NCM 112 Module 5 CD GI PDF

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 - 2025 MODULE 5: COMMON COMMMUNICABLE...

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 - 2025 MODULE 5: COMMON COMMMUNICABLE 5 F’s 1. Feces of infected person DISEASES AFFECTING THE 2. Flies 3. Foods GASTROINTESTINAL SYSTEM 4. Fluids 5. Fingers TYPHOID FEVER/ENTERIC FEVER  Typhoid fever, often simply referred to as typhoid, is a SIGNS AND SYMPTOMS bacterial infection caused by a bacterium called Salmonella enterica serotype Typhi (S. Typhi). This disease primarily A.) PRODROMAL STAGE affects the gastrointestinal system and is characterized by a  headache, fever, anorexia, lethargy, diarrhea or range of symptoms constipation, vomiting, abdominal pain, feeling of unwellness  Typhoid fever is a systemic bacterial infection caused by Salmonella enterica serotype Typhi (commonly referred to B.) FASTIGIAL STAGE/PYREXIAL STAGE: the following signs as Salmonella Typhi). It is typically transmitted through the appear: consumption of contaminated food or water and is prevalent a. Ladder like curve of tempt. in areas with poor sanitation and hygiene. b. Splenomegaly RISK FACTORS NOTE  Contaminated water or ice PRODROMAL (ACUTE)  Flooding High Fever: One of the most prominent symptoms of typhoid fever is a  Contaminated food and drinks sustained and high-grade fever, which can reach up to 104°F (40°C).  Raw fruits and vegetables grown in fields fertilized with Abdominal Pain: Patients may experience abdominal discomfort and pain, sewage often concentrated in the lower right quadrant of the abdomen.  Lack of hand washing and toilet access  Evidence of prior helicobacter pylori infection Gastrointestinal Symptoms: Typhoid fever can lead to diarrhea, constipation, or both. Diarrhea may be initially watery but can later become bloody. PATHOGNOMONIC SIGN Headache and Weakness: Individuals with typhoid fever may also experience  Rose Spots headaches, general weakness, and fatigue. CAUSATIVE AGENT Rose Spots: Some patients develop a rash of small, pinkish spots on the chest and abdomen, known as "rose spots."  Salmonella typhosa  Salmonella paratyphi Enlarged Spleen and Liver: The spleen and liver can become enlarged during the course of the disease. INCUBATION PERIOD c. Rose spots  7 -14 days  (Pathognomonic sign of Typhoid fever) -Groups of 5-15 pink blanching papules (little bumps) appear on PERIOD OF COMMUNICABILITY the anterior trunk, usually occur between the second and  The period of communicability is variable. As long as the fourth week of illness. patient is excreting the microorganism, he is capable of NOTE infecting others. Rose spots are a distinctive and characteristic symptom that can sometimes occur in individuals with typhoid fever. These spots are a type of skin rash that typically SOURCE OF INFECTION appears during the second week of the illness.  Feces, urine and vomitus of infected person Appearance: Rose spots are small, pink or red, and slightly raised lesions on the  A person who has just recovered from the disease or has skin. They are usually about 2-4 millimeters in diameter. recently taken care of a patient with typhoid and was infected is considered a potential carrier. Location: They tend to develop on the chest and abdomen, although they can  Ingestion of shellfish (oysters) taken from waters appear on other parts of the body as well. contaminated with sewage disposal can be a source of Evolving Pattern: Rose spots often start as flat, pink spots that gradually become infection. more raised and palpable over time. MODE OF TRANSMISSION Blanching: When you press on a rose spot, it may temporarily lose its color and turn pale (blanch), and then return to its pink or red color when you release the pressure.  The disease can be passed from one person to another This blanching and non-blanching feature is a characteristic of rose spots. through fecal-oral transmission. Transient: Rose spots are usually transient and may come and go within a few days.  The organism can be transmitted through the 5 Fs.  The disease can be transmitted through the ingestion of d. Typhoid state or “Typhoid psychosis” contaminated food, water and milk. Typhoid State include: 1. Symptoms decline in severity. 2. The tongue protrudes, becoming dry and brown. 3. Teeth and lips accumulate a dirty-brown collection of dried mucus and bacteria known as sordes (preventable by good nursing care). 4. Patient seems to be staring blankly (coma vigil). NOTE SORDES(POOR ORAL HYGIENE) Typhoid psychosis, also known as typhoid delirium or typhoid encephalopathy, refers to a rare but serious neurological complication that can occur in some individuals with typhoid fever. Typhoid fever itself is primarily a gastrointestinal infection caused by the bacterium Salmonella enterica serotype Typhi. However, in severe cases, the infection can affect the central nervous system, leading to a range of neurological symptoms. 1| INALGAN, F. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 – 2025 COMPLICATIONS Occurrence: Typhoid psychosis is relatively uncommon and tends to occur in more severe cases of typhoid fever. It is more likely to affect adults than children. 1. Hemorrhage or perforation - the two most dreaded complications Symptoms: The neurological symptoms of typhoid psychosis can include 2. Peritonitis confusion, agitation, hallucinations, delirium, and altered consciousness. These 3. Bronchitis and pneumonia symptoms may be severe and can sometimes lead to a coma. 4. Meteorism or excessive distention of the bowels (tympanites) Timing: Typhoid psychosis typically develops in the second or third week of the illness, often after the gastrointestinal symptoms have been present for some 5. Thrombosis and embolism time. 6. Early heart failure 7. “Typhoid spine” or neuritis Mechanism: The exact mechanism by which Salmonella Typhi bacteria affect the 8. Septicemia central nervous system is not fully understood. It is believed that the bacteria or 9. Reiter’s syndrome - joint pain, eye irritation and painful their toxins can enter the bloodstream and affect the brain, leading to neurological urination that can lead to chronic arthritis symptoms. Diagnosis: The diagnosis of typhoid psychosis is made based on clinical NOTE symptoms and is often supported by laboratory tests that confirm the presence of Peritonitis is a medical condition characterized by inflammation of the Salmonella Typhi in the bloodstream or other body fluids. peritoneum, which is the thin tissue lining the inner wall of the abdomen and covering the abdominal organs. Treatment: Typhoid psychosis is a medical emergency, and affected individuals require immediate hospitalization and treatment. Treatment typically involves (Show the Pathophysiology) antibiotics to target the underlying Salmonella infection. Supportive care, including fluids, electrolyte balance, and management of neurological symptoms, may also Peritonitis can develop as a serious complication of typhoid fever, typically be necessary. during the later stages of the illness if it goes untreated. The primary cause of peritonitis in typhoid fever is intestinal perforation, which occurs due to PATHOPHYSIOLOGY ulceration of the Peyer's patches in the intestinal wall. Infection and Systemic Inflammation: Steps Leading to Peritonitis in Typhoid Fever: Typhoid fever is caused by Salmonella Typhi, which enters the body 1. Infection and Inflammation: Typhoid fever is caused by Salmonella through contaminated food or water. Typhi, which invades the lymphoid tissues of the intestines, especially The bacteria invade the intestinal mucosa and spread to the the Peyer’s patches located in the small intestine (specifically, the bloodstream, causing a systemic infection. ileum). This invasion leads to inflammation and ulceration of these Bacteremia and Immune Response: tissues. The presence of Salmonella Typhi in the bloodstream (bacteremia) 2. Ulcer Formation: As the infection progresses, the inflammatory triggers a strong immune response. process weakens the intestinal wall, leading to the formation of ulcers. Inflammatory cytokines are released, leading to systemic These ulcers typically form in the ileum but can occur throughout the inflammation throughout the body, including the brain. gastrointestinal tract. Neuroinflammation: 3. Intestinal Perforation: In severe cases, these ulcers can deepen, The inflammatory mediators can cross the blood-brain barrier, eventually perforating the intestinal wall. This creates a hole or causing neuroinflammation in the central nervous system (CNS). rupture, allowing the contents of the intestine, including bacteria, bile, This inflammation disrupts normal brain function and leads to and partially digested food, to spill into the sterile peritoneal cavity. symptoms of encephalopathy, such as confusion, agitation, and 4. Development of Peritonitis: Once the intestinal contents enter the altered mental status. peritoneal cavity, they cause infection and widespread inflammation of Cerebral Hypoxia: the peritoneum, the thin membrane lining the abdominal cavity. This In severe cases, the systemic infection can lead to septic shock, leads to peritonitis, which is a life-threatening condition. resulting in decreased blood flow and oxygen delivery to the brain (cerebral hypoxia). D.) CONVALESCENT STAGE Reduced oxygen supply can cause neuronal dysfunction and  gradual disappearance of signs and symptoms contribute to encephalopathy. Electrolyte and Metabolic Imbalances: Prolonged illness may lead to dehydration and imbalances in DIAGNOSTIC TESTS electrolytes (e.g., low sodium), which can further affect brain function. ▪ Clinical examination Metabolic derangements, such as acidosis, can also impair neuronal ▪ Culture of Blood, bone marrow, urine , stool for S. typhi, activity. rectal swab HIGH AMMONIA ▪ Serological Tests : Typhidot - confirmatory Increased Protein Breakdown: ▪ ELISA (Enzyme Linked Immunoassay) In severe infections, the body may undergo catabolism (breakdown ▪ Widal test of proteins) as part of the stress response. This increased protein catabolism results in higher production of NOTE ammonia, which can overwhelm the liver's ability to convert it to urea. CONVALESCENT (RECOVERY) Patients with typhoid fever may experience dehydration and electrolyte imbalances, which can further impair kidney and liver A Typhidot test is a diagnostic blood test used to detect antibodies specific to function. Salmonella enterica serotype Typhi (S. Typhi), the bacterium responsible for Electrolyte disturbances, particularly low sodium or potassium levels, causing typhoid fever. This test is also sometimes referred to as a "Typhidot IgM" can affect the kidney's ability to excrete ammonia efficiently. or "Typhidot IgG/IgM" test. 5. Twitching of the tendons sets in, especially those of the wrist The Enzyme-Linked Immunosorbent Assay, or ELISA test, is a widely used (subsultustendinum). laboratory technique for detecting the presence of specific antibodies, antigens, or 6. Patient mutters deliriously and picks up aimlessly at proteins in biological samples. ELISA tests are commonly employed in medical diagnostics, immunology, and research. bedclothes with his fingers in a continuous fashion (carphologia). 7. There is a constant tendency for the patient to slip down to TREATMENT the foot part of the bed. Medication: Antibiotics 8. In severe cases rambling delirium sets in, often ending in death.  Antibiotics, such as ampicillin, Chloramphenicol (Drug of choice for treatment of typhoid fever), fluoroquinolone C.) DEFERVESCENT STAGE trimethoprim-sulfamethoxazole, Amoxicillin and ciprofloxacin  fever gradually subsides etc. are used to treat typhoid fever. If the patient does not  severity of previous conditions, onset of complications respond to chloramphenicol, 3rd and 4th generation drugs are administered. 2| INALGAN, F. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 – 2025 NOTE RISK FACTORS Treatment: Antibiotics such as ceftriaxone, azithromycin, or fluoroquinolones are used to treat typhoid fever. Early diagnosis and treatment are essential to prevent complications. 1st Generation Antibiotics: These are the earliest antibiotics developed, and they usually have a narrow spectrum of activity, meaning they are effective against a specific group of bacteria. An example is penicillin, which primarily targets Gram-positive bacteria. 2nd Generation Antibiotics: These antibiotics were developed to have a broader spectrum of activity than 1st generation antibiotics. They are effective against both Gram-positive and some Gram-negative bacteria. Examples include ampicillin and amoxicillin. 3rd Generation Antibiotics: These antibiotics have an even broader spectrum of activity and are often effective against a wider range of Gram-negative bacteria. They were developed to combat bacteria that had become resistant to earlier generations of antibiotics. Examples include ceftriaxone and ceftazidime. 4th Generation Antibiotics: These antibiotics are designed to be even more effective against Gram-negative bacteria, including those that have developed resistance to earlier antibiotics. They often have extended activity against beta- Occupational Risk: Certain occupations, such as agriculture, mining, lactamase-producing bacteria, which are enzymes produced by some bacteria and water-related activities, may be at higher risk of leptospirosis due to break down antibiotics. An example is cefepime. to increased exposure to contaminated environments. CAUSATIVE AGENT NURSING MANAGEMENT  Leptospira interrogans 1. Isolation by the medical aseptic technique 2. Maintain or restore fluid and electrolyte balance by giving INCUBATION PERIOD nourishing fluids in small quantities at frequent intervals. 3. Monitor the patient’s vital signs.  6 -15 days / 7-10 days 4. Prevent further injury (such as falls) of patient with typhoid psychosis. PERIOD OF COMMUNICABILITY 5. Maintain good personal hygiene and mouth care.  Leptospira is found in the urine between 10 to 20 days after 6. Cooling measures are necessary during the febrile state. disease onset and may be excreted in the urine for 1 month 7. Watch out for signs of intestinal bleeding. while in some other cases up to 11 months. PREVENTION AND CONTROL NOTE 1. Sanitary and proper disposal of excreta The incubation period for leptospirosis, which is the time between exposure to the 2. Proper supervision of food handlers Leptospira bacteria and the onset of symptoms, can vary but is typically about 5 to 14 days. However, it can range from 2 to 30 days or more in some cases. The 3. Enteric isolation incubation period may be influenced by factors such as the specific Leptospira 4. Provision of adequate amounts of safe drinking water supply serovar involved, the individual's immune response, and the bacterial load to 5. Reporting of cases to health authorities which the person was exposed. 6. Detection and monitoring of typhoid carriers 7. Education of the general public on the mode of transmission SOURCE OF INFECTION 8. Terminal and concurrent disinfection 9. Observe character of stool  Infection comes from contaminated food and water and 10. Observe enteric precaution infected wildlife and domestic animals, especially rodents. 11. Position to prevent aspiration  Rats (L. ictero haemorrhagiae) are the source of Weil’s 12. Monitor for presence of complications disease frequently observed among mine, sewer and 13. Administer medication as prescribed abattoir workers. 14. Immunization  Rats (L. botaviae) are also the source of infection that 15. Handwashing attacks ricefield workers. 16. Avoid mode of transmission  Dogs (L. canicola) can also be the source of infection among 17. Decontamination of water sources, milk pasteurization veterinarians, borders and owners of dogs.  Mice (L. grippotyphosa) may also be a source of infection LEPTOSPIROSIS/WEIL’S DISEASE/CANICOLA that affects farmers and flax workers. FEVER/MUD FEVER MODE OF TRANSMISSION ▪ Leptospirosis/ Weil’s Disease/Canicola Fever/ Mud Fever 1. Direct inoculation into the broken skin , mucous membrane - An infection in rodents and other wild and domesticated 2. Ingestion of urine/ fecally contaminated food and water species. 3. Leptospirosis is transmitted through ingestion or contact with ▪ Zoonotic infectious bacterial disease carried by animals, the skin or mucous membranes of infected urine or corpses both domestic and wild. Infected urine contaminates water of either wild or domestic animals. or food, which causes disease when ingested or inoculated 4. The disease can be transmitted through the mucous through the skin membranes of the eyes, nose, and mouth, and through breaks in the skin. NOTE 5. Leptospira enters the blood to cause damage, thereafter, in Leptospirosis is a bacterial infection caused by various species of the genus the kidneys, the livers, meninges and conjunctivae. Leptospira. This disease is often referred to as "lepto" for short. Leptospirosis 6. Leptospirosis can also be transmitted by the semen of can affect both humans and animals and is considered a zoonotic disease, infected animals. meaning it can be transmitted between animals and humans. NOTE Leptospirosis is a bacterial infection caused by Leptospira bacteria. It primarily affects humans and animals, often transmitted through contact with water or soil Transmission: The bacteria are typically transmitted through contact with water, contaminated with the urine of infected animals. soil, or mud contaminated with the urine of infected animals, especially rodents (rats and mice) and livestock. Humans can become infected through breaks in the skin, mucous membranes, or by ingesting contaminated water or food. 3| INALGAN, F. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 – 2025 Resolution of Acute Symptoms: During the second phase, the high fever, Transmission: severe headaches, muscle aches, and chills that were prominent in the initial Waterborne: Infection commonly occurs through exposure to phase tend to resolve. Many patients start feeling better. contaminated water (floodwaters, lakes, rivers). Direct contact: Can also happen through skin cuts or abrasions or by Brief Asymptomatic Period: Some individuals may experience a brief period of ingestion of contaminated food or water. feeling relatively well or having only mild symptoms, which can give a false sense Commonly associated with activities like swimming, wading, or of improvement. farming in areas where rodents are present. Return of Symptoms: In some cases, as the immune system mounts a response 7. Leptospirosis is common among water sport enthusiasts in to the Leptospira bacteria, symptoms may return and become more severe. These symptoms can include high fever, jaundice (yellowing of the skin and certain areas as prolonged immersion in water is known to eyes), kidney dysfunction, liver involvement, and bleeding disorders. promote the entry of bacteria Organ Involvement: The second phase is marked by the involvement of various 8. Occupations at risk include veterinarians, slaughterhouse organs, particularly the liver and kidneys. workers, farmers and sewer workers. 9. Humans-to-human transmission is rare. WEIL SYNDROME/SEVERE LEPTOSPIROSIS SIGNS AND SYMPTOMS ▪ This form can occur during the second phase. It  Leptospirosis usually occurs in two phases: causes jaundice (yellowish discoloration of the skin and whites of the eyes that is caused by liver damage), kidney A. First phase: About 2 to 20 days after infection occurs, fever, failure, and a tendency to bleed. People may have headache, sore throat, severe muscle aches in the calves nosebleeds or cough up blood, or bleeding may occur within and back, and chills occur suddenly. The eyes usually tissues in the skin, lungs, and, less commonly, digestive become very red on the third or fourth day (Orange eyes, tract. Anemia can develop. Several organs such as the pathognomonic sign of Leptospirosis). Some people cough, heart, lungs, and kidneys may stop functioning. occasionally bringing up blood, and have chest pain. Most NOTE people recover within about 1 week. Weil's syndrome, also known as severe leptospirosis or icteric leptospirosis, is a severe form of leptospirosis, a bacterial infection caused by various species of the spirochete bacterium Leptospira. Leptospirosis is typically transmitted to humans through contact with water, soil, or food contaminated with the urine of infected animals, especially rodents. It can manifest in a range of clinical presentations, from mild flu-like symptoms to severe, life-threatening illness. Jaundice (Icteric Phase): One of the hallmark features of Weil's syndrome is jaundice, which is the yellowing of the skin and eyes due to liver dysfunction. This occurs because of the bacterium's impact on the liver. Hepatitis: Leptospirosis can cause inflammation of the liver (hepatitis), leading to symptoms like abdominal pain and tenderness in the upper right abdomen. Kidney Involvement: In addition to liver dysfunction, the kidneys may also be affected, leading to kidney injury. This can result in decreased urine output and potential kidney failure. Hemorrhage: Some individuals with Weil's syndrome may experience bleeding disorders, such as petechiae (small red or purple spots on the skin), ecchymosis (larger bruises), and even gastrointestinal bleeding. Cardiovascular and Pulmonary Complications: Severe cases of leptospirosis may NOTE involve cardiovascular and pulmonary complications, such as arrhythmias Leptospirosis typically progresses through two distinct phases, and the signs and (irregular heart rhythms) and acute respiratory distress syndrome (ARDS). symptoms of the disease can vary during each phase. The first phase of Neurological Symptoms: In rare cases, neurological symptoms can occur, leptospirosis is often referred to as the "acute" or "initial" phase and is including confusion, meningitis, and even seizures. characterized by a range of symptoms. Here are some common signs and Multi-Organ Failure: Weil's syndrome can lead to multi-organ failure, where symptoms associated with the first phase of leptospirosis: multiple organ systems in the body start to malfunction. This is a life-threatening Fever: The onset of leptospirosis is often marked by a sudden high fever, which complication. can be one of the earliest symptoms. High Mortality Rate: Weil's syndrome can be a very serious and life-threatening Headache: Many individuals with leptospirosis experience severe headaches. condition, with a significant mortality rate if left untreated. Muscle Aches: Muscle pain and body aches, especially in the calves and lower JAUNDICE (PATHO) back, are common in the initial phase. Bacterial Infection: Chills: Patients may experience chills and rigors (shivering or trembling) as the Leptospirosis is caused by Leptospira bacteria, which can enter the fever spikes. bloodstream and disseminate throughout the body, including the liver. Fatigue: Profound fatigue and weakness are frequently reported. Liver Inflammation: Eye Pain (Photophobia): Sensitivity to light and eye pain can occur in some The presence of the bacteria in the liver triggers an inflammatory cases. response. The immune system responds by sending white blood cells Gastrointestinal Symptoms: Symptoms such as nausea, vomiting, diarrhea, and and cytokines to the site of infection. abdominal pain may also be present. This inflammation can lead to hepatitis (inflammation of the liver), Joint Pain: Joint pain or arthritis-like symptoms can be seen in some cases. which disrupts normal liver function. Cough and Respiratory Symptoms: Respiratory symptoms like cough Disruption of Bilirubin Metabolism: Conjunctival Suffusion: A characteristic symptom in leptospirosis is the The liver is responsible for processing bilirubin, a byproduct of the presence of conjunctival suffusion, where the eyes appear red without discharge breakdown of red blood cells. or pus. Inflammation and liver damage can impair the liver's ability to conjugate (process) bilirubin, leading to an accumulation of B. Second (immune) phase: In some people, symptoms recur unconjugated bilirubin in the bloodstream. Biliary Obstruction: a few days later. They result from inflammation caused by In severe cases, the inflammatory response can lead to swelling and the immune system as it eliminates the bacteria from the damage to the bile ducts, causing cholestasis (reduced bile flow) body. The fever returns, and the tissues covering the brain therefore may cause formation of stones. and spinal cord (meninges) often becomes inflamed This obstruction prevents the proper excretion of bile and bilirubin (meningitis). from the liver into the intestines, further increasing bilirubin levels in the blood. NOTE Jaundice Development: The second phase of leptospirosis is known as the "immune" or "immune The accumulation of bilirubin in the bloodstream leads to phase." It occurs after the initial phase and is characterized by the resolution of hyperbilirubinemia, which manifests as jaundice—the yellowing of some of the early symptoms, followed by the onset of more severe complications the skin and sclera (the whites of the eyes). in some cases. The severity of jaundice often correlates with the extent of liver dysfunction and the severity of the leptospirosis infection. 4| INALGAN, F. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 – 2025 2. Penicillin Indication: Penicillin G can be used for severe cases of leptospirosis. Dosage: Administered intravenously, typically 1.5 to 4 million units every 4-6 hours for 7-14 days. 3. Ceftriaxone Indication: Ceftriaxone is another alternative for severe cases or when the patient cannot tolerate doxycycline or penicillin. Dosage: Usually given intravenously at a dose of 1-2 grams once daily for 7-14 days. 4. Azithromycin Indication: Azithromycin can be used in patients with penicillin allergies or when doxycycline is contraindicated. Dosage: Typically, 500 mg on the first day followed by 250 mg daily for 4 days. NURSING MANAGEMENT A. HEALTH TEACHING COMPLICATIONS 1. Provide education to clients telling them to avoid swimming 1. Meningitis or wading in potentially contaminated water or flood water. 2. Respiratory distress 2. Use of proper protection like boots and gloves when work 3. Renal intestinal tubular necrosis that results in renal failure requires exposure to contaminated water. (Weil’s disease) 3. Drain potentially contaminated water when possible. 4. Cardiovascular problems. 4. Control rats in the household by using rat traps or rat poison, maintaining cleanliness in the house. NOTE B. MANAGEMENT: PATHO 1. Isolate the patient and concurrent disinfection of soiled Systemic Dissemination: articles. Once in the bloodstream, Leptospira can spread to various organs, 2. Stringent community-wide rat eradication program.Remove including the central nervous system (CNS). rubbish from work and domestic environment to reduce The bacteria can cross the blood-brain barrier (BBB), a protective rodent population. barrier that normally limits the entry of pathogens into the CNS. 3. Report all cases of leptospirosis. Inflammatory Response: The immune system responds to the infection by releasing 4. Investigation of contacts and source of infection inflammatory cytokines and recruiting immune cells to the site of 5. Chemoprophylaxis can be done in a group of high risk infection. infected hosts This inflammatory response can lead to neuroinflammation in the meninges (the protective membranes covering the brain and spinal PREVENTION AND CONTROL cord). Meningeal Inflammation: General preventive measures include: The direct invasion of Leptospira or the inflammatory mediators can 1. Education for the public on modes of transmission, such as cause meningitis, which is characterized by the inflammation of the advice to avoid swimming or wading in potentially meninges. contaminated waters, and to use appropriate personal This inflammation can result in symptoms such as severe headache, protection when work requires potential exposure fever, stiff neck, photophobia (sensitivity to light), and altered mental status. 2. Information dissemination campaign must be conducted effectively. 3. Protecting workers in hazardous occupations with boots and DIAGNOSTIC TESTS gloves 1. Blood Culture 4. Covering abrasions and sores on skin with waterproof 2. Leptospira Agglutination test dressings 3. Leptospira Antigen -Antibody Test 5. Rodent control around human habitations 4. BUN and Creatinine 6. Prompt treatment and isolation of infected domestic animals. 5. Complete blood count (CBC) 7. Sanitation in homes, workplaces and farms is a must. 6. Creatine kinase 8. There is a need for proper drainage system and control of 7. Liver enzymes (SGPT/ Alanine Aminotransferase (AST), rodents (40-60% infected). SGOT/ Aspartate Aminotransferase (AST) 9. Animals (cattle, dogs, cats and pigs) must be vaccinated. 8. Liver function test results are usually are slightly to 10. Infected humans and pets should be treated. moderately elevated 11. Cases should be nursed with blood and body fluid precautions. Any articles soiled with urine should be TREATMENT disinfected. 12. The patient should be advised that they may continue to  Medical. Treatment of leptospirosis is geared toward: excrete leptospires in the urine for a month or more after the a. Suppressing the causative agent acute infection. b. Fighting possible complications 1. 5-to-7-day course of some antibiotics like: CHOLERA  Ampicillin  It is an acute bacterial enteric disease of the GIT  Azithromycin characterized by profuse diarrhea, vomiting, and massive  Ceftriaxone loss of fluid and electrolytes, which could result in  Doxycycline – Drug of Choice hypovolemic shock, acidosis and death.  Penicillin  Cholera is an acute diarrheal infection caused by the 2. IV fluid for hydration, administration of electrolytes ,blood as bacterium Vibrio cholerae. This bacterium produces a toxin indicated that, when ingested, can lead to rapid and severe 3. Peritoneal Dialysis dehydration. Cholera is primarily transmitted through contaminated water and food, and it can cause outbreaks in NOTE areas with inadequate sanitation and access to clean water. Doxycycline  Cholera is a life-threatening diarrheal disease Indication: Doxycycline is the preferred first-line treatment for leptospirosis, especially in mild to moderate cases. Dosage: The usual dosage is 100 mg orally twice daily for 7-14 days. 5| INALGAN, F. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 – 2025 RISK FACTORS MODE OF TRANSMISSION a. Fecal transmission passes via the oral route from contaminated water, milk and other foods. b. The organisms are transmitted through the ingestion of food or water contaminated with the stool or vomitus of a patient. c. Flies, soiled hands, and utensils also serve to transmit the infection. d. Cholera is primarily transmitted through the ingestion of water or food contaminated with the Vibrio cholerae bacterium. It can spread quickly in areas with poor sanitation, crowded living conditions, and inadequate access to clean drinking water. CLINICAL MANIFESTATION 1. There is an acute, profuse, watery diarrhea with no tenesmus or intestinal cramping. ETIOLOGIC AGENT: VIBRO CHOLERAE/VIBRO COMA 2. Intially the stool is brown and contains fecal material, but soon  The organism is a slightly curved rod (comma-shaped), becomes pale gray and "rice water-like" in appearance, with an Gram-negative and motile with a polar flagellum. inoffensive, slight fishy odor.  The organism survives well at ordinary temperature and 3. Vomiting often occurs after diarrhea has been established. multiplies well in temperatures ranging from 22-40 degrees 4. Diarrhea causes fluid loss amounting to 1 to 30 liters per day, owing centigrade. to subsequent dehydration and electrolyte loss.  They survive longer in refrigerated food. 5. Tissue turgor is poor and eyes are sunken into the orbits.  An enterotoxin, choleragen, is elaborated by the organism 6. The skin is cold; the fingers and toes are wrinkled, assuming the as it grows in the intestinal tract. characteristics "washerwoman's hand." 7. Radial pulses become imperceptible and blood pressure NOTE unobtainable. Pathophysiology: The bacterium releases a toxin in the intestines, causing the body to secrete large amounts of water and electrolytes, resulting in severe NOTE watery diarrhea, often described as "rice-water stools." Rapid loss of fluids can Symptoms: Cholera can manifest with a wide range of symptoms, from mild to lead to dehydration, electrolyte imbalance, and shock. severe. The most common symptom is profuse, watery diarrhea, often described Cyclic AMP (cAMP), or cyclic adenosine monophosphate, is a crucial signaling as "rice water" due to its appearance. Other symptoms may include vomiting, molecule within cells. It acts as a second messenger in many biological muscle cramps, and dehydration. In severe cases, rapid fluid loss can lead to processes, helping cells respond to external signals like hormones or toxins. shock and organ failure. In the context of cholera, the cholera toxin activates an enzyme called adenylate Description: cyclase inside intestinal cells. This enzyme converts ATP (adenosine The term describes a condition where the skin on the hands appears triphosphate) into cAMP. As cAMP levels rise, it causes the cells lining the wrinkled and has a white, macerated appearance, resembling the skin intestines to pump out large amounts of chloride ions into the intestinal lumen. of someone who has been immersed in water for a long time. Water and sodium follow, driven by osmotic forces, resulting in severe fluid loss This condition can also be associated with severe dehydration and and the watery diarrhea characteristic of cholera. electrolyte imbalances. Essentially, cAMP acts as a messenger that amplifies the effects of cholera toxin, Tenesmus is the sensation of urgently needing to pass stool, even when the leading to the massive outflow of fluids and electrolytes into the intestines. bowel is empty, often accompanied by discomfort or pain. This feeling is typically ineffective, meaning that very little or no stool is passed despite the intense urge. PETHOGNOMONIC SIGN 8. Cyanosis is present ▪ Rice-watery stools 9. The voice becomes hoarse and then is lost, such that the patient speaks in whisper (aphonia) INCUBATION PERIOD 10. Breathing is rapid and deep. ▪ The incubation period ranges from a few hours to 5 days, 11. Despite marked diminished peripheral circulation, consciousness is usually 1 to 3 days. present. ▪ The incubation period for cholera is usually short, ranging 12. The patient oliguria and sometimes even anuria from a few hours to a few days after exposure to the 13. Temperature could be normal at the disease but becomes bacterium. subnormal in later stages, especially if the patient is in shock. 14. When the patient is in deep shock, the passage of diarrhea stop. PERIOD OF COMMUNICABILITY 15. Death may come as rapidly as four hours after onset, but usually on the first or the second day if not properly treated. ▪ The organism are communicable during the stool-positive stage, usually a few days after recovery; however, NOTE occasionally the carrier may have the organism for several Aphonia is the complete loss of voice, making a person unable to speak or months. produce sound. It occurs when the vocal cords are unable to vibrate, usually due to damage, injury, or dysfunction in the larynx (voice box). Unlike dysphonia, which refers to partial voice impairment (hoarseness or weak voice), aphonia results in the total inability to vocalize. DIAGNOSTIC TESTS 1. Rectal swab 2. Darkfield or phase microscopy 3. Stool exam 4. Blood and stool culture 5. Rapid detection in stool using PCR (Polymerase Chain Reaction) MODALITIES OF TREATMENT Treatment of cholera consists of correcting the basic abnormalities without delay- restoring the circulating blood volume and blood electrolytes to normal levels. 1. Intravenous treatment is achieved by rapid intravenous infusion of an alkaline saline solution 6| INALGAN, F. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 – 2025 containing sodium, potassium, chloride and 9. Environmental sanitation must be observed. bicarbonate ions in proportions comparable to that 10. Weighing the patient provides additional data that in water-stool. there is no deficit in fluid input. 2. Oral therapy rehydration can be completed by 11. Appropriate diet is given according to the stage of the oral route (ORESOL, HYDRITES) unless recovery. contraindicated or if the patient is not vomiting. PREVENTION AND CONTROL NOTE Treatment: Rehydration therapy is the mainstay of cholera treatment. Oral 1. Drink only safe and clean water. If unsure, boil drinking rehydration solutions (ORS) containing a specific balance of salts and sugars can water (Upon reaching boiling point, extend boiling for two or help replace lost fluids and electrolytes. In severe cases, intravenous fluids may more minutes), or be necessary. Antibiotics like doxycycline or azithromycin can shorten the 2. Do water chlorination. duration of symptoms and reduce the severity of the illness. 3. Keep food away from insects and rats by covering it. Maintenance of the volume of fluid and electrolytes lost after rehydration. This is 4. Wash and cook food properly. done by careful intake and output measurement. 5. Sanitary disposal of human waste. 6. Use toilet properly and clean toilet everyday. 3. Antibiotics 7. Wash hands with soap after using toilet and before eating. a. Tetracycline 500mg every 6 hours might be 8. Keep surroundings clean to prevent flies and other insects administered to adults; 125mg/kg body weight for and rodents from breeding. children every 6 hours for 72 hours b. Furazolidone 100mg for adult and 125mg/kg for NOTE children might be given every 6 hours for 72 Prevention: Preventing cholera involves improving sanitation and hygiene, hours. ensuring access to safe drinking water, and educating communities about proper c. Chloramphenicol may also be given 500mg for food handling and personal hygiene practices. Vaccines, such as the oral cholera adult and 18mg/kg for children every 6 hours for vaccine, are also available and can provide some protection, particularly in 72 hours. outbreak-prone areas. d. Cotrimoxazole may also be administered 8mg/kg for 72 hours AMOEBIC DYSENTERY ▪ Is a protozoal infection of human beings initially involves the NOTE colon, but may spread to soft tissues, most commonly the Rehydration Therapy liver and lungs by contiguity or hematogenous or lymphatic Oral Rehydration Solution (ORS): The first line of treatment for dissemination cholera. It consists of a precise mixture of salts and sugars dissolved in water to replace lost fluids and electrolytes. Intravenous (IV) Fluids: In cases of severe dehydration or if the NOTE patient cannot tolerate oral intake, IV fluids may be necessary. Amoebic dysentery, also known as amoebiasis or intestinal amoebiasis, is a 2. Antibiotics gastrointestinal infection caused by a protozoan parasite called Entamoeba While not always required, antibiotics can reduce the duration of diarrhea and histolytica. This parasite primarily affects the colon (large intestine) and can lead help to eliminate the bacteria from the intestines, particularly in moderate to to a range of gastrointestinal symptoms, including severe diarrhea and abdominal severe cases. pain. Doxycycline: Amoebiasis: Amoebiasis is a general term that encompasses any infection or Often considered the first-line antibiotic for adults. disease caused by the protozoan parasite Entamoeba histolytica. This term does Typical dosage: 300 mg as a single dose. not specify the particular symptoms or severity of the infection. It can refer to both Azithromycin: asymptomatic colonization by the parasite and symptomatic disease, such as Used for both adults and children, especially in areas with diarrhea or invasive amoebic colitis. antibiotic resistance. Amoebic Dysentery: Amoebic dysentery is a specific form of amoebiasis Typical dosage: 1,000 mg as a single dose. characterized by a severe and often bloody diarrhea. It is one of the clinical Ciprofloxacin: manifestations of amoebiasis. In amoebic dysentery, the parasite E. histolytica Another option, though resistance may be a concern in invades the lining of the colon, leading to inflammation and ulceration, which some regions. results in the characteristic bloody and mucous-containing diarrhea. Amoebic Typical dosage: 500 mg twice daily for 3 days. dysentery is a more severe presentation of amoebiasis and can be associated 3. Zinc Supplementation with abdominal pain, fever, and other gastrointestinal symptoms. Zinc may be given as an adjunct therapy, especially in children, to reduce the severity and duration of diarrhea. RISK FACTORS NURSING MANAGEMENT 1. Medical aseptic protective care must be provided. Handwashing is imperative before any food item is handled. 2. Enteric isolation must be observed. 3. Vital signs must be recorded accurately. 4. Intake and output must be accurately measured. 5. A through and careful personal hygiene must be provided. 6. Excreta must be properly disposed of. 7. Concurrent disinfection must be applied. NOTE Nursing Considerations: Hydration: Immediate rehydration is the most critical intervention. Oral rehydration salts (ORS) should be administered in mild cases, while intravenous fluids may be required in severe dehydration. Monitor for Electrolyte Imbalance: As potassium and sodium levels drop, nurses must assess for signs of hypokalemia (e.g., muscle ETIOLOGIC AGENT: ENTAMOEBA HISTOLYTICA weakness) and hyponatremia (e.g., confusion). Infection Control: Ensure proper sanitation and hygiene practices to ▪ Prevalent in unsanitary areas prevent the spread of the infection, including handwashing and ▪ Common in warm climates disinfection of surfaces. ▪ Acquired by swallowing ▪ Causative Agent: Amoebic dysentery is caused by the 8. Food must be properly prepared. protozoan parasite Entamoeba histolytica. This amoeba can 7| INALGAN, F. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 – 2025 exist in two forms: a non-invasive cyst form and an invasive h) The abdomen loses its elasticity when picked up between trophozoite form. The trophozoites are responsible for the fingers. causing disease by invading the lining of the colon. i) On sigmoidoscopy, scattered ulceration, with yellowish and erythematous border is noted. - Cyst survives a few days outside of the body j) The gangrenous type (fatal) is characterized by the - Cyst passes to the large intestine and hatches into a trophozoite. It appearance of large sloughs of intestinal tissues in the passé into the mesenteric veins, the portal vein, and finally to the liver, stools, accompanied by hemorrhage where it causes amoebic liver abscess 3. Extra-intestinal forms Pathophysiology: After ingestion, E. histolytica cysts pass through a) Hepatic the stomach and release trophozoites in the intestines. These b) Pain in the upper right quadrant with tenderness of the liver trophozoites invade the lining of the colon, causing ulcers and c) Jaundice inflammation, leading to symptoms like bloody diarrhea, abdominal d) Intermittent fever pain, and cramping. In severe cases, the parasite can penetrate e) Loss of weight or anorexia deeper layers of the intestinal wall or spread to other organs, such as f) Abscess may break through the lungs; patients coughs” the liver, causing abscesses. anchovy-sauce sputum. SOURCE: CLINICAL FEATURES OF AMOEBIASIS ▪ Human excreta 1. Onset is gradual 2. Diarrhea increases and stools becomes bloody and mucoid. INCUBATION PERIOD 3. In treated cases: Fluid stools = severe bloody-mucoid stool ▪ The incubation period in severe infections is three days. Hemorrhage = intestinal perforation In sub-acute and chronic from it last for several months. Peritonitis = DEATH In average cases the incubation period varies from three to four weeks. DIAGNOSTIC TESTS PERIOD OF COMMUNICABILITY 1. Stool exam (cysts; white and yellow pus with plenty of amoeba) ▪ The microorganism is xcommunicable for the entire 2. Blood exam (leukocytes) duration of the illness. 3. Proctoscopy/sigmoidoscopy ▪ Treatment MODE OF TRANSMISSION 1. Metronidazole (flagyl) 800 ng TID x 5days. 1. The disease can be passed from one person to another 2. Tetracycline 250 mg every 6 hours through fecal-oral transmission. 3. Ampicillin, quinolone, sulfadiazine 2. The disease can be transmitted through direct contact, 4. Streptomycin SO4,chloramphenicol through sexual contact by orogenital, oroanal, and 5. Lost fluids and electrolytes should be replaced. proctogenital sexual activity. 3. Through indirect contact, the disease can infect humans by NOTE ingestion of food, especially uncooked leafy vegetables or These drugs are used to kill the trophozoites that have invaded tissues, foods contaminated with fecal material containing especially in cases of symptomatic or severe infection. E.histolytica cysts. Metronidazole (Flagyl): This is the most commonly used 4. Food or drinks may be contaminated by cysts through drug for treating amoebic dysentery. It effectively kills the pollution of water supply, exposure to flies, use of night soil invasive trophozoites in the tissues. for fertilizing vegetables, and through unhygienic practices of Typical dose: 500–750 mg three times daily for 5– food handlers. 10 days. Tinidazole: An alternative to metronidazole, with similar CLINICAL MANIFESTATION efficacy but a shorter treatment course. Typical dose: 2 g once daily for 3 days. 1. Acute amoebic dysentery Successful Treatment: a) Slight attack of diarrhea, altered with periods of When antiparasitic medications (such as metronidazole or constipations and often accompanied by tenesmus. tinidazole for invasive disease, followed by a luminal agent b) Diarrhea, watery , and foul-smelling stools often containing like paromomycin) are used correctly, the parasite blood-sneaked mucus. Entamoeba histolytica can be fully eliminated from the body. c) Colic and gaseous distension of the lower abdomen. After treatment, both the trophozoites (the active form that d) Nausea, flatulence, abdominal distension, and tenderness in causes symptoms) and cysts (the dormant form that can lead the right iliac regions over the colon. to reinfection) are usually destroyed, preventing further NOTE infection. Untreated or Improperly Treated Cases: Clinical Presentation: If treatment is incomplete or only partially effective, the cysts Diarrhea (often bloody or mucus-filled) may remain in the intestines without causing symptoms, Abdominal pain or cramping turning the person into an asymptomatic carrier. These Fever cysts can later cause reinfection or be passed to others. Weight loss Additionally, if only the symptoms are treated without using a Fatigue luminal agent to eliminate cysts, the parasite might persist in the intestines and cause a recurrence of the disease. 2. Chronic amoebic dysentery Chronic Amoebiasis: a) Attack of dysentery that last for several days usually In rare cases, untreated or inadequately treated infections succeeded by constipation. may lead to chronic amoebiasis, where the parasite b) Tenesmus accompanied by the desire to defecate. remains in the intestines and causes intermittent symptoms c) Anorexia, weight loss, and weakness over time. d) The liver may be enlarged. In severe cases, the infection can spread beyond the e) Stools at first are semifluid, but soon become watery, bloody intestines, particularly to the liver, causing amoebic liver and mucoid. abscess, which requires more aggressive treatment. f) Vague abdominal distress, flatulence, constipation or irregularity of bowel movement. g) Mild toxemia, constant fatigue, and lassitude 8| INALGAN, F. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 – 2025 NURSING MANAGEMENT dysentery is a highly contagious illness that primarily affects the colon (large intestine). 1. Observe isolation and enteric precaution Causative Organism: Amoebic Dysentery: 2. Provide health education and instruct patient to: a) Boil water before drinking or use purified water Caused by the protozoan parasite Entamoeba histolytica. b) Avoid washing food with water from open drum or pails Bacillary Dysentery: c) Cover leftover food Caused by bacterial infections, primarily from d) Wash hands after defecations and before eating and species such as Shigella (most common), but can e) Avoid eating ground vegetables (lettuce , carrots and the also include Salmonella and Escherichia coli like) (particularly enteroinvasive strains). Transmission: 3. Proper collection of stool specimen. Amoebic Dysentery: a) Never give paraffin or any oil preparation for at least 48 Transmitted through the fecal-oral route, often via hours prior to the collection of specimen. contaminated food or water, especially in areas b) Instruct the patient to avoid mixing urine with stool with poor sanitation. c) If whole stools cannot be sent to the laboratory, select as Bacillary Dysentery: large portions containing blood and mucus as possible Also transmitted through the fecal-oral route, but d) Send the specimen immediately to the laboratory; stools that typically spreads more easily and rapidly due to are not fresh person-to-person contact, especially in crowded e) Label the specimen properly settings. Impact on Test Results: 3. Symptoms: Amoebic Dysentery: Oil Preparation Interference: Paraffin or mineral oil can Symptoms may include watery or bloody diarrhea, coat the intestines and interfere with the absorption and abdominal pain, cramping, and fever. The stools excretion of fats, leading to misleading results in tests may contain mucus and blood, often described as assessing for malabsorption or fat content in the stool. Detection of Pathogens: For tests that require the "dysenteric" stools. Symptoms can be acute or chronic, with some detection of specific pathogens (e.g., Entamoeba histolytica, patients remaining asymptomatic carriers. Giardia, or bacterial cultures), the presence of oils may Bacillary Dysentery: inhibit the growth of these organisms or affect their Characterized by sudden onset of watery diarrhea, morphology, leading to false negatives. often followed by tenesmus (the feeling of needing to pass stools even when the bowels are empty), 4. Skin care abdominal cramps, and high fever. The diarrhea a) Cleanliness and freedom from wrinkles on the sheet will be can also be bloody and contain mucus. helpful with all the usual precautionary measures against Symptoms are generally more acute and severe, pressure sores and the onset is often rapid. 5. Mouth care There are four serologic groups: 6. Provide optimum comfort ▪ Shigella flexnari (group B) – common in the Philippines a) The patient should be kept warm. Dysenteric patients ▪ Shigella Boydii – Common in Asia should never be allowed to feel cold, even for a movement ▪ Shigella sonnei ▪ Shigella dysenteriae 7. Diet ✔ Considered as the most infectious a) During the acute stages, fluids should be forced ✔ Their habitat is exclusively the GIT of man b) In the beginning of an attack, cereals and strained meat ✔ Like other Gram –negative bacilli, they develop broths without fat should be given resistance against antibiotics c) Chicken and fish may be added when convalescence is ✔ They rarely invade the blood stream established NOTE d) A bland diet without cellulos or bulk-producing foods should Causative Agent: Bacillary dysentery is caused by various species of be maintained for a long time. the Shigella bacteria, including Shigella sonnei, Shigella flexneri, Shigella boydii, and Shigella dysenteriae. These bacteria are PREVENTION AND CONTROL transmitted through the fecal-oral route, often via contaminated food, 1. Health education water, or surfaces. 2. Sanitary, disposal of feces Geographic Distribution: Shigella boydii infections are more commonly 3. Protect chlorinate, and purify drinking water associated with certain regions, such as parts of Asia and Africa. 4. Observe scrupulous cleanliness in food preparation and However, it can be found in various parts of the world, and its food handling prevalence may vary by location. 5. Detection and treatment of carriers 6. Fly control ( they can serve as vectors ) INCUBATION PERIOD 1. Seven hours to seven days, with an average of three to five BACILLARY DYSENTERY days. ▪ is an acute bacterial infection of the intestines characterized by diarrhea and fever and is the associated with the passing PERIOD OF COMMUNICABILITY out of bloody-mucoid stools accompanied by tenesmus 1. The patient is capable of transmitting the microorganism ▪ Etiologic Agent during the acute infection until the feces are negative of the ▪ The causative agent is a bacterium of the Shigella group, a organism. Some patient remain carriers for a year or two. short, non-motile, Gram-negative organism. MODE OF TRANSMISSION NOTE Bacillary dysentery, also known as shigellosis, is a gastrointestinal ▪ The organism is transmitted through ingestion of infection caused by a group of bacteria known as Shigella. It is contaminated food or water or milk. characterized by severe diarrhea, often accompanied by blood and ▪ It may be transmitted by flies or through other mucus in the stool, along with abdominal cramps and fever. Bacillary objects contaminated by feces of the patient. ▪ Fecal-oral transmission is possible. 9| INALGAN, F. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE & CHRONIC NCM 112 LECTURE | 1st Sem | BSN 3A S.Y 2024 – 2025 CLINICAL MANIFESTATION can depend on local resistance patterns, but commonly used antibiotics include: ▪ Fever, especially in children Ciprofloxacin: A fluoroquinolone antibiotic effective against ▪ Tenesmus, nausea, vomiting, and headache Shigella. ▪ Colicky or cramping abdominal pain associated with anorexia and body weakness Typical dose: 500 mg orally every 12 hours for 3 days. ▪ Diarrhea with bloody mucoid stools that are Azithromycin: A macrolide antibiotic used especially in watery at first children or in areas with high resistance to fluoroquinolones. ▪ Rapid dehydration and loss of weight Typical dose: 1 g orally as a single dose or 500 mg daily for 3 days. COMPLICATIONS Ceftriaxone: A third-generation cephalosporin that may be 1. Rectal prolapse , particularly in undernourished used for severe cases or when oral antibiotics are not children feasible. 2. Respiratory complications, such as cough and Typical dose: 1–2 g IV once daily. pneumonia Trimethoprim-Sulfamethoxazole (TMP-SMX): While its use 3. Non-Suppurative arthritis and peripheral has declined due to resistance, it can still be effective in neuropathy certain situations. Typical dose: 160/800 mg orally every 12 hours for NOTE 5–7 days. Cough and Pneumonia: Aspiration: Patients with severe diarrhea may inadvertently aspirate gastric contents or secretions, leading to aspiration NURSING MANAGEMENT pneumonia. Sepsis: In rare cases, if Shigella bacteria enter the ▪ Maintain fluid and electrolyte balance to prevent bloodstream, they can lead to systemic infections, including profound dehydration pneumonia. ▪ Keep the patient warm and comfortable Respiratory Complications: Generalized weakness and ▪ Restrict food until nausea and vomiting subsides dehydration from severe diarrhea can compromise ▪ Isolation can be carried out through medical respiratory function, making patients more susceptible to aseptic technique respiratory infections. ▪ Personal hygiene must be maintained Non-Suppurative Arthritis: ▪ Excreta must be properly disposed Reactive Arthritis: Following a Shigella infection, some