Unit 1 - Communicable Diseases PDF

NCM 112A: Communicable Disease Nursing Prof. André N. Canaria, DPed, MSN, RN Basic Concepts A. Communicable Diseases – an illness due to an infection agent or its toxic products which is transmitted directly or indirectly to a well person or animal or thru an agency of an intermediate of an animal host, vector of the inanimate environment Contagious Disease vs. Infectious Disease A. Contagious Disease – easily spread directly from person to person; all contagious diseases are infectious. B. Infectious Disease – applied to diseases not transmitted by ordinary contact, but requires a direct inoculation of a break in the previously intact skin or mucus membrane Factors Responsible For The Transmission of Infection Causative or Etiologic Agent - mode of action of infectious agent Reservoirs of Infection – living bodies that harbor, sustain, and maintain the growth and multiplication of infectious agent Two Types of Reservoirs A. Human Reservoir - main reservoirs of infection 1. Infected persons from whom the infectious agent is transmitted to another person 2. Frank or Typical – person who are obviously ill and manifest typical signs and symptoms 3. Subclinical – infected persons where the disease is so mild that signs and symptoms are inapparent; referred to as missed or abortive, ambulatory/ walking cases NCM 112: Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 1 4. Carriers – infected persons who do not manifest any recognizable signs and symptoms (Strictly speaking no disease but the most dangerous) 5. Contact – close association 6. Suspect – medical history reveals that he has the disease B. Animal Reservoir Mode of Transmissions A. By Contact Transmission 1. Direct contact (person to person) 2. Indirect contact (usually thru an inanimate object) 3. Droplet contact (from coughing, sneezing, or talking) B. By Vehicle Route (thru contaminated items) 1. Food – salmonellosis (poisoning) 2. Water – shigellosis 3. Drugs – bacteremia resulting from infusion of a contaminated product 4. Blood – hepatitis B C. By Airborne Transmission 1. Droplet nuclei – residue of evaporated droplets that remain suspended in the air 2. Dust particle containing the infectious agent 3. Organism shed into skin thru environment D. By Vector Borne Transmission (via contaminated or infected arthropods such as ﬂies, ticks, and others) E. By Vertical Transmission (from the mother to the neonate, e.g., AIDS, Hepatitis B and C, Malaria, Syphilis) Mode of Entry/ Portal of Exit 1. Respiratory Tract – most common 2. GI Tract – easiest way thru indirect contamination 3. Genitourinary 4. Direct infection of Skin/ Mucus Membrane 5. Percutaneous Infection – infections, bites and stings Susceptible Host – humans or animals that don’t have resistance to infection Factors AFecting Entrance of Infection To The Body 1. Age, Sex, Genetic Constitution 2. Nutritional Status, Fitness, Environmental Factors 3. Absent or Abnormal Immunoglobulins a. Immunoglobulin (Ig) – related proteins that act as antibodies 4. General Physical, Mental, and Emotional Health 5. Status of hematopoietic system, e^icacy of reticuloendothelial system a. E^icacy of Reticuloendothelial System (RES) – concerned with defense against microbial infections 6. Presence of underlying disease (DM, Leukemia) 7. Patients treated with radiation, chemotherapy, corticosteroids, and other immunosuppressive agents Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 2 Patterns of Occurrence and Distribution NO PATTERN CHARACTERISTICS H- High, L - Low 1 SPORADIC Intermittent occurrence of a few isolated and unrelated cases in a H Immune given locality L Susceptibility Disease occasionally present here and there Examples: Rabies 2 ENDEMIC Continuous occurrence throughout a period of time of the usual L Immune number of cases in a given locality Examples: Malaria, Schistosomiasis L Susceptibility 3 EPIDEMIC Occurrence of an unusually large number of cases in a relatively short L Immune period of time Examples: AIDS H Susceptibility 4 PANDEMIC Simultaneous occurrence of epidemics of the same disease in several L Immune countries Worldwide epidemic H Susceptibility Examples: AIDS, COVID – 19 *Herd Immunity – state of immunity of the community Principles / Philosophy of Immunization 1. Immunization – the prevention of communicable diseases through the utilization of speciﬁc immunizing agents, by the use of which the body protects itself against infections and diseases 2. Resistance/ Immunity – the body’s ability to withstand infection, but it does not absolutely meant hat one who possesses it is free from disease Types of Immunity A. Natural Immunity – inborn protection 1. Racial – inherent to a certain race (e.g., blacks against yellow fever) 2. Hereditary – through genetic make – up 3. Congenital – resistance of the body in the uterus through placenta (e.g., measles) 4. Individual – to distinct person (e.g., body built) B. Acquired Immunity – after birth 1. Active – antibodies are manufactured by the tissues of the body *Types of Active Immunity a. Natural Active Acquired – initiated by the production of the antibodies following a clinical attack infection b. Artiﬁcial Active Acquired – acquired by the production of the antibodies which is artiﬁcial (e.g., vaccination) 2. Passive – antibodies are already formed and introduced into the body *Types of Passive Immunity a. Natural Passive Acquired – antibodies produced by natural processes (e.g., breastfeeding, colostrum, maternal antibodies) b. Artiﬁcial Passive Acquired – man develops antibodies (e.g., serum, Ig) Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 3 Stages of Illness A. Incubation Period (IP) *The time interval between the ﬁrst exposure to the appearance of the ﬁrst signs and symptoms B. Prodromal Period *The premonitory sign, indicates the impending attack C. Period of Illness *The stage where typical signs and symptoms are manifesting D. Period of Convalescence *On the road to recovery Responsibility to the Communicable Disease Patient: A. Give nursing care B. Prevent others from contracting the disease C. Prevent oneself from contracting the disease D. Prevent cross infection E. Disseminate information to others General Care of Patients with Communicable Disease A. Prevent the spread of the communicable disease 1. Health education 2. Immunization 3. Environmental sanitation 4. Supervision in the preparation of food B. Control Measures 1. Isolation – the separation of persons su^ering from communicable disease or carriers of the infecting organism from other persons and placing them under such condition that direct transmission to susceptible person is prevented based on the period of communicability (time wherein the body is still discharging the microorganism) Types of Isolation Purpose/ Objective Enteric Isolation To prevent the spread of the disease that can be transmitted through direct contact with infected feces Respiratory Isolation To prevent omission of organism by means of droplets that are coughed, sneezed, and breathed into the environment Strict Isolation To prevent the spread of infectious diseases by preventing contamination of environment, products, or personnel Wound and Skin To prevent cross infection of personnel and patients Precaution from infection transmissible by direct contact with wounds and other conditions resulting to skin secretion and heavily contaminated particles Reverse Isolation To protect the patients from acquiring other disease because of lowered resistance 2. Quarantine – limitation of movement based on longest incubation period; client has NO signs of infection 3. Disinfection – destruction of the pathogen a.) Concurrent – done in the presence of an infection b.) Terminal – done after the patient is discharged from the hospital i. Medical Asepsis ii. Gowning – protects the inner part iii. Mask – ﬁlter the microorganisms iv. Medical Handwashing – simplest and the most e^ective v. Placarding – placing a reminder at the patients’ rooms Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 4 OUTLINE OF COMMUNICABLE DISEASES NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT A. DISEASE CAUSED BY BACTERIA 1. Pulmonary Tuberculosis 2. Bacterial Meningitis 3. Diphtheria 4. Pertussis B. VIRAL INFECTIONS 1. Measles 2. German Measles 3. Chicken Pox (Varicella) 4. Herpes Zoster 5. Mumps NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE GASTROINTESTINAL TRACT (GIT) A. DISEASE CAUSED BY BACTERIA 1. Typhoid Fever 2. Cholera (El Tor) 3. Bacillary Dysentery B. DISEASES CAUSED BY VIRUSES 1. Poliomyelitis C. DISEASE CAUSED BY PARASITES 1. Amoebiasis 2. Helminth Infections a. Trichinosis b. Ancylostomiasis c. Ascariasis d. Enterobiasis e. Taeniasis f. Trichuriasis g. Paragonimiasis NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE INTEGUMENTARY (SKIN) A. DISEASE CAUSED BY TRAUMA AND INOCULATION 1. Tetanus 2. Rabies 3. Malaria 4. Dengue Fever 5. Leptospirosis 6. Schistosomiasis 7. Leprosy NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE GENITOURINARYTRACT (GUT) A. Gonorrhea B. Syphilis C. Acquired Immuno-Deﬁciency Syndrome (AIDS) D. Chlamydiasis Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 5 DISCUSSION ON COMMUNICABLE DISEASES NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT A. DISEASE CAUSED BY BACTERIA 1. Pulmonary Tuberculosis (PTB) (Phitis, Consumption) – wasting away of the body Koch’s Disease – Robert Koch identiﬁed the microorganism CA: Mycobacterium tuberculosis MOT: Droplet Infection IP: 2 – 10 weeks Clinical Manifestations (CM) PRIMARY INFECTION – vague symptoms First infection with tubercle bacilli Most cases; ( + ) tuberculin test/ Puriﬁed Protein Derivative (PPD) Infection without Signs and Symptoms Change in behavior (restlessness and irritability) Easy fatigability Crepitation and rales POST PRIMARY TUBERCULOSIS Visibly ill due to fever Distressing cough Distressing breath sounds CHRIONIC PTB A. Generalized signs and symptoms General malaise, anorexia, easy fatigability, apathy, irritability, indigestion Tachycardia, dyspnea, cyanosis Fever – late in the afternoon Night sweats – acute exudates involvement (advanced cases) Loses weight Malaise Hemoptysis DIAGNOSTIC TEST A. Sputum Acid – Fast Bacilli Staining Best diagnostic test Results of Sputum Microscopy O Negative for bacilli + 1 – 4 bacilli ++ 5 – 10 bacilli +++ 11 – 20 bacilli ++++ More than 20 bacilli B. Chest X – ray C. Mantoux Test Most common tuberculin testing Intradermal injury of puriﬁed protein derivative (PPD), results read after 48 – 72 hours Induration of 10 mm or more is POSITIVE D. Stemeedle – multiple – puncture of six needles Using PPD Induration of 4mm or more points to be read after 3 – 7 days is POSITIVE Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 6 TREATMENT (NEW COURSE) DRUGS R Rifampicin 450 mg Urine may turn reddish – orange. Harmless but may stain clothing and contact lenses. WOF: liver problems (jaundice, dark urine, persistent nausea) I Isoniazid 300 mg Taken with Vit. B6 (Pyridoxine) to prevent neuropathy WOF: liver problems (jaundice of skin/ eyes, abdominal pain) P Pyrazinamide 500 mg Hydration to prevent uric acid buildup (reduce risk for gout -like symptoms) E Ethambutol 400 mg Regular eye examination (can cause optic neuritis) S Streptomycin 1g Regular hearing and kidney function tests Category Cases Intensive Phase Maintenance Phase I Sputum Positive (New Patient) PTB with Extensive Lung Damage ( - ) AFB RIPE (2 months) RI (4 months) Extrapulmonary TB II TB Relapse and Failures RIPES (2 months) RIE (5 months) RIPE (1 month) III TB with Sputum Negative, but ( + ) CXR Extrapulmonary IB (not serious) RIP (2 months) RI (2 months) Nursing Care 1. Complete Bed Rest (CBR) 2. Adequate Nutrition 3. Ambulatory Chemotherapy (due to long duration [typically 6 – 9 months], and multiple medicatoiins) 4. NPO – hemoptysis (due to risk of aspiration and determine underlying cause) 5. Oxygen Inhalation 6. Blood Transfusion 7. Coagulants – Vit. K and Hemostan (Risk of Pulmonary Embolism) NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT A. DISEASE CAUSED BY BACTERIA 2. Bacterial Meningitis Spotted Fever, Cerebrospinal Fever, Epidemic Cerebrospinal Fever, Meningococcal Meningitis CA: Neisseria meningitidis Other strains a. Hemophilus inﬂuenza – common in young children b. Streptococcus pneumonia – common in adults c. Staphylococcus aureus Period Communicability – until meningococci are no longer present in the mouth and nasal discharges IP: 3 – 6 days MOT: respiratory droplets Clinical Manifestations 1. Nuchal Rigidity – pathognomonic sign, meningeal irritation 2. Neck, Shoulder, and Back Sti^ness – due to spasm of extensor muscles 3. Opisthotonus – postural abnormality characterized by hyperextension of the back and neck muscles and retraction of the head and arching forward of the trunk Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 7 4. Positive Neurologic Exam a.) ( + ) Kernig’s Sign – if thigh is ﬂexed on the abdomen, patient cannot extend his legs *Resistance or pain during knee extension while the hip is ﬂexed is indicative of meningeal irritation. b.) ( + ) Brudzinski’s Sign – when the neck is ﬂexed on the chest, ﬂexion of knees and hips is produced *When passive ﬂexion of one side of the lower extremity is made, similar movement will be seen on the opposite extremity. Diagnostic Exam 1. Lumbar Puncture To decrease intracranial pressure (ICP) To introduce medications To obtain specimen 2. Positive Neurologic Exam Nursing Care 1. Isolate the patient – quiet and darkened room 2. Prevent stress -provoking factors 3. Prevent injury during episodes of convulsions 4. Maintain ﬂuid and electrolyte balance 5. Provide balanced diet – low fat 6. Maintain personal hygiene and cleanliness NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT A. DISEASE CAUSED BY BACTERIA 3. Diphtheria It is characterized by formation of pseudo membrane commonly in the faucial area and tonsils by the exotoxin produced by Corynebacterium diphtheriae (KLEBS-LOEFFLER BACILLUS) Common in children 6 months to 5 years Rare below 6 months due to immunity passed from the mother MOT: a.) Direct contact of mouth secretions b.) Indirect through toys and clothing that are contaminated IC: 2 to 6 days Pathognomonic Sign: Pseudo membrane Period of Communicability a.) 1 to 2 days in treated patients b.) 2 to 4 weeks in untreated patients Three Types (with signs and symptoms) a.) Nasal – pseudo membrane in nose, excoriation of upper lips with serosanguinous secretions b.) Pharyngeal – sore throat, bull’s neck appearance (swelling of neck), dysphagia, weight loss, and anorexia c.) Laryngeal – hoarseness may be cough, laryngeal obstruction and respiratory arrest *Pseudo membrane may be coughed out by the 6th to 10th day which could cause death secondary to airway obstruction TREATMENT 1. Serum Therapy (Diphtheria Antitoxin) *** a.) Goal: neutralization of the toxin b.) Skin testing is done to determine allergy 2. Antibiotics – destruction of microorganism (e.g., penicillin or erythromycin) 3. Isolation of the Patient – until 2 to 3 cultures from both nose and throat with 24 hours interval have ( - ) result 4. Tracheostomy – laryngeal obstruction Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 8 NURSING INTERVENTION 1. CBR – prevent complications 2. Oral Hygiene 3. Maintain ﬂuids and electrolytes 4. Adequate nutrition 5. Ice collar – to relieve pain PREVENTION AND CONTROL 1. Active Immunization – DPT vaccine 2. Covering of mouth when coughing/ sneezing 3. Proper disposal of secretions COMPLICATIONS 1. Toxic Myocarditis – action of the toxin in the heart muscle (usually during the 10th to 14th day) 2. Neuritis – absorption of toxin in the nerve DIAGNOSTIC TEST 1. Schick’s Test – determine susceptibility or immunity a.) ID injection of diluted Diphtheria toxin and read 48 to 72 hours after b.) Reveals local circumscribed area of redness usually 3 to 4 cm in diameter 2. Nose and Throat Swab 3. Maloney’s Test – determine hypersensitivity to Diphtheria toxoid a.) ID injection of 0.1cc of ﬂuid toxoid b.) Reveals erythema (abnormal ﬂushing) within 24 hours of injection NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT A. DISEASE CAUSED BY BACTERIA 4. Pertussis (Whooping cough) Characterized by repeated attacks or spasmodic coughing which consist of a series of explosive expiration typically ending in a long-drawn force inspiration which produces the characterized crowing sound the “whoop” &usually followed by vomiting. Caused by Bordetella Pertussis (Whooping Cough Syndrome – caused by B. parapertussis, B. bronchiseptics, Adenoviruses Mode of Transmission Direct contact from droplet spread from infected child during incubation period and catarrhal stage PERIOD OF COMMUNICABILY : Days after exposure to 3 weeks after of typical paroxysms INCUBATION PERIOD: 7 to 14 days (dis. Is only about 6 weeks) CLINICAL MANIFESTATION: CATARRHAL STAGE (last about 1 to 2 weeks) Nasopharyngeal secretions Wheezing and cough Low grade fever Stage of hyper communicability PAROXYSMAL STAGE Beginning at the end of 2nd week and last for 4 to 6 weeks Spasmodic cough – whoop which is provoked by eating, crying and exertion Subconjunctival hemorrhage – rupture of capillaries - abdominal hernia Convulsion- due to anoxia and intracerebral hemorrhage During the attack, the child is cyanotic, eye bulging or popping out, tongue protrudes, lacrimation, choking spells and may be with epistaxis. Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 9 CONVALESCENT STAGE End of the 4th week or 6th week attack begins to diminish unless there is secondary respiratory tract infection. Diagnostic Test COUGH PLATE – culture from nasopharyngeal secretions Treatment 1. CONTROL PLATE – sedatives or narcotic-derived expectorants 2. ANTIBIOTICS – Erythromycin or penicillin Nursing Care 1. CBR 2. Increase Fluid Intake – not during attack 3. Abdominal binders – to prevent abdominal hernia 4. No large nipples – to prevent aspiration 5. No feeding during attacks 6. Isolation during communicability stage 7. Avoid excitement 8. Do not bring to outdoors Prevention 1. DPT VACCINE – may give cross immunity 2. Avoid prolonged skin to skin contact NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT B. VIRAL INFECTIONS 1. Measles (Rubeola, 7-day measles, Morbilli, & Red Measles) Contagious exanthematous disease of acute onset Caused by measles virus (paramyxovirus – ﬁlterable virus) Mode of transmission Droplet infection OR AIRBORNE. Indirect thru contaminated articles with respiratory secretions INCUBATION PERIOD: 10 to 22 days PERIOD OF COMMUNICABILITY: 5h day of incubation period until the day of the rash. Three Stages A. Pre-eruptive stage (highly communicable) Fever Catarrhal symptoms – inﬂammation of the mucous membrane Respiratory symptoms – common cough colds Enanthem sign – eruption in the mucous membrane KOPLIK’S SPOTS – pathognomonic sign, small whitish pinpoint spots in inner cheeks due to epithelial necrosis STIMSON’S LINE – pu^iness of eyelids with reddish line on conjunctiva. B. Eruptive stage – following the appearance of KOPLIK SPOTS all signs during the ﬁrst stage will disappear. Exanthem – eruption on the skin; maculopapular rashes (red in color) Starts from hairline behind the ears, face, neck, upper and lower extremities (concentrates on the face and trunk) on the day Anorexia and irritability Pruritus Lethargy C. Post-eruptive stage – ﬁne desquamation of skin and rashes in the name manner as they appear (observe for branny desquamation) Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 10 Diagnostic test: 1 Nose and throat swabbing 2 Urinalysis 3 Blood chemistry – increases lymphocytes 4 Complement ﬁxation or hemagglutination test (conﬁrmatory test) Treatment: No therapy for uncomplicated measles (self-limiting) Prevention: immunization with measles vaccine Nursing Inventions: 1. Symptomatic and supportive a. Eye-care-wash face and avoid direct sunlight b. Oral hygiene c. Skin-care – no strong soaps and alcohol d. Anti-pyrectics for fever e. Hypoallergenic diet f. Vitamin A as ordered – to protect the epithelial lining of the resp. tract, GIT and eyes. 2. Vaseline – applied to edges of eyelids to prevent them from sticking together. 3. Penicillin for secondary infections NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT B. VIRAL INFECTIONS 2. German Measles (3 days measles, rubella) Caused by rubella virus and characterized exanthem and fever with minimal complications but has teratogenic e^ect on o^spring during pregnancy Mode of transmission: airborne droplet nuclei or close contact Incubation period: 10 to 21 days Period of communicability: Entire course of illness Clinical manifestations: 1. Fever and malaise 2. Lymphadenopathy – enlargement of lymph node a. Postauricular lymph nodes b. Post cervical lymph nodes c. Suboccipital lymph nodes 3. Pinkish maculopapular rash – begins on the ﬁrst day, starting on the face rapidly to trunk and limbs and fades on the third day leaving no pigmentation no desquamation 4. Forscheimer’s spot- small red lesions on soft palate and mucous membrane 5. Splenomegaly 6. Testicular pain on young adults Congenital defects to fetus: Bilateral congenital cataracts Congenital heart disease Microcephaly with MR Diagnostic test: Hemagglutination - inhibition test(HI) Antibody test most useful technique for diagnosis Compliment – ﬁxation test (CF) Elisa (Enzyme Linked Immunosorbent Assay) – determine amount of substance using antibody reaction Treatment/nursing care: PURELY SYMPTOMATIC (SELF-LIMITING) PREVENTION - Live attenuated: Rubella vaccines – from 1 week to puberty (MMR – 5th month of age) - Gamma Globulin- may be given to a pregnant client exposed to rubella. Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 11 NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT B.VIRAL INFECTIONS 3. Chicken Pox (Varicella) Highly contagious disease caused by herpes virus characterized by vascular eruptions on the skin and mucous membrane. Mode of transmission: direct thru droplets infection or airborne; indirect thru linen and fomites. Incubation period: 10 to 21 days Clinical Manifestations: 1. Mild fever and malaise 2. Rash – start form the truck and spread to others parts, progression completed in 6 to 8 hours a. Macule- lesion that is ﬂat b. Papule- an elevated lesion c. Vesicle- ﬁlled with clear ﬂuid d. Crust – a scab lesion caused by secretion of a vesicle drying on the skin e. Pustule – vesicle a^ected and ﬁlled with pus 3. Pruritus – accompanying annoying symptom Diagnostic test: 1. Determination of varicella-zoster antibody by: a. Compliment – ﬁxation test b. Fluorescent and membrane antigen Treatment: symptomatic (self – limiting) Nursing interventions: 1. Isolation until crust have fallen o^ 2. Calamine lotion over rashes 3. Antipyretics- for fever 4. Handwashing and cutting of ﬁngernails NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT B.VIRAL INFECTIONS 4. Herpes Zoster (Shingles, zoster, acute posterior ganglionitis) An acute viral infection of the nerve structure caused by variety of varicella-zoster virus (chicken pox) Mode of transmission: direct thru droplet infection/indirect thru infected articles Period of communicability: Until the last crust falls o^ Incubation period: 1 to 2 weeks Clinical manifestations 1. Vesicular rashes that appear in cluster, painful, and unilateral. 2. Vesicle formation – last for 1 to 2 weeks 3. Fever and regional lymphadenopathy 4. Gasserian ganglionitis (iridocyclitis & corneal anesthesia) 5. Ramsay hunt syndrome – paralysis of the auditory canal secondary to infection of seventh cranial nerve Diagnostic exam 1. Viral Culture of the vesicles 2. Smear of the vesicular ﬂuid Treatment: ACYCLOVIR (drug of choice) Nursing actions: 1. Compress of NSS or Potassium permanganate on lesions 2. Symptomatic treatment with antipyretics & analgesic 3. Proper disposal of secretion – reduce possibility of recurrence Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 12 NURSING CARE OF PATIENTS WITH DISEASES OF AND AQUIRED THROUGH THE RESPIRATORY TRACT B.VIRAL INFECTIONS 5. Mumps (Epidemic Parotitis) Acute viral infection of the salivary glands particularly the parotids caused by paramyxovirus group. Mode of transmission: person to person thru droplet infection Period of communicability: 7 days before and 9 days after parotid glands swell Clinical manifestation: 1. Slight malaise with low grade fever 2. Headache 3. Pain below the ear when moving the jaws 4. Parotid glands (70%) are swollen, painful, enlarge and tender 5. Pain on chewing and swallowing – earliest symptom 6. Constitutional manifestation may last about days while glands remain swollen for 5 to 19 days Nursing intervention 1. Isolation precaution 2. Support to comfort and corticosteroids to relieve pain in orchitis 3. Bed rest 4. Cold application 5. Soft bland diet Incubation period: 14 to 28 days Diagnostic test: 1. Blood exam- high leukocytes 2. Viral culture – form mouth swabs, saliva 3. Viral serology- complement ﬁxation Treatment: Symptomatic (self-limiting) Orchitis- may occur even without swelling of the parotids may produce sterility a dreaded complication on males NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GIT) A. DISEASE CAUSED BY BACTERIA 1. Typhoid Fever (Enteric fever, typhus abdominals) - general infection caused by salmonella typh; involving primarily the lymphoid tissue (Peyer’s patches) Small intestine Mode of transmission: Ingestion of contaminated food and water Period of communicability: as long as bacteria is excreted Incubation Period: 10 days 20 days Stages A. Prodromal stage: fever, Abdominal pain , constipation/diarrhea B. Fastigial stage – 3 cardinal symptoms 1. Intermittent ladder like fever 2. Rose spots (pathognomonic) – macules that disappears after applying pressure on abdomen and chest 3. Splenomegaly Diagnostic test 1. Widal test – blood serum agglutination test; best done during 8th day (2nd stage) 3 antigens used - (+) antigen O – active typhoid stage - (+) antigen H – Previously infected or vaccinated individual - (+) antigen VI – Common in carries 2. Typhidot exam – may be done on the 2nd week of illness 3. Blood culture - best done on the 1st week or 1st stage, will conﬁrm typhoid fever. 4. Urine culture – done during the 1st 2 weeks 5. Stool culture – best done during the 3rd stage Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 13 Treatment: Chloramphenicol – drug of choice Prevention: 1. Immunization with CDT (cholera, dysentery, typhoid) 2. Proper disposal of feces 3. Hand washing 4. Proper preparation, storage and cooking foods Nursing intervention 1. Supportive care – ﬂuid and electrolytes 2. Monitor intake and output 3. Increase ﬂuid intake 4. High caloric, low residue and non – irritating foods 5. Watch for complication: a. Perforation of intestines S/sx: sudden sharp abdominal pain rigidity and shock b. Typhoid psychosis stage- organism goes to the brain S/sx: coma vigil look – blank stare dilated pupils Carphologia – involuntary picking of lines Sultus tendinum – involuntary twitching of the tendons of the wrist. NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GIT) DISEASE CAUSED BY BACTERIA 2. Cholera (El Tor) Characterized by vomiting and massive watery diarrhea with rapid dehydration and shock. Can occur in epidemics and caused by: Vibrio coma – OGAWA, INIBA, HIROJIMA Vibrio cholerae – classic, el tor Spirillum cholerae, Spirillum asiatica Mode of transmission: Fecal-oral thru contaminated food and water Period of communicability not known but presumed till (+) stool culture Clinical manifestation: A. Mild cases- undetectable B. Severe cases – starts with colicky pain in abdomen and mild diarrhea (eneralgia) 1. Stool is yellow at ﬁrst 2. Marked mental depression 3. Headache 4. Continuous vomiting – dehydration 5. Thirst is terrible 6. Violent cramps of lower extremity 7. Patient may collapse 8. Temperature of 104 deg F 9. Rice watery stool & washer womans hands (pathognomonic signs) Prevention: 1. Immunization with CDT 2. Control of lies breeding places 3. Water sterilization 4. Proper disposal waste Incubation period: 1 to 3 days and vary from few hours to 5 days Diagnostics exam: culture of stool and vomitus Nursing actions: 1. Isolation 2. Personal hygiene 3. Intake and output monitoring 4. Proper disposal of feces 5. Precautions of ﬁve F’s (Food, Flies, Feces, Fingers, & Fomites) Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 14 Treatment 1. Fluid replacement – IV 2. Oral hydration – Oresol 3. Antibiotics – Penicillin or tetracyclines 4. Correction of electrolyte imbalance like hypokalemia and metabolic acidosis. NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GIT) DISEASE CAUSED BY BACTERIA 3. Bacillary Dysentery (Shigellosis, bloody ﬂux) Acute bacterial disease of the intestinal tract that includes a group of enteric infection caused by stair of bacillus dysentery. Four major serologic groups 1. Shigella dysenteria- most infections 2. Shigella Flexner – most infections 3. Shigella boydei 4. Shigella sonnei Mode of transmission: ingestion of contaminated food and water Incubation Period: 3 to 4 days (vary from 7 hours to 7 days) Clinical manifestation 1. Fever – initial symptom 2. Vomiting and headache 3. Colicky or cramping abdominal pain and tenderness with anorexia, malaise and weakness 4. Bowel movements- numerous accompanied with abdominal cramps and tenesmus Nursing Intervention 1. Maintain ﬂuid and electrolyte balance 2. Assess weight loss, skin turgor, mucous membrane urinary volume 3. Weigh daily 4. O^er liquids 5. Restrict food till nausea and vomiting subsides 6. Supervision on food storage, cooking and preparation. 7. Medical handwashing Treatment Fluid replacement Cotrimoxazole Correction of electrolyte imbalance and metabolic acidosis Prevention Fly control program Surveillance of water sanitation Handwashing after defecation Detection and treatment of carries NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GIT) B. DISEASES CAUSED BY VIRUSES 1. Poliomyelitis (infantile paralysis, acute anterior poliomyelitis) - a^ects mostly the anterior horn cells of the spinal cord and medulla, cerebellum and mid-brain Causative agent: caused by polio virus (legio debilitants) Serologic Types (no cross-immunity) 1. Type I – BRUNHILDE, most frequent cause of paralysis, both occurring in epeidemic 2. Type II – LANSING, next most frequent 3. Type III – LEON, least common Period communicability: most contagious a few days before and after onset of symptoms when the virus is found in oropharynx for about a week and feces for 3 months. Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 15 Three types of paralysis 1. Spinal paralytic poliomyelitis – involvement of the anterior horn cells 2. Bulbar paralytic poliomyelitis - involvement of cranial nerves 9th cranial nerves (gloss swallowing reﬂex) 10th cranial nerves (vagus) – cardiac and respiratory reﬂex 3. Bulbospinal paralytic poliomyelitis – involvement of brain and spinal cord Clinical manifestation (3 stages): host reacts to any stage and recover 1. Intestinal/Invasive phase a. Signs, and symptoms of URTI; fever, malaise headache and sore throat b. Signs and symptoms of GI disturbance: anorexia vomiting and abdominal pain If patient does not progress to stage 2, polio is an abortive type. 2. Viremic phase (virus in the blood) a. Fever, headache, vomiting an irritability 3. Neural phase – CNS involvement a. (+) POKER SPINE - meningeal irritation b. Any motion that produces anterior ﬂexion of spine cause sti^ening of the neck and spine Hypersensitivity – touch very irritating Paralysis & Flaccid Paralysis (+) HAYNE ‘S SPINE -head falls back when in the supine and shoulders elevated - inability to raise legs to full 90 degrees (+) KERNING’S & BRUDZIKI’S SIGNS Diagnostic exam: 1. PANDY’S TEST – isolation 2. LUMBAR PUNCTURE – CSF exam shows elevated protein level. 3. MUSCLE TESTING- to determine extent of muscle paralysis Treatment: No speciﬁc treatment Nursing interventions: 1. Bed rest- provide ﬁrm non sagging bed 2. Analgesic – relieve head and back pains & muscle spasms 3. Hot moist pack – relieve muscle spasms Prevention 1. POLIO VACCINE IMMUNIZATION a. SALK – solution of killed viruses b. SABIN – attenuated viruses - given oral for 3 doses (2gtts) NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GIT) C.DISEASE CAUSED BY PARASITES 1. Amoebiasis (amoebic dysentery) Infection caused by Entamoeba histolytica involving colon but may a^ect soft tissues or organ. Clinical variation 1. Acute amoebic dysentery Stools contained blood and mucus which may give rise to amoebic hepatitis or liver abscess 2. Chronic amoebic dysentery – with recurrent attach of diarrhea or relatively mild dysentery 3. Amoebic colitis – characterized by episode of abdominal discomfort – frequently stimulating appendicitis 4. Carriers – with stools containing the organism but remains free form symptoms Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 16 Clinical manifestation 1. Symptomatic for carries 2. Attacks of diarrhea alternating, blood streaked and mucoid 3. Eructations 4. Fever 5. Anoxia, weight loss and weakness Nursing action 1. Isolation of patient 2. Health teaching Sterilization of water Cover left over foods Handwashing Diagnostic exam 1. Stool exam 2. Serologic test 0 indirect hemagglutination Treatment Metronidazole, chloroquine, diloxanide furoate Complication 1. Liver absences – ACHOVY SAUCE – appearance of the abscess (thick reddish brown ﬂuid similar to a chocolate) 2. Lung abscess 3. Brain abscess NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GIT) C.DISEASE CAUSED BY PARASITES 2. Helminth Infections Worm infection a. Trichinosis caused by nematode (trichinella spirilia)- round worms thru ingestion of uncooked pork products secondary to feeding uncooked garbage b. Ancylostomiasis (HOOKWORM DISEASE) Thru contaminated soil by human feces containing hook ova caused by: Ancylostomna duodenale – common in Asia Necator americanus – common in America c. Ascariasis – caused by ascaris lumbricoides which is large round worm. Fertilized eggs contaminates food and water d. Enterobiasis (PINWORM, THREAWORM OR SEATWORM) caused by Enterobius vernularis thru and oral transmission or eggs or indirect transmission from contaminated clothing, beddings or food characterized by nocturnal anal itchiness. e. Taeniasis caused by: taenia saginata – beef tapeworm/taenia solium – pork tapeworm f. Trichuriasis (WHIPWORM) caused by trichuris trichura from soil and food contaminated with feces. g. Paragonimiasis (PULMONARY DISTOMIASIS) caused by paragonimus estennai (lung ﬂuke) from ingestion of raw or insu^iciently cooked crab or crayﬁsh containing larvae. Mode of transmission 1. indirect contact – ingestion of contaminated food or water 2. direct contact but unusual (urogenital, or anal sexual Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 17 Incubation: 3 to 4 weeks ( days for severe infection while several months for sub-acute or chronic forms Period of communicability: entire duration of illness Clinical manifestation : 1. Voracious appetite – greedy in eating 2. Pot belly – protruding abdomen 3. Malnourished with anemia Diagnostic exam : stool exam Nursing care 1. Symptomatic 2. Focused on hygiene of the patient Treatment 1. Anti-helminthes-combatrin or antiox Prevention 1. Proper preparation of food 2. Proper disposal of waste 3. Precaution of the ﬁve P’s NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE INTEGUMENTARY (SKIN) A. DISEASE CAUSED BY TRAUMA AND INOCULATION 1. Tetanus - infectious disease caused by an anaerobic bacteria/cannot leave in the presence of oxygen) which produces a potent exotoxin TWO FORMS: 1. VEGETATIVE - destroyed by heat, chemical 2. SPORE-BEARING MODE OF TRANSMISSION - direct and indirect contamination of wound, umbilical stump in newborn INCUBATION PEROD: 3 days to 3 weeks with average of 10 days PERIOD OF COMMUNICABILITY: not transmitted persons to person directly CLINICAL MANIFESTATIONS: 1. LOCKJAW or TRISMUS painful spasm of the masticatory muscles because Trigeminal nerves are a^ected 2. RISUS SARDONICUS / SARDONIC SMILE due to spasm of the facial nerves are a^ected 3. OPISTHOTONUS - arching of the back 4. MUSCULAR SPASM - general rigidity TONIC - continuous contraction of muscles CLONIC - alternate contraction an relaxation of muscles BOARDLIKE ABDOMEN PHOTOPHOBIA - eyes partially close LARYNGEAL / PHARYGEAL SPASM IRRITABILITY AND RESTLESSNESS CONVULSIONS PREVENTION: Ø Consider every break in the skin as potential of entry: wash wounds thoroughly Ø Active immunization - DPT immunization, tetanus toxoid for women Ø Passive immunization - ATS or TIG TOXINS PRODUCED TETANOSPASMIN - responsible for muscular spasm TETANOLYSIN - lysis of the RBC SOURCES OF INFECTION: Ø Animal or human feces Ø Soil and dust containing spores Ø Unsterile instruments Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 18 DIAGNOSTIC EXAMS: Ø History of punctured wound Ø Clinical manifestations Ø CSF is normal Ø Blood exam - normal or slightly elevated WBC ct. TREATMENT (3 OBJECTIVES ) 1. NEUTRALIZE THE TOXIN ü Anti- tetanus serum (ATS) ü Tetanus immune globulin (TIG) ü Tetanus antitoxin (TAT) or tetanus horse serum antitoxin ü Skin testing is imperative, if positive, desensitize the person by giving the serum in fractional doses 2. DESTRUCTION OF MICROORGANISMS: penicillin, tetracyclines, erythromycins 3. PREVENTION AND CONTROL OF SPASMS - Diazepam NURSING CARE 1. Proved quiet semi dark environment 2. Minimal handling 3. Prepare tongue depressions 4. Maintain an adequate airway 5. Closely guard the patient 6. Support during spasm and convulsions 7. No restraints 8. Adequate ﬂuid and electrolytes 9. High calorie liquid to soft diet NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE INTEGUMENTARY (SKIN) A. DISEASE CAUSED BY TRAUMA AND INOCULATION 2. Rabies (LYSSA, HYDROPHOBIA) - severe viral infection of the CNS that is communicated to human in the saliva of infected animals or human caused by rabies virus (RHABDOVIRUS) - ﬁlterable virus and inactivated by sunlight TWO TYPES OF RABIES VIRUS STREET VIRUS - natural virus invading / transmitted in the saliva FIXED VIRUS - do not usually invade the salivary glands with constant incubation period of 4 to 6 days INCUBATION PERIOD a. In dogs and cats 1 week to 7 ½ month b. In man - 4 to 8 weeks MODE OF TRANSMISSION - contamination of a bite/scratch or other break in the skin from saliva Ø RABIED ANIMAL a. DUMB STAGE - quiet, stays n corner with copious salivation b. FURIOUS STAGE - easily agitated, hydrophobic CLINICAL MANIFESTATION: Presence of NEGRI BODIES in brain tissues (round or oval bodies found in the cytoplasm of neurons in animal with rabies) PERIOD OF COMMUNICABILITY: in dogs and cats, from 3 to 5 days before the onset of symptoms until the entire course of illness Ø RABIED MAN a. MENTAL DEPRESSIONS STAGE - copious salivation quiet and depress b. EXCIMENT PHASE - restless. irtable, hydrophobic and aerophobic Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 19 THREE (03) STAGES A. PRODROMAL OR INVASSION STAGE 1. Characterized by fever, anorexia, malaise, sore throat, copious salivation, lacrimation, perspirations, irritability, hyperexcitability, apprehension, restlessness, drowsiness, mental depressions, insomia and melancholia 2. Pain in the region of the original infection, headache and nausea 3. Sensitivity to light, sound and changes in temperature 4. MYALGIA - general body pain 5. Numbness, tingling burning or cold sensation in are of the bite, dilation of pupils, husky voice, mild di^iculty in swallowing B. STAGE OF EXCITEMENT - stimulated by noise and touch 1. Characterized by marked excitation, apprehension and even terror 2. Delirium assoc. with nuchal sti^ness and depression 3. Maniacal behavior, alternating listlessness and depression 4. Sensitive to light, noise and faint odors, eyes ﬁxed and glossy, cold clammy skin 5. Characteristic symptom manifest - violent, severe painful spasms of the muscles of the mouth, pharynx and larynx when attempting to swallow food or water and even the sight of it known as Hydrophobia 6. Aerophobia - fear of air 7. Drooling of saliva - in order to avoid painful spasm associated with swallowing 8. Fever of 3 to 4 days with tonic-clonic contraction of muscles 9. Death may during episodes of spasm or due to cardiac / respiratory failure 10. Patient deteriorates rapidly and progresses to terminal stage within 1 to 3 days C. TERMINAL OR PARALYTICS STAGE 1. Quiet an unconscious, loss of bowel and bladder control 2. Tachycardia, labored irregular respiration and steadily rising temperature 3. Spasms cease, and progressive increasing paralysis sets in 4. Respiratory distress or paralysis, circulatory collapse or heart failure, coma ensues and death to respiratory paralysis 5. Patient dies within 24 o 72 hours upon manifestation of signs and symptoms of rabies DIAGNOSTIC EXAM: 1. History of exposure - bites 2. Development of characteristic symptoms 3. Microscopic exams - presence of NEGRI BODIES in brain tissue and saliva 4. FLOURESCENT RABIES ANTIBODY (FRA) TECHIQUE - highly preferred diagnostic exam wherein the ﬂuorescent rabies antibody is allowed to react with its speciﬁc antigens in culture or smear and the result is in precipitate form - positive TREATMENT: SYMPTOMATIC (RABIES IS PREVENTABLE BUT NOT CURABLE) NURSING CARE: symptomatic and supportive 1. Treatment of wound with soap and water or zephiran betadine 2. Isolate patient - provide restful, quiet and semi dark environment 3. Cover IVF with paper bag - no sight of water 4. Provide comfort PREVENTION AND CONTROL A. ACTIVE IMMUNIZATION 1. DUCK EMBRYO VACCINE (DEV) OR PURIFIED DUCK EMBRYO CONCENTRATED VACCINE - prepared from cell culture, virus is killed and leaving only vital protein, injected intramuscularly at deltoid or subcutaneously for 14 days 2. HUMAN DIPLOID CELL VACCINE (HDCV) - more e^ective than DEV and used in USA where human exposed to rabies survive 3. ANTI-RABIES VACCINE (ARV) - simple type (used by DOH), needs skin testing given 2 cc subcutaneous daily for 14 day in the abdominal wall Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 20 B. PASSIVE IMMUNIZATION - not indicated before exposure 1. RABUMAN - 20 IU single dose/kg of body weight - IM for human 2. HYPER RAB - 20 IU single dose 3. IMOGRAM - same with above but only half the dose, used to inﬁltrate into the wound (antiserum globulin prepared from the horse) NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE INTEGUMENTARY (SKIN) A. DISEASE CAUSED BY TRAUMA AND INOCULATION 3. Malaria (MARSH FEVER., PERIODIC FEVER. KING OF TROPICAL DISEASE) an acute or chronic disease caused by protozoa plasmodia transmitted to man by the bite of infected female anopheles mosquito (Anopheles minimus ﬂavirostris) which is a night biting and breeds in ﬂowing clear and shaded stream FOUR SPECIES 1. Plasmodium vivax - causes vivax or benign tertian malaria (2 days interval of fever ) 2. Plasmodium falciparum - most frequently encountered in the Phil., causes malignant tertian malaria or known as PERNICIOUS MALARIA and is the most serious type 3. Plasmodium ovale - less frequent 4. Plasmodium malariae MODE OF TRANSMISSION 1. Person to person thru bites of an infected mosquito 2. Parenterally - blood transfusion or contaminated syringes and needles 3. Mingling of infected maternal blood with that of the infant during delivery 4. Transplacental ( congenital malaria) - very rare INCUBATION PERIOD (varies depending on greater or lesser resistance of individual) 1. P. vivax - 17 days or up to several years 2. P falciparum - 10 to 12 days after mosquito injects sporozoites 3. malariae - 10 to 14 days or up to several years 4. P ovale - 11 to 26 days PERIOD OF COMMUNICABILITY 1. P vivax - 3 to 5 days 2. P. falciparum - 7 to 14 days maximum of 1 year 3. P. malariae - 7 to 14 days, maximum of 30 years 4. P ovale - 3 to 5 days CLINICAL MANIFESTATION A PRODROMAL PHASE 1. P. falciparum - headache, nausea, fatigue, vague abdominal pains, muscle aches, anemia nose bleeding, highly colored urine, orthostatic hypotension, hepatomegaly an splenomegaly 2. P. vivax - headache, photophobia, muscle aches, anorexia, nausea and vomiting 3. P. ovale and P malariae - not signiﬁcant COMPLICATIONS 1. BLACK WATER FEVER- a serious complication of P. falciparum in which there is massive destruction of RBC leading to blood pigment in the urine ( mahogany colored) DIAGNOSTIC EXAM - BLOOD SMEAR OF MALARIA PARASITE (BSMP) - conﬁrms presence of specie and density - blood taken at the height of the fever, if negative, repeated after 12 hour of the attack - SPLEENIC BIOPSY - HISTORY OF TRAVEL TO ENDEMIC AREAS - QUARANTINE BUFFY COAT Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 21 TREATMENT GOALS 1. Destroy promptly all asexual forms of the parasite to care chemical attack 2. Destroy gametocytes so that mosquito is prevented SPECIFIC THERAPY: a.) AMINOQUINOLINES (Choloroquine, Aminodiaquine and Quimine) - used to treat all forms b.) PRIMAQUINE - can achieve 2nd goal of treatment c.) PYRIMETHAMINE-SULFADOXINE (FANSIDAR) - safest during pregnancy NURSING INTERVENTIONS 1. Isolation 2 Supportive care PREVENTION: 1. Eliminate breeding places of mosquitoes 2. Advise travelers of high risk areas 3. Screening of windows NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE INTEGUMENTARY (SKIN) A. DISEASE CAUSED BY TRAUMA AND INOCULATION 4. Dengue Fever (H. FEVER or HEMORRHAGIC FEVER, ACUTE INFECTIONS THROMBOCYTOPENIC PURPURA BREAK BONE or DANDY FEVER, DENGUE SHOCK SYNDROME ) acute tropical disease characterized by severe pain in the eye and in the joints and bones an accompanied by an initial erythema caused by dengue virus and transmitted by mosquito Aedes aegypti BREAK BONE/DANDY FEVER - patient experiences pain in the joint and bones and walks on tip toes MODE OF TRANSMISSION: bite of an infected Aedes aegypti mosquito which is day biting with limited ﬂying movement INCUBATION PERIOD: 4 to 6 days HEMORRHAGIC FEVER is a result of Increase capillary fragility - strong immune complex reaction that produce toxic substance like histamine bradykinin, which damage capillary wall Thrombocytopenia - due to faulty maturation of megakaryocytes which results in diminished production of platelets Decreased blood coagulation factor - due to acute excessive consumption of platelets due to generalized intravascular clotting CLINICAL MANIFESTATION. 1. Sudden onset of hyperpyrexia and headache, patient is ﬂushed and acutely ill 2. Anorexia, nausea and vomiting severe abdominal pain and tenderness 3. Hepatomegaly - 50 to 60% of cases CLASSIFICATION OF DENGUE FEVER ACCORDING TO SEVERITY GRADE I - fever, abdominal pain, headache, muscle and joint pains - prognosis good GRADE Il - Grade I symptoms plus spontaneous bleeding - prognosis is good GRADE III - Grade Il symptoms plus circulatory failure, cold clammy skin, weak pulse and hypotension (prognosis is guarded) GRADE IV - Grade Ill symptoms plus shock due to blood loss, death - prognosis is critical DIAGNOSTIC EXAM: 1. POSITIVE TOURNIQUET TEST (RUMPEL LEED TEST) - increase capillary fragility 2. HEMATOLOGIC EXAM - decrease Platelet determination count (150,000 to 400,000/cu. mm ) 3. HEMAGGLUTINATION-INHIBITION TEST - most frequently used TREATMENT: SYMPTOMATIC (SELF-LIMITING) Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 22 NURSING CARE 1. Epistaxis - ice compress on bridge of nose, let patient bite something 2. Gum bleeding - ice chips, bristle toothbrush 3. Gl bleeding - observe signs of bleeding, place o NPO. Avoid highly seasoned food 4. DO NOT GIVE ASPIRIN - causes platelet degeneration and may cause further bleeding PREVENTION 1. Avoid densely populated areas 2. Destroy mosquito breeding places NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE INTEGUMENTARY (SKIN) A. DISEASE CAUSED BY TRAUMA AND INOCULATION 5. LEPTOSPIROSIS (WEIL'S DISEASE, MUDFEVER, SWINEHERD'S DISEASE, CANICOLAFEVER) infection carried by animal both domesticated and wild whose excreta is contaminated or food which is ingested or inoculated thru skin or mucus membrane CAUSATIVE AGENT: Leptospira pyrogenes L. macilae (commonly found) L. canicola PERIOD COMMUNICABILITY: none but leptospira are found in the patients urine between 10 to 20 days after onset INCUBATION PERIOD: 6 to 15 days THREE (03) STAGES OF CLINICAL MANIFESTATION (ranges from asymptomatic to fatal) 1. SEPTICEMIC STAGE - fever lasting 4 to 7 days which is abrupt and remittent with chills, headache, anorexia, nausea and vomiting 2. IMMUNE or TOXIC STAGE - with or without jaundice lasting for 4 to 30 days, if severe, death may occur on the 9th to 16* day Ø ANICTERIC TYPE - presence of leptospira - leptospires in the urine\ Ø ICTERIC TYPE - known as WEIL'S SYNDROME (hepatorenal failure) 3. CONVALSCENCE - replaces may occur during the 4th to 5th week Ø Renal and Hepatic failure- causes of death DIAGNOSTIC EXAM: 1. CULTURES a. BLOOD - during the ﬁrst week b. CSF - 5" to 12' day c. URINE - after the 1" week to convalescence 2. AGGLUTINATION TEST a. LEPTOSPIRA AGGLUTINATION TEST (LAT) b. LEPTOSPIRA ANTIGEN-ANTIBODY TEST (LAAT) c. MICROCAPSULE AGGLUTINATION TEST (MCAT) TREATMENT: o PENICILIN G - drug of choice. o TETRACYCLINES NURSING CARE isolation and monitor I and O religiously. PREVENTION: environmental sanitation Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 23 NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE INTEGUMENTARY (SKIN) A. DISEASE CAUSED BY TRAUMA AND INOCULATION 6. Schistosomiasis (BLOOD FLUKE, SNAIL FEVER, BILHARZIASIS ) CAUSATIVE AGENT: caused by 3 species of blood ﬂuke A. Schistosomiasis haematobimm- common in the Near East, Iran, Iraq and Portugal ad causes BILHARZIASIS or URINARY SCHISTOSOMIASIS B. Schistosorna mansoni- found in south part of Africa, South America and causes HEPATO-INTESTINAL SCHISTOSOMIASIS C. Schistosoma japonicum- endemic in the Philippines and causes KATAYAMA DISEASE or HEPATO-INTESTAL SCHISTOSOMIASIS Oncomelania Quadrasi - snail vector MODE OF TRANSMISSION - direct penetration of cercaria to the skin ( 3 to 5 minutes ) INCUBATION PERIOD - at least 2 months LIFE CYCLE OF SCHISTOSOMA JAPONNICUM - Adult male and female in copulation in portal vessels - eggs into the intestinal lumen - eggs pass out with female hatch upon contact with water and liberate the miracidia ( 1"" stage larvae released into water with urine and feces - penetrate snail host - sporocyst 2** stage larvae ) develops within the snail (4 to 8 weeks) - cercaria (ﬁnal stage larva) escape into water ( 1 to 3 days ) - penetrate skin of host ( 3 to 5 minutes ) – schistosoma caried in circulation - adult in 29 days and start laying eggs CLINICAL MANIFESTATION 1. INCUBATION PERIOD - dermatitis on cercarial area, minute lesions with ﬂeeting needle pain (SWIMMER'S ITCH) cough, hepatomegaly with portal cirrhosis 2 PERIOD OF EGG DEPOSITION AND EXTRUSION - toxic diarrhea with fresh blood and mucoid stool, patient becomes ill and bedridden 3. PERIOD OF TISSUE REPAIR AND PROLIFETATION - jaundice, ascites, urine insu^iciently. bleeding and terminal hematuna DIAGNOSTIC EXAM a DIRECT FECAL SMEAR (KATO-KATZ) b. CIRCUMOVAL PRECIPITIN TEST / CERCARIAL ENVELOPE REACTIONS recommended in view of di^iculty in demonstrating eggs in feces TREATMENT: R.A # 4359 - created National Schistosomiasis Control Commission on June 19, 1956 TARTAR EMITIC (ANTIMONY POTASSIUM TARTRATE) - toxic and initiating salt administered by slow IV STIBOPHEN (FUADIN) PRAZIQUANTEL - drug of choice (TID PO WITH MEALS FOR ONE DAY ONLY) NIRIDAZOLE NURSING CARE: Symptomatic PREVENTION: 1. Proper disposal of human feces 2. Molluscides spraying 3. Creating foot bridges 4. Wearing of protective clothing / boots 5. Agro-engineering measures - irrigation system Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 24 NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE INTEGUMENTARY (SKIN) A. DISEASE CAUSED BY TRAUMA AND INOCULATION 7. Leprosy - ( HANSEN'S DISEASE, LEPRA, HANSENOSIS, LEONTIASIS ) chronic mildly communicable disease with insidious outset a^ecting the skin, mucus membranes and nervous tissue and eventually producing deformities and caused by Mycobacterium leprae (Hansen's bacillus ) MODE OF TRANSMISSION: prolonged skin to skin contact, fomites and droplet infection INCUBATION PERIOD: 1 to 5 years or more (variable) PERIOD OF COMMUNICABILITY as long as there are open lesions CLASSIFICATION OF LEPROSY TUBERCULOID (TT) - a single anesthetic macules or plaques, borders well deﬁned, peripheral nerve involvement common BORDERLINE TUBERCULOID (BT) - lesions similar to TT but more numerous, borders of lesions less distinct, satellite lesions present around larger lesions, peripheral nerve involvement common BORDERLINE (BB) - more lesions than BT, borders more vague, satellite lesions often seen, peripheral involvement BORDERLINE LEPROMATOUS (BL) - lesions are numerous and similar to BB, some nerve damage LEPROMATOUS (LL) - multiple non-anesthetic, macular or popular, symmetrically distributed lesions, no neural lesions until late, complications of madarosis, leonine face INDETERMINATE (L) - vaguely deﬁned hypopigmented or erythematous macule (like chronic dermatitis) OTHER SIGNS - madarosis - falling of eyebrow - Anhidrosis - absence of sweat - Atrophy of the skin DIAGNOSTIC EXAM 1. Mean- from mucocutaneous lesions 2. Lepromin Skin Test - has cross sensitivity to tuberculosis infection and BCG vaccination chemical is prepared from lumps/lesions 3. Mitsuda Reaction - more useful for the determination of the type of disease and prognosis TREATMENT: RA # 4073 - liberates the treatment of leprosy from segregation in sanitaria to home treatment National Leprosy Program - puts all legible case leprosy cases of leprosy under the multiple drug therapy A. Paucibacillary Regimen - few bacilli at any site Duration: 6 months Drugs rifampicin 500 mg Daily for 6 to 8 months (not prolonged due to its toxic e^ect ) dapsone 10 mg / kg / day Type: indeterminate tuberculoid and tuberculoid B. Multibacillary Regimen Duration: 24 months Drugs: Rifampicin 600 mg. Daily dapsone 10 mg / kg / day Lamprene 1 mg/ kg / day ( not recommended for patients below 18 years of age) Type: borderline lepromatous, NURSING INTERVENTION 1. Isolation 2. Maintain balance nutrition, sleep and rest 3. Help the family to understand and accept to remove social stigma 4. Good personal hygiene 5. Handling of infants and young ones should be avoided Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 25 NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GUT) A. Gonorrhea ( GC, CLAP, DRIP, STRAIN) CAUSATIVE AGENT: Neisseriae gonorrhea MODE OF TRANSMISSION: sexual contact, direct contact with contaminated vaginal secretion during delivery CLINICAL MANIFESTATIONS: A. males - burning sensation thick yellowish B. female - MOSTLY ASYMPTOMATIC; burning sensation upon urination, discharges may or may not be person COMPLICATIONS Pelvic Inﬂammatory Disease (PID) signs and symptoms of PID; fever, pelvic pain, nausea and vomiting abdominal pain Ophthalmia neonatorum (newborn) signs and symptoms: profuse purulent conjunctival exudates, corneal lacrimation loss of sight DIAGNOSTIC EXAM: Culture of penile or cervical secretions. TREATMENT: CETRIAXONE + DOXYCYCLINE 9drug of choice) NURSING CARE: Symptomatic and supportive, isolation of patient until recovery from illness PREVENTION: ABSTINENCE / Faithful partner / CONDOM/ Crede's prophylaxis NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GUT) B. Syphilis (LUES, FRENCH POX, BAD BLOOD) CAUSIVE AGENT Treponema pallidum STAGES OF SYPHILIS A. PRIMARY STAGE - formation of lesions (chancre) CHANCRE - elevated red and smooth surface with indurated edges and PAINLESS MALE - prepuce or glans penis / FEMALE - labia majors and minora - symptoms disappear without treatment B. SECONDARY STAGE - appearance of CONDYLOMATA LATA - lesions with ulcerations and spread all over the body; also known as SYPHILIS DERMATOSIS falling of public hair and eyebrows - lesions will disappear without treatment and will proceed to LATENT SYPHILIS (no signs) C. THIRD STAGE - delayed for years - GUMMAS (lesions ) begin to appear - necrotic tissue destruction D. FORTH STAGE - PARASYPHILIC STAGE - Nervous System involvement (neurosyphilis) S/S: optic atrophy – blindness, deafness paralysis: insanity DIAGNOSTIC EXAM: 1. DARKFIELD EXAM - identiﬁes T pallidum from chancre ﬂuid specimen 2. VDRL TITER 3. WASSERMANN TEST - detection of antibody formed by syphilic patient 4. SEROLOGIC TEST FOR SYPHILIS (STS) - FTA-ABS TREATMENT: BENZATHINE PENICILLIN MODE OF TRANSMISSION: sexual contact / blood transfusion / vertical transmission NURSING CARE: SYMPTOMATIC PREVENTION ABSTINENCE / AVOID SEXUAL CONTACT / USE OF LATEX CONDOM MANIFESTATIONS OF CONGENITAL SYPHILIS - saddle nose, Hutchinson's teeth (saw-like teeth with mouth and gum deformity), deafness, intestinal keratitis Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 26 NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GUT) C. Acquired Immuno-Deﬁciency Syndrome (AIDS) - is Chronic viral infection that involves the immune system and later causes di^erent OPPORTUNISTIC infections in the body: - causes severe depletion of CD4 T cells in the blood - WORLDWIDE phenomenon!!! (pandemic) - In 2000, 30-40 million people in the world are with HIV / AIDS - Discovered lasts 1981 - FIRST Screening of BLOOD for HIV started last 1985. High-Risk Groups for HIV Transmission Homosexual or bisexual men Intravenous (IV) drug users Transfusion and blood products recipients (before 1985) Heterosexual contacts of HIV-positive individuals Newborn babies of mothers who are HIV positive Causative Agent - Human Immunodeﬁciency Virus (HIV-1 and HIV-2) is a RETROVIRUS. the virus contains reverse transcriptase; IP --- 1 - 3 months to detect the presence of antibodies in the blood: 2 months - 20 years is the conversion from HIV to AIDS Mode of Transmission: Repeated sexual contact - most common; Habitual needie accident IV drug users thru sharing of needles Transplacental or Perinatal transmission Blood transfusion - not so common today due to strict blood screening Direct or indirect contact with mucus membranes Breast milk (?) Clinical Manifestations: Most of the time ASYMPTOMATIC; When it becomes symptomatic, Begins as a MONONUCLEOSIS-like manifestations (fever, anorexia, lymphadenopathy, weight loss, etc) Unexplained weight loss (WASTING SYNDROME!!!) Dry and heavy persistent coughing (PCP) Oral candidiasis or Oral thrush; Diarrhea of >7 days duration; Jaundice Ø Skin lesions (Kaposis sarcoma) - this is an unusual type of cancer seen only among homosexual. Ø Opportunistic Infections: Pneumocystic carinii pneumonia - most common in the world, PTB - most common in the Philippines, Pinoy tayo eh!!! Kaposi's sarcoma - probably secondary to HPV infection; Cytomegalovirus retinitis - can cause BLINDNESS!!!! Toxoplasma encephalitis Herpes simplex Herpes zoster Mycobacterium avium intracellular (MAI) Scabies Candidiasis Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 27 Ø HIV Infection - a client with (+) HIV test conﬁrmed by Western blot Ø AIDS - a client with HIV (+) plus signs of immunodeﬁciency and opportunistic infection CD4 T cells less than 200/ mm Diagnostic Examination. Enzyme-linked Immunosorbent Assay (ELISA) - for SCREENING!!! Western Blot - for CONFIRMATION!!! Polymerase Chain Reaction (PCR) - to identify nucleic acid sequence, P24 - serologic test to identify circulating antigen, CBC with WBC count Chest X-ray Urinalysis and fecalysis Blood/ urine/ sputum culture for bacterial and fungal infections Sputum GS and AFB Liver function test Renal function test - BUN / Creatinine Medical Management: Ø Anti-Retroviral Therapy - to prolong life and prevent the development of opportunistic infections by INHIBITING VIRAL REPLICATION and keep CD4 T cells more than 200 Ø Combination of several anti-retroviral agents is given to ﬁght resistance and to broaden to anti-viral coverage Three (03) diFerent types of Anti-retroviral agents: Protease inhibitors. o Amprenavir o Ritonavir o Indinavir o Saquinavir Nucleoside reverse transcriptase inhibitors (NRTI) o Zidovudine(AZT) o Didanosine o Zalcitabine o Lamivudin Non-nucleoside reverse transcriptase (NNRT)) o Efavirenze o Nevirapine o Delavirdine Other potential therapies: o Immunomodulary agents - designed to boost the weakened immune system o Anti-infective and anti-neoplastic agents - to combat opportunistic infection and associated cancers. (Some are used prophylactically to help prevent opportunistic infections) o HIV VACCINE Nursing Interventions: o Abstinence!!! It is the safest way to prevent AIDS. o Monogamous relationship or faithfulness practice SAFE SEX (ex. Use of Latex condoms!!!) o Patient and public awareness is very important. o Observe and practice STANDARD precaution to all patients. As into ALL PATIENTS!!! o In a client with AIDS, reverse isolation should be practiced Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 28 NURSING CARE OF PATIENTS WITH DISEASE OF AND ACQUIRED THROUGH THE (GUT) D. Chlamydiasis Ø also known as non-gonococcal urethritis Ø "the most common type of STI;" Ø Causes inclusion conjunctivitis and lympho-granuloma-venereum (LGV); CAUSATIVE AGENT: Chlamydia trachomatis IP: 2 - 3 weeks; Mode of Transmission Ø Sexual contact Ø Indirect contact with vaginal and urethral secretions, Clinical Manifestations In MALES urethral discharge burning and itching on urethral oriﬁce; burning sensation on urination; In FEMALES slight vaginal discharge dyspareunia vaginal itching abdominal pelvic pain Diagnostic Exams Urinalysis Gram stain and Culture of penile and cervical discharges Treatment DOXYCYCLINE - drug of choice Communicable Disease Nursing [Dr. André N. Canaria, Ph.D. NSc, MSN, RN] 29

Unit 1 - Communicable Diseases PDF

Document Details

Tags

Related

Summary

Full Transcript

Upgrade to continue