COMMUNICABLE DISEASE│PART ONE

COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN

CLASSIFICATION OF HEALTH DISEASES AND HEALTH 5. All forms of tuberculosis
PROBLEMS 6. Accidents
 Organ or organ systems
7. COPD
 i.e. heart disease, kidney disease, respiratory infection
8. Diabetes Mellitus
 Causative Agent
9. Nephritis/Nephritic syndrome
 Biological Agents
10. Other diseases of the respiratory system
 Chemical Agents
 Physical Agents
Top 10 Communicable Diseases in the Philippines
 Communicable vs Non-communicable
1. Tuberculosis
 Acute vs Chronic
2. Dengue Fever
 Peak symptoms within 3 months (acute) or longer than
3. Pneumonia
3 months (chronic)
4. Malaria
5. Diarrhea
Non-Communicable Diseases: They refer to diseases that are
6. Bronchitis
not transmissible directly from one person to another.
7. Influenza
8. Acute febrile illness
Communicable Diseases: They refer to diseases that are caused
9. HIV
by an infectious agent that are transmitted directly or indirectly
10. Lower respiratory tract illness
to a well person through an agency, vector or inanimate object.

Diseases Model
Non-communicable Appendicitis,
Acute Diseases poisoning, trauma HOST
Communicable Common cold,
pneumonia, mumps,
measles, pertussis,
typhoid fever, cholera
Non-communicable Diabetes, coronary
Chronic Diseases heart disease, AGENT ENVIRONMENT
osteoarthritis,
cirrhosis of the liver COMMUNICABLE DISEASES
Communicable Tuberculosis, AIDS,
Lyme disease,
syphilis, rheumatic
Environment
fever

 Communicable diseases are primary cause of mortality

gap between rich and poor countries.
 Non-communicable diseases account for 59% of all deaths
worldwide—estimated to rise from 28m in 1990 to 50m in Your
2020. genetic
 About 60% of deaths caused by communicable diseases
endowment
can be attributed to:
 HIV/AIDS
Behavioral Choices
 Malaria
 Tuberculosis
 Measles
 Diarrheal disease
 Acute respiratory infection
NON-COMMUNICABLE DISEASES

Top 10 leading causes of death in the Philippines

1. Diseases of the heart DEFINITION OF TERMS
Contagious Disease
2. Diseases of the vascular system
 Disease that is easily transmitted from one person to
3. Pneumonia
another.
4. Malignant neoplasms/cancers

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 1
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
 An individual who harbors the organism and can
Infectious Disease transmit it without showing manifestations of the
 Disease transmitted by direct inoculation through a disease.
break in the skin.
Infection TYPES OF CARRIERS
 Entry and multiplication of an infectious agent into the 1. Incubatory Carrier
tissue of the host.  Capable of transmitting pathogens during the
Infestation incubation period.
 Lodgement and development of arthropods on the 2. Convalescent Carrier
surface of the body.  Transmit disease during covalescent or
recovery period
Contagious Infectious 3. Active Carrier
Easily transmitted through Not easily transmitted  Completely recovered from the disease but
direct or indirect mode continue to harbor the pathogen indefinitely.
Trasmitted via: Transmitted via: 4. Passive Carrier
 Carry the pathogen whithout ever having the
a) Airborne: measles, a) Blood Transfusions: disease
pneumonia AIDS, Hepatitis B
Case
b) Droplet: PTB, b) Sexual Intercourse:  A person who is infected and manifesting the signs and
Hepatitis A, multiple sex symptoms of the disease.
Diphtheria partners Suspect
1. Bacterial: gonorrhea,  A person whose medical history and signs and
syphilis, STD symptoms suggest that such person is suffering from
2. Viral: AIDS, Hepatitis B that disease.
3. Fungal: Candidiasis Contact
4. Protozoal:  Any person who had been in close association with an
Trichomonas vaginalis infected person.
Host
c) Contaminated  A person, animal, or plant which harbors and provides
Article/Equipment: nourishment for a parasite.
needles and Reservoir
syringes  Natural habitat for the growth, multiplication and
reproduction of microorganism.
d) Placental transfer Isolation
 The separation of persons with communicable diseases
from other persons.
Quarantine
Asepsis
 The limitation of the freedom of movement of persons
 Absence of disease—producing microorganisms.
exposed to communicable diseases.
Sepsis
Sterilization
 The presence of infection.
 The process by which all microorganisms including
Medical Asepsis
spores are destroyed.
 Practices designed to reduce the number and transfer
Disinfection
of pathogens.
 The process by which pathogens but not their spores
 Clean technique
are destroyed from inanimate objects.
Surgical Asepsis
Cleaning
 Practices that render and keep objects and areas free
 The physical removal of visible dirt and debris by
from microorganisms
washing contaminated surfaces.
 Sterile technique
Concurrent
Carrier
 Done immediately after the discharge of infectious
materials or secretions.
Terminal

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 2
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
 Applied when the patient is no longer the source of 7. Tetanus Toxin (ATS)
infection
Bactericidal
 A chemical that kills the microorganisms.
Bacteriostatic CHAIN OF INFECTION
 An agent that prevents bacterial multiplication but Infectious Agent
does not kill the microorganisms.  Any microorganism capable of producing a disease
How does the following terms differ from each other? Reservoir
 Antibiotic  Environment or object on which an organism can
 Antiseptic survive and multiply
 Disinfectant Portal of Exit
 Antiviral  The venue or way in which the organism leaves the
reservoir.
Immunity Mode of Transmission
 The ability of an organism to resist a particular  The means by which the infectious agent passes from
infection or toxin by the action of specific antibodies the portal of exit from the reservoir to the susceptible
or sensitized white blood cells. host.
Natural Immunity Portal of Entry
 Passive Immunity—from mother to baby  Permits the organism to gain entrance into the host.
 Active Immunity—if I experience the disease, by having Susceptible Host
the disease, the disease itself develop a lifelong  A person at risk for infection, whose defense
immunity in me (ex. Chickenpox) mechanisms are unable to withstand invasion of
Artificial Immunity pathogens.
 Passive Immunity—from immunoglobulin, antitoxin
 Active Immunity—provided by vaccines CAUSATIVE OR INFECTIOUS AGENT
A. Pathogenicity: ability to cause disease
IMMUNIZATION B. Virulence: disease severity and invasiveness (ability to
Active Immunization enter and move through tissue)
1. BCG C. Infective dose: number of organisms needed to initiate
2. DPT infection
3. OPV/IPV D. Organisms specificity: (host preference) antigenic
4. Measles variations
5. TB E. Elaboration of toxin
6. Hepatitis B F. Viability: ability to survive outside the host
7. Varicella G. Invasiveness: ability to penetrate the cell
8. Hemophilus influenzae B (Hib)
RESERVOIR
 Natural habitat of the organism that is where it resides
Active Immunization not routinely given
and multiplies.
1. Cholera vaccine
A. Human: man is the reservoir of the diseases that is more
2. Rabies
dangerous to humans than to other species.
3. Typhoid
B. Animal: responsible for infestations with trophozoite,
4. Influenza A & B
worms, etc.
5. Meningococcal
C. Non-animal: street dust, garden soil, lint from bedding
6. Pneumococcal vaccine
7. HPV vaccine
PORTAL OF EXIT
 Mode of escape from reservoir
Passive Immunization
A. Respiratory tract (most common in man)
1. Diptheria antitoxin
B. Gastrointestinal tract
2. Hepatitis B immunoglobulin (HBIG)
C. Genito-urinary tract
3. Measles immunoglobulin
D. Open lesions
4. Varicella immunoglobulin (VZIG)
E. Mechanical escape (includes bite of insects)
5. Rabies Human immunoglobulin (RIG)
F. Blood
6. Tetabus human immunoglobulin (TIG)

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 3
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN

MODE OF TRANSMISSION SUSCEPTIBLE HOST

Direct Contact  A person or animal or plant upon which parasite
 Actual physical contact with the infected person from depends for its survival.
one person to another. Host Factors:
Indirect Contact 1. Age, sex, genetic predisposition
 Contact of a susceptible person with a contaminated 2. Nutritional status, fitness, environment factors
object from inanimate object to a person fomite 3. General physical, mental, and emotional health
(soiled clothes). 4. Absent or abnormal Ig.
Break in the Skin Integrity 5. Status of the hematopoetic system
 Infection from an open wound, abrasion, or bite. 6. Presence of underlying disease: DM, lymphoma,
Vertical Transmission leukemia, neoplasia, granulocytopenia, or uremia
 From mother to child 7. Patient treated with certain antimicrobials,
Horizontal Transmission corticosteriods, radiations, or immunosuppresive
 Direct, indirect, break in skin integrity agents

Mode of Transmission BREAKING THE CHAIN OF INFECTION

 It indicates the potential of the disease;  Weakest link is the MODE OF TRANSMISSION
 Conveyance of the agent to the host;
 It can be by common source transmission, contact Contact
source, airborne transmission  In close association with an infected person or animal;
exposed
There are four main routes of transmission: Carrier
A. By Contact Transmission  Without symptoms of disease who harbors the specific
1) Direct Contact (person to person) agent and may serve as a source of infection was
2) Indirect Contact (usually an inanimate object) able to harbor the organisms
3) Droplet Contact (from coughing, sneezing, or Suspect
talking, or talking by an infected person)  Medical history suggests development of infecton
Patient
B. By Vehicle Route (through contaminated items)  Shows signs and symptoms of the disease
1) Food - salmonellosis
2) Water - shigellosis, legionellosis STAGES OF INFECTION
3) Drugs - bacteremia resulting from infusion of a Incubation
contaminated infusion product  Entry of microorganisms into the body to the onset of
4) Blood - hepatitis B, C signs and symptoms
Prodromal
C. Airborne Transmission  Onset of non-specific signs and symptoms to the
1) Droplet of nuclei appearance of specific signs and symptoms
2) Dust particle in the air containing the infectious  The only stage of the disease. . . (Catarrhal)
agent Period of Illness/Acme
3) Organisms shed into environment from skin,  Peak of the disease
hair, wounds, or perineal area  Specific signs and symptoms develop and become
evident
D. Vector borne Transmission Recovery, Covalescence or Decline
1) Arthropods such as flies, mosquitoes, ticks, and  Signs and symptoms start to abate until the client
others. returns to normal state of health

PORTAL OF ENTRY EPIDEMIOLOGY

 Mode of entry of organisms into human  The study of the spread of disease in the community.
A. Respiratory tract  The branch of medical science that investigates all the
B. Gastrointestinal tract factors that determine the presence or absence of
C. Genito-urinary tract diseases and disorders.
D. Direct infections of mucous membranes

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 4
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
 Epidemiological research helps us to understand how  Environmental Sanitation:
many people have a disease or disorder, if those  PD 856 Environmental Sanitation Code of the
numbers are changing, and how the disorder affects Philippines
our society and our economy.  PD 825 Garbage Disposal Law
 In epidemiology, the patient is the community and  RA 9003 Ecological Solid Waste Management
individuals are viewed collectively. Act
 RA 8749 Clean Air Act
PATTERN OF DISEASE OCCURENCE  RA 9275 Clean Water Act
Sporadic
 Intermittent occurrence or on-and-off presence of a Preventive Aspect
disease.  Water Source
Endemic  Excreta Disposal
 Continuous or constant occurrence of a disease in a  Garbage Disposal
certain area.  Food Handling
Epidemic Four rights in food handling:
 Sudden increase in the number of cases in a short  Right source
period of time in a certain area.  Right preparation
 Outbreak  Right cooking
Pandemic  Right storage
 Worldwide epidemic or global outbreak
PROPER FOOD HANDLING
INFLAMMATORY PROCESS  Use high quality foods
1. Inflammant  Proper refrigeration and storage of food
 Microorganisms  Proper washing, preparing, and cooking of food
 Physical  Proper disposal of uneaten food
 Mechanical  Proper hand washing
 Proper disposal of oral and nasal secretion
2. Would Lead to Tissue Injury  Cover hair and wear clean clothes and apron
 Local Adaptation Syndrome - it will only localize the  Provide periodic health exam for kitchen workers
experience  Keep cutting boards clean
 General Adaptation Syndrome - systemic  Prohibit anyone with respiratory or GIT disease from
handling food
3. Inflammation  Rinse and wash utensils with temperature above 80°C

4. Vasoconstriction LEVELS OF PREVENTION

a) Would lead to Hyperemia - a) Primary
i. Redness or Rubor (1st) i. Health promotion/specific protection
ii. Heat or Calor (2nd) ii. Target: well clients (prepathogenic)
iii. Aspects: General health promotion (health
b) Would lead to Tissue Permeability - education), Specific Protection (Immunization),
i. Fluid shifting Primordial Prevention (elimination of risk
ii. Edema formation due to fluid shifting factors)
iii. Swelling or Tumor (3rd)
iv. Pain or Dolor (4th) - due to compression of nerve b) Secondary
endings i. Early diagnosis/Prompt treatment
v. Loss of function (5th) ii. Target: Early Sick, Pathogenic, Symptomatic
iii. Aspects: Early Detection (screening, case finding,
GENERAL NURSING CARE determining and identifying signs and
Preventive Aspect symptoms) and prompt treatment (to prevent
 Health Education: increasing the knowledge, skills, and complication)
attitude
 Immunization: PD 996 (compulsory immunization of all c) Tertiary
children below age 8 years old) i. Rehabilitation

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 5
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
ii. Target: Late sick, symptomatic, and pathogenic,  Water
at Covalescent Stage  Before and after contact
iii. Aspects: Rehabilitation
 Prevention of Further Disability Barrier Precaution
 Prevention of Permanent Damage  Gloves - protects hands from being exposed to blood
and body secretions or when you are touching an
CONTROL ASPECT instrument exposed to blood or any secretions
a) Isolation  Gown - protect the body from accidental splashing or
i. Separation from the period of communicability splattering of blood
of infected persons from other persons who are  Eye wear - eye shields to protect the eyes
susceptible  Face shield - especially if there is an outbreak; protect
ii. Best time to do isolation technique: During mouth
period of communicability  Mask - protect nose and mouth; airborne and droplet
precaution (within 3 feet from patient)
b) Quarantine
i. Complete Quarantine Transmission Based Precaution
 Limitation of freedom of movement of person  Airborne precaution - N95 mask; less than 5 micron or
exposed to communicable diseases during smaller (Ex. TB)
the longest incubation period  Droplet precaution - Surgical mask; larger than 5
ii. Modified Quarantine micron particles (Ex. Coughing, sneezing)
 Selective partial limitation of freedom  Contact Precaution - if there is direct or indirect
contact
c) Surveillance  Strict - highly transmissible diseases by direct
i. Monitoring contact and airborne routes of transmission
ii. Close supervision of contacts without restriction  Respiratory - droplet transmission
of their movement  TB - suspected/active TB patients
 Contact - infectious diseases or multiple
d) Disinfection resistant microorganisms that are spread by
i. Killing a pathogenic agent by chemical or close or direct contact
physical means
Private Hand Gloving Gowning Mask
e) Fumigation Room washing
i. Killing of animal forms by gaseous agent Strict x x x x x
Respiratory x x x x
f) Medical Asepsis TB x x x
i. Gloving, gowning, and hand washing, eye shield, Contact x x x x x
Enteric x x
eye goggles
Drainage x x
ii. Using barriers
Universal x x x

STANDARD PRECAUTION
 Correlates with Universal Precaution CONTROL OF COMMUNICABLE DISEASES
 Control of Communicable Diseases regulated under RA
 All patients are considered infectious
3573: Public Health Workers (PHW) to report any
 Focused on use of protective barriers
occurrences and incidence of communicable
 Interrupting transmission
diseases.
 Added Airborne, Contact, and Droplet routes as
 PHW’s are members of the health team who are
categories of precautions
professionals:
1. Medical Officer (MO) - Physician
Hand Hygiene
2. Public Health Nurse (PHN) - Registered Nurse
 Most effective means of preventing the spread of
3. Rural Health Midwife (RHM) - Registered
disease
Midwife
 Elements:
4. Dentist
 Friction
5. Nutritionist
 Soap

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 6
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
6.
Medical Technologist  Wound or Cutaneous Diphtheria
7.
Pharmacist  Yellow spots or sores in the skin
8.
Rural Sanitary Inspector (RSI) - must be a
sanitary engineer Complications:
 5 Communicable Diseases reported weekly and  Myocarditis
monthly:  Bronchopneumonia
1. Rabies  Airway obstruction
2. Measles  Nose bleeding
3. Polio Signs and Symptoms
4. Neonatal Tetanus - children delivered at home  Pseudomembrane
by midwives or “hilots”  “Bull neck” appearance
5. Sexually Transmitted Disease (STD) - all forms
6. Diarrhea - not a disease but a symptom which Diagnostic Exam
are reported by PHN monthly  Swab nose and throat and other suspected lesions
 Schick’s test: determines susceptibility and immunity
DIPHTHERIA to diphtheria
Etiology:  Maloney’s test: determine hypersensitivity to
 Corynebacterium diphtheria (Diphtheria bacillus) diphtheria anti-toxin
Incubation period:
 2-5 days or longer Nursing Assessment
Communicability Period:  A child with diphtheria usually seeks medical help for
 Several hours before onset of the disease until one of aforementioned complaints (sometimes they
organism disappear from the respiratory tract. are called types).
 2-4 weeks  Other signs and symptoms: These could be present
Mode of Transmission: (especially in severe cases)
 Droplet from respiratory tract of an infected person or  Purulent conjunctivitis
a carrier directly or indirectly  Otitis media
 Ulcerative vulvovaginitis
Types:  Toxins from organisms produces fever and
 Nasal malaise
 Bloody discharge from the nose
 Excoriated nares and upper lip Nursing Considerations:
 Enlarged cervical and submaxillary gland 1. Isolate the child (place him in isolating room, use
medical aseptic techniques). Keep the child in
 Tonsilopharyngeal isolation until 2 consecutive nose and throat culture
 Fever are negative (24 hours apart between 2 cultures).
 Sore throat 2. Bed rest for about 6 weeks for all types except nasal
 Pseudomembrane: fibrinous, dirty gray and foul diphtheria.
smelling 3. For respiratory distress (if present): suction to trachea
 “Bull neck” appearance and larynx to remove secretions and pieces of
 Death occurs from toxic myocarditis or membrane, oxygen humidifier
bronchopneumonia 4. For fever: check vital signs, use 2-3-4 hours schedule;
depending on the degree of fever, degree of
 Laryngeal respiratory embarrassment and change in pulse rate.
 Increasing hoarseness Check blood pressure frequently.
 Croupy cough 5. For the membrane: oral hygiene (warm mouth wash,
 Aphonia never use toothbrush or swabs because of danger of
 Cyanosis distracting the membrane leading to bleeding and
 Diaphoresis rapid spread of toxins into blood system.
 Death due to suffocation 6. Observe: vital signs, secretions and the need for
 Management: low tracheostomy to establish suction, observe signs and symptoms of paralysis.
airway 7. Tracheostomy and or intubation trays must be ready
at bedside table of the child. If tracheostomy or

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 7
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
intubation is done, apply the proper care of followed by one deep inspiration, which may be
tracheostomy or intubation. accompanied by a whoop. Cough is worse at
 In intubation, the child can expel the tube when night, interferes with sleep and frequently
he coughs, so watch constantly as he can’t call causes vomiting.
for help. Frequent suctioning of the tube, use  With cough, face becomes flushed and in some
proper restraints so that he will not remove the instances, cyanosis and dyspnea might occur.
tube.  Anorexia
8. If myocarditis appears as a complication, guard the  Lymphocytosis occurs.
child for exhaustion, beside the other nursing care.
 Covalescent stage
Treatment:  It lasts 21 days
 Bed rest  Cough and vomiting become less
 Antibiotics
 Anti-toxins Nursing Considerations:
 Isolation: Disinfection of all utensils
Prevention:  Bed rest: Keep the child in bed in a well ventilated
 Active immunization: DPT vaccine room.
 Passive immunization: injection with anti-toxins  For paroxysmal stage: Provide;
 Calm atmosphere to avoid emotional swings
Complications: such as laugh and cry causing coughing attacks
 Bronchopneumonia  Avoid dust in the room
 Kidney dysfunction  Oxygen with humidity to relief cyanosis (may
 Paralysis use oxygen tent)
 Myocarditis  For anorexia:
 Cardiac failure  High caloric soft diet. Encourage the child to eat.
 Weight the child daily.
PERTUSSIS  For vomiting:
Etiology:  Raise head and shoulders of older children to
 Gram-negative bacillus (Bordetella pertussis) avoid aspiration of vomitus. For young children,
Incubation period: place them on abdomen if no one is attending in
 5-14 days the room.
Communicability Period:  Mouth care
 4-6 weeks from the onset of the disease  Small frequent feeding. Refeed the child
a) 1st 2 weeks of the disease immediately after vomiting.
b) Up to 3 weeks  Accurate intake and output must be kept.
c) Catarrhal period of the disease  If anorexia occurs during paroxysms, a
Mode of Transmission: tracheopharyngeal suction may be needed. So keep
 Droplet (also direct and indirect contact) the suction machine available.
Source of Infection:  Protect the child from secondary infection, keep him
 Secretions of nose and throat warm.

Signs and Symptoms: Treatment:

Three stages:  Symptomatic: sedatives and antispasmodics are
 Catarrhal stage: (coryza or prodromal stage) important
 It lasts 7-14 days  Antibiotics are effective if given early (Ampicillin and
 Mild fever, headache, anorexia Erythromycin)
 Sneezing
 Persistent cough with tearing Prevention:
1. Active immunization: DPT vaccine
 Paroxysmal stage: (spasmodic or whooping stage) 2. Passive immunization: Gamma globulin
 It lasts 14-28 days (2-4 weeks) 3. In exposed immunized children, give an immediate
 Paroxysmal cough develops. It is characterized booster dose of pertussis vaccine.
by several sharp coughs in one expiration,

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 8
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
Complications:  The nurse must be alert for number, duration
 Otitis media and frequency of convulsion (in relation to
 Bronchiectasis sedation administered)
 Hemorrhage may occur.  Record any change in trismus or inability to
 Marasmus swallow.
 Encephalitis 5. For inability to swallow:
 Pneumonia  IV therapy for nutrition and fluid balance.
TETANUS  Gavage feeding may be ordered. So the nurse
Etiology: must report if insertion of the tube causes
 Clostridium tetani (Tetanus bacillus) convulsions.
Incubation period:  Accurate intake and output chart is necessary.
 3-21 days  Mouth care is he can open his mouth.
Communicability Period: 6. For constipation, give enema.
 Not communicable from man to man, as the organism 7. Check vital signs carefully.
usually live in the animal’s intestinal tract. 8. If tracheostomy is performed: care of tracheostomy.
Mode of Transmission: 9. Nasopharyngeal suction is done frequently.
 Through a wound, as organism is present in the soil.
Treatment:
Signs and Symptoms:  Antibiotics (Penicillin)
Onset of the disease is either acute or gradual.  Antitoxin
1. Convulsions are the first warning symptoms in  Tranquilizers
children.
2. Excessive irritability and restlessness. Prevention:
3. Difficulty in swallowing. 1. Active immunization: DPT vaccine
4. Stiff neck 2. Passive immunization: Injection of tetanus
5. Within 24-48 hours, the muscular stiffness progress: immunoglobulin or antitoxin (a few hours after a
 Trismus i.e. tight jaw, inability to open the wound occur)
mouth.
 Stiff arms and legs, then entire stiffness of the Complications:
body.  Anoxia
 Swallowing usually becomes impossible.  Atelectasis
 Resus sardonicus due to spasm of facial  Pneumonia
muscles.
 Opisthotonos i.e. backward arching of the back SCARLET FEVER
as a result of the dominance of the extensor Etiology:
muscles of the spine, head draws back.  Streptococcus pyogeneous (Beta hemolytic
 These on-going tetanic spasms lasts about 10 streptococcus group A)
seconds and occurs following a slightest stimuli, Incubation period:
such as, claming the door or bumping the bed.  2-5 days
6. Dyspnea and cyanosis can develop. Communicability Period:
7. Fever 38.5-40°C  From onset to recover.
8. Constipation may develop Mode of Transmission:
9. Lumbar puncture reveals increase spinal fluid  Droplet infection, direct or indirect.
pressure.
Nursing Assessment:
Nursing Considerations:  In acute sudden onset: (toxin from the site of infection is
1. Isolation absorbed into blood stream).
2. Protect the child from any stimuli (auditory or tactile Prodromal Signs:
stimuli), so place in dark, quiet room and minimum  Vomiting
handling.  High fever then it drops when rash appears
3. If dyspnea and cyanosis are present, give oxygen.  Headache
4. For tetanic spasm:  Rapid pulse
 Protect the child from falling

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 9
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
 Tongue: white tongue coating desquamates and
red strawberry tongue results. CHICKEN POX (VARICELLA)
 Tonsils are red, enlarged, swallow, and may have a Etiology:
patchy whitish exudates on their surface.  Virus [Varicella-Zoster Virus (VZV)]
 Then rash appears within the first 5 days of the disease. Incubation period:
The rash will be all over the body but not on the face. The  10-21 days (2-3 weeks)
chest and back are affected first, and then the rash moves Communicability Period:
downwards involving the legs last. The rash fades upon  One day before and six days after the appearance of
pressure. the first vesicle.
 Distinct odor of the skin Mode of Transmission:
 Desquamation i.e. peeling of the skin, is the typical of  Droplet (direct or indirect). Dry scabs are not infectious.
scarlet fever. Desquamation could occur early at 4-5-
6 day or later to 4th week of the disease. It starts at Nursing Assessment:
the top of the body and proceeds downwards.  Onset is sudden with:
Prodromal Stage
Nursing Considerations:  Mild or light fever
1. Isolation.  Anorexia
2. Bed rest for 12 days and good ventilated room.  Headache
3. Keep patient warm, dry, and comfortable as possible. Acute phase:
4. For the distinct body odor which associates with  Rash: Successive crops of macules, papules,
scarlet fever: daily bath and change linen frequently. vesicles, crusts (vesicle heals by forming the
5. For skin: crusts by the end of the two weeks). (Acute
 Lubricate the skin well with oil (daily) as phase).
doctor’s order.  Rash appears in the successive crops and
 Protect skin under and around the nose and lips lesions in all stages of development at the same
with ointment. (When nasal discharge is time.
constant.)  Rash is itchy.
6. Nasal aspiration by gentle suction or soft rubber ear
syringe is essential. Nursing Considerations:
7. If the child is less than 2 years, elevate head and 1. Isolation:
shoulders to prevent danger of otitis media.  Use medical aseptic technique.
8. Accurate intake and output chart is important.  Nasal and oral discharge, cloths and linens are
9. Diet in the first week: high caloric liquids then soft diet. currently disinfected.
Avoid irritant liquid juice “citrus”.  Keep the child in isolation until crusts disappear.
10. For constipation, which accompanies scarlet fever, 2. For fever:
enema or mild cathartics is needed.  Check vital signs and record it, especially the
11. If there is pain in cervical lymph nodes, treat with temperature.
heat in the form of hot packs or cold in the form of ice  Keep records for the first 7 days of the disease.
collar according to the doctor’s order. 3. For rash or lesion:
12. Observe for complications.  Cleaning the skin according to the doctor’s
order once or twice daily. Cool sponge bath
Treatment: without soap.
 Penicillin  Change the child’s clothes and bed linens daily
 Diet to prevent skin infection.
 Sedatives for pain  For itchy lesions, nails must be cut and cleaned.
Mittens and gloves to prevent scratching.
Prevention:  Restraints may be needed to control scratching.
 No immunization  Observe skin lesions, change in appearance and
it must be recorded.
Complications:  If lesions in mouth, use mouthwash.
 Rheumatic fever  If lesions in genital organ, apply cold compress.
 Glomerulonephritis
 Pneumonia Treatment:

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 10
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
 No specific treatment.  Rash is itchy.
 To relieve itching, calamine lotion, antihistamine and
local anesthetic ointment are prescribed. Nursing Considerations:
 Antibiotics for secondary infection. 1. Isolation.
 Don’t give aspirin due to high risk of Reye syndrome. 2. Bed rest: Occupy the child in bed after acute phase
with activities. Explain the reason for being in bed if
the child is old enough to understand.
Prevention: 3. For photophobia and conjunctivitis:
 None  Subduced light make the child more
comfortable. “Dark room.”
Complications:  Eye care with warm saline solution to remove
 Abscess secretions or crust.
 Encephalitis  Keep the child’s hands away from eyes,
 Glomerulonephritis may occur. examine child for signs and symptoms of
ulceration.
MEASLES (RUBEOLA) 4. For fever:
 Most cases occur before adolescence, and it occurs more  Measure temperatures carefully.
in spring months.  Antipyretic as doctor’s order.
Etiology:  Encourage fluids.
 Paramyxoviridae Virus  Tipped compresses.
Incubation period: 5. For itchy rash: Observe degree of itching and apply
 7-14 days (usually 10-20 days) ointment or lotion or ointment as doctor’s order.
Communicability Period: 6. For Koplik’s spots: Mouth care. Use gargle solution.
 4 days before the appearance of rash to 5 days after 7. Carry out the plan of care of complicated cases such
rash appearance. as, encephalitis (convulsions), dyspnea, etc.
Mode of Transmission:
 Droplet (direct or indirect). Treatment:
 Symptomatic
Nursing Assessment:  Antibacterial therapy
a) Coryza: Primary symptoms which resembles common
cold and occur before rash appearance: Prevention:
 Sneezing a) Active immunization: live attenuated vaccine
 Fever (range from 38.5 to 40°C , tending to be highest b) Passive immunization:
just before the appearance of the rash)  Newborn through the mothers while they were
 Brassy or barking cough in the uterus.
 On the 4th day, conjunctivitis and photophobia  Gammaglobulin
 Acute catarrhal inflammation of the mucous
membrane of the nose. Complications:
 Enlarged posterior cervical lymph nodes.  Otitis media
b) Koplik’s Spots: Are pathogenic, appear on the day before  Tracheobronchitis
rash. Whitish spots resting on a reddish base appear on  Impetigo, purpura
the inside of the mouth. They can appear and disappear  Lymphoadenitis
suddenly.  Pneumonia
c) Rash: Rash appears on the 2nd to 5th day and remain about  Encephalitis
a week.
 Appear first on the face, behind the ears, on the neck, GERMAN MEASLES (RUBELLA)
forehead or cheeks. Then spread downwards over the  It is not as communicable as measles. Fetus may contact
rest of the body (trunk, arms, and legs). the disease in uterus if the mother develops the disease
 The rash is pinkish in color, begins with macular lesions during pregnancy (1st trimester).
which progress to the popular type. Then rash Etiology:
becomes dark in color (brownish color on the 5th day).  Rubella Virus (Togoviridae, genus: Rubivirus)
 Desquamation, which is find usually, follow the rash Incubation period:
appearance and then fades (disappears).  14-21 days

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 11
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
Communicability Period:  Encephalitis
 During prodromal period and for 5 days after the rash.
Mode of Transmission: GERMAN MEASLES (RUBELLA)
1. Direct contact with nose and throat secretions of the  Mumps is common in children 5-10 years. It is an acute
infected persons. virus infectious disease, which may involve many organs
2. Indirect via articles freshly contaminated with but commonly affects the salivary glands (mainly the
nasopharyngeal secretion. parotid glands).
3. Transplacenta congenital infection from infected Etiology:
mother to the fetus.  Paramyxovirus Virus
Incubation period:
Nursing Assessment:  14-21 days
Prodromal Stage Communicability Period:
 Mild fever (Disappear when rash appear)  One to six days before the first symptoms appears
 Slight malaise, headache, and anorexia until the swelling disappears.
 Running nose, sore throat Mode of Transmission:
 Rash is faint macular rash. It is a small pinpoint pink or  Direct or indirect contact with salivary secretion of
pale red macules which are closely grouped to look infected person.
like red scarlet blush (botchy), which fades on
pressure. It begins on face and hairline, move to trunk, Nursing Assessment:
then extremities. Prodromal Stage “Coryza”
- Rash disappears in 3 days.  Low grade fever
 Swelling of posterior cervical and occipital lymph nodes.  Vomiting
 No Koplik’s spots or photophobia.  Headache
 Malaise and anorexia
Measles Rubella Acute Phase
Rash Yes Yes 1. Pain in or behind ears and pain on swallowing or
Fever Yes Yes chewing.
Characteristic Confluent macular Maculopapular 2. Swelling and pain in glands (unilateral or bilateral),
rash, Koplik spots discrete rash, which return to normal in 10 days.
Forchheimer spots 3. Orchitis in males and mastitis in female adolescent
Transmission Droplet, airborne Droplet
may occur.
Symptoms High fever, runny Rash with minimal to
nose, cough for 3-5 no fever or toxicity;
Nursing Considerations:
days, followed by a infection possible
rash without rash 1. Isolation.
2. Bed rest until swelling disappears.
Nursing Considerations: 3. For fever: Encourage fluids and soft food, avoid food
1. Isolation especially from pregnant women. required chewing, and tipped compresses,
2. Bed rest until fever subsided. antipyretics.
4. For orchitis: Support scrotum, use cold compresses for
Treatment: 20 minutes, then remove it for 30 minutes, then
 Symptomatic reapply it for 20 minutes.
5. For mastitis: Breast support, use cold compresses.
Prevention: 6. For glands:
a) Active immunization: live attenuated rubella virus  Mouth care and gargle frequently.
vaccine  Apply hot or cold compressed for the swelling.
b) Passive immunization: Gammaglobulin Use ice bag (watch weight of the bag in order to
not increase the pain).
Complications:
 Fetus damage if mother contacts the disease during Treatment:
pregnancy  Symptomatic
 Newborn may have congenital anomalies, such as  Sedatives
deafness, microcephaly, mental retardation
Prevention:

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 12
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
a) Active immunization: live attenuated vaccine Constipation or stool incontinent and urinary
b) Passive immunization: Gammaglobulin incontinent may occur.
- Bulbar: More life threatening. It causes damage to
Complications: (rare) cranial nerve nuclei, vital centers of respiration,
 Sterility circulation and temperature control.
 Ovaritis - It may lead to swallowing problem and
 Inflammation of the testicles regurgitation of fluids from nose and inability to
 Deafness swallow saliva, which puddles in the pharynx. If not
POLIOMYELITIS (INFANTILE PARALYSIS) aspirated, choking may occur.
Etiology:  Encephalitis: Manifesting as encephalitis, only
 Virus. The disease is caused by any of the three diagnosed as polioencephalitis if spinal or bulbar
polioviruses: affections or both are present.
1. Type 1 (Brunhilde) - Convulsion
2. Type 2 (Lansing) - Personality disturbances
3. Type 3 (Leon)
Incubation period: Nursing Considerations:
 5-14 days 1. Isolation and bed rest.
Communicability Period: 2. In acute stage:
 Later period of incubational period till the first week of  Put the child under close observation.
acute illness.  Notify the doctor about the degree and progress
of the paralysis (7 or 8 days of the disease).
Predisposing Factors:  Rate and type of respiration and signs of
1. Fatigue and muscle exertions respiratory distress must be observed and
2. Cortisone administration reported.
3. Tonsillectomy and adenoectomy  Oxygen therapy or place the child on respirator
4. Tooth extraction if cyanosis occurs.
5. IM injection and DPT vaccine  If tracheostomy is done in case of
diaphragmatic paralysis, care of tracheostomy.
Nursing Assessment: 3. For paralysis:
 Severity of nerve involvement can vary from an absence of  Change position frequently. Careful positioning
all clinical signs of paralysis to complete paralysis. There for affected limbs each time he is turned or
are different possible consequences of infection: moved.
 Inapparent Poliomyelitis: (Silent) No signs or  To minimize the degree of deformity, correct
symptoms appears. body alignment and optimum position must be
 Abortive Poliomyelitis: Initial symptoms of upper maintained.
respiratory tract infection: fever, headache, vomiting,  Place the child on firm mattress.
etc  Use foot board to prevent foot drop when child
 Non-paralytic Poliomyelitis: Problems as those of is on back. If the child is on abdomen, pull the
Aseptic Meningitis Syndrome mattress away from foot of bed and letting feet
 Stiffness of neck, back, and limbs protrude over the edge to prevent pressure on
 Nausea and vomiting become more severe than toes.
stage II  Application of heat to affected muscles to relax
 Fever them.
 Increase protein in CSF 4. Suction of the pharynx and postural drainage to
 Paralytic Poliomyelitis: This may begin with the prevent aspiration of secretions.
manifestations of the abortive or non-paralytic type. 5. For swallowing difficulties:
 Spinal: Paralysis appear within a day or two  Soft diet if they can swallow with difficulty.
after the above manifestations and 2-5 days  If swallowing is difficult, use gavage feeding.
from the onset of the disease. 6. For incontinent:
- Paralysis of the limbs is the most common affected  Skin care and perineal region is padded to
muscles. provide absorption for exretions. Catheter may
- Muscles of the chest, abdominal wall, diaphragm, be done.
urinary bladder and bowel can be affected. 7. For constioation: Use enemas.

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 13
COMMUNICABLE DISEASE│PART ONE
COMPETENCY APPRAISAL 1 / DR. HUEMER O. UY, DSN(c), MSN, RN, USRN
8. Treat fever and headache.

Treatment:
 Symptomatic
 Physiotherapy

Prevention:
a) Active immunization: Trivalent poliovirus vaccine
(TOPV).
 Sabine: Attenuated virus, which is
administerred orally.
 Salk: Killed virus, which is administered by
injection.
Note: If a child is affected by poliomyelitis, he must receive the
vaccine to prevent further infection from other poliovirus types.
b) Passive immunization: Gammaglobulin

Complications:
 Emotional disturbance
 Gastric dilatation
 Hypertension

CAPITOL UNIVERSITY
Jahzeel Mary M. Ignacio, SN 14