Communicable Diseases PDF

Host – a person, animal, or plant which a COMMUNICABLE parasite depends on for its survival Infectious disease – it is transmitted not DISEASES only by or...

Host – a person, animal, or plant which a COMMUNICABLE parasite depends on for its survival Infectious disease – it is transmitted not DISEASES only by ordinary contact but also requires direct inoculation of the organism through a Communicable diseases are more often the break on the skin or mucous membranes; leading causes of illness in the country today. hence, all contagious diseases are Most often, they afflict the most vulnerable, the considered infection BUT not all infectious young and the elderly. They have numerous diseases are contagious or communicable. economic, psychological, disabling, and Isolation – the separation of an individual disfiguring effects to the afflicted individuals, suffering from a communicable disease families and communities. What is doubly from other people. threatening is the emergence of newly Quarantine – refers to the limitation of the discovered diseases and the re-emergence of freedom of movement imposed on people old ones. In this situation, the need for or animals previously exposed to information about the diseases is very bital. communicable disease/s for a period of DEFINITION OF TERMS time equivalent to the longest incubation period of that particular disease. Carrier – an individual who harbors the Reservoir – one or more species of plant or organism and is capable of transmitting it to animal in which an infectious agent lives a susceptible host. They are often and multiplies for its survival, as well as a asymptomatic. venue to reproduce itself in such a manner Communicable disease – it is transmitted that it can be transmitted to humans. not only by ordinary Surveillance – the act of watching, Contact – any person or animal who had collecting, and recording data from a been in close association with an infected particular population or area. person, animal, or freshly soiled materials. Contagious disease – a disease that is easily THE INFECTION PROCESS transmitted from one person to another Infection is defined as the entry and through direct or indirect means. multiplication of an infectious agent in or on the Disinfection – the destruction of pathogenic tissue of a host. If the agent fails to cause injury microorganisms outside the body using to the host’s cell or tissue, the pathogen is said direct, physical, or chemical means. to be colonizing the cell or tissue without o Concurrent disinfection – done causing harm. If pathogens multiply and cause immediately after the infected individual clinical signs and symptoms, the infection produces material/secretions; it is carried becomes symptomatic. out when the patient is still the source of infection When an organism damages or alters o Terminal disinfection – applied when the the host’s physiology, it is an infectious disease. patient is no longer the source of Organisms that have the ability to cause a infection. disease are called pathogens. Those that do not Habitat – a place where the organism is cause diseases are considered nonpathogenic. usually found Virulence is the measure of the likelihood that a particular organism will cause a disease. THE EPIDEMIOLOGIC TRIAD the host’s exposure to harmful microorganisms. Component of environment: a. Physical environment – the inanimate surroundings, such as geophysical condition and the climate b. Biological environment – the living things around the affected individual c. Socio-economic environment – ex. Crowding, sanitation, and the availability of health services Infectious agent – microorganisms that THE CHAIN OF INFECTION cause infection Factors that influence the cause of disease: - Pathogenicity – The ability of an organism to cause a disease - Infectivity – the ability of the organism to infect the host - Virulence – the ability of the organism to produce disease - Infective dose – the number of organisms and the amount of toxin released by 1. Infectious agents – are microbes capable of organism needed to induce a disease producing a disease. The number of Host – organisms affect their ability to cause a - Patient (case) – a person who is infected disease, as well as the susceptibility of the and manifest signs and symptoms of the host. For the organisms to cause a disease disease they must be able to: - Carrier – a person who appears to be Adhere to the skin and the mucous healthy but harbors the organism, an is membranes; capable of transmitting the disease but Penetrate the skin or mucous membranes; does not manifest signs and symptoms and - Suspect – a person whose medical history, Multiply and invade the body’s natural signs, and symptoms suggest that such a defenses person is suffering from that particular 2. Reservoir of infection – can be a person, disease animal, plain, the soil, or other substances - Contact – a person who has been in close where an infectious agent lives and association with an infected person, multiplies until it can infect the susceptible animal, or object host. Categories: Environment – the sum total of all external Human reservoir conditions that affects the development of Animal reservoir an organism and serves as an opportunity of Environmental reservoirs – living and non-living reservoirs that harbor  infectious pathogens outside bodies of microbes to another living organism. Ex. animals. Fleas, flies, mosquitoes 3. Portal of exit – the route in which the b. Vertical transmission – the passage of a organism leaves the reservoir. It usually disease=causing agent (pathogen) from the corresponds to the site where the agent is mother to her baby during (e.g. HIV can be localized. Common portals of exit or vertically transmitted pathogen) avenues for secretions, excretions, and 5. Portal of entry – the venue where the droplets are the organism infiltrates the susceptible host A. Respiratory tract – nasal discharges 6. Susceptible host – refers to an individual B. Genitourinary tract (GUT) – urethral who has the potential to contract an secretions infection. The human body has many C. Gastrointestinal (GIT) – vomitus, stools, defenses against the entry and some anal secretions multiplication of microorganisms. When D. The skin and mucous membrane – skin host’s defenses are good, infection will not infections take place E. The placenta (in vertical transmission) 4. Mode of transmission – the means by Pneumonia which the infectious agent passes from the An acute infectious disease primarily caused by portal of exit from the reservoir to the pneumococcus (Streptococcus Pnuemoniae) susceptible host. and is associated with general toxemia and a - The easiest link to break in the chain of consolidation of one or more lobes of either one infection or both lungs. a. Contact transmission – the most common - Direct contact – refers to the person-to- An inflammation of the lungs caused by an person transfer of organisms infectious agent in which the air sacs/alveoli are - Indirect contact – occurs when the filled with phlegm or exudates so that air is susceptible person comes in contact with excluded and lungs become solid. a contaminated object *Infectious Disease of Adults o Droplet spread – contact with respiratory secretions produced who the ETIOLOGIC AGENTS infected person coughs, sneezes, or talks. Microbes carried by droplets can travel Bacteria, most often is caused by the up to 3 feet or 1 meter Klebsiella group and Haemophilus o Airborne transmission – occurs when influenzae fine aerosolized droplets or dust Viruses particles containing microbes remain Fungi (from soil/bird droppings) suspended in the air for a prolonged Noxious substance (various chemicals) period an is subsequently spread by air currents and inhaled by other people TYPES OF PNEUMONIA: o Vehicle transmission – refers to the 1. Bacterial Pneumonia transmission of pathogens through Leading cause: streptococcus water, food, an air pneumoniae, followed by haemophilus o Vector-borne transmission – intermediate carriers transfer the influenzae. Other common bacteria that may cause 1. Primary Pneumonia – direct result of pneumonia are: inhalation or aspiration of pathogens or noxious substances. a. Staphylococcus aureus 2. Secondary – develops as a complication to a b. Klebsiella pneumoniae particular disease. – in about 2-3 days after c. Legionella pneumoniae the initial presentation of a viral disease, a 2. Viral Pneumonia number of bacteria could set in, such as Usually not serious and lasts for a shorter S.aureus, S.pneumoniae and Heamophilus time that bacterial pneumonia influenzae Rare in adults except if there is an outbreak Anatomical Classification of Pneumonia 3. Mycoplasma Pneumonia 1. Bronchopneumonia (Lobular or Catarrhal Mycoplasma organisms have a Pneumonia) characteristic lack of cell walls and are most common type and the infection considered that smallest and simplest self- usually starts from the bronchus and the limiting bacteria. bronchioles and spreads to the alveoli. Generally, cause milder cases of Generally caused by pneumococcus, pneumonia, usually affecting older klebsiella pneumoniae, and H.influenzae children and young adults. Onset is usually slow and low-grade fever 4. Fungal Pneumonia may be present Fungi from soil and bird droppings can The period of communicability is cause pneumonia. People who inhaled unknown. large amounts of the organisms. 2. Lobar pneumonia (Croupous pneumonia) ❖ INCUBATION PERIOD Characterized by consolidation of one or Ranges from 1-3 days with sudden onset two lobes of the lungs of shaking chills, rapidly rising fever, and Usually manifested by chills, chest pain on stabbing chest pains aggravated by breathing, cough with blood-streaked coughing and respirations. prune juice-like or rusty-looking sputum, ❖ MODE OF TRANSMISSION which is considered as the pathognomonic Droplet infection occurs when bacteria or sign of pneumonia. viruses travel on relatively large 3. Interstitial pneumonia respiratory droplets when people sneeze, Involves the areas in between the alveoli, cough, or laugh. sometimes known as Interstitial Indirect contact through exposure to pneumonitis. contaminated objects or through Characterized by progressive scarring of inhalation of caustic or toxic chemicals. both lungs CLASSIFICATION OF PNEUMONIA Cough is often delayed and greenish to whitish secretions are often expected on General Classification of Pneumonia coughing on the 3rd to the 5th day. Mycoplasma pneumoniae – the most common cause  Usually results from the collection of fluid in the dorsal region of the lungs and occurs in the bedridden or elderly who are confined to a supine position for extended periods of time. According to Area of Acquisition 1. Community-acquired pneumonia (CAP) PATHOLOGY Contracted in the course of one’s daily life, at The pathology of the disease is divided into four work, at school or at the gym. stages: If a hospitalized patient develops pneumonia in 1. Stage of lung engorgement less than 36 hours during his/her stay in the Occurs within 24 hours of infection. The lungs hospital, he/she is diagnosed as having CAP. exhibit microscopic vascular congestion and S.Pneumoniae – the most common bacterial alveolar edema. cause of CAP Many bacteria and a few neutrophils are 2. Hospital-Acquired Pnuemonia (HAP or present. The lungs are heavy and dark red. nosocomial pneumonia) 2. Red Hepatization Develops while the client is in the hospital Occurs 2-3 days of infection 3. Aspiration Pneumonia This stage gets its name from the fact that the Occurs when foreign matter is inhaled lungs resemble the consistency of the liver, (aspirated) into the lungs. characterized by the presence of many erythrocytes, neutrophils, desquamated Gastric Content most common caused of epithelial cells, and fibrin within the alveoli. aspiration; enters the lungs after vomiting The lungs are still heavy and sinks in water More likely to occur if the client has a swallowing problem The lungs look like a piece of red granite 4. Ventilator-associated Pneumonia (VAP) 3. Gray Hepatization Refers to cause of pneumonia that occurs in The lungs are grayish-brown to yellow in color patients using a ventilator. due to fibrinopurulent exudates, disintegration of RBC’s, and hemosiderin 5. Pneumocystis jiroveci pneumonia Caused by the opportunistic fungus The red color changes to gray. The lungs look Pneumocystis jiroveci (formerly P. Carinii) like ordinary granite Affects patients with compromised immune It is softer and tears more easily systems 6. Hypostatic pneumonia 4. Stage of resolution Develops when the patients are not turned to Characterized by reabsorption and restoration their sides of pulmonary architecture Fibrinous inflammation may lead to resolution 2. Chest X-Ray – confirmatory diagnostic or to organization and pleural adhesions exam; determines the extent and location of the infection The inflammatory exudates are either absorbed 3. Sputum analysis, smear, culture – help by the bloodstream or expectorated pinpoint the cause of infection CLINICAL MANIFESTATION 4. Blood/serologic exam 5. Pulse oximetry Signs and symptoms 6. Computed tomography (CT) scan – obtains Sudden onset of chills with rising fever a more detailed image of the lungs Stabbing chest pains aggravated by 7. Pleural fluid collection respiration and coughing Paroxysmal or choking cough COMPLICATIONS Sputum is rusty or prune juice-like in color 1. Bacteremia – can cause septic shock (pathogpneumonic to pneumonia) 2. Lung abscess – results from pockets of pus Pain in the abdomen may be mistaken for that build up in the lungs appendicitis 3. Pleural effusion – presence of excess fluid Herpes may appear on the lips and around between the layers of the pleural outside the mouth the lungs Body malaise 4. Empyema – presence or collection of pus in Respiratory grunting with marked the pleural cavity tachypnea and flaring of the nares 5. Pleurisy/Pleuritis – is the inflammation of Labored respiration associated with the pleura diaphoresis Pulse is rapid and bounding TREATMENT MODALITIES Convulsions and vomiting in children may Antimicrobial therapy – varies with each occur agent Confusion or changes in mental awareness Supportive measures include: may occur, especially in adults age 65 and a. Humidified O2 therapy older. b. Mechanical ventilation for respiratory DIAGNOSTIC PROCEDURES failure c. High caloric diet and adequate fluid intake, 1. Physical Findings for patients with lobar unless contraindicated pneumonia are: d. Absolute bedrest Malar paleness, flushed face, and dilated Bronchodilators – aminophylline pupils, with high fever, fast respiration, and Expectorants relatively low pulse Pain reliever – for pleuritic pain Rusty sputum with hacking paroxysmal cough PREVENTION AND CONTROL Diminished chest movement on the affected Efforts should be directed to: side, with dull sounds on percussion  Prevent common colds, influenza, and other Control the spreads of infection by respiratory infection disposing of secretions properly and Avoid environmental factors enforcing mandatory handwashing Get enough rest Control the temperature by performing Eat healthy diet that includes lots of fruits, cooling measures vegetables, fiber, and lean protein Monitor vital signs closely and watch for Washing hands often in warm, soapy water danger signs like: Use an alcohol-based hand sanitizer when 1. Marked dyspnea water is not available 2. Thready, small irregular pulse Immunization with pneumonia vaccine 3. Delirium with extreme restlessness 4. Cold, most skin 2 TYPES OF PNEUMONIA VACCINES 5. Cyanosis and exhaustion a. Pneumococcal conjugate vaccine (PCV13 or RISK FACTOR THAT INCREASES ONE’S CHANCE Prevnar 13) OF ACQUIRING PNEUMONIA b. Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax) Age – children 65y/o Cigarette smoking Possible side effects of vaccines: Recent viral respiratory infections Redness or swelling around the injection Person with poor gag reflex and with sites difficulty swallowing Muscle pains Chronic lung disease Fever and sometimes associated with Cerebral palsy chills Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes *Children should not get the pneumonia vaccine Recent surgery or trauma and flu vaccine at the same time. This may increase their risk of having fever-related Persons with weakened immune system die seizures. to illness, certain medications, and autoimmune disorders NURSING MANAGEMENT TUBERCULOSIS (Koch’s disease, Maintain a patent airway and adequate oxygenation Phthisis, Consumption) Teach the patient how to cough and It is a chronic, contagious, and infection disease perform deep breathing exercise to clear commonly affecting the lungs with characteristic secretions and advise him/her to do this caseation, necrosis, and calcification. It can also often affect other parts of the body. Obtain sputum specimens as needed, and Is considered as the world’s deadliest disease teach the patient how to collect correctly and remains as major public health problems in Maintain adequate nutrition to offset high the Philippines caloric utilization It is a highly infectious chronic disease caused Provide a calm environment as the by the tubercule bacilli. It is primarily a patients need rest respiratory disease but can also affect other CLASSIFICATION organs of the body and is common among Minimal malnourished individuals living in crowded areas. It often occurs in children of Slight lesions without demonstrable underdeveloped and developing countries in excavation the primary complex especially after about a Confined to a small part of one lobe or debilitating childhood disease such as measles both lungs ETIOLOGIC AGENTS Moderately Advanced TB Mycobacterium Tuberculosis – a rod- One or both lungs may be involved shaped, acid-fast bacilli Cavity should not exceed 4cm Humans are the primary reservoir Affected area should not extend to one Mycobacterium bovis – found in cattle. lobe Bovine TB is acquired through the ingestion of unpasteurized dairy products or contact Far Advanced with airborne secretions from infected unpasteurized dairy products or contact More extensive than moderate with airborne secretions from infected CLINICAL CLASSIFICATION cattle 1. Inactive (latent) TB MODE OF TRANSMISSION Symptoms of tuberculosis are absent Droplet infection No evidence of cavity on chest X-ray Droplet nuclei are so small (1-5 microns) TB organisms are present in the client’s that air current that normally circulates in body, but the immune system stops them any indoor space can keep these airborne from spreading for long periods of time. The Client does not manifest symptoms and is microorganisms can remain suspended in deemed not contagious. However, the midair before it reaches a host microorganisms are still alive and can one day become active. INCUBATION PERIOD 2. Active 2 to 10 weeks Tuberculin (Mantoux test) test is positive Chest X-ray generally is progressive PERIOD OF COMMUNICABILITY Symptoms due to lesions are usually As long as the TB bacilli are variable present Sputum and gastric content are positive SOURCE OF INFECTION for tubercle bacilli Sputum, blood from hemoptysis, nasal Clients are capable of spreading the discharge, and saliva disease to others 90% of adults cases of active TB are from the reactivation of a latent TB infection 3. Activity not determined pancytopenia, or leukemoid reaction, When activity has not been determined which is common in patients >60y.o from a suitable period of time observation B. Sign and Symptoms of Pulmonary or adequate laboratory and X-ray studies, further observation is warranted Tuberculosis 1. Imperceptible onset of cough, which is PATHOLOGY associated with production of mucoid or, Mycobacterium tuberculosis (inhaled) mucopurulent sputum lasting for weeks or Alveoli (Ghon’s tubercle) over a month Aggregation of lymphocytes 2. Hemoptysis Death of cells 3. On-and-off dull, aching pain, or tighness in Caseous necrosis the chest is occasionally present Cheesy excretion 4. Physical findings may include rales or signs RISK FACTORS of lung consolidation Tight living quarters 5. Tuberculosis pleuritis is generally Below or at poverty line unilateral. It is associated with acute or Refugee (immigrant) recurrent pleuritic pain Immune system issues (ex. HIV) Substance abuser (ex. IV drugs) C. Results of Radiographic Examination of the Kids 10,000/cu. mm) and adults of all ages (range 0-109 years), most 7. Anorexia, nausea, and vomiting reported MERS cases have been in older adults. 8. Client in side-lying position with abdominal guarding and legs flexed Most hospitalized MERS patients have had pre- 9. Constipation or diarrhea existing medical conditions that likely increased their risk for severe illness. Among global cases COLLABORATIVE MANAGEMENT reported to date, the mortality rate of MERS 1. Bedrest cases reported to World Health Organization 2. Maintain on NPO (WHO) is approximately 35% 3. Avoid factors that increase peristalsis SIGNS AND SYMPTOMS Heat application Laxative MERS symptoms can range from mild to severe. Enema People with mild MERS infection may not 4. IV therapy receive a correct diagnosis. The more common 5. Antibiotic therapy symptoms include 6. Surgery: Appendectomy POST-OPERATIVE MANAGEMENT PATHOPHYSIOLOGY 1. Monitor temperature for signs of infection In PID organisms usually enter into the body 2. Assess incision for signs of infection such as through the vagina, pass through the cervical redness, swelling, and pain canal, this commonly occurs after childbirth or 3. Maintain NPO status until bowel function abortion. has returned Colonization of the organism occurs into the 4. Advance diet gradually as tolerated and endocervix and move upward directly through prescribed, when bowel sounds return the tissues that support the uterus by way of 5. If rupture occurred, expect a Penrose drain the lymphatics and blood vessel due to to be inserted, or the incision may be left increased blood supply to the pelvic organs. open to heal from the inside out 6. Change the dressing as prescribed and record the type and amount of drainage 7. Administer antibiotics and analgesics as In gonorrheal infection, the gonococci pass prescribed through the cervical canal into the uterus especially during menstruation, when the PELVIC INFLAMMATORY DISEASE environment is favourable (PID) Is an inflammatory condition of the pelvic cavity Multiply rapidly and causes the infection to that may begin with cervicitis and involved the spread uterus (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic Organism proceed to one or both fallopian tube, peritoneum, or pelvic vascular system ovaries, into the pelvis, and the infection tend to be bilateral. Usually caused by bacteria but may be attributed to a virus, fungus, or parasite Pelvic Inflammatory Disease PID may increase the risk of the following: Infection can cause peri-hepatic inflammation Ectopic pregnancy (fertilized eggs trapped when the organism invades the peritoneum in the tube) Infertility Recurrent pelvic pain In rare cases the infection spread through the Tubo-ovarian abscess blood stream from the lungs Recurrent disease ETIOLOGIC AGENT Neisseria gonorrhoeae – more severe Chlamydia trachomatis – less likely to cause symptoms CAUSES No clinical response to oral antimicrobial therapy Most often sexually transmitted Inability to follow or tolerate outpatient oral Invasive procedures such as endocervical regimen biopsy, abortion, hysteroscopy, or insertion Severe illness (nausea & vomiting) of IUD Tubo-ovarian abscess RISK FACTORS NURSING MANAGEMENT Early age at first intercourse Nurse assesses for both physical and Multiple sexual partners emotional effects of PID Frequent intercourse If patient is hospitalized, prepare patient for Intercourse without condoms further diagnostic evaluation and surgical Sex with partners with STIs intervention Previous pelvic inflammation Accurate recording of vital signs, I&, amount CLINICAL MANIFESTATIONS of vaginal discharge Administer analgesics as prescribed for pain Vaginal discharge relief Dyspareunia Encourage adequate rest and a healthy diet Pelvic or lower abdominal pain Minimize transmission of infection by Tenderness after menses adhering to appropriate infection control Postcoital bleeding practices Fever Perform meticulous handwashing General malaise Anorexia PATIENT EDUCATION Nausea At the completion of education, Headache patient/caregiver will be able to: Possibly vomiting State the impact of PID on physiologic COMPLICATIONS functioning, ADLs, IADLs, roles, relationships, and spirituality Peritonitis Identify the name, dose, SE, frequency, Abscesses and schedule for all medications Strictures o State the importance of completing the Fallopian tube obstruction course of antibiotic therapy Scar tissue resulting to sterility Understand interventions that may Adhesions prevent recurrence MEDICAL MANAGEMENT o Proper perineal care procedure o Take full course of antibiotic agents, as Antibiotic therapy prescribed INDICATIONS FOR HOSPITALIZATION o Recognize that sexual partners may need treatment Surgical emergencies Discuss the importance of following health Pregnancy practices  State the symptoms which require o Inflammation evaluation by healthcare provider. (Pelvic o Moderate alcohol consumption pain, abnormal discharge, etc.) PATHOPHYSIOLOGY Relate how to reach primary provider with questions or complications Etiologic factors State time and date of follow-up medical Decrease in testosterone level appointments, therapy, and testing Identify sources of support (e.g. friends, Testosterone to DHT faith community) DHT accumulated in stromal cell of prostate Identify the need for health promotion, disease prevention, and screening Enlargement of prostate activities Obstruction of urine flow BENIGN PROSTATIC HYPERPLASIA ASSESSMENT AND DIAGNOSTIC FINDINGS (ENLARGEMENT OF THE PROSTATE) Health history – UTI, family history of A noncancerous enlargement or hypertrophy of prostate disease the prostate Patient voiding diary – to record voiding One of the most common diseases in aging men frequency and urine volume DRE – reveals a large, rubbery, and Enlargement compresses the urethra, resulting nontender prostate gland in partial or complete obstruction Urinalysis – to screen for hematuria The second most common cause of surgical PSA level intervention in men older than 60 years Measurement of post-voidal residual urine Urethrocystoscopy RISK FACTORS Ultrasound Smoking ASSESSMENT Heavy alcohol consumption Obesity 1. Diminished size and force of urinary stream Reduced activity level (early sign of BPH) Hypertension 2. Urinary urgency and frequency Heart disease 3. Nocturia Diabetes 4. Inability to start (hesitancy) or continue a Western diet (high in animal fat and protein urinary stream and refined carbohydrates, low in fiber) 5. Feelings of incomplete bladder emptying 6. Postvoid dribbling from overflow ETIOLOGY incontinence (later sign) Idiopathic 7. Urinary retention and bladder distention Aging along with endocrine factors 8. Hematuria 9. Urinary stasis Accumulation of dihydroxytestosterone 10. Dysuria and bladder pain Cancer of prostate 11. UTIs Others: o Obesity INTERVENTIONS 5. Antispasmodics may be prescribed for bladder spasm 1. Encourage fluid intake of up to 2000 to 3000 6. Instruct the client to monitor and report ml/day unless contraindicated dribbling or incontinence postoperatively 2. Prepare for urinary catheterization to drain and teach perineal exercises bladder and prevent distention 7. Sterility is possible following the surgical 3. Avoid administering medications that cause procedure urinary retention, such as anticholinergics, antihistamines, decongestants, and SEXUALLY TRANSMITTED antidepressants. 4. Administer medications as prescribed to INFECTION (STIs) shrink the prostate gland and improve urine flow A. GONORRHEA (GC, CLAP, DRIP) 5. Administer medications as prescribed to CAUSATIVE AGENT: relax prostatic smooth muscle and improve urine flow Bacteria, Neisseria gonorrheae 6. Instruct the client to decrease intake of MODE OF TRANSMISSION: caffeine and artificial sweeteners and limit spicy or acidic foods Direct contact between the infectious mucous 7. Instruct the client to follow a timed voiding membranes, e.g. genital, anus, and mouth of schedule one person with the mucous membranes of 8. Prepare the client for surgery or invasive another procedures as prescribed Contaminated fingers can pass the organism SURGICAL INTERVENTION: TRANSURETHRAL from infected mucous membranes to the eyes RESECTION OF THE PROSATE (TURP) INCUBATION PERIOD 1. The procedure involves insertion of a scope Usually 2-10 days, possibly 3 days or more into the urethra to excise prostatic tissue 2. Monitor for hemorrhage; bleeding is SIGNS AND SYMPTOMS common following TURP Genitals (penis or cervix), anus, throat, and eyes 3. Postoperative continuous bladder irrigation can be infected (CBI) may be prescribed, which prevents catheter obstruction from clots Male ✓ Bladder irrigation may also be used to instill medications such as antibiotics for Burning urination treating bladder infections Pus discharges from infection of urethra (5- ✓ This is done over a period of time, and 10% have no symptoms) runs continuously Female 4. Asses for signs of transurethral resection syndrome, which include signs of cerebral Vaginal discharge although up to 80% have edema and increased intracranial pressure, no symptoms for cervical infection of such as increased BP, bradycardia, rectum confusion, disorientation, muscle twitching, Often no symptoms or mild sore throat for visual disturbances, nausea and vomiting gonorrhea of the throat Infection of the eye is rare in adults DIAGNOSIS DIAGNOSIS Gram staining Dark field illumination test Culture of cervical & urethra Kalm test TREATMENT TREATMENT As prescribed Antibiotics as prescribed COMPLICATIONS COMPLICATIONS 1. Pelvic inflammatory disease Severe damage to nervous system and other 2. Sterility in both sexes body organs possible after many years: 3. Arthritis o Heart disease 4. Blindness o Insanity 5. Meningitis o Brain damage 6. Heart and kidney damage o Severe illness or death of newborns 7. Skin rash 8. Ectopic pregnancy and eyes damage in C. CHLAMYDIA newborns B. SYPHILIS (SY, BAD BLOOD, THE CAUSATIVE AGENT POX) Chylamydia trachomatis CAUSATIVE AGENT MODE OF TRANSMISSION Treponema pallidum Sexual contact Infants can become infected during vaginal MODE OF TRANSMISSION delivery Direct contact with infectious sore INCUBATION PERIOD INCUBATION PERIOD 2-3 weeks for males; usually no symptoms 10 days to 2 months, with average of 21 days in females SIGNS AND SYMPTOMS SIGNS AND SYMPTOMS Primary stage: painless chancre (sore) at site of Females: entry of germs, swollen glands Sometimes a slight vaginal discharge Secondary stage: symptoms usually appear 1 Itching and burning of vagina, painful week to 6 months after appearance of chancre intercourse and may include rash, patchy hair loss, sore Abdominal pain throat, and swollen glands Fever in later stage (Congenital syphilis) – pregnant woman can Males: transmit the disease to her unborn child Discharge from penis Late syphilis: varies from no symptoms to Burning and itching of urethral opening indication of damage to body organs such as the Burning sensation during urination brain, heart, and liver DIAGNOSING Can be transmitted through contact with wet objects, such as towels, wash clothes, Difficulty to diagnose and touching equipment Culture test Ruling out gonorrhea with appropriate test INCUBATION PERIOD TREATMENT 4-20 days, with average being 7 days Antibiotics as prescribed SIGNS AND SYMPTOMS COMPLICATION Females If untreated, can cause sterility, pre-maturity White or greenish-yellow odorous discharge and stillbirths, infant pneumonia, and eye Vaginal itching and soreness infection in infants, which can lead to blindness. Painful urination D. GARDIANELLA VAGINITIS Males (NONSPECIFIC VAGINITIS) Slight itching of penis Painful urination CAUSATIVE AGENT: Clear discharge from penis Varies DIAGNOSIS SIGNS AND SYMPTOMS Microscopic slide of discharge Most of the people do not have any symptoms, Culture tests especially rare in males. Female symptoms may Examination include a slight greyish or yellow odorous vaginal discharge and mild itching or burning TREATMENT sensation Curable with an oral medication TREATMENT COMPLICATION Curable with antibiotics and vaginal creams or Long-term effects in adults not know. There is suppositories some evidence that infected individuals are COMPLLICATION more likely to develop cervical cancer Recently, this condition has been associated F. HEPA B with prematurity and other abnormal Is a disease of the liver which can be caused by pregnancy outcomes viruses, bacteria, protozoa, toxic chemicals, E. TRICOMONIASIS drugs and alcohol CAUSATIVE AGENT Hepa B, a STD is considered to be the most serious due to the possibility of severe Protozoan-Trichomonas vaginalis complication such as massive liver damage and MODE OF TRANSMISSION hepatocarcinoma of the liver Direct sexual contact SIGNS AND SYMPTOMS Use disposable needle and syringe or sterilize the non-disposable before and after 1. Loss of appetite use 2. Easy fatigability Avoid sharing instruments that can become 3. Malaise contaminated with blood 4. Joint and muscle pain (similar to influenza) Observe safe sex 5. Low grade fever Have an adequate sleep, rest, exercise, and 6. Nausea and vomiting eat adequate nutritious foods 7. Right-sided abdominal pain 8. Jaundice (skin and sclera) HIV/AIDS 9. Dark-colored urine CAUSATIVE AGENT MODE OF TRANSMISSION Retrovirus – Human T-cell lymphotrophic virus 3 a. From person to person (HTLV-3) b. Parental transmission c. Perinatal transmission MODE OF TRANSMISSION HIGH RISK TO HEPA B Sexual contact Blood transfusion Newborns, infants, and children of infected Contaminated syringes, needles, nipper, mother razor blades Children in localities where the occurrence Direct contact of open wound/mucous of HEPA B cases is high membrane with contaminated blood, body Sexual and household contacts of acute fluids, semen, and vaginal discharge cases and carriers Health workers exposed to handling INCUBATION PERIOD blood/blood products as doctors, dentists, Variable, 1-3 months is the time of the nurses, medical technologists, technicians, development of detectable antibodies, while attendants, and others the HIV infection to diagnosis of AIDS has Persons requiring/undergoing frequent observed range of less than 1 year to 15 years blood/plasma transfusion such as or longer hemophiliacs Sexually promiscuous individuals as active SIGNS AND SYMPTOMS heterosexuals and homosexuals A. Physical Commercial sex workers (hospitality girls) Maculo-papular rashes Drug addicts using intravenous drugs Loss of appetite PREVENTIVE MEASURES Weight loss Fever of unknown origin Immunization with Hepa B vaccine Malaise Wear protective gear Persistent diarrhea Wash hands and other skin areas before and Tuberculosis after contact with other things Esophageal candidiasis Avoid injury with sharp instruments Kaposi’s sarcoma (skin cancer) Pneumonia  Gaunt-looking, apprehensive MODE OF TRANSMISSION B. Mental Direct contact with respiratory droplets from Early stage nose and throat of infected people Forgetfulness Loss of concentration SIGNS AND SYMPTOMS Loss of libido High grade fever for first 24 hours, weakness, Apathy joint and muscle pain, hemorrhagic, rash, Psychomotor-retardation meningeal irritation Withdrawal Later stage INCUBATION PERIOD Confusion disorientation 2-10 days with an average of 3-4 days Seizures Mutism METHODS OF PREVENTION CONTROL Loss of memory 1. Respiratory isolation of patients for the first Coma 24 hours upon admission to prevent DIAGNOSIS exposure of hospital 2. Hospital personnel upon entry to Enzyme linked immune-sorbent assay meningococcemia room are required to (ELISA) presumptive test wear mask, gloves, goggles, and gown Western blot-confirmation test especially when doing endo-tracheal PREVENTION incubation 3. Chemoprophylaxis should be given among Maintain monogamous relationship school children/household contact Avoid promiscuous sexual contact especially in young children with direct Sterilize needles, syringes and instruments exposure to index patient’s secretion used for cutting operations through kissing, sharing utensils, or sleeps Proper screening of blood donors in the same house as index patient in Rigid examination of blood and other previous 7 days products for transfusion 4. The public should be educated to avoid Avoid oral, anal contact and swallowing of overcrowded places to reduce the risk of semen exposure particularly among the young and Use condoms and other protective device the elderly 5. Hospital personnel are rarely at risk even MENINGOCOCCEMIA when caring for patients thus, only those with intimate exposure to naso-pharyngeal CAUSATIVE AGENT secretion or unprotected exposure during Gram negative bacteria caused Neisseria endo-tracheal incubation warrants Meningitidis, a gram-negative diplococcus chemoprophylaxis SOURCE OF INFECTION Direct contact with respiratory droplets from nose and throat of infected people NURSING CARE NURSING CARE 1. The patient must be given Patients will be isolated in designated chemoprophylaxis before discharge to hospital using hospital referral network assure the elimination of meningococcus in Same principles of infection control applied the naso-pharynx for SARS will be observed 2. Observe infection control Early recognition of cases of Highly 3. Practice the gown technique including Pathogenic Avian Influenza (HPAI) during mask, goggles, and gloves especially when outbreak among poultry doing eno-tracheal incubation 4. Health techniques SARS (SEVERE ACUTE RESPIRATORY 5. Advice the importance of check-ups after SYNDROME) discharge MODE OF TRANSMISSION “BIRD FLU” OR INFLUENZA Close contact with respiratory droplet An infectious disease of birds ranging form mild secretion from SARS patient to severe form of illness When another person’s mucous membranes are exposed to droplets secretion Disease in Birds has two forms: INCUBATION PERIOD First form is mild illness Second form is highly pathogenic avian 2-10 days but maybe long as 13 days based on influenza cohort analysis of cases from Hong Kong and Canada SOURCE OF INFECTION SIGNS AND SYMPTOMS Viruses that normally infect only birds and less commonly pigs 1. Prodromal phase 2. Respiratory phase INCUBATION PERIOD PREVENTIVE MEASURES AND CONTROL 3 days ranges of 2-4 days 1. Establishment of triage SIGNS AND SYMPTOMS 2. Identification of patient Fever 3. Isolation of patient Body weakness and muscle pain 4. Isolation of suspected probable case Cough 5. Barrier nursing technique for suspected and Sore throat probable cases May have difficulty of breathing in severe cases sore eyes SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) CONTROL MEASURES IN BIRDS Systemic lupus erythematosus (SLE) is a chronic, 1. Rapid destruction (culling or stumping the autoimmune disease characterized by infected birds), proper disposal of carcasses inflammation of various body tissues and quarantining and rigorous disinfection of farms 2. Restriction on the movement of live poultry PREVALENCE NURSING ASSESSMENT Affects primarily women of childbearing age Joint assessment: assess for joint pain, swelling, tenderness, and deformity PATHOPHYSIOLOGY Skin assessment: assess for rashes alopecia, Autoimmune disorder: the immune system and photosensitivity mistakenly attacks and damages various Organ function: assess for signs of kidney, tissues in the body lung, heart, or neurological involvement Antibodies: the immune system produces Laboratory tests: monitor laboratory tests, antibodies that can attack DNA, cells, and such as antinuclear rate (ESR), and C- organs reactive protein (CRP) Inflammation: inflammation leads to tissue Emotional status: assess for depression, damage and organ dysfunction anxiety, or other emotional disturbances CLINICAL MANIFESTATIONS NURSING DIAGNOSIS Fatigue: a common and debilitating Fatigue symptom Chronic pain Joint pain and swelling: arthritis, often in a Impaired physical mobility symmetrical pattern Risk for impaired skin integrity Fever: low-grade fever Risk for infection Rash: a butterfly-shaped rash across the Disturbed sleep cheeks and nose Ineffective coping Alopecia: hair loss GOALS Mouth ulcers: painful sores in the mouth Photosensitivity: sensitivity to sunlight Manage fatigue Raynaud’s phenomenon: numbness and Manage pain coldness in the fingers and toes Improve physical mobility Kidney problems: glomerulonephritis can Prevent skin breakdown lead to kidney damage Reduce the risk of infection Lung problems: pleuritis or pneumonia Promote restful sleep Heart problems: pericarditis or myocarditis Enhance coping skills Neurological problems: seizures, stroke, or cognitive changes NURSING INTERVENTIONS COMPLICATIONS Symptom management: address symptoms such as fatigue, pain, and joint swelling Kidney disease: glomerulonephritis can lead Medication administration: administer to kidney failure prescribed medication, such as Heart disease: pericarditis or myocarditis corticosteroids, immunosuppressants, and Lung disease: pleuritis or pneumonia antimalarials Neurological problems: seizures, stroke, or cognitive changes Infection risk: due to immunosuppressive medications MULTIPLE SCLEROSIS (MS) COMPLICATIONS Multiple sclerosis (MS) is a chronic, Relapses: periods of worsening symptoms autoimmune disease affecting the central Remissions: periods of improvement or nervous system (CNS) stability Secondary progression: a gradual decline in PREVALENCE function even during periods of remission More common in women and individuals of Cognitive impairment: difficulty with European descent memory, concentration, or decision-making Depression and anxiety: emotional PATHOPHYSIOLOGY disturbances Immune-mediated: MS is characterized by NURSING ASSESSMENT the immune system attacking the myelin sheath surrounding nerve fibers in the CNS Neurological status: assess for changes in Lesions: the immune attack leads to the muscle strength, sensation, coordination, formation of lesions, which can cause and reflexes inflammation, scarring, and nerve damage Functional status: evaluate the patient’s Disability: as the disease progresses, the ability to perform activities of daily living lesions can interfere with nerve signals, (ADLs) leading to a variety of symptoms Cognitive function: assess for cognitive changes, such as memory loss or difficulty CLINICAL MANIFESTATIONS concentrating Fatigue: a common and debilitating Emotional status: assess for depression, symptom anxiety, or other emotional disturbances Weakness: muscle weakness, especially in NURSING DIAGNOSIS the legs Numbness and tingling: sensations in the Fatigue limbs Impaired physical mobility Spasticity: muscle stiffness and tightness Risk for impaired skin integrity Balance and coordination problem: Risk for ineffective coping difficulty walking, talking, or using fine Risk for constipation motor skills Risk for urinary incontinence or retention Vision problems: blurred vision double GOALS vision, or optic neuritis Bowel and bladder dysfunction: Manage fatigue constipation, incontinence, or urgency Improve physical mobility Cognitive changes: difficulty with making Prevent skin breakdown memory, concentration, or decision-making Enhance coping skills Charcot’s neurologic triad Maintain bowel and bladder function o Dysarthria – difficult or unclear speech o Nystagmus – involuntary eye movement o Intention tremor NURSING INTERVENTIONS TYPE III HYPERSENSITIVITY (IMMUNE COMPLEX HYPERSENSITIVITY) Education: educate patients and families about MS, its management, and available Cause: antigen-antibody complexes resources deposit in tissues, causing inflammation Emotional support: provide emotional Examples: serum sickness, support to help patients cope with the glomerulonephritis, vasculitis challenges of living with MS Management: avoidance of allergens, ALLERGY (HYPERSENSITIVITY) immunosuppressive therapy Allergies, or hypersensitivities, are abnormal TYPE IV HYPERSENSITIVITY (DELAYED-TYPE immune responses to harmless substances HYPERSENSITIVITY) called allergens Cause: T cells and macrophages are Types involved in a delayed immune response There are 4 types of hypersensitivity reactions: Examples: contact dermatitis, tuberculin skin test Type I, Type II, Type III, and Type IV Management: avoidance of allergens, TYPE I HYPERSENSITIVITY (IMMEDIATE topical corticosteroids HYPERSENSITIVITY) COMMON ALLERGENS Cause: IgE antibodies bind to mast cells Inhaled allergens: pollen, dust mites, mold, and basophils, releasing histamine and pet dander other mediators Food allergens: peanuts, tree nuts, shellfish, Symptoms: allergic rhinitis (hay fever), eggs, milk, wheat, soy asthma, urticaria (hives), angioedema, Medications: penicillin, aspirin, NSAIDs anaphylaxis Insect venom: bees, wasps, hornets Management: avoidance of allergens, COMPLICATIONS antihistamines, corticosteroids, decongestants, epinephrine for Anaphylaxis: a severe allergic reaction that anaphylaxis can be life-threatening Chronic allergic conditions: asthma, allergic TYPE II HYPERSENSITIVITY (CYTOTOXIC rhinitis, atopic dermatitis HYPERSENSITIVITY) NURSING ASSESSMENT Cause: IgG or IgM antibodies bind to cell History: obtain a detailed history of surface antigens, causing cell allergies, including triggers, symptoms, and destruction previous reactions Examples: blood transfusion reactions, Physical examination: assess for signs of hemolytic disease of the newborn allergic reactions, such as hives, swelling, Management: careful blood typing and difficulty breathing, or hypotension crossmatching, prevention of Rh Laboratory tests: order allergy testing, such incompatibility as skin prick tests or blood tests NURSING DIAGNOSIS Immune-mediated: AGN is typically caused by an immune response triggered by Risk for deficient knowledge antigens from a previous infection Risk for injury Glomerular damage: the immune response Anxiety leads to inflammation and damage to the Ineffective coping glomeruli Disturbed sleep Proteinuria and hematuria: damaged GOALS glomeruli leak protein and blood into the urine Maintain knowledge about allergies Reduce the risk of allergic reaction CLINICAL MANIFESTATIONS Manage anxiety and stress Hematuria: blood in the urine, often Improve coping skills described as “tea-colored” or “cola-colored” Promote restful sleep Proteinuria: excessive protein in the urine NURSING INTERVENTIONS Edema: swelling, especially in the face, ankles, and abdomen Education: educate patients about their Hypertension: elevated blood pressure allergies, triggers, and prevention strategies Fatigue: due to decreased kidney function Emergency preparedness: teach patients how Oliguria or anuria: decreased or no urine to use an epinephrine auto-injector and develop output an emergency action plan Flank pain or discomfort: may be present H ypertension Medication administration: administer A SO titer prescribed medications, such as antihistamines, D ecreased GFR corticosteroids, or decongestants S welling in face/eyes Allergen avoidance: help patients identify and T ea-colored or cola-colored urine avoid allergens R ecent strep infection E levated BUN & Crea Environmental control: advise patients on ways P rotenuria to reduce exposure to allergens in their environments COMPLICATIONS Acute kidney injury: severe reduction in ACUTE GLOMERUNEPHRITIS (AGN) kidney function Acute glomerulonephritis (AGN) is an Hypertension: high blood pressure inflammatory condition affecting the glomeruli, Edema: swelling the filtering units of the kidneys Heart failure: congestive heart failure due to fluid overload CAUSES Cerebral edema: swelling of the brain Often follows a streptococcal infection, but can also be caused by other infections or autoimmune diseases PATHOPHYSIOLOGY NURSING ASSESSMENT TYPE 1 DIABETES MELLITUS (DM) Vital signs: monitor blood pressure, heart Type 1 diabetes mellitus (T1DM) is an rate, respiratory rate, and temperature autoimmune disorder characterized by the Fluid status: assess for signs of fluid destruction of beta cells in the pancreas, leading overload or volume depletion to insulin deficiency Renal function: monitor urine output, specific gravity, and electrolyte levels PREVALENCE Cardiovascular status: assess for signs of Primarily affects children and young adults heart failure, such as tachycardia, tachypnea, and crackles in the lungs PATHOPHYSIOLOGY Neurological status: assess for signs of Autoimmune destruction: the immune cerebral edema, such as headache, system mistakenly attacks and destroys beta confusion, and seizures cells, which produce insulin NURSING DIAGNOSIS Insulin deficiency: lack of insulin prevents glucose from entering the cells, resulting in Risk for fluid volume excess hyperglycemia Acute pain Metabolic disturbances: hyperglycemia Deficient knowledge leads to a cascade of metabolic Risk for impaired skin integrity disturbances, including ketoacidosis Ineffective coping CLINICAL MANIFESTATIONS GOALS Polyuria: increased urine output Maintain fluid balance Polydipsia: excessive thirst Manage pain Polyphagia: increased appetite Enhance knowledge about AGN Weight loss: despite increased appetite Prevent skin breakdown Fatigue: due to decreased cellular energy Improve coping skills Blurred vision: caused by changes in blood sugar levels NURSING INTERVENTIONS Ketones in urine: a sign of diabetic Fluid management: restrict or increase fluid ketoacidosis intake as needed to maintain fluid balance COMPLICATIONS Dietary management: provide a low- sodium, protein-restricted diet to reduce Diabetic ketoacidosis (DKA): a life- edema and protect kidney function threatening condition characterized by Medication administration: administer hyperglycemia, ketosis, and metabolic prescribed medication, such as diuretics, acidosis antihypertensives, and Hypoglycemia: low blood sugar levels, immunosuppressants which can lead to seizures, coma, or death Monitoring: monitor vital signs, urine Chronic complication: cardiovascular output, and electrolyte levels disease, stroke, neuropathy, nephropathy, Education: educate the patient and family and retinopathy about the condition, treatment plan, and the importance of follow-up care NURSING ASSESSMENT Home management: teach patients how to manage diabetes during illness, including Blood glucose monitoring: assess blood adjusting insulin doses and monitoring glucose levels regularly to monitor glycemic blood glucose levels control Emotional support: provide emotional Ketone testing: test for ketones in urine, support to patients and families, helping especially during illness or stress them cope with the challenges of living with Vital signs: monitor blood pressure, heart T1DM rate, respiratory rate, and temperature Fluid status: assess for signs of dehydration TRANSPLANT REJECTION or fluid overload Neurological status: assess for signs of transplant rejection is an immune response by altered mental status, such as confusion or the recipient’s body against a transplanted lethargy organ or tissue NURSING DIAGNOSIS TYPES OF TRANSPLANT REJECTION Risk for deficient knowledge Hyperacute rejection: occurs immediately Risk for ineffective coping after transplantation Risk for imbalanced nutrition: less that body Acute rejection: develops within weeks or requirements months of transplantation Risk for impaired skin integrity Chronic rejection: occurs over a longer Risk for injury period, often years GOALS HYPERACUTE REJECTION Enhance knowledge about T1DM CAUSE: pre-existing antibodies in the recipient’s management blood that react with antigens on the donor Improve coping skills organ Maintain adequate nutrition SYMPTOMS: rapid deterioration of the Prevent skin breakdown transplanted organ Reduce the risk of injury PREVENTION: careful tissue typing and NURSING INTERVENTIONS crossmatching to identify incompatible donors Insulin therapy: administer insulin as ACUTE REJECTION prescribed, monitoring blood glucose levels and adjusting insulin doses as needed CAUSE: recipient’s immune system recognizing Blood glucose monitoring: teach patients the transplanted organ as foreign and families how to monitor blood glucose TYPES: levels and adjust insulin doses accordingly Diet education: provide education on Humoral rejection: mediated by antibodies carbohydrate counting, portion control, and Cellular rejection: mediated by T cells meal planning SYMPTOMS: swelling, tenderness, and Exercise: encourage regular physical activity decreased function of the transplanted organ to improve insulin sensitivity and blood glucose control TREATMENT: immunosuppressive medications NURSING INTERVENTIONS FOR TRANSPLANT to suppress the immune response REJECTION CHRONIC REJECTION Notify the healthcare provider immediately Monitor vital signs and assess for signs of CAUSE: gradual damage to the transplanted organ dysfunction organ due to chronic inflammation and scarring Prepare the patient for diagnostic tests, SYMPTOMS: progressive decline in organ such as biopsies function Assist with the administration of immunosuppressive medications TREATMENT: difficult to reverse; may require Provide emotional support to the patient re-transplantation and family FACTORS CONTRIBUTING TO TRANSPLANT REJECTION Donor-recipient mismatch: differences in tissues antigens Immunosuppressive medication adherence: poor adherence can lead to rejection Underlying medical condition: certain conditions can increase the risk of rejection Surgical technique: the quality of the surgical procedure can affect transplant outcomes SIGNS AND SYMPTOMS Fever Pain or tenderness at the transplant site Swelling or redness at the transplant site Decreased urine output (in kidney transplant recipients) Shortness of breath (in lung transplant recipients) Fatigue Weight gain Changes in vital signs Hatdog, 7 hours na ako nagttype, goodnight everybody. 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