NCMB312 Lec Final 2022 PDF

NCMB312 LECTURE: Exam Week 18 BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Bachelo...

NCMB312 LECTURE: Exam Week 18 BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Bachelor of Science in Nursing 3YA Professor: Dr. Potenciana A. Maroma Final Topics: - Dr. John Snow is regarded as one of the founding Cholera, Dysentery, Typhoid Fever, Hepatitis, Leprosy, fathers of modern epidemiology and discovered how Tetanus, Poliomyelitis, Meningitis, Red Tide poisoning cholera was spread in London. Schistosomiasis, Rabies, Pediculosis, Bubonic Plague, - Cholera has been nicknamed the "blue death" Anthrax, Helminthes, Candidiasis, Chlamydia, Herpes, because a person dying of cholera may lose so many Infectious Mononucleosis, Gonorrhea, Syphilis, AIDS body fluids that their skin turns bluish gray. Cancer Overview and Cancer of the CNS and Breast Causative Agent Cancer of the GIT and GUT - Vibrio coma or vibrio cholera Blood Cancer Incubation Period - From a few hours to 5 days (average of 3 days) COMMUNICABLE DISEASES Period of Communicability Discussed by: Gerardo A. Nicolas RN, RM, RPT, MAN - As long as microorganisms are present in the bowel Hepatitis excreta Hepatitis A Clinical Manifestations - Infectious hepatitis, Catarrhal-jaundice hepatitis - Mild diarrhea that becomes voluminous - Mode of Transmission: fecal-oral, oral-anal sex - Rice-watery stool (pathognomonic sign) Hepatitis B - Washer woman’s hands - Serum Hepatitis - Effortless vomiting - MOT: percutaneous, sexual contact, mother to child. - Cramping of the extremities (hypokalemia) Hepatitis C - Signs of severe dehydration - Post-transfusion hepatitis 3 Deficits During Cholera - MOT: percutaneous, sexual intercourse Severe dehydration and ECF volume deficit Clinical Manifestations: Hypokalemia - Preicteric phase: anorexia, nausea, RUQ pain, Metabolic acidosis malaise, headache, low grade fever Diagnostic Exams - Icteric phase: dark urine (increase bilirubin), pruritus, Stool or vomitus culture clay-colored stools, jaundice Serum electrolytes - Post icteric phase: malaise, fatigue, hepatomegaly for Dark field or Phase Microscopy several weeks Medical Management Diagnostic exams: - Correction of dehydration and fluid imbalance Hepatitis Profile - Antibiotics- Tetracycline (drug of choice) Liver function test Nursing Management Liver UTZ Assess patient for signs of dehydration and Complications: complications chronic hepatitis Observe enteric precautions cirrhosis Increase oral fluid intake Meds for chronic hepatitis B: Violent Bacillary Dysentery Amoebic Dysentery - Antivirals: lamivudine, interferon Dysentery Shigelosis Amoebiasis Nursing Interventions: Cholera Shigella dysenteriae Entamoeba 1. Bed rest Vibrio cholera histolitica 2. SFF, high CHO Rice watery +/- fever +/- fever 3. Avoid alcohol and OTC drugs stool +/- vomiting +/- vomiting 4. Implement Standard precaution Signs of severe Abdominal pain Abdominal pain Prevention: dehydration: (colicky or Diarrhea with - Hepatitis B vaccination (0, 6, 14 weeks 0.5 cc IM) sunken eyeball, cramping) tenesmus Washer- Diarrhea with Muco-purulent blood Cholera woman’s hand, tenesmus streaked stool - Filippo Pacini discovered of Vibrio cholera. metabolic Mucus and Blood Tx: Metronidazole - Russian-Jewish bacteriologist Waldemar acidosis, shock streaked stool Haffkine developed the first cholera vaccine in July Tx: Tetracycline Tx: Cotrimoxazole 1892. J.A.K.E 1 of 63  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Typhoid Fever Nursing Management - The first effective vaccine for typhoid was developed Enteric isolation by Almroth Edward Wright and was introduced for Vital signs must be recorded accurately military use in 1896. Intake and output must be accurately measured - Georg Gaffky was a pathologist that confirmed the Concurrent disinfection bacillus Eberthella typhi, which is known today as Isolation Salmonella enterica. Increase oral fluid intake Causative Agent - Salmonella Leprosy Incubation Period - Synonym: Hansen’s disease - Variable - Chronic disease of the skin, peripheral nerves and - Usually 1 – 3 weeks, average: 2weeks nasal mucosa Period of Communicability - “Living dead”, Was perceived to be caused by sin - As long as the bacilli appears in the excreta - Causative agent: Mycobacterium leprae Mode of Transmission Mode of transmission: - Fecal – oral route a. Intimate skin to skin contact - Ingestion of contaminated food and water 5 F’s – b. Droplet Infection fingers, feces, flies, food, fomites Types: 1. Multibacillary (MB) – infectious, malignant - Numerous macules, papules and nodules 2. Paucibacillary (PB)– hypopigmented macule Late Manifestation - Lagophthalmos – inability to close eyelids - Madarosis – loss of eyebrows - Sinking of the bridge of the nose - Leonine face - Contractures (clawing of fingers and toes) - Gynecomastia – for males Slit Skin smear – to demonstrate M. leprae o (-) in all site = Paucibacillary o (+) in all sites = Multibacillary o Number of lesions = 2-5 PB / > 5 MB Clinical Manifestations Treatment: - Gradual onset Multi drug therapy (MDT) RA 4073 - A-norexia and abdominal pain A. Paucibacillary: Rifampicin(600mg) /once a month and - B-radycardia Dapsone (100mg) OD (6-9 mos) - C-onstipation B. Multibacillary: Rifampicin, dapsone, lamprine - D-iarrhea, D-evelop skin eruptions on the abdomen, Day 1: R-600 D-100 C-300 once month back and chest (ROSE SPOTS) Day 2-28: Dapsone 100 OD Clofazimine - E-nlarged spleen (Lamprine) 50 - F-ever and chills Health education - G-eneralized body weakness - Dapsone: cutaneous eruptions, also iritis, orchitis - H-eadache - Lamprine: Brownish black skin discoloration, dryness - What are the three cardinal signs of Pyrexial stage? and flakiness Rose Spot - Skin care: Prevent injury - red spots that scattered all over the body Nursing Diagnosis Diagnostic Exams o Altered body image - CBC o Social stigma - Widal test Preventive: BCG at birth - Typhidot exam - Blood culture Pediculosis - Urine and stool culture Types: Medical Management a. Pediculosis capitis – head lice - Antibiotics: chloramphenicol – drug of choice b. Pediculosis corporis – body lice - IVF to correct dehydration or fluid imbalance c. Phthirus pubis – pubic or crabs lice - Paracetamol for the fever Mode of transmission: direct contact, beddings, towel, - Oral therapy rehydration (oresol, hydrites) clothes and hairbrush J.A.K.E 2 of 63  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Clinical manifestations: Medical Management - Intense pruritus, leads to secondary excoriation - Praziquantel (biltricide) – drug of choice - Eggs (nits) attached to the hair shaft - Oxamniquine (vansil), metrifonate Parasitic Infestations Prevention - Scabies: an infestation of the skin by Sarcoptes - Travelers to endemic areas should avoid exposure to scabiei mites fresh water that is likely to be contaminated a. Intense itching - No accepted prophylactic regimens have been b. Superficial burrows, especially between developed and no vaccines are currently available fingers, the surface of the wrist and in axilla - Eradication of snails c. Redness, swelling may be noted Treatment Helminthes A. Pediculosis MOT: ingestion 1. Permethrin 1% (Nix) 1. Pinworm- Enterobius, Seatworm 2. Pyrethrine compunds (Rid) - s/s: Nocturnal itchiness of anus (female pinworm lays B. Scabies eggs on the anal sphincter) 1. Permethrin 5% cream (Elimite) 2. Giant Roundworm (Ascariasis) Potbelly Home care: 3. Whipworm (Trichuriasis) 1. All family members and close contacts need to be 4. Tapeworm treated Taenia saginata- raw beef 2. Concurrent Disinfection Taenia solium- raw pork a. Daily washing of recently worn clothes, towels Diphyllobotrium latum – raw fish and bedding. 5. Lung fluke – Paragonimiasis b. Areas such as shared toilet and shared commode MOT: Raw mountain crab chair seats need to be thoroughly wiped after MOT: Skin penetration each use 1. Hookworm (Ancyclostomiasis) 2. Threadworm (Strongyloidiasis) Schistosomiasis - Is an endemic protozoan infection that affects the Leptospirosis liver and GIT - Adolf Weil of Heidelberg reported the clinical entity of - Capable of producing obstructive jaundice and liver fever, jaundice, hemorrhage, and renal failure in 1886. cirrhosis Other Names Other Name Weil’s disease - Bilharziasis Canicola Fever - The etiology of schistosomiasis in humans was first Mud Fever discovered in 1851 by the German physician Theodor Hemorrhagic jaundice Bilharz. Swineherd’s Disease Causative Agent Etiologic Agent - Schistosoma japonicum - A spirochete of genus Leptospira (Leptospira - Schistosoma mansoni interrogans) - Schistosoma haematobium Incubation Period Stages - 6-15 days - Adult female and male parasites Period of Communicability - Ova - Leptospira is found in the urine between 10 to 20 days - Miracidium – infective stage in snails after the onset - Cercaria – infective stage in man and animals Modes of Transmission Intermediate Host 1) Ingestion or contact with the skin and mucous - Snail (Oncomelania quadrasi) membrane of the infected urine or carcasses of wild Mode of Transmission and domestic animals. - About 2-6 weeks from skin penetration by cercaria 2) Through the mucous membrane of the eyes, nose, and Clinical Manifestations mouth, and through a break on the skin. - Abdominal pain 3) Direct human to human transmission is rare. - Diarrhea with bloody stools - Portal hypertension and signs of liver cirrhosis - Anemia Diagnostic Exams - Kato-katz – specimen is stool - Circumoval precipitin test (COPT) – specimen is blood - HBT – UTZ - Liver function tests J.A.K.E 3 of 63  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Peritoneal Dialysis - Administration of fluid and electrolyte and blood as indicated. Nursing Management - Isolate the patient, urine must be properly disposed of. - Darken patient’s room. - Observe meticulous skin care - Keep clients under close surveillance. - For home care, clean near dirty places, pools, and stagnant water. - Facilitate health education on the modes of transmission of the disease. - Encourage oral fluid intake. Prevention and Control - Sanitation in homes, workplaces, and farms is a must. - There is a need for proper drainage system and Clinical Manifestations control of rodents (40 to 60 percent infected). a) Septic Stage - Animals must be vaccinated (cattle, dogs, cats, and - This stage is marked with febrile lasting for four to pigs). seven days. - Abrupt onset of remittent fever Poliomyelitis - chills Causative Agent - headache - Legio debilitans - anorexia Type I – Brunhilde: permanent immunity; most - abdominal pain paralytogenic - severe prostration Type II – Lansing: temporary immunity - respiratory distress and fever subsides by lysis Type III – Leon: temporary immunity b) Immune or Toxic stage Predisposing Factors - Iritis - Age. About 60% of patient are under 10 years of age. - Headache - Sex. Males are more prone to the disease than females. - Meningeal manifestations Death rate is proportionately higher in males. Disorientation - Heredity. Not heredity Convulsions - Environment and hygienic condition. The rich are more with CSF findings of aseptic meningitis. often spared than the poor. Excessive work, strain and Oliguria and anuria with progressive renal failure. marked overexertion are also factors causing the Shock, coma, and congestive heart failure are disease. also seen in severe cases Mode of Transmission c) Convalescent Stage - fecal-oral: through saliva, vomitus and feces - At this stage, relapse may occur during the 4th to 5th - Direct contact from one person to another week - Ingestion through of contaminated food (fecal-oral Diagnostic Test route) - Blood urea-nitrogen and urea Incubation Period - Enzyme Link Immuno-sorbent Assay (Elisa) - 7 – 14 days - Leptospira Antigen-antibody test (LAAT) - Leptospira Antibody Test (LAT) - Liver function test Complications - Meningitis - Respiratory Distress - Renal interstitial tubular necrosis that result to renal failure (Weil’s disease) - Cardiovascular problems Management - Medical Treatment of leptospirosis is geared toward: Suppressing the causative agent Period of Communicability Fighting possible complications - Not accurately known - Penicillin G – drug of choice - Polio virus can be found in throat secretions as early as - Ampicillin, Amoxicillin 36 hours and in the feces 72 hours after exposure to - For prophylaxis, doxycycline infection. J.A.K.E 4 of 63  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 - Risk of spreading the microorganism is highest during Diagnostic Exams the prodromal period - Blood and throat culture Signs and Symptoms - Lumbar tap (pandy’s test) 1) Inapparent/ Subclinical Stage - asymptomatic stage - EMG (90-95%) - Stool exam 2) Abortive (Minor Illness Stage) Nursing Management - Fever - Strict isolation, enteric precaution - Sore throat - CBR / Firm and non-sagging bed - GI symptoms - ROM exercises - Low lumbar backache/ cervical stiffness on ante- - Analgesics / Hot moist compress flexion of spine - Protective devices 3) Major Illness Stage - Hand roll – claw hand - Non-paralytic/ pre-paralytic or meningitic type - Trochanter roll – outer - Recurrence of fever - rotation of the femur - Poker spine (stiffness of the back) - Footboard - Tightness and spasm of hamstring - There are two vaccines for polio: - Hypersensitiveness of the skin - Oral Polio Vaccine (OPV) and the Inactivated Polio - Deep reflexes are exaggerated Vaccine (IPV). - Paresis - In the Philippines still using OPV, IPV does not replace 4) Paralytic the OPV vaccine, but is used with OPV to strengthen a - With paralysis depending on the part affected child's immune system and protect them from polio. - Positive hoyne’s sign: head drop Two Types of Polio Vaccine - (+) kernig’s and brudzinki signs paralysis IPV (Salk) Types of Paralysis - Killed formulized virus Bulbar - Given SC or MI - Respiratory paralysis - Include circulating antibodies but not local (intestinal Spinal immunity) - Paralysis of the upper and lower extremities and - Prevents paralysis but does not prevent re-infection intercostal muscles - Difficult to manufacture and costly Bulbospinal - Not useful with controlling epidemics - Involvement of neurons both in brainstem and the OPV (Sabin) spinal cord - Live attenuated virus - Given orally - Immunity is both humoral and intestinal. Induces antibody quickly. - Prevents paralysis and prevent re-infection - Easy to manufacture and cheaper - Can be effectively use in controlling epidemics Rabies Republic Act 9482 - The national government has implemented the Anti- Rabies Act of 2007, which mandates the creation of the National Rabies Prevention and Control Program (NRPCP). It is the goal of the NRPCP to eliminate rabies in the country and declare the Philippines rabies-free by the year 2020. Executive Order No. 84 series of 1999 - March is Rabies Awareness Month Other Names - Lyssa - Hydrophobia - The origin of the word rabies from the Latin "rabere" (to rage). The ancient Greeks called rabies "lyssa" (violence). Today, the virus causing rabies is classified in the genus Lyssa Virus". - Louis Pasteur developed the earliest effective vaccine against rabies on 6 July 1885. J.A.K.E 5 of 63  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 - Nine-year-old Joseph Meister (1876–1940), who had been mauled by a rabid dog, was the first human to receive this vaccine. Causative Agent - Rhabdo virus o a bullet-shaped virus with strong affinity to CNS tissues Clinical Manifestations Rabid animal - Dumb stage – quiet, stays in corner with copious salivation - Furious stage – easily agitated, hydrophobia Rabid Man 1) Prodromal / Invasion stage - Mental depression, headache, sore throat, low-grade fever Modes of Transmission - Copious salivation - Bite of an infected animal - Quiet - Licking of open wounds by a rabid animal 2) Excitement stage - Scratch of a rabid animal - Restless, irritable - Man to man transmission (10%) - Hydrophobic Source of Infection - Aerophobic - Saliva of infected animals or human - Drooling of saliva Incubation Period 3) Paralytic - 10-14 days (dogs) - Flaccid ascending symmetric paralysis - 1 day – 5 yrs. (humans) - Coma, death Incubation period depends on the following factors 1. Distance of the bite to the brain 2. Extensiveness of the bite 3. Species of the animals 4. Richness of the nerve supply in the area of the bite 5. Resistance of the host Diagnostic Exams - Fluorescent rabies anti body (FRA)- Confirmatory test - Brain biopsy of the animal (Negri bodies) - 14 days observation of the animal Medical Management - No specific treatment - Prevention is the best treatment - Anti – rabies vaccination of animal and exposed individual Nursing Management - Provide a dim, quiet and non-stimulating room for the patient J.A.K.E 6 of 63  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 - Wear gown, mask and goggles Prevention - All noises no matter how minor should be avoided - Immunization - Restrain the patient when needed - Keep away from stray animal - Stimulation of any senses by fluids must be avoided - Anti – rabies vaccine Tetanus Other Names: Lock jaw Causative Agent - Clostridium tetani Two types of toxin: tetanospasmin tetanolysin Incubation Period - 3 days – 3 weeks in adult - 3 – 30 days in new born Mode of Transmission - Through breaks in the skin and mucous membranes Sources of Infection - Soil - Street dust - Animal and human feces - Rusty materials - How effective is the rabies vaccine? Clinical Manifestations - The rabies vaccine works remarkably well. Studies Neonates indicate that if the vaccine is given immediately and - Malaise, high fever appropriately to someone who was bitten by a rabid - Difficulty in sucking animal, it is 100 percent effective. - Excessive of crying - A vaccine can confer active immunity against a - Stiffness of jawAdult specific harmful agent by stimulating - Trismus – lock jaw the immune system to attack the agent. - Risus sardonicus (sardonic smile) – pathognomonic - A serum can confer passive immunity sign - (rabies immune globulin) is commonly used after a - Opisthotonus certain type of wild animal bites an individual. - Muscular spasm - A person who is exposed and has never been - Low grade fever, diaphoresis vaccinated against rabies should get 4 doses of rabies Diagnostic Exam vaccine – one dose right away, and additional doses - Clinical manifestations on the 3rd, 7th, 21st days and 5 doses of rabies - History of wound vaccine – one dose right away, and additional doses Medical Management on the 3rd, 7th, 14th and 28th days. They should also - ATS, TAT, TIG get another shot called Rabies Immune Globulin at - Pen G,Metronidazole the same time as the first dose. - Diazepam Dosage: - Muscle relaxant - Human Rabies Immune-globulin (HRIG) Nursing Management - 20 IU/kg body weight Keep the room dim and quiet. Avoid stimuli of spasm - Equine Rabies Immune-globulin (ERIG) Avoid unnecessary handling - 40IU/kg body weight Close monitoring of v/s and muscle tone Skin testing Provide adequate airway Nursing Diagnoses - Ineffective breathing pattern related to muscles spasm and neurologic impairment. - Risk for injury related to muscle spasms. Prevention - Immunization with tetanus toxoid for adults - DPT for babies and children J.A.K.E 7 of 63  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Meningitis Nursing Management Other name: Cerebrospinal fluid - Respiratory Isolation: 24 hours after onset of Etiologic Agent antibiotic therapy - Neisseria meningitides - Provide non-stimulating environment - Streptococcus pneumonia - Initiate seizure precaution - Haemophilus influenza - Avoid factors that increase ICP - Streptococcus agalactae and Listeria monocytogenes Preventive Measures Mode of Transmission - Vaccination: Hib- for children - Respiratory droplets through nasopharyngeal mucosa - Avoid MOT - Direct invasion through otitis media - Rifampicin- prophylactic treatment - May result after a skull fracture, penetrating head - Alternative: Ciprofloxacin wound Incubation Period Dengue - 3 – 6 days Other Names Period of Communicability - Breakbone fever - As long as the microorganism is present in the - Dandy fever discharges - Infectious Thrombocytopenic purpura Clinical Manifestations - H-fever - Fever Etiologic Agent - Petecchial/purpuric rashes - Group B Arbovirus (I,II,II,IV) - Signs of increased ICP - Flavivirus o Severe frontal headache - The dengue viruses, of which four serotypes are o Altered level of consciousness known (DV-1, -2, -3, and -4), are the most widespread o Restlessness arthropod-borne viruses (arboviruses). They also are o Projectile vomiting the only known arboviruses that have fully adapted to o Blurring of vision; papilledema; diplopia the human host and lost the need of an enzootic cycle o Bulging fontanel in infants for maintenance. - Signs of meningeal irritation Mode of Transmission o Kernig’s sign - Bite of infected female aedes aegypti mosquito o Nuchal rigidity – pathognomonic sign Incubation Period o Opisthotonus - 3 – 14 days o Brudzinski’s sign Clinical Manifestations o Late Signs Grade I: Symptomatic and Supportive o Decerebration o Fever o Decortication o Headache Diagnostic Tests o Malaise - Cerebrospinal fluid drawn from between two vertebrae o Anorexia Complications o Chills Bronchitis o Pain (Abdominal, Bone and Joint, and Ocular) Pneumonia o Rashes Otitis media/ Mastoiditis o + Herman’s Sign: Flushing of the skin Blindness o + Tourniquet Test (Rumple Leeds Test) Hydrocephalus Medical Treatment - Antibiotic o Penicillin G- drug of choice o Alternative: Chloramphenicol - Mannitol - Pyrentinol/Encephabol - CNS stimulant - Anticonvulsant o Diazepam o Phenytoin (Dilantin) o Corticosteroid o Prednisone o Dexamethasone J.A.K.E 8 of 63  NCMB 312 LECTURE: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Grade II: Manifestations of grade I plus spontaneous - Self-protection measures bleeding – BED REST - Seek early consultation o Epistaxis - Say no to indiscriminate fogging o Gingival Bleeding - Sustain Hydration o Petechiae or ecchymosis - Cyclical variation is the number of cases usually o Gastro intestinal bleeding increases towards the ends of the rainy season. o Ground coffee colored vomitus o Hematemesis Malaria o Melena Other names: o Hematochezia - “ague” Grade III: Manifestations of Grade II plus Beginning - King of Tropical and Sub-tropical Diseases symptoms of circulatory failure -Monitor V/S and Watch - Charles Louis Alphonse Laveran discovered that out for complication of shock malaria was caused by a protozoan parasite in 1880 o Hypotension & narrowing of pulse pressure o Weak and thready pulse o Cold, clammy skin o Restlessness GRADE IV: Manifestations of Grade III plus Shock- PROPER POSITIONING o Undetected BP and pulse Classifications: - Mild DHF: slight fever, with or without petechial hemorrhage - Moderate DHF: high fever, but less hemorrhage, no shock - Severe DHF: frank type: flushing, sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock and terminating in recovery or death. Diagnostic Tests - Tourniquet Test- Presumptive diagnosis; detects capillary fragility - Platelet Count: Confirmatory test Result: