
antibiotics
POLIOMYELITIS RABIES TETANUS
POLIOMYELITIS RABIES TETANUS
COMPLICATION
INCUBATION PERIOD
2-8 weeks Paralysis of RESPIRATORY DEATH
respiratory muscles FAILURE
7-21 days Distance of bite to Adult: 3 days-3
brain weeks
Extensiveness of the DIAGNOSTIC PROCEDURES
Neonate: 3-30 days
bite 1. Throat washings 1. Blood exam
1. Stool culture
Resistance of the 2. Flourescent rabies
2. CSF culture antibody (FRA)
host
MODE OF TRANSMISSION 3. Negri bodies
- Direct contact with ISOLATION PRECAUTION
infected feces
Bite of an infected Direct inoculation Enteric isolation Respiratory
- Direct contact with
respiratory secretions
animal through a broken isolation
skin
- Indirect with soiled
linens and articles
POLIOMYELITIS RABIES TETANUS
POLIOMYELITIS RABIES TETANUS
TREATMENT MODALITIES 1. Tetanus immune
1. Analgesics 1. Local globulin (TIG)
SIGNS AND SYMPTOMS R – isus sardonicus
treatment of 2. Tetanus antitoxin
1. Abortive type 1. Prodromal / O – pistothonus 2. Morphine (TAT)
wound
invasion 3. Moist heat
2. Pre-paralytic phase 2. Active 3. Penicillin G
T – rismus application
or meningetic immunization 4. Tetracycline
type 2. Excitement / C – onvulsions 4. Bed rest
Lyssavac 5. Diazepam
neurological
3. Paralytic type H – eadache 5. Rehabilitation 6. Phenobarbital
phase Imovax
7. Tracheostomy
3. Terminal / I – rritability Antirabies vax
8. NGT feeding
paralytic type 2. Passive
L – aryngeal
spasm immunization
POLIOMYELITIS RABIES TETANUS

POLIO
ABORTIVE TYPE NURSING MANAGEMENT
 Does not invade the CNS 1. Enteric isolation 1. Adequate airway
 Headache 1. Isolation
 Sore throat 2. Proper disposal 2. Optimum 2. Quiet, semi-dark
 Recovery within 72 hours and the disease passes by of secretions environment
comfort
unnoticed
PRE-PARALYTIC OR MENINGETIC TYPE 3. Moist hot packs 3. Restful 3. Avoid sudden
 Slight involvement of the CNS environment stimuli and light
 Pain and spasm of muscles 4. Firm /
 Transient paresis nonsagging bed 4. Emotional
 (+) Pandy’s test (increased protein in the CSF) 5. Suitable body support
PARALYTIC TYPE
alignment 5. Concurrent
 CNS involvement
 Flaccid paralysis 6. Comfort and and terminal
 Asymmetric safety disinfection
 Affects lower extremities
 Urine retention and constipation
 (+) HOYNE’S SIGN (when in supine position, head will fall
back when shoulders are elevated)

RABIES

CD-Bucud 3
 POLIOMYELITIS RABIES TETANUS BIRD FLU SARS
TREATMENT MODALITIES
PREVENTION 1. Aseptic
1. If the dog is
1. Amantadine/Rimantadine 1. No definitive treatment
Salk vaccine healthy handling of for SARS
umbilical cord - Generic flu drugs
2. If the dog dies or
- Inactivated shows signs - H5N1 developed resistance 2. Antiviral drugs
polio vaccine suggestive of 2. Tetanus toxoid (normally used to treat
rabies immunization 2. Oseltamivir (TAMIFLU) AIDS)
- Intramuscular Zanamavir (RELENZA)
3. If dog is not 3. Antibiotic - RIBAVIRIN
Sabin vaccine available for prophylaxis - Primary treatment
- Oral polio
observation - Within 2 days at onset of 3. Corticosteroids
- Penicillin symptoms
vaccine 4. Have domestic
dog 3 months to - Erythromycin - 150 mg BID x 2 days
- Per orem 1 year old
immunized - Tetracycline

BIRD FLU SARS

RESPIRATORY SYSTEM PREVENTION

1.Culling – killing of 1.Quarantine

BIRD FLU SARS sick or exposed
MAIN PROBLEM birds 2. Isolation
A new type of atypical pneumonia
Flu infection in birds that
affects humans that infects the lungs 2. Banning of 3. WHO alert
importation of on SARS
ETIOLOGIC AGENT
birds (Executive
Avian influenza virus, H5N1 Corona virus
order # 280)
(March 12,
2003)
INCUBATION PERIOD 3. Cook chicken
3-5 days 2-8 days thoroughly
MODE OF TRANSMISSION
NURSING MANAGEMENT
Inhalation of feces and Respiratory droplets BIRD FLU
discharge of an infected bird WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD
FLU
• Isolation
BIRD FLU SARS • Face mask on the patient
• Caregiver: use a face mask and eye goggles/glasses
SIGNS AND SYMPTOMS • Distance of 1 meter from the patient
• Transport the patient to a DOH referral hospital
Body weakness or muscle
pain REFERRAL HOSPITALS
• National Referral Center – Research Institute for Tropical
Cough Medicine (RITM) (Alabang, Muntinlupa)
• Luzon – San Lazaro Hospital (Quiricada St., Sta. Cruz,
Difficulty breathing Manila)
• Visayas – Vicente Sotto Memorial Medical Hospital
Episodes of sore throat (Cebu City)
• Mindanao – Davao Medical Center (Bajada, Davao City)
Fever SARS
SUSPECT CASE
1. A person presenting after 1 November 2002 with a history of:
High fever >38’Celsius  High fever >38 0C AND
Chills  Cough or breathing difficulty AND
 One or more of the following exposures during the 10 days
BIRD FLU SARS prior to the onset of symptoms:
 Close contact, with a person who is a suspect or
COMPLICATIONS probable case of SARS
Severe viral pneumonia Severe viral  History of travel, to an area with recent local
pneumonia transmission of SARS
Acute respiratory distress  Residing in an area with recent local transmission of
syndrome SARS
Hypoxemia 2. A person with an unexplained acute respiratory illness
Fluid accumulation in resulting in death after 1 November 2002, but on whom no autopsy
alveolar sacs has been performed :
AND
Respiratory failure  One or more of the following exposures during the 10 days
Severe breathing difficulties prior to the onset of symptoms:
 Close contact, with a person who is a suspect or
probable case of SARS
Multiple organ failure  History of travel, to an area with recent local
transmission of SARS
 Residing in an area with recent local transmission of
DEATH SARS
PROBABLE CASE

CD-Bucud 4
1. A suspect case with radiographic evidence of infiltrates
consistent with pneumonia or respiratory distress syndrome on Chest
DIPHTHERIA PERTUSSIS
x-ray. DIAGNOSTIC PROCEDURES

2. A suspect case of SARS that is positive for SARS coronavirus by

 SCHICK’S TESTS  CBC– increase in
one or more assays. - Susceptibility and immunity to lymphocytes
diphtheria
3. A suspect case with autopsy findings consistent with the -ID of dilute diphtheria toxin (0.1
cc)
pathology of SARS without an identifiable cause.
(+) local circumscribed area of
redness, 1-3 cm
DIPHTHERIA PERTUSSIS MALONEY’S TEST
MAIN PROBLEM -Determines hypersensitivity to
diphtheria anti-toxin
Acute bacterial disease Repeated attacks of spasmodic
characterized by the elaboration -ID of 0.1 cc fluid toxoid
coughing
of an exotoxin -(+) area of erythema in 24 hours
ETIOLOGIC AGENT

Corynebacterium diphtheriae or Bordetella pertussis

Klebs-Loeffler bacillus
DIPHTHERIA PERTUSSIS
INCUBATION PERIOD COMPLICATIONS Convulsions (brain
2-5 days 7-14 days Toxins in the bloodstream
damage from
MODE OF TRANSMISSION asphyxia)
Myocarditis Peripheral Broncho-
1. Respiratory droplets
(epigastric
or chest
paralysis
(tingling,
pneumonia
(fever,
Otitis media
2. Direct contact with respiratory secretions
pain) numbness, cough) (invading
3. Indirect contact with articles paresis)
organisms)
DIPHTHERIA PERTUSSIS Heart Respirat
Decreased Bronchopneumonia
SIGNS AND SYMPTOMS failure in ory
respiratory arrest
(most dangerous
Types: rate complication)
Stages:
1.Nasal 1. Catarrhal DEATH

2.Tonsilopharyngeal DIPHTHERIA PERTUSSIS

2. Paroxysmal
3.Laryngeal
3. Convalescent TREATMENT MODALITIES
4.Wound or
1. Diphtheria anti-toxin 1. Erythromycin – drug of
cutaneous choice
- Requires skin testing
- Early administration 2. Ampicillin – if resistant
aimed at neutralizing the to erythromycin
NASAL DIPHTHERIA toxin present in the 3. Betamethasone
• Bloody discharge from the nose circulation before it is (corticosteroid) –
• Excoriated nares and upper lip absorbed by the tissues decrease severity and
TONSILOPHARYNGEAL DIPHTHERIA 2. Antibiotic therapy length of paroxysms
• Low grade fever
• Sore throat - Penicillin G 4. Albuterol
• Bull-neck appearance (bronchodilator)
- Erythromycin
• Pseudomembrane- Group of pale yellow membrane over
tonsils and at the back of the throat as an inflammatory
response to a powerful necrotizing toxins
LARYNGEAL DIPHTHERIA DIPHTHERIA PERTUSSIS
• Hoarseness NURSING MANAGEMENT
• Croupy cough 1. Isolation: 4-6 weeks from
• Aphonia 1. Isolation: 14 days (until onset of illness
• Membrane lining thickens à airway obstruction 2-3 cultures, 24 hours
• Suffocation, cyanosis or death apart) 2. Supportive measures
WOUND OR CUTANEOUS DIPHTHERIA (bedrest, avoid
2. Bedrest for 2 weeks excitement, dust, smoke
• Yellow spots or sores in the skin
3. Care for nose and and warm baths)
PERTUSSIS throat (gentle swabbing) 3. Safety (during
CATARRHAL STAGE paroxysms, patient
• Lasts for 1 to 2 weeks 4. Ice collar (decrease pain
of sore throat) should not be left alone)
• Most communicable stage
• Begins with respiratory infection, sneezing, cough and 5. Diet (soft food, small 4. Suctioning (kept at
fever frequent feedings) bedside for emergency
• Cough becomes more frequent at night use)
PAROXYSMAL STAGE
• Lasts for 4 to 6 weeks
• Aura: sneezing, tickling, itching of throat MUMPS
• Cough, explosive outburst ending in “whoop” MAIN PROBLEM
• Mucus is thick, ends in vomiting An acute contagious disease, with swelling of one or both of the
• Becomes cyanotic parotid glands
• With profuse sweating, involuntary urination and ETIOLOGIC AGENT
exhaustion Filterable virus of paramyxovirus group
CONVALESCENT STAGE INCUBATION PERIOD
• End of 4th-6th week 12-26 days
• Decrease in paroxysms MODE OF TRANSMISSION
Respiratory droplets
PERIOD OF COMMUNICABILITY
6 days before and 9 days after onset of parotid swelling
CD-Bucud 5
SIGNS AND SYMPTOMS
AMOEBIASIS SHIGELLOSIS
PRODROMAL PHASE DIAGNOSTIC TESTS
F-ever (low grade)
H-eadache 1. Stool exam
M-alaise 2. Blood exam

PAROTITIS 3. Sigmoidoscopy
F-ace pain
E-arache TREATMENT MODALITIES
S-welling of the parotid glands
1. Metronidazole – drug 1. Cotrimoxazole – drug
COMPLICATIONS of choice of choice
• Orchitis – the most notorious complication of mumps
• Oophoritis – manifested by pain and tenderness of the 2. Tetracycline
abdomen
• CNS involvement – manifested by headache, stiff neck, 3. Chloramphenicol
delirium, double vision
• Deafness as a result of mumps
NURSING MANAGEMENT AMOEBIASIS SHIGELLOSIS
1. Prevent complications
 Scrotum supported by suspensory NURSING MANAGEMENT
 Use of sedatives to relieve pain 1.Enteric isolation
 Treatment: oral dose of 300-400 mg cortisone followed by
100 mg every 6 hours 2. Boil water for
 Nick in the membrane drinking
2. Diet
- Soft or liquid diet 3. Handwashing
- Sour foods or fruit juices are disliked
3. Respiratory isolation 4. Sexual activity
4. Comfort: ice collar or cold applications over the parotid glands may
relieve pain 5. Avoid eating
5. Fever: aspirin, tepid sponge bath uncooked leafy
6. Concurrent disinfection: all materials contaminated by these
secretions should be cleansed by boiling
vegetables
7. Terminal disinfection: room should be aired for six to eight hours

GASTROINTESTINAL TRACT
CHOLERA TYPHOID FEVER
AMOEBIASIS SHIGELLOSIS MAIN PROBLEM

Acute bacterial disease of the An infection affecting the

MAIN PROBLEM GIT characterized by profuse Peyer’s patches of the small
Protozoal infection of the large Acute infection of the lining secretory diarrhea intestines
intestine of the small intestine
ETIOLOGIC AGENT

ETIOLOGIC AGENT Vibrio cholerae Salmonella typhi

Entamoeba histolytica Shigella group INCUBATION PERIOD

- Prevalent in areas with ill 1. Shigella flesneri – most 1 to 3 days 1 to 3 weeks

sanitation common in the Philippines
MODE OF TRANSMISSION
-Acquired by swallowing 2. Shigella connei
3. Shigella boydii 1. Fecal-oral transmission
- Trophozoites: vegetative form
4. Shigella dysenterae – most 2. 5 F’s
- Cyst: infective stage
infectious type
CHOLERA TYPHOID FEVER
AMOEBIASIS SHIGELLOSIS SIGNS AND SYMPTOMS
Fever (ladder-like)
SIGNS AND SYMPTOMS Rice-water stool
1. Acute amoebic dysentery Rose spots
Fever Abdominal cramps
- Diarrhea alternated with Diarrhea
constipation Abdominal pain Vomiting TYPHOID STATE
- Tenesmus
- Bloody mucoid stools Diarrhea and Intravascular Sordes
tenesmus Dehydration
2. Chronic amoebic Subsultus Tendinum
dysentery
Shock
- Enlarged liver Bloody mucoid Coma vigil
- Large sloughs of intestinal stool Carphologia
tissues accompanied by
hemorrhage

CD-Bucud 6
 CHOLERA TYPHOID FEVER CHICKENPOX HERPES ZOSTER
TREATMENT MODALITIES • Rashes
SIGNS AND SYMPTOMS
1.Chloramphenicol –
1.Lactated Ringer’s -Unilateral, band-like
drug of choice • Rashes : Centrifugal distribution
solution distribution -Dermatomal
2. Ampicillin/
2. Oral rehydration Amoxicillin – for •Rash stages: macule - Erythematous base
therapy typhoid carriers papule vesicle - Vesicular, pustular or
3. Antibiotic therapy pustule crust crusting
3. Cotrimoxazole – for •Regional
- Tetracycline – drug severe cases with lymphadenopathy
• Pruritus
of choice relapses •Pruritus
- Cotrimoxazole •Pain – stabbing or
burning
- Chloramphenicol
CHOLERA TYPHOID FEVER CHICKENPOX HERPES ZOSTER
NURSING MANAGEMENT
COMPLICATIONS
RAMSAY-HUNT
1. Maintain and restore the fluid SYNDROME - Involvement of
SCARRING – most common
and electrolyte balance complication; associated with
the facial nerve in herpes zoster
with facial paralysis, hearing
staphylococcal or streptococcal
2. Enteric isolation infections from scratching
loss, loss of taste in half of the
tongue
3. Sanitary disposal of excreta NECROTIZING FASCIITIS – GASSERIAN
most severe complication
GANGLIONITIS –
4. Adequate provision of safe Involvement of the optic nerve
REYE SYNDROME –
drinking water abnormal accumulation of fat in resulting to corneal anesthesia
the liver plus increase of
ENCEPHALITIS – acute
5. Good personal hygiene pressure in the brain resulting to
inflammatory condition of the
coma, therefore leading to
brain
DEATH

CHICKENPOX HERPES ZOSTER

INTEGUMENTARY SYSTEM TREATMENT MODALITIES

1. Antihistamines – 4. Corticosteroids – anti-

inflammatory and decreased
CHICKENPOX HERPES ZOSTER symptomatic relief of itching
pain
Ex. Diphenhydramine
MAIN PROBLEM (Benadryl) Ex. Prednisone
A highly contagious disease An acute viral infection of 2. Analgesics and antipyretics
characterized by vesicular the sensory nerve
eruptions on the skin and Ex. Acetaminophen
mucous membranes
3. Antiviral agents – for patient to
ETIOLOGIC AGENT
Varicella zoster virus experience less pain and faster
resolution of lesions when used within
INCUBATION PERIOD
48 hours of rash onset
10-21 days 13-17 days Ex. Acyclovir (Zovirax)
MODE OF TRANSMISSION
1. Droplet method CHICKENPOX HERPES ZOSTER
2. Direct contact
NURSING MANAGEMENT
3. Indirect contact
Strict isolation
CHICKENPOX HERPES ZOSTER Prevent secondary infection (cut
fingernails short, wear mittens)
PERIOD OF COMMUNICABILITY
Eliminate itching: calamine
One day before eruption lotions, warm baths, baking soda
One day before eruption
of 1st lesion and five days paste
of 1st rash and five to six
after appearance of last
days after the last crust Encourage not going to school:
crop
usually 7 days
SIGNS AND SYMPTOMS
Disinfection of clothes and linen
PRODROMAL with nasopharyngeal discharges
PERIOD by sunlight or boiling
- Fever (low-grade)
- Headache
- Malaise

CD-Bucud 7
 MEASLES GERMAN MEASLES MEASLES GERMAN MEASLES
MAIN PROBLEM TREATMENT MODALITIES

A contagious exanthematous A benign communicable 1.Vitamin A – helps 1.Aspirin – help reduce

disease with chief symptoms to exanthematous disease caused prevent eye damage inflammation and
the upper respiratory tract by rubella virus and blindness fever
ETIOLOGIC AGENT
2. Antipyretics – for
Filterable virus of Rubella virus fever
paramyxoviridae
INCUBATION PERIOD
3. Penicillin – given
only when secondary
10-12 days 14-21 days
infection sets in
MODE OF TRANSMISSION
1. Droplet method
2. Direct contact with respiratory discharges
3. Indirect with soiled linens and articles

MEASLES GERMAN MEASLES MEASLES GERMAN MEASLES

PERIOD OF COMMUNICABILITY NURSING MANAGEMENT

4 days before and 5 days after One week before and four days 1. Darkened room to relieve photophobia
the appearance of rashes after the appearance of rashes 2. Diet: should be liquid but nourishing
SIGNS AND SYMPTOMS 3. Warm saline solution for eyes to relieve
eye irritation
PRE-ERUPTIVE STAGE PRE-ERUPTIVE STAGE
Cough Fever 4. For fever: tepid sponge bath and anti-
pyretics
Coryza Headache
5. Skin care: during eruptive stage, soap is
Conjunctivitis Malaise omitted; bicarbonate of soda in water or
lotion to relieve itchiness
Fever (high-grade) Coryza
6. Prevent spread of infection: respiratory
Photophobia Conjunctivitis isolation

KOPLIK’S SPOT (Rubeola)

- Bluish white spots surrounded by a red halo SCABIES
- Appear on the buccal mucosa opposite the premolar teeth MAIN PROBLEM
FORCHEIMER’S SPOTS (Rubella) Infestation of the skin produced by the burrowing action of a parasite
- small, red lesions mite resulting in skin irritation and formation of vesicles and pustules
- Soft palate to mucus membrane ETIOLOGIC AGENT
MEASLES GERMAN MEASLES Sarcoptes scabiei
INCUBATION PERIOD
Within 24 hours
SIGNS AND SYMPTOMS ERUPTIVE STAGE MODE OF TRANSMISSION
2. ERUPTIVE STAGE 1. Rash Direct contact
Rashes Indirect contact
- pinkish, maculopapular
- Elevated papules
- Begins on the face Sarcoptes scabiei
- Begin on the face and behind
the ears - Spread to trunk or limbs 1. Yellowish white in color
- Spread to trunk and 2. Barely seen by the unaided eye
extremities - No pigmentation or
desquamation 3. Female parasite burrows beneath the epidermis to lay eggs
Color: Dark red – purplish hue 4. Males are smaller and reside on the surface of the skin
– yellow brown 2. Posterior auricular and SIGNS AND SYMPTOMS
3. Stage of Convalescence suboccipital • Thin, pencil-mark lines on the skin
- Desquamation lymphadenopathy
• Itching, especially at night
- Rashes fade from the face • Rashes and abrasions on the skin
downwards PRIMARY LESIONS
NODULAR LESIONS
SECONDARY LESIONS
TREATMENT MODALITIES
MEASLES GERMAN MEASLES • SCABICIDE : Eurax ointment (Crotamiton)
• PEDICULICIDE : Kwell lotion (Gamma Benzene
COMPLICATIONS 1. Encephalitis Hexachloride) – contraindicated in young children and
2. Congenital rubella syndrome pregnant women
Pneumonia - Spontaneous abortion
• Topical steroids
• Hydrogen peroxide : cleanliness of wound
- Intrauterine growth retardation
Otitis media (IUGR) • Lindane Lotion
NURSING MANAGEMENT
- Thrombocytopenia purpura
• Apply cream at bedtime, from neck to toes
Severe diarrhea (leading “blueberry muffin skin”
- Cleft lip, cleft palate, club foot • Instruct patient to avoid bathing for 8 to 12 hours
to dehydration) • Dry-clean or boil bedclothes
- Heart defects (PDA, VSD)
• Report any skin irritation
Encephalitis - Eye defects (Cataract,
glaucoma)
• Family members and close contact treatment
• Good handwashing
- Ear defects (Deafness) • Terminal disinfection
- Neurologic (microcephaly,
mental retardation, behavioral
disturbances SEXUALLY TRANSMITTED DISEASES

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 AIDS SYPHILIS AIDS SYPHILIS

SIGNS AND SYMPTOMS 2. SECONDARY SYPHILIS

MAIN PROBLEM
- Skin rash
Final and most serious stage Infectious disease caused
of HIV disease, which causes - Mucous patches
severe damage to the immune
by a spirochete
system - Hair loss

ETIOLOGIC AGENT - CONDYLOMATA LATA:

coalescing papules which
Retrovirus – Human T-cell form a gray-white plaque
lymphotropic virus III Treponema pallidum
frequently in skin folds
(HTLV-3)

INCUBATION PERIOD

3 to 6 months to 8 to 10 years 10-90 days

AIDS SYPHILIS AIDS SYPHILIS

MODE OF TRANSMISSION SIGNS AND SYMPTOMS 3. TERTIARY SYPHILIS
• Sexual contact – oral, anal or - 1 to 10 years after infection
vaginal sex
- Appear on the skin, bones,
•Blood transfusion mucus membrane, URT, liver
and stomach
•Mother-to-child - GUMMA: chronic, superficial
nodule or deep
•Indirect contact through soiled granulomatous lesion that is
articles solitary, painless, indurated

AIDS SYPHILIS
AIDS SYPHILIS
SIGNS AND SYMPTOMS
OPPORTUNISTIC INFECTIONS DIAGNOSTIC PROCEDURES
1. Pneumocystis carinni
pneumonia
1.ELISA 1.Dark Field
Illumination test
2. Oral candidiasis 2. Western blot
3. Toxoplasmosis
2. Flourescent
4. Acute/chronic diarrhea 3. RIPA
Treponemal
5. Pulmonary tuberculosis
4. PCR Antibody
MALIGNANCIES
Absorption Test
1. Kaposi’s sarcoma
2. Non-Hodgkin’s lymphoma 3. VDRL
AIDS SYPHILIS
1. PRIMARY SYPHILIS
AIDS SYPHILIS
SIGNS AND SYMPTOMS
- CHANCRE: small, painless, TREATMENT MODALITIES
pimple-like ulceration on the 1. Penicillin G Benzathine
penis, labia majora, minora 1. Antivirals - Disease < 1 year: 2.4 M units
and lips once in two injection sites
- Shorten the clinical
- May erupt in the genitalia, - Disease > 1 year: 2.4 M units
anus, nipple, tonsils or eyelids course, prevent
in 2 injection sites x 3 doses
- Lymphadenopathy
complications, prevent
development of 2. Doxycycline – if allergic to
penicillin
latency, decrease
3. Tetracycline
transmission
- if allergic to penicillin
- Example: Zidovudine - Contraindicated for
(Retrovir) pregnant women

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 CHLAMYDIA GONORRHEA CANDIDIASIS HERPES SIMPLEX

MAIN PROBLEM MAIN PROBLEM

A viral disease
Sexually transmitted disease caused by a bacteria
Mild superficial fungal characterized by the
Purulent inflammation of mucous appearance of sores and
membrane surfaces infection
blisters on the skin
ETIOLOGIC AGENT

Chlamydia trachomatis Neisseria gonorrhea ETIOLOGIC AGENT

INCUBATION PERIOD Herpes simplex virus
Candida albicans types 1 and 2
2-3 weeks (males)
2-10 days
Asymptomatic (females) INCUBATION PERIOD
MODE OF TRANSMISSION
2-3 weeks 2-12 days
Sexual contact: Oral, vaginal or anal sex

CHLAMYDIA GONORRHEA CANDIDIASIS HERPES SIMPLEX

SIGNS AND SYMPTOMS Women MODE OF TRANSMISSION
Women Bleeding after intercourse 1. Rise in glucose as in TYPE 1
Abdominal or pelvic pain Burning sensation during diabetes mellitus - Respiratory droplets
Bleeding after intercourse and urination
in-between menses Yellow or bloody vaginal
2. Lowered body - Direct exposure to
discharge resistance as in cancer infected saliva
Unusual vaginal discharge
3. Increase in estrogen - Kissing and sharing
Men level in pregnant women utensils
Burning with urination
4. Broad-spectrum TYPE 2
Swollen, painful testicles antibiotics are used
White, yellow or - Sexual or genital
Discharge from the penis green pus from the
penis
contact

SIGNS AND SYMPTOMS (Candidiasis)

CHLAMYDIA GONORRHEA ONYCHOMYCOSIS
• Red, swollen darkened nailbeds
COMPLICATIONS • Purulent discharge
Women
• Separation of pruritic nails from nailbeds
Pelvic inflammatory
disease
DIAPER RASH
• Scaly, erythematous, papular rash
Ectopic pregnancy • Covered with exudates
Sterility • Appears below the breasts, between fingers, axilla, groin
and umbilicus
Men THRUSH
• Cream-colored or bluish-white patches on the tongue,
Epididymitis mouth or pharynx
Sterility • Bloody engorgement when scraped
Newborn
MONILIASIS
Conjunctivitis Newborn • White or yellow discharge
Otitis media Gonococcal ophthalmia • Pruritus
Pneumonia
• Local excoriation
• White or gray raised patches on vaginal walls with local
inflammation
CHLAMYDIA GONORRHEA
CANDIDIASIS HERPES SIMPLEX
TREATMENT MODALITIES
1. Cefixime TREATMENT MODALITIES

1. Azithromycin 1. Antifungals 1. Antivirals

(Zithromax) - Drug of choice
because of oral - Fluconazole (Diflucan) - Acyclovir (Zovirax)
- Drug of choice because
efficacy, single dose - Ketoconazole (Nizoral)
of single-dose treatment
effectiveness and lower 2. Ciprofloxacin - Imidazole (Nystatin)
cost
- Used for oral thrush
3. Ceftriaxone
2. Doxycycline - 48 hours until
- Secondary drug of 4. Erythromycin symptoms disappear
choice - Cotrimoxazole

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VECTOR-BORNE DISEASES DENGUE MALARIA

DENGUE MALARIA DIAGNOSTIC PROCEDURES 1. CLINICAL DIAGNOSIS

1. TORNIQUET TEST - Based on triad symptoms, 50%

accuracy
MAIN PROBLEM - Screening test for dengue
2. BLOOD SMEAR
An acute febrile disease An acute and chronic parasitic - A test for the tendency for blood
capillaries to break down or produce - Definitive diagnosis of infection is
disease petechial hemorrhage based on demonstration of malaria
The most common arboviral - Performed by examining the skin of
parasites in blood film
illness transmitted globally The most deadly vector-borne the forearms after the arm veins 3. RAPID DIAGNOSTIC TEST
disease in the world have been occluded for 5 minutes
- Uses immunochromatographic
ETIOLOGIC AGENT - To detect unusual capillary fragility methods to detect Plasmodium-
Dengue virus types 1, 2, 3 and 4 Plasmodium falciparum 2. PLATELET COUNT
specific antigens
- Takes about 7 to 15 minutes
Chikungunya virus Plasmodium vivax - Confirmatory test for dengue
- Sensitivity and specificity > 90%
- Decreased count is confirmatory
O’nyong’nyong virus Plasmodium ovale

West Nile virus Plasmodium malariae DENGUE MALARIA

DENGUE MALARIA TREATMENT MODALITIES 1. Chloroquine

1. Analgesics and antipyretics
2. Primaquine
INCUBATION PERIOD P. Falciparum – 12 days - acetaminophen
3. Pyrimethamine
3-14 days P. Vivax – 14 days 2. Volume expanders
- Used in the treatment of 4. Sulfadoxine
P. Ovale – 14 days intravascular volume deficits
5. Quinine
P. Malariae – 30 days - Example: Lactated Ringers
MODE OF TRANSMISSION 6. Quinidine
3. Blood transfusion – for severe
bleeding
Bite of an infected mosquito
4. Oxygen therapy
Blood transfusion, contaminated
syringe or needle 5. Sedatives

Trans-placentally
SCHISTOSOMIASIS LEPTOSPIROSIS
DENGUE MALARIA
MAIN PROBLEM
VECTOR A slowly progressive disease A zoonotic infectious disease
caused by a blood fluke
Aedes aegypti Anopheles flavirostris
ETIOLOGIC AGENT
(Aedes albopictus)
1. SCHISTOSOMA JAPONICUM Leptospira interrogans
White stripes on the back and Brown in color - Intestinal tract, endemic in the
legs (Tiger mosquito) Philippines

Day biting (2 hours after sunrise Night biting (9 PM-3 AM)

2. SCHISTOSOMA MANSONI
and 2 hours before sunset) - Africa

Breeds on clear stagnant water Breeds on clear, flowing and

3. SCHISTOSOMA HAEMATOBIUM
shaded streams
- Middle East countries like Iran and Iraq

Urban-based Rural-based
SCHISTOSOMIASIS LEPTOSPIROSIS
DENGUE MALARIA
INCUBATION PERIOD
SIGNS AND SYMPTOMS At least 2 months 7 to 19 days

FEVER FEVER
MODE OF TRANSMISSION
HEADACHE CHILLS
Ingestion
MALAISE PROFUSE SWEATING Skin penetration
RASH Contact with the skin

EPISODES OF
BLEEDING

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SCHISTOSOMIASIS LEPTOSPIROSIS SCHISTOSOMIASIS LEPTOSPIROSIS

VECTOR TREATMENT MODALITIES

1st line drugs
Oncomelania quadrasi 1. Praziquantel (Biltricide)
1. Thrives in fresh water 1. Penicillin G – drug of choice
- Taken for 6 months
stream 2. Doxycycline
- 1 tablet BID for 3 months
2. Clings to grasses and leaves 2nd line drugs
- 1 tablet OD for 3 months
3. Greenish brown in color 3. Ampicillin
4. Size is as big as the smallest 4. Amoxicillin
grain of palay

SCHISTOSOMIASIS LEPTOSPIROSIS FILARIASIS

MAIN PROBLEM
A parasitic disease caused by an African eye worm
ETIOLOGIC AGENT
SIGNS AND SYMPTOMS Septic or Leptospiremic Stage Wuchereria bancrofti
ACUTE STAGE F – ever (remittent Brugia malayi
Brugia timori
1. Cercarial dermatitis H – eadache INCUBATION PERIOD
(swimmer’s itch) 8 to 16 months
M – yalgia
MODE OF TRANSMISSION
2. Katayama syndrome N – ausea Person-to-person by mosquito bites
C - ough ACUTE STAGE
V – omiting
• Lymphadenitis (inflammation of lymph nodes)
H – eadache and fever • Lymphangitis (inflammation of lymph vessels)
C – ough
A – norexia and lethargy • Male genitalia affected leading to funiculitis, epididymitis
C – hest pain and orchitis (redness, painful and tender scrotum)
R – ash CHRONIC STAGE
M - yalgia • Develop 10-15 years from onset of first attack
• Hydrocele (swelling of the scrotum)
• Lymphedema (temporary swelling of the upper and lower
SCHISTOSOMIASIS LEPTOSPIROSIS extremities)
• Elephantiasis (enlargement and thickening of the skin of
the upper and lower extremities, scrotum and breast
SIGNS AND SYMPTOMS Immune or Toxic Stage
LABORATORY EXAMINATIONS
CHRONIC STAGE - Lasts for 4 to 30 days • Nocturnal blood examination (NBE) – taken at patient’s
1. Hepatic: pain, abdominal - Iritis, headache, meningeal residence/hospital after 8PM
distension, hematemesis, melena manifestations • Immunochromatographic test (ICT) – rapid assessment
method; an antigen test done at daytime
2. Intestinal: fatigue, abdominal pain, - Oliguria, anuria with renal TREATMENT
dysentery
failure • Diethylcarbamazine Citrate (DEC) or HETRAZAN – an
3. Urinary: dysuria, urinary individual treatment kills almost all microfilaria and a good
frequency, hematuria - Shock, coma and congestive
proportion of adult worms.
heart failure
4. Cardiopulmonary: palpitations, PREVENTION AND CONTROL
dyspnea on exertion • Measures aimed to control vectors
• Environmental sanitation such as proper drainage and
5. CNS: seizures, headache, back cleanliness of surroundings
pain and paresthesia
• Spraying with insecticides
PREVENTION AND CONTROL
SCHISTOSOMIASIS LEPTOSPIROSIS • Measures aimed to protect individuals and families:
• Use of mosquito nets
• Use of long sleeves, long pants and socks
DIAGNOSTIC PROCEDURES • Application of insect repellants
• Screening of houses
1. Fecalysis

2. Kato-Katz Technique

3. Cercum ova precipitin test

(COPT)
- Confirmatory test for
schistosomiasis

CD-Bucud 12