Communicable Disease Nursing PDF

# Communicable Disease Nursing ## Definition of terms * **Infection** - the implantation and successful replication of an organism in the tissue of the host, resulting in signs and symptoms, as well as immunologic response * **Carrier** - an individual who harbors the organism and is capable of tr...

# Communicable Disease Nursing ## Definition of terms * **Infection** - the implantation and successful replication of an organism in the tissue of the host, resulting in signs and symptoms, as well as immunologic response * **Carrier** - an individual who harbors the organism and is capable of transmitting it to a susceptible host but does not show manifestations of the disease. * **Contact** - is any person or animal that is in close association with an infected person, animal or freshly soiled linen materials. * **Disinfection** - is the destruction of pathogenic microorganisms outside the body through direct physical or chemical means. * **Concurrent Disinfection** - is a method done immediately after the infected individual discharges infectious material/secretions, ie it is done while the patient is still the source of infection * **Terminal Disinfection** - is applied when the patient is no longer a source of infection (either because the patient has died or has been discharged). Everything the patient had used, including the room he/she occupied, is disinfected. * **Habitat** - is a place where an organism lives or where an organism is usually found * **Host** - is a person, animal, or plant on which a parasite lives for its survival * **Isolation** - is the separation from other person of an individual suffering from a communicable disease * **Quarantine** - is the limitation of the freedom of movement of persons or animals which have been exposed to a communicable disease for a period of time equivalent to the longest incubation period of that disease * **Reservoir** - is an animal or plant in which an infectious agent lives and reproduces in such a manner that it can be transmitted to a man * **Surveillance** - is the act of watching ## What is infection? It is the invasion and multiplication of microorganisms in the tissues of the host, resulting in signs and symptoms, as well as immunologic response ## Patterns of disease occurrence: * **Sporadic Disease** - are diseases that occur occasionally and irregularly with no specific pattern (tetanus, gas gangrene) * **Epidemic** - are diseases that occur in a greater number than what is expected in a specific area over a specific time * **Pandemic** - is an epidemic that affects several countries or continents. * **Endemic** - present in a population or community at times. They usually involve few people during specific periods. ## Chain of infection 1. **Causative Agent** - is any microbe capable of producing disease. * Bacteria * Spirochete * Viruses * Rickettsia * Chlamydiae * Fungi * Protozoa * Parasites 2. **Reservoir** - organism survives and multiplies. * Human * Animals * Non-living thing 3. **Portal of Exit** - is the path or way through which the organism leaves the reservoir. Usually, this is where the organisms grow. The common portals of exit are the: * Respiratory System, * (genitourinary) GUT, * (gastrointestinal tract) GIT, * Skin and Mucous Membrane, * placenta 4. **Mode of Transmission** - is the means by which the infectious agent passes through from the portal of exit of the reservoir to the susceptible host. This is the easiest link to break the chain of infection. There are four modes by which infectious agents can be transmitted: * **Contact transmission** - is the most common mode of transmission. There are three types: * **Direct contact** - refers to a person-to-person transfer of organism * **Indirect contact** - occurs when the susceptible person comes in contact with a contaminated object * **Droplet spread** - is transmission through contact with respiratory secretions when the infected person coughs, sneezes or talks. Microbes carried in droplets can travel up to three feet (one meter). The organism is not suspended in the air but settles on a surface. * **Airborne transmission** - occurs when fine microbial particles or dust particles containing microbes remain suspended in the air for a prolonged period. The infectious disease is spread by air current and is inhaled by a susceptible host * **Vehicle transmission** - is the transmission of infectious disease through articles or substances that harbor the organism until it is ingested by or inoculated into the host * **Vector borne transmission** - occurs when intermediate carriers, such as fleas, flies, and mosquitoes, transfer the microbes to another living organism. 5. **Portal of entry** - is avenue through which the organism gains entrance into the susceptible host. The infective microbes use the same avenue when they exit from the reservoir. 6. **Susceptible host** - the human body has many defenses against the entry and multiplication of organisms. When the defenses are good, no infection takes place. However, in a weakened host, microbes launch an infectious disease. * **Factors:** * Age * Heredity * Stress * Surgery * Nutrition * General Health Status ## Stages of the infectious process: 1. **Incubation period** - From entry to onset of symptoms (invasion & multiplication) 2. **Prodromal period** - onset of non-specific symptoms. 3. **Period of Illness** - manifesting signs & symptoms. 4. **Convalescent period** - acute symptoms disappear - gradual return to pre-illness period (recovery) ## Immunity Terms **Types of Immunization**: * **Active** - antibodies produced by the body * **Natural**- acquired in response to the entry of a live pathogen into the body. It has a long immunity * **Artificial** - immunity that is acquired in response to vaccine. * **Passive** - antibodies are produced by another source * **Natural**- antibodies are transferred form the mother to newborn through placenta, breastmilk (colostrum) * **Artificial** - immune serum (antibody) from an animal or another human is injected to a person. ## SEVEN CATEGORIES OF ISOLATION 1. **STRICT ISOLATION** - Prevent highly contagious or virulent infections spread primarily by close/direct contact. 2. **CONTACT ISOLATION** - Prevent transmission of infectious distances over short distances 3. **AIRBORNE ISOLATION** - Indicated for patients with positive smear or chest x-ray which strongly suggests tuberculosis 4. **DROPLET ISOLATION** - Prevent transmission through direct contact with feces 5. **DRAINAGE ISOLATION** - Prevent transmission by direct or indirect contact with purulent materials or drainage 6. **UNIVERSAL ISOLATION** - Prevent transmission of blood and body fluids borne pathogens ## The Expanded Program on Immunization (EPI) in the Philippines The Expanded Program on Immunization (EPI) in the Philippines began in 1979. The four major strategies include: 1. Sustaining high routine Full Immunized Child (FIC) coverage of at least 90% in all provinces and cities; 2. Sustaining the polio-free country for global certification; 3. Eliminating measles by 2008; and 4. Eliminating neonatal tetanus by 2008 ### Routine Schedule of Immunization * **Every WEDNESDAY** is designated as immunization day and is adopted in all parts of the country. Immunization is done **MONTHLY** in barangay health stations, **QUARTERLY** in remote areas of the country. ### Routine Immunization Schedule for Infants The standard routine immunization schedule for infants in the Philippines is adopted to provide maximum immunity against the seven vaccine preventable diseases in the country before the child’s first birthday. The fully immunized child must have completed BCG 1, DPT 1, DPT 2, DPT 3, OPV1 OPV 2, OPV 3, HB 1, HB 2, HB 3 and measles vaccines before the child is 12 months of age. | Vaccine | Minimum Age at 1st Dose | Number of Doses | Dose | Minimum Interval Between Doses | Route | Site | Reason | |---|---|---|---|---|---|---|---| | BCG Bacillus Calmette-Guérin | At birth | 1 | 0.05ml | None | ID | Right deltoid region and/or arm | BCG given as early as possible age protects against the possibility of TB, meningitis and other infections. | | DPT Diphtheria, Pertussis, Tetanus | 6 wks | 3 | 0.1ml | DPT1 - 6 wks DPT2- 10 wks DPT3 - 14 wks | IM | Vastus lateralis for DPT DPT- right DPT- left DPT - left | For DPT | | OPV Oral Polio Vaccine | 6 wks | 3 | 2-3 drops | 4 weeks interval | Oral | | Protection against poliomyelitis | | HEPA B | At birth | 3 | 0.5ml | 4 weeks | IM | Vastus lateralis R/L/R left right right | Protection against Hepatitis B | | Measles Vaccine | 9 months | 1 | 0.5ml | None | Subcut. | Right deltoid (outer portion of the arm) | Protection against measles, scarlet fever, and rubella | ## Tetanus Toxoid Immunization Schedule for Women When given to women of childbearing age, vaccines that contain tetanus toxoid (TT or Td) not only protect women against tetanus, but also prevent neonatal tetanus in their newborn infants | Vaccine | Minimum Age/Interval | Percent Protected | Duration of Protection | |---|---|---|---| | TT1 | At 20th wks AOG | 0% | Protection of the mother from the first delivery. | | TT2 | Atleast 4 wiks later | 80% | Infants born to the mother will be protected upon neonatal injection - 3 yrs. protection | | TT3 | At least 6 months later | 85% | 7 yrs. neonatal tetanus | | TT4 | At least 1yr later | 99% | 7 to 10 yrs. | | TT5 | Atleast 1yr later | 99% | Vaginal lifetime protection to the mother - all infants born to that mother will be protected | ## The cold chain system Maintenance of the correct temperature for vaccines starts with the **MANUFACTURER** and followed through by the **AIRPORT/REGIONAL STORE** or **CENTRAL VACCINE STORE/ DISTRICT HOSPITAL/HEALTH CENTERS/DISPENSARY** and the **CLIENT**. ## Common Communicable Diseases ### The world’s deadliest disease **TUBERCULOSIS** (Koch's dse.; Phthisis/consumption) * 6th leading cause of morbidity and mortality in the Philippines * Children: **PRIMARY COMPLEX** * Causative agent: **MYCOBACTERIUM TUBERCULOSIS** * Source of infection: **SPUTUM BUT ALSO FROM NASAL DISCHARGES & FECES** * Transmission: 1. **INHALATION OF ORGANISM** 2. **DIRECT (INDIRECT) CONTACT WITH INFECTED PERSON. DISTANCE VARIES FROM A FEW INCHES TO A FEW FEET** 3. **CONTACT WITH CONTAMINATED EATING OR DRINKING UTENSILS.** 4. **INOCULATION BY CONTAMINATED FINGER OR SKIN LESION.** * Incubation Period: **2 WKS.** * Period of Communicability: **AS LONG AS VIABLE TUBERCLE BACILLI ARE BEING DISCHARGED.** * Other agents: **MYCOBACTERIUM AFRICANUM, BOVIS, HUMANS, CADDLES/CATTLE** #### Signs and symptoms: * **Hemoptysis** - sign, pathognomonic * **Cough** for more than 2 weeks - dry to productive * **Night sweats** * **Dyspnea** * **Afternoon rise temp** * **Body maluse & Wt. Loss** * **Occasional chest pain** * **Sputum positive for AFB** (acid-fast-Bacilli) #### Definitive test for tuberculosis * **Sputum Analysis for AFB** (to determine bacter susceptibility to anti-TB drug.) * **Purified Protein Derivative/ Mantoux test/ Tuberculin Syringe test** * When is it read? **48-72 hrs** * When is it positive? **5mm** * For an AIDS/ immunosuppressed patient? **< 5mm** * **Chest x-ray**, secondary test #### Categories of Tuberculosis 1. **Newly diagnosed sputum positive pulmonary tuberculosis** * **Sputum negative pulmonary tuberculosis with extensive parenchymal involvement.** * **Severe form of extrapulmonary tuberculosis** * **Treatment regimen:** * 2 months **RIPE** (intensive phase) * 4 months **RI (continuation phase) * **R - Rifampicin** * **I - Isoniazid** * **P - Pyrazinamide** * **E - Ethambutol** 2. **Treatment failure cases** * **Relapse cases** * **Return after interruption** * **Treatment regimen:** 2 months **RIPE** + 1 month **HIPE** 3. **Sputum negative pulmonary tuberculosis with minimal involvement** * **Less severe form of extrapulmonary tuberculosis** * **Treatment regimen:** 2 months **RIPE**, 4 months **RI** #### 5 Components of TB-DOTS Program * **Political or Management commitment** ### Common Communicable Diseases #### The world’s deadliest disease **TUBERCULOSIS** (Koch's dse.; Phthisis/consumption) * 6th leading cause of morbidity and mortality in the Philippines * Children: **PRIMARY COMPLEX** * Causative agent: **MYCOBACTERIUM TUBERCULOSIS** * Source of infection: **SPUTUM BUT ALSO FROM NASAL DISCHARGES & FECES** * Transmission: 1. **INHALATION OF ORGANISM** 2. **DIRECT (INDIRECT) CONTACT WITH INFECTED PERSON. DISTANCE VARIES FROM A FEW INCHES TO A FEW FEET** 3. **CONTACT WITH CONTAMINATED EATING OR DRINKING UTENSILS.** 4. **INOCULATION BY CONTAMINATED FINGER OR SKIN LESION.** * Incubation Period: **2 WKS.** * Period of Communicability: **AS LONG AS VIABLE TUBERCLE BACILLI ARE BEING DISCHARGED.** * Other agents: **MYCOBACTERIUM AFRICANUM, BOVIS, HUMANS, CADDLES/CATTLE** #### Signs and symptoms: * **Hemoptysis** - sign, pathognomonic * **Cough** for more than 2 weeks - dry to productive * **Night sweats** * **Dyspnea** * **Afternoon rise temp** * **Body maluse & Wt. Loss** * **Occasional chest pain** * **Sputum positive for AFB** (acid-fast-Bacilli) #### Definitive test for tuberculosis * **Sputum Analysis for AFB** (to determine bacter susceptibility to anti-TB drug.) * **Purified Protein Derivative/ Mantoux test/ Tuberculin Syringe test** * When is it read? **48-72 hrs** * When is it positive? **5mm** * For an AIDS/ immunosuppressed patient? **< 5mm** * **Chest x-ray**, secondary test #### Categories of Tuberculosis 1. **Newly diagnosed sputum positive pulmonary tuberculosis** * **Sputum negative pulmonary tuberculosis with extensive parenchymal involvement.** * **Severe form of extrapulmonary tuberculosis** * **Treatment regimen:** * 2 months **RIPE** (intensive phase) * 4 months **RI (continuation phase) * **R - Rifampicin** * **I - Isoniazid** * **P - Pyrazinamide** * **E - Ethambutol** 2. **Treatment failure cases** * **Relapse cases** * **Return after interruption** * **Treatment regimen:** 2 months **RIPE** + 1 month **HIPE** 3. **Sputum negative pulmonary tuberculosis with minimal involvement** * **Less severe form of extrapulmonary tuberculosis** * **Treatment regimen:** 2 months **RIPE**, 4 months **RI** #### 5 Components of TB-DOTS Program * **Political or Management commitment** ### Common Communicable Diseases #### The world’s deadliest disease **TUBERCULOSIS** (Koch's dse.; Phthisis/consumption) * 6th leading cause of morbidity and mortality in the Philippines * Children: **PRIMARY COMPLEX** * Causative agent: **MYCOBACTERIUM TUBERCULOSIS** * Source of infection: **SPUTUM BUT ALSO FROM NASAL DISCHARGES & FECES** * Transmission: 1. **INHALATION OF ORGANISM** 2. **DIRECT (INDIRECT) CONTACT WITH INFECTED PERSON. DISTANCE VARIES FROM A FEW INCHES TO A FEW FEET** 3. **CONTACT WITH CONTAMINATED EATING OR DRINKING UTENSILS.** 4. **INOCULATION BY CONTAMINATED FINGER OR SKIN LESION.** * Incubation Period: **2 WKS.** * Period of Communicability: **AS LONG AS VIABLE TUBERCLE BACILLI ARE BEING DISCHARGED.** * Other agents: **MYCOBACTERIUM AFRICANUM, BOVIS, HUMANS, CADDLES/CATTLE** #### Signs and symptoms: * **Hemoptysis** - sign, pathognomonic * **Cough** for more than 2 weeks - dry to productive * **Night sweats** * **Dyspnea** * **Afternoon rise temp** * **Body maluse & Wt. Loss** * **Occasional chest pain** * **Sputum positive for AFB** (acid-fast-Bacilli) #### Definitive test for tuberculosis * **Sputum Analysis for AFB** (to determine bacter susceptibility to anti-TB drug.) * **Purified Protein Derivative/ Mantoux test/ Tuberculin Syringe test** * When is it read? **48-72 hrs** * When is it positive? **5mm** * For an AIDS/ immunosuppressed patient? **< 5mm** * **Chest x-ray**, secondary test #### Categories of Tuberculosis 1. **Newly diagnosed sputum positive pulmonary tuberculosis** * **Sputum negative pulmonary tuberculosis with extensive parenchymal involvement.** * **Severe form of extrapulmonary tuberculosis** * **Treatment regimen:** * 2 months **RIPE** (intensive phase) * 4 months **RI (continuation phase) * **R - Rifampicin** * **I - Isoniazid** * **P - Pyrazinamide** * **E - Ethambutol** 2. **Treatment failure cases** * **Relapse cases** * **Return after interruption** * **Treatment regimen:** 2 months **RIPE** + 1 month **HIPE** 3. **Sputum negative pulmonary tuberculosis with minimal involvement** * **Less severe form of extrapulmonary tuberculosis** * **Treatment regimen:** 2 months **RIPE**, 4 months **RI** #### 5 Components of TB-DOTS Program * **Political or Management commitment** ### Common Communicable Diseases #### The world’s deadliest disease **TUBERCULOSIS** (Koch's dse.; Phthisis/consumption) * 6th leading cause of morbidity and mortality in the Philippines * Children: **PRIMARY COMPLEX** * Causative agent: **MYCOBACTERIUM TUBERCULOSIS** * Source of infection: **SPUTUM BUT ALSO FROM NASAL DISCHARGES & FECES** * Transmission: 1. **INHALATION OF ORGANISM** 2. **DIRECT (INDIRECT) CONTACT WITH INFECTED PERSON. DISTANCE VARIES FROM A FEW INCHES TO A FEW FEET** 3. **CONTACT WITH CONTAMINATED EATING OR DRINKING UTENSILS.** 4. **INOCULATION BY CONTAMINATED FINGER OR SKIN LESION.** * Incubation Period: **2 WKS.** * Period of Communicability: **AS LONG AS VIABLE TUBERCLE BACILLI ARE BEING DISCHARGED.** * Other agents: **MYCOBACTERIUM AFRICANUM, BOVIS, HUMANS, CADDLES/CATTLE** #### Signs and symptoms: * **Hemoptysis** - sign, pathognomonic * **Cough** for more than 2 weeks - dry to productive * **Night sweats** * **Dyspnea** * **Afternoon rise temp** * **Body maluse & Wt. Loss** * **Occasional chest pain** * **Sputum positive for AFB** (acid-fast-Bacilli) #### Definitive test for tuberculosis * **Sputum Analysis for AFB** (to determine bacter susceptibility to anti-TB drug.) * **Purified Protein Derivative/ Mantoux test/ Tuberculin Syringe test** * When is it read? **48-72 hrs** * When is it positive? **5mm** * For an AIDS/ immunosuppressed patient? **< 5mm** * **Chest x-ray**, secondary test #### Categories of Tuberculosis 1. **Newly diagnosed sputum positive pulmonary tuberculosis** * **Sputum negative pulmonary tuberculosis with extensive parenchymal involvement.** * **Severe form of extrapulmonary tuberculosis** * **Treatment regimen:** * 2 months **RIPE** (intensive phase) * 4 months **RI (continuation phase) * **R - Rifampicin** * **I - Isoniazid** * **P - Pyrazinamide** * **E - Ethambutol** 2. **Treatment failure cases** * **Relapse cases** * **Return after interruption** * **Treatment regimen:** 2 months **RIPE** + 1 month **HIPE** 3. **Sputum negative pulmonary tuberculosis with minimal involvement** * **Less severe form of extrapulmonary tuberculosis** * **Treatment regimen:** 2 months **RIPE**, 4 months **RI** #### 5 Components of TB-DOTS Program * **Political or Management commitment** ### Common Communicable Diseases #### The world’s deadliest disease **TUBERCULOSIS** (Koch's dse.; Phthisis/consumption) * 6th leading cause of morbidity and mortality in the Philippines * Children: **PRIMARY COMPLEX** * Causative agent: **MYCOBACTERIUM TUBERCULOSIS** * Source of infection: **SPUTUM BUT ALSO FROM NASAL DISCHARGES & FECES** * Transmission: 1. **INHALATION OF ORGANISM** 2. **DIRECT (INDIRECT) CONTACT WITH INFECTED PERSON. DISTANCE VARIES FROM A FEW INCHES TO A FEW FEET** 3. **CONTACT WITH CONTAMINATED EATING OR DRINKING UTENSILS.** 4. **INOCULATION BY CONTAMINATED FINGER OR SKIN LESION.** * Incubation Period: **2 WKS.** * Period of Communicability: **AS LONG AS VIABLE TUBERCLE BACILLI ARE BEING DISCHARGED.** * Other agents: **MYCOBACTERIUM AFRICANUM, BOVIS, HUMANS, CADDLES/CATTLE** #### Signs and symptoms: * **Hemoptysis** - sign, pathognomonic * **Cough** for more than 2 weeks - dry to productive * **Night sweats** * **Dyspnea** * **Afternoon rise temp** * **Body maluse & Wt. Loss** * **Occasional chest pain** * **Sputum positive for AFB** (acid-fast-Bacilli) #### Definitive test for tuberculosis * **Sputum Analysis for AFB** (to determine bacter susceptibility to anti-TB drug.) * **Purified Protein Derivative/ Mantoux test/ Tuberculin Syringe test** * When is it read? **48-72 hrs** * When is it positive? **5mm** * For an AIDS/ immunosuppressed patient? **< 5mm** * **Chest x-ray**, secondary test #### Categories of Tuberculosis 1. **Newly diagnosed sputum positive pulmonary tuberculosis** * **Sputum negative pulmonary tuberculosis with extensive parenchymal involvement.** * **Severe form of extrapulmonary tuberculosis** * **Treatment regimen:** * 2 months **RIPE** (intensive phase) * 4 months **RI (continuation phase) * **R - Rifampicin** * **I - Isoniazid** * **P - Pyrazinamide** * **E - Ethambutol** 2. **Treatment failure cases** * **Relapse cases** * **Return after interruption** * **Treatment regimen:** 2 months **RIPE** + 1 month **HIPE** 3. **Sputum negative pulmonary tuberculosis with minimal involvement** * **Less severe form of extrapulmonary tuberculosis** * **Treatment regimen:** 2 months **RIPE**, 4 months **RI** #### 5 Components of TB-DOTS Program * **Political or Management commitment** ### Common Communicable Diseases #### **LEPROSY** (Koch) * Leading cause of permanent physical disability * Causative agent: **MYCOBACTERIUM LEPRAE** * Source of infection: **AIRBORNE (PROLONGED SKIN TO SKIN CONTACT)** * Transmission: **AIRBORNE** * Diagnostic test: **SKIN TEST, SMEAR** * Early: **P-L-O-U-C** * **Pain** - redness of the eyes, paralysis of facial nerves (thickened, muscle weakness) * **Loss of sensation** - in the skin lesion, loss of decrease sweating, hair smooth over the lesion, * **Obstruction** - nasal * **Ulceration** - do not heal * **Change in color** (red) * Late: **U-S-M-E-L** - like lion * **Ulcers** - chronic * **S** - pointing of the nose bridge * **M** - Madarosis (loss of eye brows) * **E** - Eye enlargement of the breast in females (gynecomastia) * **L** - Lagophthalmos (incompetent, miss eye lids) * **Like lion** - Clowing of fingers & toes (contractures) #### The 2009 WHO classifications are simply based on the number of skin lesions as follows: * **PAUCIBACIUARY (non-infections)** - skin lesions with no bacilli (M. leprae) seen in a skin smear * **MULTIBACILLARY (infections)** - skin lesions with bacilli (M. leprae) seen in a skin smear * Investigators state that up to about four to five skin lesions constitutes paucibacillary leprosy, while about five or more constitutes multibacillary leprosy. #### **PAUCIBACILLARY LEPROSY** usually includes: * **INDETERMINATE** - a few hypopigmented macules; can heal spontaneously, this form persists or advances to other forms * **TUBERCULOID** - a few hypopigmented macules, some are large and some become anesthetic (lose pain sensation); some neural involvement in which nerves become enlarged; spontaneous resolution in a few years, persists or advances to other forms * **BORDERLINE** - lesions like tuberculoid leprosy but smaller and more numerous with less nerve enlargement; this form may persist, revert to tuberculoid leprosy, or advance to other forms #### **MULTIBACILLARY LEPROSY** usually includes the * **MID-BORDERLINE LEPROSY** - many reddish plaques that are asymmetrically distributed, moderately anesthetic, with regional adenopathy (swollen lymph nodes); the form may persist, regress to another form, or progress * **BORDERLINE LEPROMATOUS** - many skin lesions with macules (flat lesions), papules (raised bumps), plaques, and nodules, sometimes with or without anesthesia; the form may persist, regress or progress to lepromatous leprosy * **LEPROMATOUS LEPROSY** - Early lesions are pale macules (flat areas) that are diffuse and symmetric; later many M. leprae organisms can be found in them. Alopecia (hair loss) occurs; often patients have no eyebrows or eyelashes. As the disease progresses, nerve involvement leads to anesthetic areas and limb weakness; progression leads to aseptic necrosis (tissue death from lack of blood to area), lepromas (skin nodules), and disfigurement of many areas, including the face. The lepromatous form does not regress to the other less severe forms. Histoid leprosy is a clinical variant of lepromatous leprosy that presents with clusters of histiocytes (a type of cell involved in the inflammatory response) and a grenz zone (an area of collagen separating the lesion from normal tissue) seen in microscopic tissue sections. #### Treatment: * **Multidrug therapy (MDT) with three antibiotics (Dapsone, Rifampicin, and clofazimine)** is used for multibacillary leprosy. * **Modified MDT with two antibiotics ( Dapsone and Rifampicin) ** is recommended for paucibacillary leprosy * **Multi-drug therapy may discolor urine** #### Prevention: * **BCG** #### Most important Nursing intervention: Health education ### **Common Childhood Communicable Diseases** #### **MEASLES** (Rubeola, Morbilli) * Causative agent: **FILTRABLE VIRUS** * Incubation period: **10-12 DAYS (Vorgart days - 20 / shortest day - 8)** * Mode of transmission: a. **respiratory droplets** source of infection: pt. fluid * b. **direct contact with respiratory discharges** * c. **indirect contact through soiled linens and articles** * Period of Communicability: **9 - 10 days. 4 days before & 5 days after the onset of the rash.** * Signs and symptoms: * **Pre - eruptive stage** * **Cough** * **Coryza** - runny mucide, anggestion, cold in the head. * **Conjunctivits** * **Fever** (high grade) * **Pathognomonic sign**: **KOPLIK'S SPOTS (ENANTHEM) / SIGNS/ STAINLINE** - bluish white spots surrounded by a red halo * **Appears on the inner surfaces of the cheek for days before rashes usually rash** * **Eruptive Stage** * **Pattern of rashes**: Fit in the cheek, bridge of the nose, temples, eyes, lobe, along the hairline * **Type of rashes**: Maculopapular rash. * **Stage of Convalescence** - rashes fade away in the same manner as they appeared. #### **GERMAN MEASLES** (Rubella) or 3 day Merscher * Causative agent: **Rubella Virus** * Incubation period: **14 - 21 days.** * Mode of transmission: a. **respiratory droplets** * b. **direct contact respiratory discharges** * c. **indirect contact through soiled linens and articles** * Period of Communicability: **1 wk before & 5 days after the onset of rashes.** * Signs and symptoms: * **Pre - eruptive stage** (Predial period) * **Fever** * **Headache** * **Malaise** * **Coryza** * **Pathognomonic sign**: **FORCHHEIMER'S SPOT** - small red lesions ○ Appears on the face, spreading to neck, arm, trunk & legs. * **Eruptive stage** * **Rashes**: pinkish * **Posterior auricular and suboccipital lymphadenopathy** * Nursing management (both measles and german measles) - symptomatic * **Darkened room** to relieve photophobia * **Warm saline solution** for eyes to relieve irritation * **For fever**: tepid sponge bath and antipyretics * **Skin care**: during eruptive stage: **OMIT SOAP!** Use bicarbonate of soda in water or lotion to relieve itchiness * **Respiratory isolation** * Prevention**: Measles vaccine and MMR #### **CHICKEN POX** (Varicella) * Causative agent: **VARICELLA ZOSTER VIRUS** * Incubation period: **14-21 days** * Mode of transmission: **droplets spread and direct contact**, INDIRECT source of infection: resp. secretion of infected person * Period of communicability: **1-2 days before the eruption of the 1st lesion up to 6 days after the appearance of the last crust** * Signs and symptoms: * **Fever** * **Headache** * **Malaise** * **Rashes**: (pattern) **Starts on the trunk (unexposed area), spread to other parts of the body.** * **Stages of rashes**: **MACULE** - a lesion is not elevated **PAPULE** - raised bump, the skin surface is elevated **VESICLE** - small, thin-walled vesicle filled with fluid **PUSTULE** - filled with pus if a lesion becomes infected, the size may be big & wide **CRUST** - scabs/scarve exschar - secondary lesion * **Pruritus** * Nursing Management: * **Strict isolation** * **Prevent secondary infection** (cut fingernails, wear mittens) * **Eliminate itching**: calamine lotion, warm baths, baking soda paste * **Encourage not going to school**: Usually 1 week * **Disinfect clothes by boiling or by sunlight** #### **MUMPS** (Epidemic Parotitis) * Causative agent: **PARAMYXOVIRUS** (croup) * Incubation period: **14-21 days** are **18 days** * Mode of transmission: **direct contact**, respiratory droplets * Period of communicability: **48 hrs** (highest communicable) on set of swelling * Signs and symptoms: * **Painful swelling** in front of ear, angle of jaws down the neck * **Fever** * **Malaise** - orchitis in male adult, oophoritis - inflammation of testes * **Orchitis in boys** / loss of appetite, head ache, deafness - tx, antivionl drug. hot/cold pack #### **DIPHTHERIA** * Causative agent: **CORYNEBACTERIUM DIPHTHERIAE** (Klebs-Loeffler bacillus) * Incubation period: **1-5 days** * Mode of transmission: **respiratory droplets, contact with contaminated articles and MILK** * Period of communicability: **It rarries perodonto/ source: inre then 24 hrs or intreated pts. 1-2 days is treated pts.** * Signs and symptoms: * **Sore throat** * **Fever** * **Discharge from nose, throat & eyes** or **effusions on other parts of the body** * **Enlarged cervical lymph nodes** and **swelling of the soft tissues of the neck** - "bull neck appearance" * **Hoarseness and stridor** may be present * **Pathognomonic sign**: **Pseudomembrane** (false membrane) * Nursing Management: * **Educate community on pasteurization of milk** * **Teach on prevention via DPT immunization** * **Teach procedures of disposal by burning of nose and throat discharges.** * **Treat by the symptoms** * **Report cases to the MHO** (municipal Health office) * **Schick test** - test for susceptibility. #### **PERTUSSIS** (Whooping Cough) * Causative agent: **BORDETELLA PERTUSSIS** * Incubation period: **7-14 days** * Mode of transmission: **respiratory droplets** * Period of communicability: **14 days after exposure until 3 wks after the onset of paroxysmal cough, 6 to 3 wks** * Signs and symptoms: * **Begins as an ordinary cold**, becomes increasingly severe, and during the second week sudden outburst or after frequent symptom of cough and ending in a whoop as breath is drawn in (**paroxymal cough**) - it is differentiated with diptheria. * Nursing management: * **Paroxysms of cough** * **Isolation** * **Teach parents how to pick the infant or child during paroxysmal cough, giving abdominal support** * **General care for throat and nose discharges** * **Care should be focused on prevention of complications** #### **TETANUS** (Lock jaw) * Causative agent: **CLOSTRIDIUM TETANI** * Incubation period: **