Meningitis Past Paper PDF

NCM 112: Communicable Disease Nursing RJ Marquez, RN, MANc 02 Disorders of the CNS REVIEW OF THE CNS  Diseases Affecting the CNS DEFINITION - an acute bacterial disease that causes inflammation of the pia and arachnoid space CAUSES...

NCM 112: Communicable Disease Nursing RJ Marquez, RN, MANc 02 Disorders of the CNS REVIEW OF THE CNS  Diseases Affecting the CNS DEFINITION - an acute bacterial disease that causes inflammation of the pia and arachnoid space CAUSES - tubercle bacilli - Neisseria meningitidis (N. meningitidis) - meningococcus EPIDEMIOLOGY - greatest incidence occurs during winter and OCCURENCE spring - epidemics occur irregularly - common in children and young adults - common in crowded living conditions MENINGITIS  Diseases Affecting the CNS RESERVOIR - humans MODE OF TRANSMISSION - direct contact with respiratory droplets from nose and throat of infected person INCUBATION PERIOD - 2-10 day, commonly 3-4 days PERIOD OF COMMUNICABILITY - as long as the bacteria is present in the discharge SUSCEPTIBILITY AND - low and decreases with age RESISTANCE MENINGITIS  Diseases Affecting the CNS CLINICAL MANIFESTIONS - sudden onset of fever, intense headache, nausea and often vomiting - neck stiffness (nuchal rigidity) - frequently, petechial rash with pink macules - (+) Kernig’s sign patient feels back pain when one of the lower limbs is flexed at the knee joint and extended forward in an elevated position - (+) Brudinski’s sign when the patient’s neck is flexed, the two lower extremities get flexed or raised up - delirium and coma often appear MENINGITIS  KERNIG’S SIGN BRUDZINSKI’S SIGN MENINGITIS  Diseases Affecting the CNS DIAGNOSIS - based on clinical and epidemiological grounds - WBC count (neutrophils) - cerebrospinal fluid analysis (Gram stain, white cell count, etc.) TREATMENT - admit the patient and administer high dose of crystalline penicillin, IV - antipyretic MENINGITIS  NURSING MANAGEMENT 1. Maintain fluid balance (input and output) 2. Maintain body temperature to normal 3. Timely administration of antibiotics 4. Monitor vital signs 5. Isolation and strict aseptic technique 6. Emotional support PREVENTION AND CONTROL 1. Educate the public on the need to reduce direct contact and exposure to droplet infection 2. Reduce overcrowding in workplaces, schools, camps, etc. 3. Polysaccharide vaccines containing group A, C and Y strains 4. Chemotherapy of cases 5. Chemo prophylaxis (e.g., Rifampin for 2 days) 6. Report to the concerned health authorities MENINGITIS: Nursing Care  Diseases Affecting the CNS DEFINITION - an inflammation of the brain occurring as a sequelae or complication to some viral diseases CAUSES Primary – direct inhalation of noxious substances Secondary – post infection (recovery from viral disease) RESERVOIR mosquito Culex triteaniorhynchus - breeds on rice field water - rampant in rice growing, poultry and hog raising areas - life cycle ends in human ENCEPHALITIS  Diseases Affecting the CNS CLINICAL MANIFESTIONS - tremors - mental confusion - ataxia - nuchal rigidity - convulsions ENCEPHALITIS  NURSING MANAGEMENT 1. Sanitary disposal of nose and throat secretions 2. Provide safety 3. Intake and output should be closely monitored PREVENTION AND CONTROL 1. Destruction of breeding places 2. Screening of houses 3. Use of repellent 4. Prompt treatment ENCEPHALITIS: Nursing Care  Diseases Affecting the CNS DEFINITION - almost invariably fatal: acute vial encephalomyelitis - attacking brain and meninges CAUSES - Rabies virus (rhabdovirus) EPIDEMIOLOGY - worldwide in wildlife particularly in developing OCCURENCE countries - primarily a disease of animals (zoonotic) - primarily an infection of carnivores transmitted through bite RABIES  Diseases Affecting the CNS RESERVOIR - dog is common in urban areas - in the wild, wild carnivores and bats MODE OF TRANSMISSION - saliva of rabid animal introduced by a bite or scratch - man to man is dead-ended INCUBATION PERIOD - usually, 3-8 weeks PERIOD OF COMMUNICABILITY - usually, 3-7 days before the onset of the disease and throughout the course of the disease SUSCEPTIBILITY AND - all mammals to varying degrees RESISTANCE - humans are more resistant to infection than several animal species RABIES  Diseases Affecting the CNS CLINICAL MANIFESTIONS Prodromal phase - onset is heralded by a sense of apprehension, headache, fever and nausea, abnormal sensations at the site of inoculation (bite) is most significant - paresthesia (tingling sensations at the bite site) Excitatory phase or Aerophobia - slightest sound/wind excites the victim - irritability, restless, nervousness, tendency to bite Paralytic phase - spasm of swallowing muscles leads to drooling of saliva - hydrophobia (fear of water) - delirium and convulsions form, death is often d/t respiratory muscle paralysis RABIES  Diseases Affecting the CNS DIAGNOSIS - history of bite by known rabid animal and the bitten person show typical symptoms leading to clinical diagnosis TREATMENT 1. Wound Care - wash the wound with soap and water thoroughly to decrease the viral load - if there is bleeding cover the wound - never suture the wound as this will spread the virus 2. Start anti-rabies vaccine immediately if it is proved to be rabid animal bite 3. Antibiotics (Ceftriaxone), anticonvulsants, acetaminophen RABIES  PREVENTION AND CONTROL 1. Immunize all dogs and cats 2. Detain and clinically observe for 10 days any healthy appearing dog or cat known to have bitten a person 3. Post exposure prophylaxis Treatment of bite wounds Specific immunologic protection 4. Keep dogs and cats at home 5. Destroy stray animals where rabies is endemic. RABIES: Nursing Care  Diseases Affecting the CNS DEFINITION - an infectious disease caused by contamination of wounds from the bacteria or the spores they produce that live in the soil, and animal feces CAUSES - Clostridium tetani bacteria TETANUS  Diseases Affecting the CNS RESERVOIR - soils, feces MODE OF TRANSMISSION - punctured wounds contaminated by dust, soil, animal feces containing Clostridium tetani - rugged, traumatic wounds and burns - umbilical stump of newborn - babies delivered to mothers without TT immunizations - unrecognized wounds (cleaning of the ears with sharp materials) - dental extraction, circumcision, ear piercings INCUBATION PERIOD - 3 days to 3 weeks in adult - 3-30 days in newborn TETANUS  Diseases Affecting the CNS TYPES OF TETANUS generalized tetanus - the most common form of tetanus and makes up roughly 80% of all tetanus - normally presents with a descending pattern (starting at the top of the body and moving downward) where the first sign is trismus, or lock jaw, and a facial spasm known as risus sardonicus, then followed by a stiffness of the neck with difficulty swallowing, then of the spasm of muscles neonatal tetanus - found in newly born children – often as a result of an infection of the umbilical stump TETANUS  Diseases Affecting the CNS TYPES OF TETANUS local tetanus - the contractions and spasms are localized to the site of the injury cephalic tetanus - a rare version of tetanus that sometimes occurs alongside ear infections - the tetani bacteria is present in the flora of the ear or around the head and affects mostly the cranial nerves and facial nerves TETANUS  OPISTHOTONUS - spasm of the muscles causing backward arching of the head, neck, and spine RISUS SARDONICUS - fixed contraction of the facial muscles resulting in a peculiar distorted grin TETANUS TETANUS  Diseases Affecting the CNS DIAGNOSIS 1. Serum Toxin Test 2. Clostridium Tetani detection from wound tissue 3. Serum Antitoxin Antibodies Test 4. Spores on drug samples 5. Lumbar Puncture 6. EEG (Electroencephalography) 7. EMG (Electromyography) TETANUS  Diseases Affecting the CNS TREATMENT 1. Antitoxin: ATS 2. Antibiotics: Metronidazole 3. Vaccine 4. Sedatives: Diazepam 5. Other medications, such as magnesium sulfate and certain beta blockers, might be used to regulate involuntary muscle activity, such as heartbeat and breathing. 6. Morphine TETANUS  PREVENTION AND CONTROL - vaccine - for minor wound: 1. Control bleeding; apply direct pressure to control bleeding 2. Keep the wound clean: after the bleeding stops, rinse the wound thoroughly with clean running water 3. Clean the area around the wound with soap and a washcloth. If something is embedded in a wound, see your doctor. 4. Use antibiotics, after cleaning the wound, apply a thin layer of an antibiotic cream or ointment TETANUS: Nursing Care  NURSING MANAGEMENT Acute Pain related to spasm of facial muscles as evidenced by patient’s verbalization. GOAL: To reduce the pain of the patient. INTERVENTIONS: 1. Assess the patient’s general condition. 2. Provide diversional therapies such as TV, Radio, etc. 3. Provide analgesics to the patient as prescribed by the physician. TETANUS: Nursing Care  NURSING MANAGEMENT Altered thermoregulatory pattern related to fever and chills as evidenced by vital signs. GOAL: To maintain the body temperature of the patient. INTERVENTIONS: 1. Assess the patient’s general condition. 2. Provide with hot applications such as hot water bottles, etc. 3. Give him more clothes and blankets to cover the body. TETANUS: Nursing Care Prepare for your QUIZ #2 NCM 112: Communicable Disease Nursing RJ Marquez, RN, MANc 03 Disorders of the Respiratory System REVIEW OF THE RS  Diseases Affecting the RS DEFINITION - a chronic and infectious mycobacterial disease important as a major cause of illness and death in many parts of the world CAUSES - Mycobacterium tuberculosis - human tubercle bacilli (most common) - Mycobacterium bovis - cattle and man - Mycobacterium avium - birds and man EPIDEMIOLOGY - worldwide, underdeveloped areas are more OCCURENCE affected - affects all ages and both sexes - age groups between 15-45 years are mainly affected TUBERCULOSIS  Diseases Affecting the RS WHO, 1995: - 9 million cases and 3 million deaths have occurred Ministry of Health, 1993: - leading cause of outpatient morbidity (ranked 8th with 2.2%) - leading cause of hospitalization (ranked 3rd with 7.8%) - leading cause of hospital death (ranked 1st with 10.1%) TUBERCULOSIS  Diseases Affecting the RS RESERVOIR - untreated pulmonary tuberculosis positive (PTB+) cases are the source of infection MODE OF TRANSMISSION - aerosolized droplets mainly from persons with active ulcerative lesion of lung expelled during talking, sneezing, singing, or coughing directly - length of time of contact an individual shares volume of air with an infectious case; intimate, prolonged or frequent contact is required - transmission through contaminated fomites (clothes, personal articles) is rare - ingestion of unpasteurized milk transmits bovine tuberculosis - overcrowding and poor housing conditions favor the disease transmission TUBERCULOSIS  Diseases Affecting the RS INCUBATION PERIOD - 4-12 weeks PERIOD OF COMMUNICABILITY - as far as the bacilli is present in the sputum SUSCEPTIBILITY AND - under 3 years old children, adolescents, young RESISTANCE adults, the very old and the immuno-suppressed are susceptible - everyone who is non-infected or non- vaccinated can be infected - HIV is an important risk factor for the development of HIV- associated tuberculosis by facilitating: Reactivation or Progression of recent infection or Reinfection TUBERCULOSIS  Diseases Affecting the RS MAJOR CLINICAL FORMS Pulmonary (80%) - primarily occurs during childhood and secondarily 15-45 years or later Extra pulmonary - affects all parts of the body - most common sites are lymph nodes, pleura, GI tract, bone and joints, meninges and peritoneum TUBERCULOSIS  Diseases Affecting the RS CLINICAL MANIFESTIONS pulmonary tuberculosis - persistent cough for 3 weeks or more - productive cough with or without blood-stained sputum - shortness of breath and chest pain - intermittent fevers, night sweats, loss of weight, loss of appetite, fatigue and malaise TB lymph adenitis - slowly developing and painless enlargement of lymph nodes followed by matting and drainage of pus TUBERCULOSIS  Diseases Affecting the RS CLINICAL MANIFESTIONS TB pleurisy - pain while breathing in, dull lower chest pain, slight cough, breathlessness on exertion TB of bones and joints - localized pain and/or swelling, discharging of pus, muscle weakness, paralysis and stiffness of joints. intestinal TB - loss of weight and appetite - abdominal pain, diarrhea and constipation Mass in the abdomen - fluid in the abdominal cavity (ascites) TUBERCULOSIS  Diseases Affecting the RS CLINICAL MANIFESTIONS TB meningitis - headache, fever, vomiting, neck stiffness and mental confusion of insidious onset TUBERCULOSIS  PATHOGENESIS TUBERCULOSIS  Diseases Affecting the RS DIAGNOSIS 1. Clinical manifestations 2. Sputum smears for acid-fast bacilli (AFB), which is the Golden standard. However, one positive result does not justify starting anti TB treatment since errors can never be excluded. 3. Acid-fast stain for AFB can be done for extra pulmonary tuberculosis having pus-y discharge. 4. Radiological examination: This is unreliable because it can be caused by a variety of conditions or previous TB patients who are healed may have chest x-ray giving the appearance of active TB, which requires treatment. 5. Histopathological examination: Biopsies for extrapulmonary TB (e.g., TB lymphadenitis) TUBERCULOSIS  Diseases Affecting the RS DIAGNOSIS 6. Tuberculin test (Mantoux)- helpful in non-BCG vaccinated children under 6 years of age. 7. Culture- complex and sophisticated tool, which takes several weeks to yield results. TUBERCULOSIS  Diseases Affecting the RS TREATMENT - Medications: Single-drug Formulation/SDF (RIPES) Rifampin (R) Isoniazid (I) TB-DOTS Pyrazinamide (P) (Directly Observed Treatment, Short- Ethambutol (E) course) Streptomycin (S) daily IM injection - a trained health care worker or other Fixed-dose Formulation/FDC designated individual provide the Quadtab prescribed TB drugs and watches Myrin P patient swallow every dose Myrin TUBERCULOSIS PATHOGENESIS  NURSING MANAGEMENT 1. Educate the patient how and when to take the prescribed medication. 2. Tell the patient not to stop the medication unless he/she is told to do so. 3. Tell the patient to come to the health institution if he/she develops drug side effects. 4. Advice the patient on the importance of taking adequate and balanced diet and to eat what is available at home. TUBERCULOSIS: Nursing Care  PREVENTION AND CONTROL 1. Chemotherapy of cases 2. Chemoprophylaxis for contacts INH (Isoniazid) for adults and children who have close contact with the source of infection 3. Immunization of infants with BCG 4. Educate patients with TB about the mode of disease transmission and how to dispose their sputum and cover their mouth while coughing, sneezing, etc. 5. Public health education about the modes of disease transmission and methods of control: - improved standard of living - adequate nutrition - health housing - environmental sanitation - personal hygiene; etc. - active case finding and treatment TUBERCULOSIS: Nursing Care  Diseases Affecting the RS DEFINITION - an acute bacterial infection of the lung tissue and bronchi CAUSES - Streptococcus pneumoniae (pneumococcus) EPIDEMIOLOGY - particularly in infancy, old age and persons OCCURENCE with underlying medical conditions - common in lower socio-economic groups and developing countries PNEUMONIA  Diseases Affecting the RS RESERVOIR - humans - usually found in the URT of healthy people throughout the world MODE OF TRANSMISSION - droplet spread, direct oral contact or indirectly through articles freshly soiled with respiratory discharges - person to person transmission is common. INCUBATION PERIOD - not well determined, may be as short as 1-3 days PNEUMONIA  Diseases Affecting the RS PERIOD OF COMMUNICABILITY - until discharges of mouth and nose no longer contain virulent pneumococci in significant number SUSCEPTIBILITY AND - increased by influenza, pulmonary edema of RESISTANCE any cause, aspiration following alcohol intoxication, chronic lung disease, exposure to irritants in the air, etc. - malnutrition and low birth weight in infants and young children in developing countries - immunity following an attack may last for years PNEUMONIA  Diseases Affecting the RS CLINICAL MANIFESTIONS - sudden onset of chill, fever, pleural pain, dyspnea, tachypnea, a cough productive of rusty sputum - chest indrawing, shallow and rapid respiration in infants and young children - vomiting and convulsion may occur in infants and young children PNEUMONIA PNEUMONIA  Diseases Affecting the RS DIAGNOSIS - chest X-ray (reveals consolidation of the affected lung tissue but not in children) - sputum gram stain (reveals gram negative diplococci) TREATMENT - antipyretic and pain medications - Ampicillin or procaine penicillin for adults - crystalline penicillin for children - anticonvulsants for infants - bronchodilators and expectorants PNEUMONIA  NURSING MANAGEMENT 1. Monitor vital signs especially of children. 2. Maintain high body temperature to normal. 3. Intermittent administration of humidified oxygen if indicated especially for young children. 4. Timely administration of ordered medication. PREVENTION AND CONTROL 1. Treatment of cases 2. Treatment of other underlying medical conditions 3. Improved standard of living (adequate and ventilated housing and better nutrition) 4. Avoid overcrowding. PNEUMONIA: Nursing Care  Diseases Affecting the RS DEFINITION - an acute bacterial disease involving primarily tonsils, pharynx, nose, occasionally other mucus membranes or skin and sometimes the conjunctiva or genitalia CAUSES - Corynebacterium diphtheriae EPIDEMIOLOGY - disease of colder months in temperate zones, OCCURENCE involving primarily non-immunized children under 15 years of age - often found among adult population groups whose immunization was neglected - unapparent, cutaneous and wound diphtheria cases are much more common in the tropics DIPHTHERIA  Diseases Affecting the RS RESERVOIR - humans MODE OF TRANSMISSION - contact with a patient of carrier. i.e. with oral or nasal secretions or infected skin INCUBATION PERIOD - usually, 2-5 days PERIOD OF COMMUNICABILITY - variable, until virulent bacilli have disappeared from discharges and lesion; usually 2 weeks or less DIPHTHERIA  Diseases Affecting the RS SUSCEPTIBILITY AND - susceptibility is universal RESISTANCE - infants borne to immune mothers are relatively immune, but protection is passive and usually lost before 6 months - recovery from clinical disease is not always followed by lasting immunity - immunity is often acquired through unapparent infection - prolonged active immunity can be induced by diphtheria toxoid DIPHTHERIA  Diseases Affecting the RS CLINICAL MANIFESTIONS - characteristic lesion marked by a patch or patches of an adherent grayish membrane with a surrounding inflammation (pseudo membrane) - throat is moderately sore in pharyngo-tonsillar diphtheria (bull neck) - with cervical lymph nodes somewhat enlarged and tender - in severe cases, there is marked swelling and edema of neck - late effects of absorption of toxin appearing after 2-6 weeks, including cranial and peripheral, motor and sensory nerve palsies and myocarditis (which may occur early) and are often severe DIPHTHERIA  Diseases Affecting the RS PSEUDO MEMBRANE BULL NECK DIPHTHERIA  Diseases Affecting the RS DIAGNOSIS - based on clinical and epidemiological grounds - bacteriologic examination of discharges from lesions TREATMENT - diphtheria antitoxin - Erythromycin for 2 weeks but 1 week for cutaneous form or Procaine penicillin for 14 days or single dose of Benzathin penicillin - primary goal of antibiotic therapy for patients or carriers is to eradicate C. diphtheriae and prevent transmission from the patient to susceptible contacts DIPHTHERIA  NURSING MANAGEMENT 1. Absolute bed rest 2. Care of tracheostomy 3. Maintain fluid/electrolyte balance 4. Diet 5. Concurrent/terminal disinfection PREVENTION AND CONTROL 1. Educate of the hazards of diphtheria and the necessity for active immunization 2. Immunization of infants with diphtheria toxoid 3. Concurrent and terminal disinfection of articles in contact with patient and soiled by discharges of patient 4. Single dose of penicillin (IM) or 7-10 days course of Erythromycin (PO) is recommended for all persons exposed to diphtheria DIPHTHERIA: Nursing Care  Diseases Affecting the RS DEFINITION - an acute bacterial disease involving the respiratory tract CAUSES - Bordetella pertusis EPIDEMIOLOGY - an endemic disease common to children OCCURENCE especially young children everywhere in the world - marked decline has occurred in incidence and mortality rates during the past four decade - outbreaks occur periodically - endemic in developing world and 90% of attacks occur in children under 6 years of age PERTUSIS  Diseases Affecting the RS RESERVOIR - humans MODE OF TRANSMISSION - direct contact with discharges from respiratory mucus membranes of infected persons by airborne route, probably by droplets - indirectly by handling objects freshly solid with nasopharyngeal secretions INCUBATION PERIOD - 1-3 weeks PERTUSIS  Diseases Affecting the RS PERIOD OF COMMUNICABILITY - highly communicable in early catarrhal stage before the paroxysmal cough stage - the most contagious disease with an attack rate of 75-90% - gradually decreases and becomes negligible in about 3 weeks - when treated with erythromycin, infectiousness is usually 5 days or less after onset of therapy SUSCEPTIBILITY AND - non-immunized individuals is universal RESISTANCE - one attack usually confers prolonged immunity but may not be lifelong PERTUSIS  Diseases Affecting the RS CLINICAL MANIFESTIONS catarrhal phase - lasts 1-2 weeks - cough and rhinorrhea paroxysmal phase - explosive, repetitive and prolonged cough - child usually vomits at the end of paroxysm - expulsion of clear tenacious mucus often followed by vomiting - whoop (inspiratory whoop against closed glottis) between paroxysms - child looks healthy between paroxysms - paroxysm of cough interferes with nutrition and cough - cyanosis and sub conjunctiva hemorrhage due to violent cough PERTUSIS  Diseases Affecting the RS CLINICAL MANIFESTIONS convalescent phase - the cough may diminish slowly or may last long time - after improvement, the disease may recur PERTUSIS  Diseases Affecting the RS DIAGNOSIS - difficult to distinguish it from other URTI - history and physical examination at phase two (paroxysmal phase) ensure the diagnosis - marked lymphocytosis TREATMENT - Erythromycin (to treat the infection in phase one but to decrease transmission in phase two) - antibiotics for super infections like pneumonia because of bacterial invasion due to damage to cilia PERTUSIS  NURSING MANAGEMENT 1. Proper feeding of the child. 2. Encourage breastfeeding immediately after an attack (each paroxysm). 3. Proper ventilation- continuous well humidified oxygen administration. 4. Reassurance of the mother (care giver). PREVENTION AND CONTROL 1. Educate the public about the dangers of whooping cough and the advantages of initiating immunization at 6 weeks of age. 2. Consider protection of health workers at high risk of exposure by using erythromycin for 14 days. PERTUSIS: Nursing Care 04 Disorders of the Gastro- Intestinal System REVIEW OF THE GIS  Diseases Affecting the GIS DEFINITION - acute illness caused by an enterotoxin elaborated by vibrio cholerae CAUSES - Vibrio cholerae EPIDEMIOLOGY - periodic outbreaks in different parts of the OCCURENCE world and given rise to pandemics - endemic predominantly in children CHOLERA  Diseases Affecting the GIS RESERVOIR - humans MODE OF TRANSMISSION - by ingestion of food or water directly or indirectly contaminated with feces or vomitus of infected person INCUBATION PERIOD - from a few hours to 5 days, usually 2-3 days PERIOD OF COMMUNICABILITY - for the duration of the stool positive stage, usually only a few days after recovery - antibiotics shorten the period of communicability SUSCEPTIBILITY AND - gastric achlorhydria increases risk of illness RESISTANCE - breast-fed infants are protected CHOLERA  Diseases Affecting the GIS CLINICAL MANIFESTIONS - abrupt painless watery diarrhea; the diarrhea looks like rice water - in severe cases, several liters of liquid may be lost in few hours leading to shock - severely ill patients are cyanotic, have sunken eyes and cheeks, scaphoid abdomen, poor skin turgor, and thready or absent pulse - loss of fluid continues for 1-7 days CHOLERA  Diseases Affecting the GIS DIAGNOSIS - based on clinical grounds Culture (stool) confirmation TREATMENT 1. Prompt replacement of fluids and electrolytes. Rapid IV infusions of large amounts isotonic saline solutions alternating with isotonic sodium bicarbonate or sodium lactate 2. Antibiotics like tetracycline dramatically reduce the duration and volume of diarrhea resulting in early eradication of vibrio cholerae. CHOLERA  NURSING MANAGEMENT 1. Wear gown and gloves. 2. Wash your hands. 3. Monitor output including stool output. 4. Protect the patient family by administering Tetracycline. 5. Health education. PREVENTION AND CONTROL 1. Case treatment 2. Safe disposal of human excreta and control of flies 3. Safe public water supply 4. Handwashing and sanitary handling of food 5. Control and management of contact cases CHOLERA: Nursing Care  Diseases Affecting the GIS DEFINITION - a systemic infectious disease characterized by high continuous fever, malaise and involvement of lymphoid tissues CAUSES - Salmonella typhi - Salmonella enteritidis (rare cause) EPIDEMIOLOGY - it occurs worldwide, particularly in poor socio- OCCURENCE economic areas - annual incidence is estimated at about 17 million cases with approximately 600,000 deaths worldwide - in endemic areas the disease is most common in preschool and school aged children (5-19 years of age) THYPOID FEVER  Diseases Affecting the GIS RESERVOIR - humans MODE OF TRANSMISSION - by water and food contaminated by feces and urine of patients and carriers - flies may infect foods in which the organisms then multiply to achieve an infective dose. INCUBATION PERIOD - 1-3 weeks PERIOD OF COMMUNICABILITY - as long as the bacilli appear in excreta, usually from the first week throughout convalescence - - - about 10% of untreated patients will discharge bacilli for 3 months after onset of symptoms, and 2%-5% become chronic carriers THYPOID FEVER  Diseases Affecting the GIS SUSCEPTIBILITY AND - general and increased in individuals with RESISTANCE gastric achlorhydria or those who are HIV positive - relative specific immunity follows recovery from clinical disease, unapparent infection and active immunization but inadequate to protect against subsequent ingestion of large numbers of organisms THYPOID FEVER  Diseases Affecting the GIS CLINICAL MANIFESTIONS first week - mild illness characterized by fever rising stepwise (ladder type), anorexia, lethargy, malaise and general aches - dull and continuous frontal headache is prominent - nose bleeding, vague abdominal pain and constipation in 10% of patients second week - sustained temperature (fever) - severe illness with weakness, mental dullness or delirium, abdominal discomfort and distension - diarrhea is more common than first week and feces may contain blood THYPOID FEVER  Diseases Affecting the GIS CLINICAL MANIFESTIONS third week - patient continues to be febrile and increasingly exhausted - if no complications occur, patient begins to improve, and temperature decreases gradually Fever - sustained fever (ladder fashion) Rose spots - small pallor, blanching, slightly raised macules usually seen on chest and abdomen in the first week in 25% of white people. Relative bradycardia - slower than would be expected from the level of temperature Leucopoenia - WBC count is less than 4000/mm3 THYPOID FEVER  Diseases Affecting the GIS DIAGNOSIS - based on clinical grounds but this is confused with wide variety of diseases - widal reaction against somatic and flagellar antigens - blood, feces or urine culture. TREATMENT 1. Ampicillin or co-trimoxazole for carriers and mild cases. 2. Chloramphenicol or ciprofloxacin or ceftriaxone for seriously ill patients. THYPOID FEVER  NURSING MANAGEMENT 1. Maintain body temperature to normal. 2. Apply comfort measures. 3. Follow side effects of drugs. 4. Monitor vital signs. 5. Follow strictly enteric precautions: wash hands, wear gloves, teach all persons about personal hygiene 6. Observe the patient closely for sign and symptoms of: bowel perforation erosion of intestinal ulcers sudden pain in the lower right side of the abdomen abdominal rigidity sudden fall of temperature and blood pressure 7. Accurately record intake and output. 8. Provide proper skin and mouth care. THYPOID FEVER: Nursing Care  PREVENTION AND CONTROL 1. Treatment of patients and carriers 2. Education on handwashing, particularly food handlers, patients and childcare givers 3. Sanitary disposal of feces and control of flies. 4. Provision of safe and adequate water 5. Safe handling of food. 6. Exclusion of typhoid carriers and patients from handling of food and patients 7. Immunization for people at special risk (e.g., travelers to endemic areas) 8. Regular check-up of food handlers in food and drinking establishments THYPOID FEVER: Nursing Care  Diseases Affecting the GIS DEFINITION - a blood fluke (trematode) infection with adult worms living within mesenteric or vesicle veins of the host over a life span of many years CAUSES - major schistoma species: Schistosoma mansoni Schistosoma Japonicum Schistosoma Hematobium - others in limited areas: S. mekongi S. intercalatum S. malayesis S. mattheei SCHISTOSOMIASIS  Diseases Affecting the GIS CAUSES - most prevalent species in Africa: S. mansoni and S. hematobium - snail vectors are: Bulinus- S. hematobium Biomphalaria- S. mansoni Onchomelania- S. japonicum EPIDEMIOLOGY - S. mansoni is found in South America, OCCURENCE Caribbean Islands, Africa and the Middle East - S. hematobium is found in Africa and the Middle East - S. Japonicum is found in the Far East SCHISTOSOMIASIS  Diseases Affecting the GIS EPIDEMIOLOGY - the disease occurs worldwide OCCURENCE - 2 million people are expected to be infected - most infected individuals show few or no signs and symptoms, and only a small minority develop significant disease RESERVOIR - man- principal reservoir for S. mansoni, S. hematobium and S. intercalatum - other animals, like dog, cat, pig, cattle, water buffalo, horse and wild rodents, are hosts for S. japonicum SCHISTOSOMIASIS  Diseases Affecting the GIS MODE OF TRANSMISSION - acquired from water containing free-swimming larval forms (cercariae) that have developed in snails INCUBATION PERIOD - acute systemic manifestations (katayama fever) may occur in primary infections 2-6 weeks after exposure, immediately before and during initial egg deposition - infection in humans can persist up to 10 years - snails release cercariae as long as they live (from several weeks to 3 months) SUSCEPTIBILITY AND - universal, poorly defined RESISTANCE SCHISTOSOMIASIS  Diseases Affecting the GIS CLINICAL MANIFESTIONS invasion stage - cercariae penetrate skin - cercarial dermatitis with itching papules and local edema - cercariae remain in skin for 5 days before they enter the lymphatic system and reach the liver maturation - schistosoma mature in the liver - fever, eosinophilia, abdominal pain and transient generalized urticaria (katayama syndrome) - worms descend the portal vein: S. manson migrates to mesenteric veins in the intestinal wall and S. haematobium to bladder plexus - this stage may be diagnosed as clinical malaria or may pass unnoticed SCHISTOSOMIASIS  Diseases Affecting the GIS CLINICAL MANIFESTIONS established infection - stage of egg production and eggs reach to the lumen of bladder and bowel - some eggs penetrate the tissue, reach the bladder and intestinal wall are discharged with urine and feces - eggs that could not penetrate the tissue are carried with blood to the liver and lungs - other eggs that fail to reach the lumen of the bladder or bowel provoke an inflammatory reaction - the inflammatory reaction, resulting in fibrosis, causes signs and symptoms of schistosomiasis - sign of colitis with bloody diarrhea and cramps in S. mansoni infection - terminal hematuria and dysuria in S. haematobium infection SCHISTOSOMIASIS  Diseases Affecting the GIS CLINICAL MANIFESTIONS late stage - the stage of fibrosis, which occurs where there are eggs… 1. in the tissues around the bladder this may result in: - Stricture of urethra leading to urine retention or fistula - Dilatation of ureters (hydroureter) and kidney (hydronephrosis) possibly leading to kidney failure - Calcification of bladder 2. in the liver portal hypertension leads to hypersplenism and anemia, esophageal varices and bleeding 3. in the lungs fibrosis results in pulmonary hypertension, which leads to congestive cardiac failure SCHISTOSOMIASIS  Diseases Affecting the GIS DIAGNOSIS - demonstration of ova in urine or feces - biopsy of urine and feces are repeatedly negative (rectal snip, liver biopsy, bladder biopsy) TREATMENT - praziquantel and oxamniquine are the drugs of choice but in Africa praziquantel is best because of resistance strain of oxamniquine SCHISTOSOMIASIS  PREVENTION AND CONTROL 1. Treatment of cases 2. Intermittent irrigation 3. Drainage of water bodies 4. Clearing of vegetation in water bodies to deprive snails of food and resting place 5. Flooding 6. Straightening and deepening margins of water bodies 7. Educating the public about the mode of transmission and ways of prevention 8. Proper disposal of human feces and urine 9. Avoid swimming in water bodies known to have the infection 10. Use rubber boots to prevent exposure to contaminated water SCHISTOSOMIASIS: Nursing Care  Diseases Affecting the GIS DEFINITION - an infection due to a protozoan parasite that causes intestinal or extra-intestinal disease - “amoebic dysentery” CAUSES - Entamoeba histolytica EPIDEMIOLOGY - worldwide but most common in the tropics and OCCURENCE sub-tropics - prevalent in areas with poor sanitation, in mental institutions and homosexuals - invasive amoebiasis is mostly a disease of young people (adults) - rare below 5 years of age, especially below 2 years AMOEBIASIS  Diseases Affecting the GIS MODE OF TRANSMISSION - fecal-oral transmission by ingestion of food or water contaminated by feces containing the cyst - acute amoebic dysentery poses limited danger INCUBATION PERIOD - variable from few days to several months or years; commonly 2-4 weeks PERIOD OF COMMUNICABILITY - during the period of passing cysts of E. histolytica, which may continue for years SUSCEPTIBILITY AND - susceptibility is general RESISTANCE - susceptibility to reinfection has been demonstrated but is apparently rare AMOEBIASIS  Diseases Affecting the GIS CLINICAL MANIFESTIONS - starts with a prodormal episode of diarrhea, abdominal cramps, nausea, vomiting and tenesmus (feeling of incomplete defecation) - with dysentery, feces are generally watery, containing mucus and blood DIAGNOSIS - demonstration of etamoeba histolytica cyst or trophozoite in stool TREATMENT - Metronidazole or Tinidazole AMOEBIASIS  NURSING MANAGEMENT - Observe Isolation and Enteric precaution - Provide Health Education Boil water or use purified water Avoid washing food with water from open drums or pails Cover left over food Wash hands - Proper collection of stool specimen Never give paraffin or oil prep at least 48 hours before collection Avoid mixing with urine Select large portion containing mucus or blood Send immediately to the laboratory - Skin Care Wrinkle-free sheet to prevent pressure ulcers - Mouth Care Provide optimum comfort Kept warm, dysenteric patient should not be allowed to feel cold AMOEBIASIS: Nursing Care  NURSING MANAGEMENT - Diet Acute stage: fluids should be enforced Beginning of attack: cereals and strained meat broth without fat Bland diet PREVENTION AND CONTROL 1. Adequate treatment of cases 2. Provision of safe drinking water 3. Proper disposal of human excreta (feces) and handwashing following defecation 4. Cleaning and cooking of local foods (e.g. raw vegetables) to avoid eating food contaminated with feces. AMOEBIASIS: Nursing Care Prepare for your QUIZ #3