Dr. Israel Handouts for Immuno-Inflam & Communicable Disease Nursing PDF

HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING COMMUNICABLE DISEASES Diseases caused by pathogenic microorganisms, Infectious Diseases which can be transmitted from an infected person to a Diseases wherein there is a presence of a living suscept...

HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING COMMUNICABLE DISEASES Diseases caused by pathogenic microorganisms, Infectious Diseases which can be transmitted from an infected person to a Diseases wherein there is a presence of a living susceptible person by direct, indirect means or microorganism in the body, which may not be through a break in skin integrity transmitted through ordinary contact Need not be transferred from one person to another Communicable Diseases are transmitted through: Contagious Diseases 1. Direct Mode of Transmission Diseases that can easily be transmitted A person to person transmission Most common is through Droplet transmission Concepts: Examples: All communicable diseases are infectious but not o Kissing contagious o Sexual Contact Because there is the presence of a living Happens in humans microorganism 2. Indirect Mode of Transmission Because not all of the microorganisms can be easily From a source of transmission to a new host with transmitted intermediary object All contagious diseases are infectious A bridge connects you to an infected person All contagious diseases are communicable diseases Bridges or intermediate objects Diphtheria is a disease, which is Examples: o Contagious o Vehicle-borne Transmission o Communicable ▪ Non-living things o Infectious ▪ Articles used by patient like Malaria is a disease, which is catheter, tubings, linens o Communicable Vector-borne Transmission o Infectious ▪ Living things but are non-human o But not contagious ▪ Insects, arthropods, rodents Tetanus is a disease, which is 3. Break in Skin Transmission o Infectious only Inoculation Contaminated sharps or needles Epidemiological Triad Animal Bites Three (3) factors for a disease to take place 4. Airborne Transmission 1. HOST Microorganisms are suspended in air A person There is no limitation to the distance traveled by An animal microorganism Concept: Different from Droplet transmission Consider the susceptibility of the host Microorganism remains on surface Susceptibility Travel is limited to a maximum distance of three (3) o Pertains to degree of resistance feet. If resistance is low, susceptible person is prone to Concept: infection All these modes are classified under Horizontal Transmission Types of Hosts: 1.1) Patient Horizontal Transmission A person infected manifesting signs and symptoms Manner of transfer of microorganisms is in a 1.2) Carrier horizontal position Individual who harbors microorganisms but shows no Vertical Transmission signs and symptoms Manner in which microorganisms are transferred is in 1.3) Suspect a vertical manner – from up going down Individual whose medical history and symptoms Example: suggests that he may be developing a specific o Infected mother to newborn child infection transmission Signs and symptoms are suggestive 1|P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING 1.4) Contact Viral infections have own time frame Individuals who come in close association or in Example: contact or exposed to infected person o Colds last for 2-3 days with watery secretions as symptoms Concepts: ▪ After this, complications would be The PATIENT is the least source of infection the one present with yellowish or The PATIENT has the least chance to spread mucoid discharges probably microorganisms indicative of sinusitis o Because he manifests signs and symptoms o Influenza is present for one week of the disease, he is isolated ▪ After one week, pneumonia sets in. o Precautionary measures are now taken Medical management for viral infections: The CARRIER has the highest potential to spread o Treated symptomatically not by anti-viral infection agents o Because he does not manifest signs and o Antibiotics may be used to treat secondary symptoms of the disease bacterial infections o However, he has the microorganisms o Purpose is to increase body resistance 2. AGENT 3. ENVIRONMENT Microorganisms Must be conducive and favorable to growth of They have the highest population among all living microorganisms things Example: Not all are susceptible to microorganisms o Clostridium tetani will not cause infection in Not all microorganisms are virulent the presence of oxygen because it is an anaerobic microorganism Concepts: Virulence Concept: Strength and power of microorganisms to cause There must be an interplay between the three factors: infection Host Pathogenicity of microorganisms Agent Capacity of microorganisms to cause infection Environment for infection to set in. Two (2) most common microorganisms causing infections Bacteria CHAIN OF INFECTIOUS PROCESS Viruses A cycle Bacteria It is continuous Can multiply in both living and non-living things Cannot pass through filters in the body because they Six (6) Factors are big 1. Causative agent Therefore, it is okay to have bacterial infection even Microorganisms during pregnancy, except for Treponema pallidum, which passes through the placental barrier after the 2. Reservoir 16th week of pregnancy. A place where microorganisms can live and multiply Syphilis is not fatal in the first trimester Examples: Syphilis is fatal in the third trimester o T. pallidum’s reservoir is the human genitalia Anti-bacterial medications give only temporary o Measles virus reservoir is the nasopharynx immunity o Salmonella typhosa’s reservoir are the Viruses Peyer’s patches of the small intestines Can only multiply in living things 3. Portal of Exit Reservoir is a living thing From the reservoir, microorganisms look for a way out Can pass through the body filters: This pertains to the individual’s body system o Blood Brain Barrier Examples: o Placental Barrier o T. pallidum’s portal of exit is the It gives rise to self-limiting diseases genitourinary system 2|P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING o Measles’ virus portal of exit is the respiratory Acquired Immunity system 1. Natural Immunity o Salmonella typhosa’s portal of exit is the Inherent in an individual’s body tissues and fluids gastrointestinal tract A person is born with it 4. Mode of Transmission A person dies with it When outside of the host, this pertains to the It is within the genes that you have these antibodies microorganism’s means of transportation This is a rare type of immunity Examples: Example: o T. pallidum’s mode of transmission is sexual o Race contact o Measles’ virus mode of transmission is 2. Acquired Immunity airborne nuclei This is the more common type of immunity o Salmonella typhosa’s mode of transmission It is either a person is able to PRODUCE it or a is fecal-oral ingestion person is able to GET it 5. Portal of Entry A microorganism’s way in to the new host Two (2) Types of Acquired Immunity Also corresponds to the individual’s body system Examples: 2.1) Active Acquired Immunity o T. pallidum’s portal of entry is the An actual participation of the individual’s body tissues genitourinary system and fluid in PRODUCING immunity o Measles’ virus portal of entry is the You produce the antibodies yourself when respiratory system microorganisms are given to you o Salmonella typhosa’s portal of entry is the gastrointestinal tract Two (2) Ways of Producing Antibodies: 6. Susceptible Host 2.1.1) Naturally Acquired Active Immunity Concept: Antibodies are produced by nature Objective or goal is to limit, prevent or control spread Unintentionally of communicable diseases by breaking the chain of Examples: diseases o Previous attack of a disease Look for the weakest link in the chain o Chicken pox attack wherein antibodies are Among the six (6) factors, the MODE OF produced by nature TRANSMISSION is the weakest link o Measles attack wherein antibodies are o It is not the CAUSATIVE AGENT because produced by nature of its huge population Sub-clinical immunity o It is not the RESERVOIR (i.e. you cannot o Developed due to constant exposure to remove the nasopharynx in humans infected certain infection by measles virus) o Body produces antibodies non-intentionally o It is not the PORTAL OF EXIT nor the by nature that provides immunity PORTAL OF ENTRY (i.e. you cannot remove the genitals of humans infected by 2.1.2) Artificially Acquired Active Immunity T. pallidum) Body produces antibodies because it was o It is not the SUSCEPTIBLE HOST for you intentionally done cannot kill it. Examples: IMPORTANT CONCEPTS!!! o Vaccines Typhoid mode of transmission is fecal-oral ingestion ▪ Attenuated (weakened) First word is the PORTAL OF EXIT microorganisms Second word is the PORTAL OF ENTRY o Toxoids DO NOT INTERCHANGE THIS!!! ▪ Attenuated toxins (poisonous IMMUNITY substances) produced by State of having resistance microorganisms State of being free from infection Concepts! Two (2) Types of Immunity When administering vaccines or toxoids, alcohol is Natural Immunity NOT used to clean injection site. 3|P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING Use instead cotton balls with a clean bowl of water. o Natural because it is from mother When alcohol is used, be sure alcohol HAS DRIED o Passive because it is done via placental OFF before administration of the vaccine or toxoid transfer If the site has not dried off, there will be VACCINE Mother receives Artificially Acquired Active Immunity FAILURE! Three (3) Factors to Know before taking care of Patients Therefore, squeeze off excess alcohol with Communicable Disease Know the CAUSATIVE AGENT Know what BODY SECRETION harbors the microorganism 2.2) Passive Acquired Immunity Know the MODE OF TRANSMISSION Immunity is developed due to presence of antibodies within the serum, which is not coming from the GENERAL CARE FOR PATIENTS WITH COMMUNICABLE individual itself DISEASES You get it or it is given to you Two (2) Aspects Two (2) Types of Passive Immunity Preventive Aspect 2.2.1) Naturally Acquired Passive Immunity Control Aspect Done by nature Antibodies given or obtained by nature, in an 1. PREVENTIVE ASPECT unintentional manner You do not have infection yet Examples: 1.1) Health Education o Infants below six (6) months seldom develop Main goal is to effect change in knowledge, skills and infection attitude o Maternal transfer of antibodies Change in behavior towards health o Placental transfer of antibodies 1.2) Immunization o Infants who are breast-fed Three (3) Laws in Immunization ▪ Colostrum intake Presidential Decree 996 – Compulsory Immunization ▪ Contains antibodies from mother for Children below Eight (8) years old given unintentionally Proclamation No. 6 – United Nations’ Universal Child 2.2.2) Artificially Acquired Passive Immunity Immunization Administration of substances containing antibodies in Proclamation No.46 of 2000 – National Immunization an intentional manner Day Examples: o Anti-toxins Common Goal is to prevent the seven (7) Childhood o Anti-serum Diseases o Gamma globulin Tuberculosis (give Bacillus Calmette Guerin or BCG) o Immunoglobulins Diphtheria IMPORTANT CONCEPTS!!! Pertussis If both microorganisms and antibodies are to be Tetanus given, do not give both injections on the same site Poliomyelitis (give Oral Polio Vaccine or OPV) Artificially Acquired Passive Immunity Hepatitis B o Provides immediate protection Measles (give anti-measles vaccine) o Provides immunity for only a short period as there are no reserves of it. IMPORTANT CONCEPT o Immunity is lost once exhausted There are only two (2) PERMANENT Active Immunity (i.e. – vaccines and toxoids) provide CONTRAINDICATIONS to Immunization longer protection Allergy o Because you produced the antibodies Encephalopathy without known cause or convulsions yourself, they would be there anytime they within seven (7) days after pertussis vaccine are needed. administration Pregnant mother can be given tetanus toxoid Newborn receives naturally acquired passive There are four (4) TEMPORARY CONTRAINDICATIONS for immunity Immunization 4|P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING Pregnancy Presidential Decree 825 o (i.e. MMR vaccine) Anti-Littering Law Recent receipt of blood products Proper disposal of garbage o Wait two (2) to three (3) months Anyone caught littering would have a penalty of Very severe disease Php2,000 to Php5,000 and imprisonment for one (1) o Hospital confinement year. o Hospital personnel will decide when immunization would be given 1.4) Proper Supervision of Food Handlers Immunocompromised situation A responsibility of the Department of Health facilitated by its Sanitary Inspectors Fever, diarrhea and colds are NOT Also a responsibility of the Bureau of Food and Drug CONTRAINDICATIONS to Immunization. Monitors food and drug sold to public to assure that it Immunization can still be given despite their presence is safe for consumption In a private setting, the physician can POSTPONE 2. CONTROL ASPECT IMMUNIZATION in the presence of fever, diarrhea, Done when signs and symptoms are already present colds because patient is returned by mother to the There is already the presence of infection physician once these conditions are resolved. Goal is to limit the infection Current target group of Expanded Program on Immunization of the Department of Health is 2.1) Isolation composed of CHILDREN BELOW FIVE (5) YEARS Separation of an infected person during period of OLD communicability CDT VACCINE Two (2) ways of Isolation Cholera, Dysentery, Typhoid Vaccine 2.1.1) Strict Isolation Given by DOH for free Intended to protect other persons (not the patient) Adult dose is 0.5 cc from infection Adult injection site is the deltoid muscle It intends to limit the microorganisms to be within the Child dose is 0.25 cc patient Child injection site is the vastus lateralis 2.1.2) Reverse Isolation Given INTRAMUSCULARLY (I.M.) Also called Protective Isolation Given when there are outbreaks of epidemic Intended to protect the immunocompromised patient Immunity lasts only for six (6) months. from infection Anti-Rabies Vaccine Intends to keep microorganisms out of the patient Target group would be the animals Concepts: Animals are brought to the Barangay for free Quarantine immunization Limitation of freedom of movement of a well person Barangay Captain is responsible for obtaining during the longest incubation period vaccines from DOH It involves the separation of persons who are carriers Dogs must initially be registered before this vaccine These are persons who are not sick could be administered These are persons who do not manifest signs and 1.3) Environmental Sanitation symptoms of the disease Objective: o No proliferation of arthropods, rodents (both Center for Disease Control’s two (2) Revised of which are good vectors) Isolation Precautions Presidential Decree 856 1) Standard Precaution Sanitation Code Best strategy to prevent nosocomial infection Also includes submission of sex workers in Slowly taking place of Universal Precaution determination of sexually transmitted diseases Applies to all patients regardless of their diagnosis o For gonorrhea – two times a month Applies to blood and all body fluids, excretions and o For syphilis – once a month secretions except sweat. o Physical Examination – once a month Applies to mucous membrane and non-intact skin Concept: 5|P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING Universal Precaution Particulate mask Has double standards o For measles, chicken pox, TB Used only if patient is diagnosed or suspected of having blood-borne diseases Droplet Precaution Elements included in Standard Precautions No contact to mucous membrane, nose, mouth 1. Practice hand washing for each patient care Use mask – ordinary mask will do For contact with body fluids of patient Use goggles Duration is 10 – 15 seconds o For meningitis, mumps, pertussis, German Length of washing is not important measles, diphtheria What is important is the friction that is applied Concepts: Contact Precaution For Medical Asepsis: Avoid person to person contact Hand is lower than the elbow Use gloves Hand is the dirtiest part Use gown Elbow is the cleaner part For diarrheal diseases, typhoid, cholera, hepatitis, skin diseases like ringworm, scabies and pediculosis For Surgical Asepsis: Control Measures other than Isolation Hand is placed up and remains up 1. Disinfection Hand is the cleanest portion Killing of pathogenic microorganisms by physical or Elbow is less clean than the hands chemical means (i.e. boiling, soaking) 2. Use of Protective Barriers or Use of Personal Protective Types of Disinfection Equipment (PPEs) If you wear them all, the correct sequence for wearing Concurrent Disinfection them would be: Done when the person is still a source of infection o Mask Example: o Goggles o When patient is still in the hospital o Cap / Bonnet Boil all patient gowns o Gown o Gloves Terminal Disinfection If you are about to remove them, the correct Done when person is no longer a source of infection sequence is: Example: o Gloves o Room of patient is cleaned upon discharge o Do hand washing of patient using UV rays or Lysol o Gown o Cap / Bonnet 2. Disinfestation o Goggles Killing of undesirable small animal forms such as o Mask arthropods, rodents, insects by physical or chemical means 3. Avoidance of Needle Stick or Sharps Injury Do not recap, bend or break needles 3. Fumigation There must be puncture-resistant sharps collector Use of gaseous agents to kill arthropods, rodents and insects. IMPORTANT CONCEPT!!! If patient is diagnosed as having communicable disease, practice both Standard Precaution and 4. Medical Asepsis Transmission-based Precaution Hand washing Gloving Transmission Based Precaution Gowning Airborne Precaution Masking Use of mask Placarding Special ultrafilterable mask 6|P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING o Placing “NO SMOKING” sign when there is oxygen inhalation in progress. IMPORTANT CONCEPT! Toxin is released to the blood and is responsible for COMMUNICABLE DISEASES OF THE CENTRAL NERVOUS the manifesting signs and symptoms of the disease SYSTEM Two (2) Types of Toxins in Tetanus Bacterial infections Tetanus 1. Tetanolysin Meningitis Dissolves red blood cells Viral Infections Results to anemia Encephalitis Thus, patient is pale-looking Poliomyelitis Rabies 2. Tetanospasmin TETANUS Causes muscle spasm Also called LOCKJAW Acts on MYONEURAL JUNCTION of the muscles With painful muscular spasms and on the INTERNUNCIAL FIBERS of the spinal Ten times more painful than leg cramps cord and the brain. Results into multiple muscle spasms Clostridium tetani Inhibits the spastic muscle from sending o Causative agent of Tetanus transmissions to the brain, which would inhibit o Anaerobic microorganism progression of spasms. Due to this, adjacent o Abundant in soil, dust, clothing muscles will also undergo spasm similar to a chain o It exists in the form of a SPORE outside the reaction or a domino reaction. human body o That is why it survives outside the human In the wound, there would be an inflammatory response: body even in the presence of oxygen Rubor - rednes o Sterilization is needed to kill the Calor - heat microorganism Tumor - swelling Dolor - pain Important Concepts: Functiolaesa – loss of function When inside the human being, the spore transforms into a VEGETATIVE FORM, which can be destroyed Signs and Symptoms of Tetanus by the presence of oxygen The patient manifests: Why is Clostridium tetani abundant in soil? o Restlessness o Normal habitat of C. tetani is in the intestines o Fever of herbivorous animals (i.e. cows, carabaos, o Profuse Sweating goats, sheep, horses) IMPORTANT CONCEPTS!!! o Manure of these animals is used as fertilizer Masseter muscle is involved Mode of Transmission of C. tetani o It functions for mastication, for opening and o Break in skin integrity closing of the mouth Person is at risk for infection when there is any kind of o Tetanus affects strong muscles would (i.e. splinter or salubsob, tooth decay, otitis o Therefore, it affects the closing of the mouth media) muscle o This is called LOCKJAW or TRISMUS Important Concepts! Facial muscle is affected You need not be wounded by a RUSTY OBJECT to o Gives rise to “risus sardonicus” acquire tetanus o Known as the “Sardonic Smile” In the newborn, tetanus neonatorum is caused by o Also known as “Ngiting Aso” poor cord care. o Patient is smiling but his eyebrows are When C. tetani enters the body, it seldom migrates to raised. the bloodstream where oxygen is present Spinal muscle is affected C. tetani remains in the wound but the effects are o Resulting into the Ophistotonus position systemic o This is the arching of the back 7|P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING o In the vernacular, it is called “LIAD” o If (+) for skin testing, DO NOT GIVE the Respiratory muscles are affected drug. o Results to difficulty of breathing, dyspnea ▪ Resort to human serum – tetanus and chest heaviness immunoglobulin Genitourinary tract muscles are affected Concept: o Results into urinary retention In the Philippine setting, the horse serum is still given o Intervention would involve catheterization despite a positive skin test. Gastrointestinal muscles are affected This is done by giving fractional doses. o Resulting into constipation Example: Abdominal muscles are affected o Initial administration of 0.01 of drug and 0.99 o Results into abdominal rigidity PNSS o Abdomen is hard as a board o After 30 minutes, 0.05 of the drug and 0.95 o This sign serves as a basis for recovery of PNSS o If abdominal rigidity decreases, it means that o After another 30 minutes, another increase the patient is on his way to recovery in the dose of the drug Extremity muscles are affected o Results into stiffness of extremities IMPORTANT CONCEPT!!! o There is difficulty in flexing When administering tetanus horse serum, always o Robot gait is evident have ready the following: o EPINEPHRINE Concept! o CORTICOSTEROID Thus, almost all of the muscles are rigid and stiff in These would be necessary to counteract any delayed Tetanus! reaction, which may cause hypersensitivity reactions leading to anaphylaxis and eventually the death of the Diagnostics for Tetanus: patient. 2. Kill the Microorganism 1. Clinical Observation Give Penicillin Assess patient physically o This is the drug of choice to kill the bacteria Assess for the presence of lockjaw In the fresh wound, do daily cleansing with the use of If this is positive, a logical question would be – “Do hydrogen peroxide you have a wound” Then apply antiseptic solution like Betadine or Povidone 2. Obtain history of wound Then cover wound with THIN DRESSING to allow air Wound Culture to circulate through the wound. If there is a fresh wound, microorganism is still It may also be good to expose the wound but avoid present there contact with flies. Concept: 3. Prevent and Control Spasm The shorter the incubation period, the poorer the Give muscle relaxant prognosis o Given during the acute phase of tetanus Shortest incubation period is 2 – 3 days. o Done via the I.V. route An incubation period of one month has a better Give Diazepam / Valium prognosis than an incubation period of 2 – 3 days. o Use I.V. push or I.V. drip Concepts: Three (3) Objectives of Medical Management I.V. drip regulation is titrated based on the frequency of the spasm. Neutralize the toxin o The more frequent the spasm, the faster the This is the top priority rate of the titration The toxin is responsible for the signs and symptoms of the disease and the systemic infection When the patient is on his way to recovery, muscle Give anti-tetanus serum or tetanus anti-toxin relaxants per orem may be used: o It comes from a horse serum o Methocarbamol or Robaxin o Do skin testing first o Lionesal or Baclofen 8|P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING o Eperison or Myonal oThis results to pooling of respiratory secretions in the lungs Proceed with other supportive management o This leads to pulmonary infection For urinary retention, do catheterization Profuse sweating and draft exposure also leads to For constipation, administer laxatives as ordered pulmonary infection Nursing Management in tetanus Therefore, always keep patient dry; especially at the Muscle spasms are the first concern back. Concept: Stimuli trigger spasms. Physical Injury Types of Stimuli: For falls: o Never leave the patient alone 1. Exteroceptive o If you do leave the patient, keep the padded Comes from outside environment of the patient side rails up Examples are bright light and noise o Keep call light within the reach of the patient Place the patient in dim and quiet environment Fractures due to spasm: 2. Interoceptive o Caused by restraining by relatives Comes from inside or within the patient Examples are stress, pain, coughing, passage of Provide Patient with Comfort Measures flatus Oral care 3. Proprioceptive o To prevent mouth sores There is participation of patient and other persons o Cotton swab used on inner and outer chick Examples are touching, turning, jarring the bed of the o Do not use toothbrush patient Nursing Care in Tetanus IMPORTANT CONCEPT!!! Done to prevent patient from having spasms Attack of tetanus does not give permanent immunity Place the patient in a dim and quiet environment Practice minimal handling of the patient Vaccine Given: o Avoid unnecessary disturbance of the Diphtheria Pertussis Tetanus Vaccine or DPT vaccine patient When given: Practice Cluster Care o 1st Dose: 6 weeks after birth; 0.5 ml o Do all nursing care activities in one setting o 2nd Dose: 10 weeks after birth; 0.5 o Do other nursing care activities with vital ml signs taking o 3rd Dose: 14 weeks after birth; 0.5 Gentle handling of the patient ml Touching is not contraindicated Number of Doses: Turning is not contraindicated o Three (3) o However, do these as gently as possible Interval between Doses: o Inform the patient before proceeding with o Four (4) weeks any procedure Administration Site: Concept: o Vastus lateralis muscle o Tetanus patients are isolated so as not to be Route: exposed to stimuli o Intramuscular Prevent injury: IMPORTANT CONCEPTS!!! Respiratory injury Expect fever to set in after administration of DPT Airway obstruction vaccine Tongue could be drawn back and cause blockage or o Give paracetamol obstruction o Apply warm compress for better drug Use padded tongue depressor for retaining patency of absorption the airway o Immediately follow up with cold compress to Respiratory Infection avoid soreness Turning to side is usually not done If tenderness or swelling on site of injection is present: 9|P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING o Do cold compress within twenty-four (24) If a person is low risk, give booster dose every ten hours (10) years o Then do warm compress Effect of Tetanus Toxoid administration on the Mother Observe for signs of convulsions within seven (7) Slight soreness or heaviness on site of injection days after DPT immunization o This indicates that child has reaction with the Wound Care pertussis component of the drug Wash wound with soap and running water o Therefore, succeeding doses of DPT will Place antiseptic solution on wound NOT BE GIVEN Use thin dressing o Give ONLY the DT components Band Aid Plastic Strips are allowable as they have air o If DPT is given again, this predisposes the ventilation holes child to neurologic disorders Do not use plaster Observe if child cries uncontrollably Use only those types of plasters with air ventilation ▪ This is an indication of development holes to introduce oxygen to the wound of neurologic disorders. Key Concept!!! Avoid Wounds DPT Immunization for Pregnant Individuals Dose: 0.5 ml MENINGITIS Route: Intramuscular Inflammation of the meninges (covering of the brain Number of Doses given: and spinal cord) o Two (2) doses with three (3) booster doses Concepts! or; Meninges are composed of: o Two (2) doses with booster dose given every o Dura mater pregnancy o Arachnoid mater When given: o Pia mater o 1st Dose: Anytime during second trimester of Cerebrospinal Fluid or CSF is found in the pregnancy SUBARACHNOID SPACE o 2nd Dose: With one (1) month interval Causative Agents in Meningitis o Booster Dose: Given with successive Viral pregnancy/ies o CMV – Cytomegalovirus ▪ Opportunistic infection for AIDS For High-Risk Individual Fungal 1st Dose given: o Cryptococcal Meningitis o 03-05-2005 ▪ Source is excreta of fowls and 2nd Dose given: feathered animals o 04-05-2005 ▪ Another form of opportunistic 3rd Dose given: infection for AIDS o 10-05-2005 (six months after the LAST Bacterial dose) o Tubercle Bacilli 4th Dose given: ▪ TB meningitis o 10-05-2006 (After one (1) year from the Staphylococcal meningitis LAST dose) o Secondary to skin infection 5th Dose given: Haemophilus influenzae bacilli o 10-05-2007 (After one (1) year from the o Common cause of meningitis in the United LAST dose) States Meningococcemia IMPORTANT CONCEPTS!!! o Meningococcemial meningitis Succeeding doses of Tetanus Toxoid are given based o Spotted Fever Disease on DATE OF LAST DOSE o Most fatal If a person is high-risk, give booster dose every five o The only type of meningitis where the (5) years VASCULAR SYSTEM is affected o Bleeding is triggered 10 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING o Disseminated Intravascular Coagulation occurs and leads to vascular collapse Pathophysiology of Meningococcemia o Vascular collapse leads to death in ten Portal of entry of Neisseria meningitidis is also the percent (10%) of patients nasopharynx o This ten percent (10%) has the FULMINANT The bacteria then goes to the bloodstream TYPE or the Waterhouse-Freiderichen Presence of bacteria in the bloodstream causes Syndrome (characterized by vascular ecchymosis collapse) o These ecchymoses are blotchy (pantal- o Causative agent is Neisseria meningitides pantal) purpuric lesions o They are purplish in color Important Concept! o Usually found on the wrist and the ankles In children below four (4) years old, Neisseria From the bloodstream, they go to the meninges and meningitidis is a normal flora in the nasopharynx. irritate them. If resistance goes down, these children become Same sequence of events follow as mentioned above prone to infection Mode of Transmission Signs and Symptoms of Meningitis Droplet transmission Once the microorganism is at the nasopharynx: In cryptococcal meningitis: o Fever o Inhalation of spores o Headache Portal of Entry o Sore throat Respiratory system via the nasopharynx o Cough Pathophysiology of Meningitis o Colds From the nasopharynx, the microorganism goes to Other signs and symptoms present as discussed in the bloodstream the pathophysiology Once in the bloodstream, the microorganism causes petechiae formation (pin point red spots on the skin) Pathognomonic Sign of Meningitis From the bloodstream, microorganism goes to the Nuchal Rigidity meninges and irritates them Stiffening of the neck o There is inflammation of the meninges and o No flexing of the neck accumulation of substances in the meninges o No hyperextending of the neck This results into increased Intracranial Pressure (ICP) o No turning from side to side o Increased ICP leads to: Abnormal Reflexes ▪ Severe headache o Positive for Kernig’s Sign ▪ Projectile Vomiting ▪ Place patient in supine position ▪ Two (2) to three (3) feet away from ▪ Flex both knees toward the patient abdomen o Management involves turning patient to side ▪ Then ask the patient to extend the ▪ Position kidney basin about two (2) legs to three (3) feet away ▪ If pain is present, the patient is said Altered Vital Signs to be positive (+) for Kernig’s Sign o Increased Temperature or difficulty of extending the leg o Decreased Pulse Rate Positive for Brudzinski’s Sign o Decreased Respiratory Rate o Place the patient in supine position o Increase in Systolic Blood Pressure and o Flex the neck Normal Diastolic Pressure o If there is no reaction, the patient is said to ▪ This results in the widening of the be negative (-) for Brudzinski’s Sign. Pulse Pressure o If there is INVOLUNTARY DRAWING UP of Convulsions (seizures) the LEGS / HIP upon flexion of the neck, the Diplopia patient is said to be positive (+) for o Due to choking of optic discs Brudzinski’s Sign o Double vision but not crossed eyed o Determined by finger counting Diagnostic Tests for Meningitis Altered level of consciousness 11 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING 1. Lumbar Puncture ▪ Retains CSF Cerebrospinal Fluid (CSF) is the specimen used If with excess CSF o Assess for the color of the CSF o Give osmotic diuretic in the form of Bacterial infection is present if: MANNITOL o CSF is yellowish, turbid, cloudy o Check blood pressure before administration Viral infection is present if: as it causes hypotension o CSF is clear o Monitor the intake and output to evaluate the No infection is present if: effectiveness of Mannitol o CSF is clear o Expect that after two (2) to three (3) hours, Send CSF for Laboratory Examination the urine output must increase by thirty (30) Laboratory findings would show: to fifty (50) ml. o Increased protein levels o If no changes in urine output occurs, then o Increased White Blood Cell levels Mannitol is not effective o Decreased Sugar content o Refer this to the physician Concepts If there are convulsions due to CNS infection If caused by bacteria, do Culture and Sensitivity test o Give anti-convulsants o This is done to know what bacteria caused ▪ Dilantin the infection ▪ Phenytoin o This is also done to determine what drug will Routes of Administration of Dilantin be used to kill the offending microorganism o Per Intravenous ▪ Nursing Care for I.V. administration If CSF is clear, it is subjected to Counter Immuno- of Dilantin Electrophoresis (CIE) Sandwich Dilantin with This is done to determine if causative agent or a NSS protozoa NSS – Dilantin – NSS IMPORTANT CONCEPT!!! ▪ Rationale: In patients with HIGHLY INCREASED Dilantin would crystallize INTRACRANIAL PRESSURE due to CNS infection, o Per Orem lumbar puncture or aspiration of the CSF is ▪ Nursing Care for P.O. CONTRAINDICATED administration of Dilantin o This will bring about HERNIATION OF THE Do frequent oral care BRAIN and would eventually lead to death Do gum massage Therefore, it is important that the nurse performs o Rationale: Physical Assessment before doing a lumbar tap. ▪ Dilantin causes gingival hyperplasia 2. Blood Culture or overgrowth of the gums Done because microorganism can travel to the bloodstream Important Concept! Medical Management of Meningitis Dilantin is never given Intramuscularly If bacterial o This is irritating to the tissues o Give anti-bacterial agent in the form of o This has an erratic effect antibiotics If viral Nursing Care o Symptomatic Symptomatic If fungal Supportive o Give Amphotericin B If with inflammation Nursing Diagnoses o Give corticosteroids in the form of DEXAMETHASONE 1. Alteration in body temperature related to infection o Never give PREDNISONE Priority is to lower body temperature ▪ Prednisone does not cross the o Do TSB Blood-Brain barrier o Provide cold compress ▪ Prednisone causes sodium o Provide loose clothing retention 12 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING 2. Pain: Alteration in comfort related to increased o Make the patient wear a mask so as not to Intracranial Pressure infect people in the hallway, elevator, etc. Priority is to relieve headache within thirty (30) Wear mask when you enter the patient’s room minutes 3. Vaccine o Provide diversion Hib vaccine for Haemophilus influenza o Provide proper positioning ▪ Low-Fowler’s position (30° incline) BRAIN FEVER o Provide comfort measures Arbovirus o Massage the forehead Arthropod-borne Virus o Do petrissage with circular action Primary cause 3. Potential for injury related to altered level of St. Louise consciousness Japan B Never leave the patient alone Australian X: Equine (E-W) Place call switch and light within reach of patient Mode of Transmission 4. Potential for fluid and electrolyte imbalance due to Mosquito bites projectile vomiting o Aedes Sollicitans Monitor intake and output o Culex tarsalis Provide fluids per orem ▪ Ticks of horse Important Concept ▪ Migratory birds An attack of meningitis does not provide permanent Secondary cause immunity Post racene encephalitis Toxic Preventive Measures Metal poisoning o Lead poisoning 1.Proper disposal of nasopharyngeal secretions o Mercury poisoning Burning Burying ENCEPHALITIS Proper procedure for disposal of nasopharyngeal secretions Signs and Symptoms o Use tissue paper With altered level of consciousness o Put it in a plastic bag after use With lethargy o Knot the plastic bag o Difficult to awaken o Dispose plastic bag in a trashcan o Patient is abnormally sleepy Important Concepts! With behavioral changes The best and most economic way preventing spread Brain is immediately affected relative to meningitis of infection is through swallowing of nasopharyngeal secretions Diagnostic Tests o This brings the secretions to the stomach 1. Lumbar Puncture and to the intestines and would then be Specimen is cerebrospinal fluid (CSF) eliminated in the stool Laboratory Results would indicate: Children have less chance of spreading infection o Increased Proteins because they swallow nasopharyngeal secretions. o Increased White Blood Cells This is contraindicated, however, for tuberculosis o Normal Sugar Content patients Thus, for TB patients, they have to spit out 2. Electroencephalogram (EEG) nasopharygeal secretions To assess extent of brain damage Swallowing is allowable for other respiratory Patient recovers but because he is epileptic, he infections develops irreversible brain damage Medical Management 2. Cover nose and mouth when sneezing and coughing Symptomatic due to viral cause Important Concepts! When you transfer patient… 13 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING Concepts! Portal of Entry No permanent immunity is obtained from attack of Gastrointestinal Tract encephalitis, only temporary immunity, due to Pathophysiology causation by various viruses Legio debilitans goes to the nasopharynx or the mouth Source of infection is mosquito If in the nasopharynx, it goes to the tonsils and causes: Preventive Management: o Sore throat CLEAN PROGRAM o Fever and chills o C – Chemically Treated Mosquito Net o Headache with body malaise o L – Lavivorous fishes If at the mouth, it goes to the Peyer’s patches and o E – Environmental Sanitation causes: o A – Anti-mosquito Soap (Basic Soap) o Abdominal pain o N – Neem Trees or Eucalyptus Tree (draws o Anorexia away mosquitoes) o Nausea and Vomiting Concepts! o Diarrhea or Constipation To kill mosquitoes in canal, pour oil or gas in canal o This depletes oxygen present in the canal STAGES of POLIOMYELITIS o There is no need to light it up 1ST Stage: Invasive Stage or Abortive Stage POLIOMYELITIS All the abovementioned signs and symptoms will Also called: appear o Infantile Paralysis Patient recovers o Heine-Medin Disease Disease process is aborted Affects children below ten (10) years of age But there will be instances when disease process will Less risk for people above ten (10) years Old not be aborted Causative Agent Tonsils Peyer’s Patches Virus ▼ ▼ o Legio debilitans Cervical Mesenteric ▪ Type 1 – Brunhilde Lymph Lymph ▪ Type 2 – Lansing Nodes Nodes ▪ Type 3 – Leon ▼▼▼ ▼▼▼ If Brunhilde BLOODSTREAM o Gives permanent immunity ▼▼▼ If Lansing or Leon Central Nervous System o Gives temporary immunity 2nd Stage: Pre-paralytic Stage of Poliomyelitis Important Concepts! Central Nervous System is already involved but there When Brunhilde infects you, Leon or Lansing will no will be no paralysis longer affect you! Signs and Symptoms: In the Philippines, the most prominent type is Once in the CNS, microorganism will cause: Brunhilde! o Sever muscle pain Mode of Transmission ▪ Do not keep on turning or holding Droplet patient o In early stage of infection, virus if found at ▪ Do not do massage nasopharyngeal secretions ▪ No positioning will relieve patient Fecal-Oral Route o Instead, what would relieve the patient would o In late stage of transmission, virus is found be: at the mouth ▪ Application of warm packs ▪ Analgesics o Never administer Morphine 14 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING ▪ It is a narcotic analgesic that would o Paralysis of extremities cause respiratory depression o Paralysis of intercostal muscles leads to DIFFICULTY OF BREATHING Once in the CNS, the microorganism will also cause: o Stiffness of the hamstring 3. Bulbo-Spinal Type o Patient will be positive for HOYNE’S Sign Combination of Bulbar and Spinal types and exhibit a HEAD DROP Patient has cranial nerve affectations and anterior o To check for Hoyne’s Sign horn cell affectations ▪ Lift shoulders of patient when lying supine or extend head of patient Important Concepts!!! beyond the edge of the bed Not all patients will develop paralysis ▪ If head of patient drops, he is said If patient is non-paralytic, to be positive (+) for Hoyne’s Sign o He has GOOD PROGNOSIS Diagnostic Tests Once in the microorganism is in the CNS, the patient would elicit a POKER SPINE 1. Lumbar Puncture o Ophistotonus with head retraction Laboratory results would reveal: o Sitting position cannot be assumed o Increased White Blood Cell levels o Therefore, patient will assume a TRIPOD o Increased Protein levels POSITION o Normal Sugar levels 2. Muscle Testing Central Nervous System To determine what specific muscle is affected ▼▼▼ 3. Electromyelogram Paralysis To determine extent of muscle involvement Concept! 4. Stool Examination From the CNS, the patient will experience paralysis. Perfomed at the late stage This leads to the third (3rd) stage of the disease About ten (10) days after being affected 3 Stage: Paralytic Stage rd 5. Nasopharyngeal Examination Presence of paralysis Performed at the early stage Characteristics of Paralysis: Medical Management o Flaccid Symptomatic ▪ Soft Causative agent is viral ▪ Flabby If there is respiratory paralysis ▪ Limp Place patient in a MECHANICAL VENTILATOR Important Concept! Use the IRON LUNG MACHING Flaccid Paralysis is PATHOGNOMONIC SIGN of o This works on the principle of Negative Poliomyelitis Pressure Breathing o No tracheostomy tube needed Three (3) Types of Paralysis (tracheostomy tube or endotracheal tube work on the principle of Positive Pressure 1. Bulbar Type Breathing) Cranial nerves are affected o Capsular in shape 9Th cranial nerve (Glossopharyngeal Nerve) and 10th o With glass windows cranial nerve (Vagus Nerve) affectations give rise to: o With metal plate o Respiratory problems o Works on electricity o Vocal cord swelling / paralysis o During brownout or power shortages, o Excessive salivation operate the machine manually o Aspiration o It has a steering wheel, which can be o Regurgitation manipulated manually 2. Spinal Type o Patient stays in the Iron Lung Machine for Most common type of paralysis months Affects ANTERIOR HORN CELLS Nursing Care for Poliomyelitis Affects MOTOR FUNCTION Symptomatic and Supportive 15 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING Psychological Aspect of Care ▪ 1st Dose – at six (6) weeks old o Use empathy ▪ 2nd Dose – at ten (10) weeks old ▪ 3rd Dose – at fourteen (14) weeks Preventive Measures old 1. Immunization o Rationale: Vaccine given: ▪ Because stool of child may contain o Oral Polio Vaccine (OPV) or Sabin the virus if OPV is given o Dose: ▪ Two (2) to three (3) drops o Route: 2. Avoid mode of transmission ▪ Oral Proper disposal of nasopharyngeal secretions o Number of Doses: Cover mouth when coughing ▪ Three (3) Do not put anything through the mouth o Interval: ▪ Four (4) weeks RABIES o When given: Also called: ▪ 1st Dose – at six (6) weeks old o Hydrophobia ▪ 2nd Dose – at ten (10) weeks old o Lyssa ▪ 3rd Dose – at fourteen (14) weeks o La Rage old A disease of a low form of animal o Important Concepts!!! o Not a human infection ▪ Do not feed child for thirty (30) o Only accidentally transmitted to man minutes after administration of OPV Occurs in canine animals or animals with fangs: o Rationale: o Fox ▪ For better absorption o Wolves o If child vomits, REPEAT!!! o Boar o If child has diarrhea o Monkeys ▪ Give OPV o Bats ▪ But do not record it o Cats ▪ Not all of the vaccine may be o Dogs absorbed properly ▪ When OPV 3 is given four weeks Causative Agent: after, record it as OPV 2 Rhabdovirus o A neurotropic virus Integrated Management of Childhood Illnesses (IMCI) o Has special affinity to neurons and the o Tell mother also that she should be very Central Nervous System careful in handling stool of child because this vaccine eliminates virus to the stool R H A B D O V I R U S o If significant others at home are ▼▼▼ ▼▼▼ immunocompromised Peripheral Efferent o Do not administer OPV Nerves Nerves o Due to feces of child ▼▼▼ ▼▼▼ o Rather give, IPV or Inactivated Polio Vaccine CNS Salivary / SALK Pathologic Gland o Dose: Lesions of Rabid ▪ 0.5 cc (negri bodies) Animal o Route: ▪ Intramuscular o Number of Doses: Important Concept! ▪ Three (3) Pathologic lesions that are formed as microorganism o Interval: multiplies ▪ Four (4) weeks o When given: 16 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING If there is no multiplication of the microorganisms at Itchiness on the site of the bite the Central Nervous System, there will be NO negri Flu-like symptoms bodies. o Fever Mode of Transmission o Headache Contact with saliva of a rabid animal o Sore throat Marked Insomnia Important Concept! Restless Therefore, you need not be bitten Irritable Even a scratch could cause rabies as animals lick Apprehensive their paws Slight photosensitivity Infection may occur through: Vague symptoms o Corneal transplantation o Kissing animal Important Concept! o Dog licking wounds When a family member at home is bitten by a rabid animal, vaccinate all people at home because patient Manifestation: has virus at saliva In Animals o Incubation Period Stage 2 – Excitement Stage ▪ Three (3) to eight (8) weeks Acrophobia o Fear of Air Stages of Manifestations in Animals Hydrophobia o Fear of Water Stage 1 – Dumb Stage Important Concept! Animal will have complete change in disposition Air and Water both cause PHARYNGOLARYNGEAL May show any of the following behaviors: SPASM o Withdrawn This is characterized by: o Stays in one corner o A drowning sensation o Depressed o Strangulation to death syndrome o May be overly affectionate o Like breathing in thick smoke ▪ Can lick wounds Other signs and symptoms o May be walking to and from o Photosensitivity o Hyperactive o Maniacal behavior o Manic o Resembles attitude of a rabid animal It is better if the animal is withdrawn as it is easy to o Easily agitated note o Runs after people o Violent Stage 2 – Furious Stage o Club walls Easily agitated o Jumps out of window Easily bites Important Concepts! With vicious look Before, THORAZINE and BENADRYL were given for With drooling of the saliva maniacal behavior but had proven to be ineffective Expect the animal to die Now, HALOPERIDOL and BENADRYL are Dying and biting happens on this stage administered and are very effective against maniacal Animal can die without biting behavior Stage 3 – Paralytic Sage Manifestation: Patient’s spasms will stop In Humans He can be fed, etc., o Incubation Period Paralysis sets in from toes going upwards ▪ Ten (10) days to twenty one (21) If respiratory system is affected, the patient will die years (this is the longest incubation Manifestation of signs and symptoms sets within 24 period recorded in the Philippines) hours and death follows Stage 1 – Invasive Stage Important Concept!!! Numbness on the site of the bite Rabies is a preventable but not a curable disease 17 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING Maximum time before death occurs is seventy-two Then, WORRY, because (72) hours. IT IS A RABID DOG!!! Medical Management Diagnostic Tests Done Before Patient Manifests Signs and Post-Exposure Prophylaxis Vaccines Symptoms Active Form of Vaccine Important Concept! Made up of microorganisms There is no diagnostic examination done to humans, Purified Vero Cell Vaccine ONLY TO ANIMALS o PVCV Brain Biopsy of the Animal o One of the more common types Identifies presence of negri bodies o Verorab 10% of animals have rabies but are negative for negri o Stock dose is 0.5 cc / vial bodies o Because virus may travel through efferent Purified Duck Embryo Virus nerves and may not have reached the CNS o PDEV before death o Lyssavac Therefore, do the next test… o Stock dose is 1.0 cc / vial Direct Fluorescent Antibody Test (DFA Test) Purified Chick Embryo Cell Confirmatory test for rabies o PCEC Observation of the Animal o Also one of the more common types Done for ten (10) days o Rabipur Important Concept! o Stock dose is 1.0 cc / vial o Submit yourself for treatment if, within ten (10) days: Important Concepts!!! ▪ Animal dies If given intramuscularly (I.M.) ▪ Animal shows behavioral changes o Do skin testing first Consider the following: If given intradermally (I.D.) o Site of Bite o No skin testing is done ▪ If above waist Site Submit yourself for o Deltoid treatment as soon as o Vastus lateralis possible Important Concepts!!! This is due to the proximity If active form of vaccine of the bite to the brain If via I.M. o Velocity of Virus Schedule is: ▪ Three millimeters per hour Dose Day Example Dosage Remarks (3mm/hr) 1st 00 03/05/ 2 vials 1 cc on o Extent of Bite 2005 each ▪ Submit yourself for treatment at site; One once if: on the You have multiple bites left and You have a deep bite one on o Reason for the Bite the right ▪ If bite is provoked 2nd 07 3/12/ 1 vial One site ▪ Example: 2005 only You stepped on the dog’s 3rd 21 3/26/ 1 vial One site tail 2005 only Do not worry Important Concepts!!! ▪ If unprovoked Counting is ALWAYS BASED on the FIRST DOSE!!! ▪ Example: You can afford not to continue vaccine if dog does not There is no reason die after ten (10) days 18 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING However, continuance is encouraged because doing Rabipur so would give three (3) years of immunity Important Concepts!!! If you abort vaccination, you will not get three (3) Verorab years of immunity o Once reconstituted is only potent for eight When you get bitten again, you start all over again (8) hours In case the dog: Antibodies are produced in about seven (7) days o Died Therefore, also give passive form of vaccine. o Disappeared Passive Forms o Was killed within (3) days Temporary antibodies Avail of complete doses plus a BOOSTER DOSE o Booster Dose Animal Serum ▪ Given at DAY 91 Equine Rabies Immunoglobulin (ERIG) ▪ In the tabulated example o Anti-rabies serum Schedule would be at o HyperRab 6/05/2005 o FaviRab Dosage is one vial Important Concepts! If via I.D. Do skin test first Schedule is: o If negative for skin test, give drug Dose Day Example Dosage Remarks ▪ Dosage is based on body weight 1st 00 03/05/ 0.1 cc if Given on and is provided in direct proportion 2005 Verorab each site: ▪ 0.2 cc / kg body weight is the or Right and standard 0.2 cc if Left ▪ Example: Lyssavac A 50 kg person would Or receive 10 ml of ERIG Rabipur Cost is approximately 2nd 03 3/08/ 0.1 cc if Given on Php1,800 / 5.0 cc 2005 Verorab each site: o If positive for skin test, give HRIG or Human or Right and Rabies Immunolobulin 0.2 cc if Left ▪ Imogam Lyssavac ▪ Rabuman Or ▪ 0.133 cc / kg body weight is the Rabipur standard dose 3rd 07 3/12/ 0.1 cc if Given on ▪ Example: 2005 Verorab each site: A 50 kg person would or Right and receive 6.65 cc of HRIG 0.2 cc if Left ▪ Cost is approximately Php4,500 / Lyssavac 2.0 cc Or o This is given as a single dose within seven Rabipur (7) days from the date of the bite 4th 28 04/01/ 0.1 cc if Given on o After seven days, patient already has to 2005 Verorab one site antibodies 30 to or only o Computed Dosage is divided in two 04/03/ 0.2 cc if ▪ Half is given Intramuscular 2005 Lyssavac ▪ On the ventrogluteal muscle or at Or the side of the buttocks Rabipur o Other half is... 5th 90 06/03/ 0.1 cc if Given on ▪ Infiltrated around site of bite using 2005 Verorab one site four distinct points or or only ▪ Given inside the wound of the 0.2 cc if patient Lyssavac o This is prophylactic and is not considered as Or a treatment 19 | P a g e  HANDOUTS FOR NCM 112: IMMUNO-INFLAM / COMMUNICABLE DISEASE NURSING