NCMB312 Finals 2024 PDF

NCMB312 LECTURE BSN 3RD YEAR 1ST SEMESTER FINALS 2024 Bachelor of Science in Nursing 3-YA Professor: Mr. Gerry Nicolas, RN, MAN...

NCMB312 LECTURE BSN 3RD YEAR 1ST SEMESTER FINALS 2024 Bachelor of Science in Nursing 3-YA Professor: Mr. Gerry Nicolas, RN, MAN 13-1 HEPATITIS - Esp. HepB  Hepatitis A o Use gloves and standard precaution when handling - Infectious hepatitis, Catarrhal-jaundice hepatitis the patient - Mode of Transmission: fecal-oral, oral-anal sex  Hepatitis B Prevention  Hepatitis B Vaccination @ 0, 6, 14 weeks 0.5 cc IM - Serum Hepatitis - MOT: percutaneous, sexual contact, mother to child.  Hepatitis C - Post-transfusion hepatitis - MOT: percutaneous, sexual intercourse Clinical Manifestations Pre-icteric Phase  Anorexia  Nausea  RUQ pain  Malaise  Headache  low grade fever Icteric Phase  dark urine (increase bilirubin) CHOLERA  pruritus  Filippo Pacini  clay colored stools – d/t decreased excretion of conjugated - discovered of Vibrio cholera bilirubin in the intestine  Waldemar Haffkine  jaundice (icteric jaundice) - Russian-Jewish bacteriologist developed the first cholera vaccine in July 1892 Post-icteric Phase  Dr. John Snow - regarded as one of the founding fathers of modern  malaise epidemiology and discovered how cholera was spread in  fatigue London  hepatomegaly for several weeks – to submit patient for UTZ  Cholera has been nicknamed the "blue death" because a person dying of cholera may lose so many body fluids that Diagnostic Exams their skin turns bluish-gray (cyanosis)  Hepatitis Profile  Liver function test Causative Agent  Liver UTZ – to know the extent of liver damage  Vibrio Coma or Vibrio Cholera (bacteria) Complications Incubation Period  Chronic Hepatitis  From a few hours to 5 days (average of 3 days)  Cirrhosis – s/s of ascites and abdominal distention - To check abdominal girth every day Period of Communicability - Monitor weight every day  As long as microorganisms are present in the bowel excreta Medications Clinical Manifestations  Lamivudine  Mild-diarrhea that becomes voluminous  Interferon  Rice-watery stool (pathognomonic sign)  Washer woman’s hands Nursing Interventions  Effortless vomiting 1. Bed rest  Cramping of the extremities (hypokalemia) - d/t O2 imbalance in O2 supply and demand  Signs of severe dehydration 2. SFF, high CHO - SFF – small frequent feedings 3 Deficits During Cholera 3. Avoid alcohol and OTC drugs 1. Severe dehydration and ECF volume deficit - Some OTC drugs are hepatotoxic 2. Hypokalemia 4. Implement Standard precaution 3. Metabolic acidosis Jhameel - Page 1 of 2  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINALS 2024 Diagnostic Exams Clinical Manifestations  Stool or vomitus culture  Gradual onset  Serum electrolytes  A-norexia and abdominal pain  Dark field or Phase Microscopy  B-radycardia  C-onstipation Medical Management  D-iarrhea, D-evelop skin eruptions on the abdomen, back and  Correction of dehydration and fluid imbalance chest (ROSE SPOTS)  Antibiotics- Tetracycline (drug of choice)  E-nlarged spleen  F-ever and chills Nursing Management  G-eneralized body weakness  Assess patient for signs of dehydration and complications  H-eadache  Observe enteric precautions  What are the three cardinal signs of Pyrexial stage?  Increase oral fluid intake - D = developed skin eruptions Violent Dysentery Bacillary Dysentery Amoebic Dysentery - E = enlarged spleen Cholera Shigelosis Amoebiasis - P = fever Vibrio cholera Shigella Dysenteriae Entamoeba Histo.  Rice watery stool  +/- fever  +/- fever  Signs of severe  +/- vomiting  +/- vomiting dehydration:  Abdominal pain  Abdominal pain sunken eyeball, (colicky or  Diarrhea with Washer- cramping) tenesmus woman’s hand,  Diarrhea with  Muco-purulent metabolic tenesmus blood streaked acidosis, shock  Mucus and Blood stool streaked stool Tx: Tetracycline Tx: Metronidazole Tx: Cotrimoxazole TYPHOID FEVER  Almroth Edward Wright - Developed the first effective vaccine for typhoid and introduced for military use in 1896  Georg Gaffky - pathologist that confirmed the bacillus Eberthella typhi, which is known today as Salmonella enterica Diagnostic Exams  CBC Causative Agent  Widal test – agglutination test  Salmonella Typhi  Typhidot exam – detecting antibodies for typhoid fever  Blood culture Incubation Period  Urine and stool culture  Variable  Usually 1 – 3 weeks, average: 2weeks Medical Management  Antibiotics: chloramphenicol – drug of choice Period of Communicability  IVF to correct dehydration or fluid imbalance  As long as the bacilli appears in the excreta  Paracetamol for the fever  Oral therapy rehydration (oresol, hydrites) Mode of Transmission  Fecal – oral route Nursing Management  Ingestion of contaminated food and water 5 F’s – fingers,  Enteric isolation feces, flies, food, fomites + 2 (fluid and field)  Vital signs must be recorded accurately  Intake and output must be accurately measured  Concurrent disinfection  Isolation  Increase oral fluid intake Jhameel - Page 2 of 2  NCMB312 LECTURE BSN 3RD YEAR 1ST SEMESTER FINALS 2024 Bachelor of Science in Nursing 3-YA Professor: Mr. Gerry Nicolas, RN, MAN 13-2 RED TIDE POISONING Four Syndromes of Shellfish Poisoning  A "red tide" is a common term used for a harmful algal bloom 1. Paralytic Shellfish Poisoning (HAB), occur when colonies of algae—simple plants that live 2. Diarrheal Shellfish Poisoning in the sea and freshwater—grow out of control while producing 3. Amnesic Shellfish Poisoning toxic effects on people, fish, shellfish, marine mammals, and 4. Neurologic Shellfish Poisoning birds.  Is caused by a “population explosion” of toxic, naturally Clinical Manifestation occuring microscopic phytoplanktons, specifically a subgroup  The initial sign is tingling of the lips and tongue which known as dinoflagellates. spreads to the face, neck, fingertips and toes  Explosions or “Blooms” are coastal phenomena caused by  Headache, dizziness and nausea follow, symptoms which may environmental conditions which promote the explosive growth be mistaken as being due to a drunken condition of microorganisms.  Such symptoms are aggravated by alcohol consumption  Factors which are favorable for growth are.  In severe cases, muscular paralysis and breathing difficulty - Warm surface temperatures; may occur in five to twelve hours due to paralysis of the - High-nutrient content; diaphragm; the victim can survive only with the aid of a - Low salinity and calm seas; and respirator - Rainy days followed by sunny weather  Fatalities from respiratory arrest have been reported  DOES IT REALLY COLOR THE WATER? - Yes. water in the coastal areas can be colored red by the Modalities of Treatment algae, thus, the term red tide.  The patient is induced to vomit.  Only certain kinds of seafood accumulate red tide toxins.  Charcoal hemoperfusion  Shellfish are particularly prone to contamination as they - a process done by pumping the arterial blood through an feed by filtering microscopic food out of the water. activated charcoal filter to remove the toxin  These shellfish are filter feeders and, therefore, accumulate  Alkaline fluids toxins produced by microscopic algae in the form of - such as sodium bicarbonate, are thought to be helpful dinoflagellates and diatoms. because the toxins in unstable in alkaline condition  Lobster, crabs, shrimps and fish do not accumulates toxins  Artificial respiration and are safe to eat even if they are from affected waters. - required if the patient exhibits respiratory stress Prevention and Control  All shellfish-producing areas should have a monitoring program to test water, sediments, and shellfish for contamination.  The Department of Environmental Quality Engineering (DEQE) is responsible for year-round testing of shellfish and shellfish-growing area.  When blooms subside, shellfish has purifies themselves of the toxin and when testing indicates a return to safe levels, the areas are reopened.  If accidental ingestion of toxic shellfish is suspected, seek medical attention immediately  Recreational shellfish gatherers should look for posted warnings and pay close attention to local media Pathophysiology announcements.  Eating toxic shellfish can cause paralytic shellfish poisoning (PSP) in humans. LEPROSY  PSP is caused by saxitoxin, which is produced by A. catanella  Synonym: Hansen’s disease and is one of the most potent toxins known.  Chronic disease of the skin, peripheral nerves and nasal  Saitoxin acts by blocking sodium movement in muscle tissue. mucosa  Conduction block primarily occurs in the neurons and muscles.  “Living dead”, Was perceived to be caused by sin  The toxins responsible for shellfish poisoning are water- soluble, heat-and acid stable, and are not inactivated by Causative agent ordinary cooking. Cooking or freezing does not destroy  Mycobacterium leprae the red tide toxin.  After ingestion, the toxin immediately affects the nervous Mode of Transmission system, with symptoms usually appearing within 30 minutes.  Intimate skin to skin contact – w/ (+) break on the skin to permit Severity depends on the amount of toxins consumed. the entry of MO Jhameel - Page 1 of 5  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINALS 2024  Droplet  Social stigma  Infection Prevention Types  BCG @ birth 0.05 ID Multibacillary (MB) TETANUS  Infectious  Other names: LOCKJAW  Malignant  Numerous macules Causative Agent  papules and nodules  Clostridium tetani  Two types of toxin: Paucibacillary (PB) - Tetanospasmin – unable to control the muscles  hypopigmented macule - Tetanolysin – w/ RBC destruction Incubation Period  3 days – 3 weeks in adult  3 – 30 days in new born Mode of Tramission  Through breaks in the skin and mucous membranes Source of Infection  Soil  Street dust  Animal and human feces  Rusty materials Clinical Manifestations  Neonates Late Manifestations  Lagophthalmos – inability to close eyelids - Malaise, high fever - Difficulty in sucking  Madarosis – loss of eyebrows - Excessive of crying  Sinking of the bridge of the nose - Stiffness of jaw  Leonine face / Lion face – PATHOGNOMONIC SIGN  Adult  Contractures (clawing of fingers and toes) - Trismus – lock jaw  Gynecomastia – for males - Risus sardonicus (sardonic smile) – pathognomonic sign Diagnostic Test - Opisthotonus  Slit Skin smear – to demonstrate M. leprae - Muscular spasm - (-) in all site = Paucibacillary - Low grade fever, diaphoresis - (+) in all sites = Multibacillary  Number of lesions = 2-5 PB; > 5 MB Ablett Classification of Severity Treatment:  Multi drug therapy (MDT) RA 4073 Paucibacillary  Rifampicin(600mg) /once a mo  Dapsone (100mg) OD (6-9 mos) Multibacillary  Rifampicin, dapsone, lamprine - Day 1: R-600 D-100 C-300 once month - Day 2-28: Dapsone 100 OD  Clofazimine (Lamprine) 50 mg OD (24-30 mos) Health Education  Dapsone - cutaneous eruptions, also iritis, orchitis  Lamprine - Brownish black skin discoloration, dryness and flakiness  Skin care: Prevent injury Nursing Diagnosis  Altered body image Jhameel - Page 2 of 5  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINALS 2024 Predisposing Factors  Age. - About 60% of patient are - under 10 years of age  Sex - Males are more prone to the disease than females. Death rate is proportionately higher in males.  Heredity - Not heredity  Environment and hygienic condition - The rich are more often spared than the poor. Excessive work, strain and marked overexertion are also factors causing the disease. Diagnostic Exam Incubation Period  Clinical manifestations  7-14 days  History of wound Medical Management  ATS, TAT, TIG - ATS o It is used for both preventing and curing Tetanus. ATS is a solution of purified antibodies prepared from Equine Blood. Skin test is needed.  Pen G, Metronidazole  Diazepam  Muscle relaxant  Equine tetanus antitoxin - should no longer be used, as there is a risk of hypersensitivity and serum sickness Period of Communicability - It should be replaced by human tetanus immunoglobulin.  Not accurately known  Tetanus antiserum  Polio virus can be found in throat secretions as early as 36 - provides temporary passive immunity against tetanus for hours and in the feces 72 hours after exposure to infection. 2 weeks  Risk of spreading the microorganism is highest during the  Child and adult prodromal period - 1500 IU single dose; 3000 IU if more than 24 hours has elapsed. It is administered as soon as possible after injury, Signs and Symptoms along with the tetanus vaccine, in a separate syringe and Inapparent/ Subclinical Stage injection site.  Asymtomatic Stage (90-95%) Nursing Management  Keep the room dim and quiet. Avoid stimuli of spasm Abortive (Minor Illness Stage)  Avoid unnecessary handling  Fever  Close monitoring of v/s and muscle tone  Sore throat  Provide adequate airway  GI symptoms  Low lumbar backache/ cervical stiffness on ante-flexion of Nursing Diagnosis spine  Ineffective breathing pattern related to muscles spasm and neurologic impairment. Major Illness Stage  Risk for injury related to muscle spasms. a. Non-paralytic/ pre-paralytic or meningitic type Prevention - Recurrence of fever  Immunization with tetanus toxoid for adults - Poker spine (stiffness of the back) – pathognomonic sign  DPT for babies and children - Tightness and spasm of hamstring - Hypersensitiveness of the skin POLIOMYELITIS - Deep reflexes are exaggerated Causative Agent - Paresis  Legio debilitans b. Paralytic - Type I – Brunhilde: permanent immunity; most - With paralysis depending on the part affected paralytogenic - Positive hoyne’s sign: head drop - Type II – Lansing: temporary immunity - (+) kernig’s and brudzinki signs - Type III – Leon: temporary immunity - paralysis Jhameel - Page 3 of 5  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINALS 2024 Types of Paralysis  Haemophilus influenza  Bulbar  Streptococcus agalactae and Listeria monocytogenes - Respiratory paralysis  Spinal Mode of Transmission - Paralysis of the upper and lower extremities and  Respiratory droplets through nasopharyngeal mucosa intercostal muscles  Direct invasion through otitis media  Bulbospinal  May result after a skull fracture, penetrating head wound - Involvement of neurons both in brainstem and the spinal Incubation Period cord  3-6 days Diagnostic Exams Period of Communicability  Blood and throat culture  As long as the microorganism is present in the discharges  Lumbar tap (pandy’s test)  EMG Clinical Manifestations  Stool exam  Fever  Petecchial/purpuric rashes Polio Treatment  Signs of increased ICP  Pain relievers (like ibuprofen) - Severe frontal headache  A ventilator (a device that helps breathing) - Altered level of consciousness  Physical therapy that can help keep the muscles working. - Restlessness  Bed rest and fluids for flu-like symptoms. - Projectile vomiting  Antispasmodic medications to relax muscles. - Blurring of vision; papilledema; diplopia  Antibiotics for urinary tract infections. - Bulging fontanel in infants  A heating pad for muscle aches and spasms.  Signs of meningeal irritation - Kernig’s sign Nursing Management - Nuchal rigidity – pathognomonic sign  Strict isolation, enteric precaution (d/t fecal mot) - Opisthotonus  CBR / Firm and non-sagging bed - Brudzinski’s sign  ROM exercises  Late Signs  Analgesics / Hot moist compress - Decerebration  Protective devices - Decortication  Hand roll – claw hand  Trochanter roll – outer rotation of the femur  Footboard Two Vaccine for Polio  Oral Polio Vaccine (OPV) and the Inactivated Polio Vaccine (IPV).  In the Philippines still using OPV, IPV does not replace the OPV vaccine, but is used with OPV to strengthen a child's immune system and protect them from polio. Two Types of Polio Vaccine IPV (Salk) - Jonas OPV (Sabin) – Albert Bruce  Killed formulized virus  Live attenuated virus  Given SC or MI  Given orally  Include circulating  Immunity is both humoral antibodies but not local and intestinal. Induces (intestinal immunity) antibody quickly.  Prevents paralysis but  Prevents paralysis and does not prevent re- prevent re-infection infection  Easy to manufacture and  Difficult to manufacture cheaper and costly  Can be effectively use in  Not useful with controlling controlling epidemics epidemics Diagnostic Test MENINGITIS  Lumbar Tap  Other Name: Cerebrospinal Fever - CSF fluid drawn from between two vertebrae Etiologic Agent  Neisseria meningitides  Streptococcus pneumonia Jhameel - Page 4 of 5  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINALS 2024 Complications  Bronchitis  Pneumonia  Otitis media/ Mastoiditis  Blindness  Hydrocephalus Medical Treatment  Antibiotic - Penicillin G- drug of choice - Alternative: Chloramphenicol  Mannitol  Pyrentinol/Encephabol - CNS stimulant  Anticonvulsant - Diazepam - Phenytoin (Dilantin)  Corticosteroid - Prednisone - Dexamethasone Nursing Management  Respiratory Isolation: 24 hours after onset of antibiotic therapy  Provide non-stimulating environment  Initiate seizure precaution  Avoid factors that increase ICP Preventive Measures  Vaccination: Hib- for children  Avoid MOT  Rifampicin- prophylactic treatment - Alternative: Ciprofloxacin Jhameel - Page 5 of 5  NCMB312 LECTURE BSN 3RD YEAR 1ST SEMESTER FINALS 2024 Bachelor of Science in Nursing 3-YA Professor: Mr. Gerry Nicolas, RN, MAN 14-1 LEPTOSPIROSIS Clinical Manifestations  Adolf Weil of Heidelberg Septic Stage - reported the clinical entity of fever, jaundice, hemorrhage,  This stage is marked with febrile lasting for four to seven days. and renal failure in 1886  Abrupt onset of remittent fever  Other names  chills - Weil’s disease  headache - Canicola Fever  anorexia - Mud Fever  abdominal pain - Hemorrhagic jaundice - Swineherd’s Disease  severe prostration  respiratory distress and fever subsides by lysis Etiologic Agent  A spirochete of genus Leptospira (Leptospira interrogans) Immune or Toxic Stage  Iritis Incubation Period  Headache  6-15 days  Meningeal manifestations - Disorientation Period of Communicability - Convulsions  Leptospira is found in the urine between 10 to 20 days after - with CSF findings of aseptic meningitis the onset  Oliguria and anuria with progressive renal failure. Mode of Transmission  Shock, coma, and congestive heart failure are also seen in a. Ingestion or contact with the skin and mucous membrane severe cases of the infected urine or carcasses of wild and domestic Convalescent Stage animals. b. Through the mucous membrane of the eyes, nose, and  At this stage, relapse may occur during the 4th to 5th week mouth, and through a break on the skin. Diagnostic Test c. Direct human to human transmission is rare.  Blood urea-nitrogen and urea  Enzyme Link Immuno-sorbent Assay (Elisa)  Leptospira Antigen-antibody test (LAAT)  Leptospira Antibody Test (LAT)  Liver function test Complications  Meningitis  Respiratory Distress  Renal interstitial tubular necrosis that result to renal failure (Weil’s disease)  Cardiovascular problems Management 1. Medical Treatment of leptospirosis is geared toward: - Suppressing the causative agent - Fighting possible complications o Penicillin G – drug of choice o Ampicillin, Amaaoxicillin o For prophylaxis = doxycycline 2. Peritoneal Dialysis - Administration of fluid and electrolyte and blood as indicated. Nursing Management  Isolate the patient, urine must be properly disposed of.  Darken patient’s room.  Observe meticulous skin care  Keep clients under close surveillance.  For home care, clean near dirty places, pools, and stagnant water. Jhameel - Page 1 of 6  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINALS 2024  Facilitate health education on the modes of transmission of the - vomiting with stiffness disease. - neurologic manifestations within 24 hours, dizziness,  Encourage oral fluid intake. conjunctivitis o arthralgia myalgia Prevention and Control o decreased IQ  Sanitation in homes, workplaces, and farms is a must. o serious brain damage.  There is a need for proper drainage system and control of  The symptoms rapidly worsen, with signs and symptoms of: rodents (40 to 60 percent infected). - Rigidity  Animals must be vaccinated (cattle, dogs, cats, and pigs). - Ataxia - speech difficulties ENCEPHALITIS - ocular palsy  Encephalitis, also, known as brain fever is an acute - flaccid paralysis inflammation (swelling) of the brain usually resulting from - seizures either a viral infection or due to the body’s own immune system - confusion mistakenly attacking brain tissue. - loss of consciousness  This disease is most prevalent in Southeast Asia and the Far - coma East  Encephalitis can be life-threatening, but this is rare.  Mortality depends on a number of factors, including the Causative Agent severity of the disease and age.  The most common cause is a viral infection. The brain  Younger patients tend to recover without many ongoing becomes inflamed as a result of the body’s attempt to fight off health issues, whereas older patients are at higher risk for the virus. Encephalitis occurs in 1 in every 1,000 cases of complications and mortality. measles.  Encephalitis is more likely to affect children, older adults,  The Vector individuals with weakened immune systems, and people who - Culex Tritaenorhynchus live in areas where mosquitoes and ticks that spread specific - Culex Vishnui viruses are common. - Culex Gelidus  Primary encephalitis Laboratory Diagnosis - occurs when a virus directly infects the brain and spinal Lumbar Tap cord  Secondary encephalitis  Detection of Antigen from serum or cerebrospinal fluid (CSF) - occurs when an infection starts elsewhere in the body and to detect virus-specific IgM antibodies within 7 days of onset of then travels to the brain disease  Encephalitis can develop as a result of a direct infection to the brain by a virus, bacterium, or fungus, or when the Compliment Fixation Test immune system responds to a previous infection; the  To detect antibodies for infection immune system mistakenly attacks brain tissue. Neutralization Test Primary Encephalitis Three main categories of viruses:  To detect the presence of virus infections 1. Common viruses Immunofluorescence Assay - including HSV (herpes simplex virus) and EBV (Epstein- Barr virus);  To detect the antigen and antibodies 2. Childhood viruses - including measles and mumps Diagnosis and Treatment 3. Arboviruses  Clinical - (spread by mosquitoes, ticks, and other insects), including  Laboratory Tests Japanese encephalitis, West Nile encephalitis, and tick- - Tentative Diagnosis borne encephalitis o Antibody titer: e.g. ELISA o JE-specific IgM in serum or CSF Secondary Encephalitis - Definitive Diagnosis  could be caused by a complication of a viral infection o Virus Isolation  Symptoms start to appear days or even weeks after the initial  Treatment infection. The patient’s immune system treats healthy brain - No specific Treatment cells as foreign organisms and attacks them. - Supportive care  The incubation period is 4 to 21 days. Medical Management Japanese Encephalitis  The medical management is symptomatic and supportive  Japanese Encephalitis generally begins with: management. - Fever  Treatment for encephalitis focuses on alleviating symptoms. - Nausea  For patients with mild symptoms, the best treatment is rest, - Chills plenty of fluids, and Tylenol (paracetamol) for fever and - Headache headaches. Jhameel - Page 2 of 6  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINALS 2024 Medications  Season  Antiviral agents - more frequently during rainy seasons; but cases are all - Acyclovir year round o success is limited for most infections except when  Location the condition is due to herpes simplex - more prevalent in urban than rural communities  Corticosteroids - to reduce the brain’s inflammation, especially in cases of Mode of Transmission post-infectious (secondary) encephalitis  Bite of infected female AEDES AEGYPTI mosquito  Anticonvulsants - Carries the virus but is not a virus itself - Seizures Incubation Period - if Dilantin - check for WBC  3-14 days o causes agranulocytosis  Sedatives Clinical Manifestations - effective for seizures, restlessness, and irritability Grade I  If the patient has severe symptoms, they may need mechanical ventilation to help them breathe and other supportive  Symptomatic and supportive treatment. - Fever - Headache Nursing Management - Malaise  Provide comfort - Anorexia - keep patient in a quiet, well ventilated room; encourage - Chills oral hygiene and bed bath - Pain (Abdominal, Bone and Joint, and Ocular)  Prevent from complications - Rashes - turn the patient at least every 2 hours, encourage - (+) Herman’s Sign: Flushing of the skin increase oral fluid intake, encourage high caloric diet, - (+) Tourniquet Test (Rumple Leeds Test) moisten lips with mineral oil  Monitor intake and output Prevention and Control  The prevention are identification of vectors and eliminating breeding grounds, destruction of larvae, screening homes, and use of repellants.  Personal protective measures and mosquito elimination are the most important  Travellers going to endemic areas may consider vaccination DENGUE DF mosquito Malaria Mosquito  Aedes aegypti  Anopheles  Day biting  Night biting  Breeds in stagnant water  Breeds in clear, flowing  Dotted mosquito and shaded streams  Usually bite a person in  Brown colored and bigger motion in size  Usually do not bite a person in motion  Anopheles  Night biting  Breeds in clear, flowing and shaded streams  Brown colored and bigger in size  Usually do not bite a person in motion Etiologic Agent  Group B Arbovirus (I,II,II,IV)  Flavivirus  Chikungunya virus  Zika virus Incidence  Age Grade II - may occur at any age but peak in 4 to 9 years old  Manifestations of grade I plus spontaneous bleeding – BED  Sex REST - both sexes can be affected - Epistaxis Jhameel - Page 3 of 6  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINALS 2024 - Gingival Bleeding the NS1 rapid test aims to detect dengue NS1 antigen, it - Petechiae or ecchymosis should be performed within 5 days of onset of fever. - Gastro intestinal bleeding  A positive NS1 test result confirms dengue virus infection. o Ground coffee colored vomitus  A negative NS1 test result does not rule out infection. o Hematemesis - People with negative NS1 results should be tested for the o Melena presence of dengue IgM antibodies to determine possible o Hematochezia recent dengue exposure. Grade III  Manifestations of Grade II plus Beginning symptoms of circulatory failure - Monitor V/S and Watch out for complication of shock - Hypotension & narrowing of pulse pressure - Weak and thready pulse - Cold, clammy skin - Restlessness Grade IV  Manifestations of Grade III plus Shock- PROPER Complications POSITIONING  Shock  DEATH - Undetected BP and pulse Medical Treatment Classifications  Antipyretic/ Analgesic Mild DHF - Do not administer NSAID for Fever  slight fever  Intravenous Fluid Therapy  with or without petechial hemorrhage - Protocol for Fluid correction with NO SHOCK o IVF Crystalloids- D5LR or D5 0.9 NaCl or PLR at 5- 7 ml/kg/hr Moderate DHF - Protocol for fluid correction with SHOCK  high fever o IVF Crystalloids- PLR or P 0.9 NSS at 20ml/KBW IV  but less hemorrhage bolus in