Communicable Disease PDF

COMMUNICABLE DISEASE Lecturer: Christian John B. Timogan, RN, USRN BASIC TERMINOLOGIES  BASIC TERMINOLOGIES COMMUNICABLE DISEASE  An illness caused by infectious agent that are transmitted directly or indirectly to a well person. HOST  A person, animal, or p...

COMMUNICABLE DISEASE Lecturer: Christian John B. Timogan, RN, USRN BASIC TERMINOLOGIES  BASIC TERMINOLOGIES COMMUNICABLE DISEASE  An illness caused by infectious agent that are transmitted directly or indirectly to a well person. HOST  A person, animal, or plant that provides a suitable environment for a pathogen to live, grow, and reproduce.  BASIC TERMINOLOGIES CARRIER  A person who got the organism and is capable of transmitting it to a susceptible host without showing manifestations. HABITAT / RESERVOIR  A place where an organism lives or where an organism is usually found  BASIC TERMINOLOGIES CONTACT  Any person or animal who is in close association with an infected person, animal, or freshly soiled materials  BASIC TERMINOLOGIES MACULE  Circumscribed  Flat lesion with color change  Not palpable  BASIC TERMINOLOGIES PAPULE  Circumscribed  Elevated solid lesion  BASIC TERMINOLOGIES PUSTULE  Circumscribed  Elevated purulent fluid – filled lesion  BASIC TERMINOLOGIES VESICLE  Circumscribed  Elevated fluid – filled lesion. EPIDEMIOLOGY The study of occurrence and distribution of the disease in a specified population PATTERNS OF OCCURRENCE AND DISTRIBUTION SPORADIC  Seasonal  Occasional (On & Off)  Example: Tag ulan = Leptospirosis Tag init = Rabies PATTERNS OF OCCURRENCE AND DISTRIBUTION ENDEMIC  Di titigil  The disease is always occurring in the locality  Examples: Schistosomiasis (Leyte & Samar) Filariasis (Sorsogon) Malaria (Palawan) PATTERNS OF OCCURRENCE AND DISTRIBUTION EPIDEMIC  Pakalit ug saka  Disease outbreak  Sudden increase in number  Location-based  Example: Novel Corona Virus at Wuhan, China (2019) PATTERNS OF OCCURRENCE AND DISTRIBUTION PANDEMIC  PANdaig-digan  The simultaneous occurrence of epidemic of the same disease in several countries  Examples: HIV / AIDS SARS COVID 19 CHAIN OF INFECTION  MODE OF TRANSMISSION  Most common type of transmission  Types: DIRECT CONTACT – Person to person INDIRECT CONTACT – Person to a contaminated object DROPLET SPREAD – Contact with respiratory secretions which is limited to 3 feet.  MODE OF TRANSMISSION  Microbes remain suspended in the air for a prolonged period.  Transmission can be more than 3 feet.  MODE OF TRANSMISSION  When an inanimate object such as soil, water, or air harbors the organism until it is ingested into the host  MODE OF TRANSMISSION  When carriers transfer the microbes into another living organism before ingested into the host IMMUNITY  IMMUNITY TYPES OF IMMUNITY:  NATURAL - Immunity created by the body  ARTIFICIAL - From synthetic sources  IMMUNITY NATURAL IMMUNITY  ACTIVE - Acquired through recovery from a certain disease - Provides “Life-Long” protection - Example: Chicken pox  IMMUNITY NATURAL IMMUNITY  PASSIVE - Acquired through mother and child transfer - Offers immediate but short-acting - Example: Placenta – Immunoglobulin G Milk – Immunoglobulin A  IMMUNITY ARTIFICIAL IMMUNITY  ACTIVE - Acquired through administration of live attenuated or inactivated micro organism - Offers long term immunity - Example: EPI vaccines Tetanus Toxoid Covid – 19 vaccines  IMMUNITY ARTIFICIAL IMMUNITY  PASSIVE - Acquired through administration of antitoxin, antiserum, convalescent serum, and immunoglobulins - Offers immediate protection - Example: Gamma Globulins Anti venom Anti rabies Anti tetanus  IMMUNITY HERD IMMUNITY 80% of the community members are immune to a particular disease ISOLATION  ISOLATION CONTACT ISOLATION  Prevents the spread of infection primarily by close contact or direct contact RESPIRATORY ISOLATION  Prevents transmission of infectious diseases over short distance through air  ISOLATION TB ISOLATION  For TB patients with positive smear or with chest x-ray which strongly suggests active TB ENTERIC ISOLATION  For infection with direct contact with feces  ISOLATION REVERSE / NEUTROPENIC ISOLATION  An immunocompromised client is separated to prevent contracting infection from environment PRECAUTIONS Infection control practices used to prevent transmission of diseases  PRECAUTIONS STANDARD PRECAUTIONS  Minimum infection prevention practices that APPLY TO ALL patient care.  Inclusions: Hand hygiene Use of PPE (Gloves, Mask, Gown, Eyewear) PRECAUTIONS  PRECAUTIONS STANDARD PRECAUTIONS  Minimum infection prevention practices that APPLY TO ALL patient care.  Inclusions: Hand hygiene Use of PPE (Gloves, Mask, Gown, Eyewear) Respiratory Hygiene / Cough Etiquette PRECAUTIONS  PRECAUTIONS STANDARD PRECAUTIONS  Minimum infection prevention practices that APPLY TO ALL patient care.  Inclusions: Hand hygiene Use of PPE (Gloves, Mask, Gown, Eyewear) Respiratory Hygiene / Cough Etiquette Sharps safety  PRECAUTIONS Safe injection practices Sterile instruments and devices Clean and disinfected environmental surfaces  PRECAUTIONS UNIVERSAL PRECAUTIONS  Intended to prevent exposure of health care workers to blood borne pathogens  Treat everyone’s bodily fluids as if they have potential infections TRANSMISSION – BASED PRECAUTIONS CONTACT PRECAUTIONS  Methods used to contain diseases that are spread by: Direct Contact Indirect Contact TRANSMISSION – BASED PRECAUTIONS CONTACT PRECAUTIONS  Inclusions: Single-patient room is preferred Dedicated patient equipment If cohorting, ≥3 feet space in between beds  Healthcare personnel: Gown Gloves TRANSMISSION – BASED PRECAUTIONS  Don PPE upon room entry and discarding before exiting the patient’s room  Handwashing thereafter TRANSMISSION – BASED PRECAUTIONS  Example Diseases: CONTACT PRECAUTION M ultidrug resistant organism R espiratory infection S kin infection Wound infection E nteric infection (Clostridium difficile) E ye infection (Conjunctivitis) TRANSMISSION – BASED PRECAUTIONS DROPLET PRECAUTIONS  Prevents transmission of diseases spread by: Coughing Sneezing Talking  Inclusions: Single-patient room is preferred If cohorting, ≥3 feet space and DRAWING CURTAIN in between beds TRANSMISSION – BASED PRECAUTIONS  Healthcare personnel: Surgical mask  Don MASK upon room entry and discarding before exiting the patient’s room  Use STANDARD PRECAUTIONS when handling items contaminated with respiratory secretions. TRANSMISSION – BASED PRECAUTIONS  Patient to be transported outside the room: wear face mask TRANSMISSION – BASED PRECAUTIONS  Example Diseases: DROPLET PRECAUTION S epsis / Scarlet fever / Streptococcal pharyngitis P arvovirus B19 / Pneumonia / Pertusis I nfluenza D iphtheria E piglottitis R ubella M umps / Meningitis A De Novirus TRANSMISSION – BASED PRECAUTIONS AIRBORNE PRECAUTIONS  Inclusions: Single-patient with negative pressure room Avoid cohorting Patient: Surgical Mask Health care personnel: - N95 Respirator - Powered Air Purifying Respirator TRANSMISSION – BASED PRECAUTIONS  Example Diseases: AIRBORNE PRECAUTION M easles T uberculosis V aricella Zoster (Chicken Pox) INTEGUMENTARY DISEASES CHICKEN POX (Varicella Zoster)  CHICKEN POX (Varicella Zoster)  Causative agent: Human Herpes Virus 3  Sources of infection: Secretions of respiratory tract (cough, sneeze) Lesions Scabs secretions  Incubation period: 2 – 3 weeks  CHICKEN POX (Varicella Zoster)  Mode of transmission: Direct contact to lesions Contact with contaminated linens Airborne  Period of communicability: 2 days before symptoms until 5 days from the onset of rash  CHICKEN POX (Varicella Zoster)  Signs and symptoms: Flu-like symptoms (Moderate) Pruritus Maculopapular rash – For few hours Vesicular rash – For 3-4 days CHICKEN POX (Varicella Zoster)  CHICKEN POX (Varicella Zoster)  Signs and symptoms: Flu-like symptoms (Moderate) Pruritus Maculopapular rash – For few hours Vesicular rash – For 3-4 days Centrifugal pattern  Diagnostic Test: Polymerase Chain Reaction (PCR) from scabs secretions  CHICKEN POX (Varicella Zoster)  Nursing Management: Exclusion from school until lesions have crusted over. Avoid contact with susceptible persons (immunocompromised) Do not scratch the lesions Teach the child and family how to apply topical antipruritic medication  CHICKEN POX (Varicella Zoster)  Prevention / Prophylaxis: Varicella – Zoster Immunoglobulin (VZIG) - Given IM within 10 days of exposure  MEASLES (Rubeola / 7 day measles) MEASLES (Rubeola / 7 day measles)  Causative agent: Paramyxovirus  Sources of infection: Secretions of nose and throat of infected person  Incubation period: 1-2 weeks MEASLES (Rubeola / 7 day measles)  Mode of transmission: Airborne – The virus can remain in the air up to two hours  Period of communicability: Day 1 of symptoms until 4 days after the rash appears MEASLES (Rubeola / 7 day measles)  Signs and Symptoms: Koplik’s Spots – Pathognomonic sign MEASLES (Rubeola / 7 day measles)  Signs and Symptoms: Koplik’s Spots – Pathognomonic sign Flu-like symptoms High fever Stimson’s Line – Transverse line in eye lid MEASLES (Rubeola / 7 day measles) MEASLES (Rubeola / 7 day measles)  Signs and Symptoms: Koplik’s Spots – Pathognomonic sign Flu-like symptoms High fever Stimson’s Line – Transverse line in eye lid Maculopapular rash - Cephalocaudal MEASLES (Rubeola / 7 day measles)  MEASLES (Rubeola / 7 day measles)  Diagnostic test: Real Time Polymerase Chain Reaction (RT-PCR) - Specimen: Throat or nasopharyngeal swab - Ideally done within 3 days of rash onset - Confirmatory test for measles Virus Isolation Culture - Specimen: Throat or nasopharyngeal swab - Also a confirmatory test for measles Measles Ig M Antibody Test - Detects antibody against measles  MEASLES (Rubeola / 7 day measles)  Nursing Management: Medication:  Isoprenosine (Antiviral)  Penicillin (Antibiotic)  Vitamin A Supplement - 12 months = 200,000 IU  Acetaminophen (Paracetamol) - Avoid aspirin as it could develop into Reye’s Syndrome (Inflammation of the liver and brain)  MEASLES (Rubeola / 7 day measles) Promote rest Fluid resuscitation Airborne & standard precaution Eye care (pt. prone to develop photosensitivity)  Prevention: Measles Vaccine: (0.5 mL) - Given 9 months (6 months if with outbreak) - Subcutaneous route - Outer part of upper arm - 80% protection MEASLES (Rubeola / 7 day measles) MMR Vaccine: (0.5 mL) - Given 9 – 12 months - Subcutaneous route - Second dose: 4 – 6 years old - Assessed for EGG Allergy  GERMAN MEASLES (Rubella / 3 day measles) GERMAN MESLES (Rubella / 3 day measles)  Causative agent: Togavirus  Incubation period: 2-3 weeks  Mode of transmission: Droplet  Period of communicability: “-7 +7 after onset of rash” GERMAN MESLES (Rubella / 3 day measles)  Signs and symptoms: Flu-like symptoms (Mild) Low grade fever Lymphadenopathy: - Post occipital - Post auricular Eye irritation (Conjunctivitis) Forscheimer’s Spots – Pathognomonic sign GERMAN MESLES (Rubella / 3 day measles) GERMAN MESLES (Rubella / 3 day measles)  Signs and symptoms: Flu-like symptoms (Mild) Low grade fever Lymphadenopathy: - Post occipital - Post auricular Forscheimer’s Spots – Pathognomonic sign Testicular pain – Young adults Arthralgia – Joint pain Maculopapular rash – Confluent pattern GERMAN MESLES (Rubella / 3 day measles)  Treatment: Acetaminophen for fever and joint pain Isolation  Nursing Management: Cold compress for lymphadenopathy Darken the room to prevent photophobia Eye irrigation as needed Make sure female patients understand how important it is to avoid this disease when pregnant GERMAN MESLES (Rubella / 3 day measles)  Prevention MMR Vaccine Immune serum globulin – 1 week post exposure to rubella HERPES ZOSTER (Shingles)  HERPES ZOSTER (Shingles)  Causative agent: Varicella Virus  Incubation period: 2-3 weeks  Mode of transmission: Airborne, Contact  Period of communicability: 1 day before the appearance of rash up to 5-6 days after the last crust  HERPES ZOSTER (Shingles)  Signs and Symptoms: Fever and Malaise Deep pain and pruritus on trunk, arms, and legs Vesicular / Pustular rash on painful areas  Diagnostic test: Fluorescent Light Test - To differentiate Herpes Zoster from Herpes Simplex  Drug of choice: Acyclovir – Antiviral Drug Analgesics to control pain  HERPES ZOSTER (Shingles)  Nursing Management: Airborne and contract precaution If vesicles rupture, apply cold compress Instruct patient to avoid scratching the lesions Maintain meticulous hygiene Bed rest and supportive care  Prevention: Varicella Vaccine Avoid exposure to patient with varicella infection LEPROSY (Hansenosis)  LEPROSY (Hansenosis)  Causative agent: Mycobacterium Leprae  Incubation period: 9 months to 20 years  Mode of transmission: Droplet PROLONGED skin Contact  LEPROSY (Hansenosis)  Period of communicability: After the first dose of multi- drug therapy  Three Distinct Forms: LEPROMATOUS (Multibacillary) LEPROSY - Most serious type - Not infectious - Affects: respiratory tract, eyes, nerves, testes, and skin LEPROSY (Hansenosis)  LEPROSY (Hansenosis) TUBERCULOID (Paucibacillary) LEPROSY - Affects: peripheral nerves, skin, face, eyes, testes - Macules are elevated with clearing at the center  LEPROSY (Hansenosis) BORDERLINE (Dimorphous) LEPROSY - Has the characteristics of both lepromatous and tuberculoid leprosy  Signs and Symptoms: Changes in skin color (reddish/white) Loss of sensation on the skin (Anesthetized) Decrease / Loss of sweating and hair growth over the lesions Thickened / Painful nerves  LEPROSY (Hansenosis) Muscle weakness Madarosis (Loss of eyebrow and eyelashes) Lagopthalmos (Inability to close eyelids) Sinking of nose bridge Gynecomastia Nasal obstruction  LEPROSY (Hansenosis)  Diagnostic Test: Slit skin smear / biopsy  Treatment: Sulfone Therapy: Dapsone Multi-drug Therapy: 1. Multibacillary (Rifampicin, Clofazimine, Dapsone) - Duration: 12 months 2. Paubacillary (Rifampicin and Dapsone) - Duration: 6 – 9 months  LEPROSY (Hansenosis)  Nursing Management: Isolate the patient Give antipyretic / analgesic PRN Provide emotional support Artificial tears – for Lagophthalmos Avoid thermal injury to anesthetized limb  Prevention: BCG Vaccine – At birth SCABIES (Sarcoptic Mange)  SCABIES (Sarcoptic Mange)  Causative agent: Sarcoptes Scabei  Incubation period: Within 24 hours after original contact  Mode of transmission: Skin to Skin contact  SCABIES (Sarcoptic Mange)  Period of communicability: Entire period the host is infected  Signs & Symptoms: Pruritus (More severe at night) – Most common Burrows (lesions)  SCABIES (Sarcoptic Mange)  Treatment: Aqueous Malathion Lotion Permethrin Derma Cream Benzyl Benzoate Ivermectin – Antihelminthic Antipruritic Emolient Topical Steroid for itching  SCABIES (Sarcoptic Mange)  Nursing Management: Cut fingernails short Contaminated clothing and beddings must be dry cleaned or boiled Contact precaution Good personal hygiene  Prevention: Infection control measure: Use Gloves Avoid sharing of items PEDICULOSIS  PEDICULOSIS  Human infestation of lice  Types: PEDICULOSIS CAPITIS - Lice feed on the scalp, skin, eyebrows, and beard PEDICULOSIS CORPORIS - Lice live in clothing PEDICULOSIS PUBIS - Lice live in pubic hair  PEDICULOSIS  Mode of Transmission: Head to head contact Fomites  Incubation period: 3 – 7 days  Signs and Symptoms: Pruritus of the infestation site Tickling sensation of something moving Head lice and nits on hairs and scalp  PEDICULOSIS  Diagnostic Test: Wood’s Light Examination  Treatment: Permethrine / Pyrethrin - Initial treatment of choice - Topical pediculoside Fine-tooth comb dipped in vinegar Oral anthelmintic (Ivermectin, Levamisole, Albendazole)  PEDICULOSIS  Nursing Management: Contact precaution Cut fingernails short Instruct patient how to apply creams Clothes and bedlinens must be washed in hot water, ironed, or dry cleaned. Storing clothes or linen for more than 30 days or placing them in dry heat to kill lice RESPIRATORY DISEASES DIPHTHERIA  DIPHTHERIA  Causative agent: Corynebacterium Diphtheriae  Incubation period: 2 – 5 days  Mode of transmission: Droplet Contact to infected articles Milk ingestion  DIPHTHERIA  Types: NASAL DIPHTERIA - With foul-smelling serosanguinous secretions from the nose TONSILLAR DIPHTERIA - Lesions present at tonsils but may spread into the soft palate and uvula NASOPHARYNGEAL DIPHTERIA - Cervical lymph nodes are swollen - Neck tissues are edematous  DIPHTHERIA  Types: LARYNGEAL DIPHTERIA - Most common in children - Most severe and most fatal - Starts with hoarseness = diminished voice = absent WOUND / CUTANEOUS DIPHTERIA - Affects the mucous membrane or any break in the skin  DIPHTHERIA  Signs and Symptoms: Fatigue, Fever, and Malaise Slight sore throat Husky voice (Hoarseness) Swelling of the palate Difficulty of breathing Bull-neck formation DIPHTHERIA  DIPHTHERIA  Signs and Symptoms: Fatigue, Fever, and Malaise Slight sore throat Husky voice (Hoarseness) Swelling of the palate Difficulty of breathing Bull-neck formation Diphtheric patch  DIPHTHERIA  Diagnostic Test: SCHICK TEST - Giving 0.1 mL of diluted diphtheria toxin via ID - Area is checked in 3-4 days - (+) If with inflammation or induration MOLONEY TEST - Diphtheria toxoid given via ID - To assess diphtheria allergy  DIPHTHERIA  Treatment: Penicillin Diphtheria Anti-toxin Erythromycin  Nursing Management: Ice collar applied to the neck Absolute bed rest for 2 weeks Droplet precaution  DIPHTHERIA  Prevention: Pentavalent Vaccine: - Penta 1 = 6 weeks (1 ½ months) - Penta 2 = 10 weeks (2 ½ months) - Penta 3 = 14 weeks ( 3 ½ months) Pasteurization of milk PERTUSSIS (Whooping Cough) PERTUSSIS (Whooping Cough)  Causative agent: Haemophilus Pertussis Bordet Gengou Bacillus Bordetella Pertussis  Incubation period: 7 - 10 days  Period of communicability: 3 weeks after onset of cough  Mode of transmission: Droplet PERTUSSIS (Whooping Cough)  Signs and Symptoms: STAGE 1 (CATARRHAL PHASE) Nasal congestion Rhinorrhea Sneezing Low grade fever Conjunctival Suffusion (Hemorrhage) PERTUSSIS (Whooping Cough) PERTUSSIS (Whooping Cough)  Signs and Symptoms: STAGE 2 (PAROXYSMAL PHASE) Intense coughing followed by whooping sound Vomiting after prolonged coughing Turning red when coughing STAGE 3 (CONVALESCENT PHASE) Chronic cough that last for weeks PERTUSSIS (Whooping Cough)  Diagnostic Test: Nasopharyngeal swab Sputum culture Chest X-ray reveals infiltrates  Treatment: Supportive Therapy - Fluid & Electrolyte Replacement - Adequate nutrition - Oxygen therapy PERTUSSIS (Whooping Cough) Antibiotics - Erythromycin - Ampicillin Post Exposure Treatment - Hyper immune Convalescent Serum  Nursing Management: Droplet precaution Suction equipment at bedside Instructing cough etiquette PERTUSSIS (Whooping Cough)  Prevention: Pentavalent Vaccine: - Penta 1 = 6 weeks (1 ½ months) - Penta 2 = 10 weeks (2 ½ months) - Penta 3 = 14 weeks ( 3 ½ months) INFLUENZA (La Grippe)  INFLUENZA (La Grippe)  Causative agent: Influenza Virus A, B, C  Incubation period: 1 – 3 days  Period of communicability: 1 day before until 3-5 days after onset of symptoms  Mode of transmission: Droplet  INFLUENZA (La Grippe)  Signs and Symptoms: Chilly sensation Fever Severe aches and pain at the back Vomiting Sore throat Cough & Cold  INFLUENZA (La Grippe)  Diagnostic Test: CBC – Usually normal but leukopenia noted Viral Culture via oropharyngeal swab Chest X-Ray  Nursing Management: Instruct patient to stay at home Fluid management: 8-10 glasses of water Fever management: Paracetamol Droplet precaution  INFLUENZA (La Grippe)  Prevention: Influenza Vaccine every year (annually) Earliest age to give: 6 months Recommended for high risk groups such as: - Older adults (65 y/o) - Health Workers - Pregnant  ANTHRAX (Wool-sorter’s Disease)  ANTHRAX  Causative agent: Bacillus Anthracis  Mode of Transmission: Droplet & Contact  3 types: CUTANEOUS ANTHRAX - Most common - Can enter through cuts and scrapes - Sign: Black – Eschar  ANTHRAX GASTRO-INTESTINAL ANTHRAX - From raw meat / undercooked meat - Sign: Severe Gastroenteritis PULMONARY ANTHRAX - Inhaled Spores - Sign: Respiratory Distress  ANTHRAX  Management: Decontaminate client prior to treatment Ciprofloxacin for 60 days Post exposure prophylaxis: - 3 dose SQ of Anthrax Vaccine Pre exposure vaccine: Given to high risk individual - 5 IM doses at 0 , 1 , 6, 12, & 18 months - Yearly booster TUBERCULOSIS (Koch’s Disease)  TUBERCULOSIS  Top 8 highest cases of TB in the world (Philippines)  Causative agent: Mycobacterium Tuberculosis  Mode of Transmission: Airborne & Droplet  TUBERCULOSIS  Signs and Symptoms: A – Afternoon low grade fever B – Blood in the sputum (hemoptysis) C – Cough x >2 weeks D – Decrease in weight E – Evening / Night sweats  Types: Pulmonary Extra pulmonary  TUBERCULOSIS  Diagnostics: 1. PPD / Mantoux Test - Uses tuberculin syringe - Inject ID at inner forearm - Read after 48 – 72 hours - (+) induration of: >10 mm - (+) if immunocompromize: >5 mm - Positive indicates exposure to TB  TUBERCULOSIS  Diagnostics: 2. DSSM (Direct Sputum Smear Microscopy) - Primary diagnostic tool - Best time to collect specimen: Early Morning 3. Sputum Culture (AFB) - Sputum will be put into incubator - Results in 2 – 4 weeks - CONFIRMATORY  TUBERCULOSIS  Diagnostics: 4. Chest X-Ray - Checks lesions to lungs  TUBERCULOSIS  Classifications of TB: PRESUMPTIVE TB - (+) signs and symptoms of TB - X-ray findings suggestive of TB DEFINITE / CONFIRM CASE - (+) Sputum culture  TUBERCULOSIS  Classifications of TB: NEW CASE - No previous treatment of TB - Taken Anti-TB 1 month in the past = Discontinued = Treatment again RELAPSE - Previous TB cured = Diagnosed again  TUBERCULOSIS  Classifications of TB: TREATMENT AFTER FAILURE - Previous TB care = FAILURE - Still sputum smear (+) after 5 months of treatment TREATMENT AFTER LOST FOLLOW UP (TALF) - Interrupted treatment for >2 months and returns to treatment PREVIOUS TREATMENT OUTCOME UNKNOWN (PTOU) - Treated but whose outcome undocumented  TUBERCULOSIS  Management: DOTS - Direct Observe Treatment Short-course RIFAMPICIN - Red – orange urine ISONIAZID - Hepatotoxic - Reduces vitamin B6 (Pyridoxine) = Peripheral Neuritis  TUBERCULOSIS PYRAZINAMIDE - Increases uric acid level - PyURICzinamide ETHAMBUTOL - Eye problem (Optic Neuritis) - No to children 20 petechiae per square inch DENGUE DIAGNOSTICS  NS1 (Non-Structural) ANTIGEN TEST (PROBABLE) - Rapid dengue test - Earliest test for dengue - Can detect as early as Day 1 dengue infection DENGUE IgM / IgG (ELISA) (PROBABLE) - Used to detect dengue antibodies - Ig M Antibody = Active dengue infection - Ig G Antibody = History of dengue infection  POLYMERASE CHAIN REACTION - Molecular based confirmatory test for dengue - Gold standard lab test to confirm dengue NUCLEIC ACID AMPLIFICATION TEST – LOOP MEDIATED ISOTHERMAL AMPLIFICATION ASSAY (NAAT-LAMP) - “Kalma ang epep! Pangalan ray taas ani!” - Newest molecular based confirmatory test - Same with PCR, but cheaper and simpler  PLAQUE REDUCTION NEUTRALIZATION TEST - Gold standard to characterized and quantify level of dengue antibodies COMPLETE BLOOD COUNT - Decrease platelet - Elevated hematocrit CLINICAL COURSE OF DHF  Manifestations: DENGUE Headache with periorbital pain On and off fever x 2-3 days Tourniquet test positive Low platelets Abdominal pain Muscle pain (myalgia) On and off fever Capillary refill (>3 seconds) CATEGORIES OF PATIENT WITH DENGUE CATEGORY - A: Dengue patient without warning signs  Able to drink oral fluids  Able to pass urine q6 hours  Stable hematocrit  Management: 1. Treat and send home CATEGORIES OF PATIENT WITH DENGUE CATEGORY - B: Dengue patient without warning signs but: Newborn Pregnant With pre-existing condition (DM, HPN, Chronic Disease) CATEGORY - B: Dengue patient with warning signs: CATEGORIES OF PATIENT WITH DENGUE  Management: 1. Admit 2. No resuscitation CATEGORIES OF PATIENT WITH DENGUE CATEGORY - C: Severe Dengue Patient: Severe hemorrhage Organ Failure Septicemia  Management: 1. Needs resuscitation  Treatment: DENGUE Don’t give aspirin (Use Paracetamol) Hydration Fresh Whole Blood Transfusion  Nursing management: Nose bleeding = Icepack on nosebridge WOF: Signs of shock (HypoTachyTachy)  DENGUE  Prevention: Search and destroy Seek early consultation Self protection measures Say yes to fogging only during outbreaks  DENGUE  “Always remember asa nag skwela si Dengue!” D – Day biting L – Low flying S – Stagnant water Note: Baliha ni tanan, mao nani ang MALARIA! U – Urban City MALARIA  MALARIA  Causative Agent: Plasmodium Falciparum (Most common) Plasmodium Vivax Plasmodium Malariae Plasmodium Ovale  Mode of Transmission: Bite of infected female anopheles mosquito Blood transfusion Placental transmission  MALARIA  Incubation Period: Plasmodium Falciparum = 5 – 7 days Plasmodium Vivax = 6 – 8 days Plasmodium Malariae = 8 – 9 days Plasmodium Ovale = 12 – 16 days  Signs and Symptoms: Paroxysms (Shivering and cold) Rapid rising fever with severe headache Profuse sweating Myalgia  MALARIA Splenomegaly Hepatomegaly  Chemoprophylaxis: CHLOROQUINE - Taken in with weekly intervals - Starting from 1 – 2 weeks before entering endemic areas  Preventive Measures: House spraying of insecticide Wearing long clothes Avoiding outdoor night activities (9PM – 3AM)  MALARIA  “Always remember asa nag skwela si MALARIA!” “Desidido Muhaval National Highschool” D – Dool sa bukid nga Area (Rural) M – Magdagan nga Water (Running water) N – Night biting H – High flying FILARIASIS (Elephantiasis)  FILARIASIS  A parasitic disease caused by an African eye worm  Causative Agent: Wuchereria Bancrofti Brugia Malayi Brugia Timori  Mode of Transmission: Bite of infected Aedes Poecillus mosquito  FILARIASIS Incubation Period: 8 – 16 Months  Signs and Symptoms: Lymphadenitis Epididymitis Hydrocele Lymphedema Elephantiasis  Diagnostics: Immunochromatographic Test (ICT) – Rapid antigen test  FILARIASIS  Treatment: Diethylcarbamazine Citrate (Hetrazan)  Nursing Management: Health education Environmental sanitation Psychological and emotional support Mosquito net application Mosquito repellent application Wash bitten area with soap and water RABIES  RABIES  A viral infection communicated to man by saliva of an infected animal  Causative Agent: Rhabdovirus / Lyssa Virus  Mode of Transmission: Bite of infected animal  RABIES  Vector: Dogs  Attacks the CNS causing ENCEPHALITIS  Incubation Period: 2-8 weeks Dog bites in Head, Face, and Neck = 1 month)  HIV - AIDS  Stages of HIV Infection: STAGE 4: - Acquired Immunodeficiency Syndrome (AIDS) - CD4 cell count: