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<ul><li>COMMUNICABLE DISEASE </li></ul><ul><li>Is any disease that can be transmitted directly or indirectly from one pers...
<ul><li>INFECTION </li></ul><ul><li>Is a condition caused by the entry and multiplication of pathogenic microorganisms wit...
FACTORS AFFECTING RISK OF INFECTION <ul><li>AGE </li></ul><ul><li>HEREDITY </li></ul><ul><li>LEVEL OF STRESS </li></ul><ul...
IMMUNITY <ul><li>THE QUALITY OF BEING INSUSCEPTIBLE TO OR UNAFFECTED BY A PARTICULAR DISEASE. </li></ul>
TYPES OF IMMUNITY <ul><li>INNATE = within the HOST Immune System </li></ul><ul><li>ACQUIRED = inoculation and disease Acti...
<ul><li>IMMUNE SYSTEM PROTECTION AGAINST ANTIGEN OR DISEASES BY A SYSTEM OF ANTIBODY PRODUCTION  </li></ul><ul><li>ANTIBOD...
IMMUNOGLOBULINS <ul><li>IgG MOST PREVALENT ANTIBODY 80%,  PRODUCE LATER  IN THE IMMUNE RESPONSE, ONLY Ig THAT CAN CROSS TH...
IMMUNIZATION <ul><li>A PROCESS BY WHICH RESISTANCE TO AN INFECTIOUS DISEASE IS INDUCED OR AUGMENTED. </li></ul><ul><li>ACT...
EPI <ul><li>Hepa b 3 shots, 0-1-6 mo, im, 0.5 ml, vas. lateralis  </li></ul><ul><li>Bcg 1 at birth, id, 0.05 ml, right arm...
Active Immunity <ul><li>ANTIBODIES ARE PRODUCED BY THE BODY IN RESPONSE TO INFECTION.  ANTIGEN   IS INTRODUCED, LONG DURAT...
ARTIFICIAL ACTIVE <ul><li>ANTIGENS (VACCINES OR TOXOIDS)   ARE ADMINISTERED TO STIMULATE ANTIBODY PRODUCTION. REINFORCED B...
Artificial Active
Artificial Active
Artificial Active
PASSIVE IMMUNITY <ul><li>ANTIBODIES ARE PRODUCED BY ANOTHER SOURCE.  ANTIBODIES  ARE INTRODUCED, SHORT DURATION </li></ul>...
ARTIFICIAL PASSIVE <ul><li>IMMUNE SERUM (ANTIBODY) FROM  ANIMAL OR HUMAN IS INJECTED. PROVIDE IMMEDIATE PROTECTION (DIPHTH...
CONDITIONS BEFORE AN INFECTION DEVELOPS <ul><li>Sufficient  number of microorganisms  </li></ul><ul><li>Virulence   of mic...
THE INFECTION PROCESS CYCLE <ul><li>Agent  (bacteria or virus) </li></ul><ul><li>Reservoir (fomites or living things) </li...
STAGES OF AN INFECTIOUS PROCESS <ul><li>INCUBATION PERIOD </li></ul><ul><li>PRODROMAL PERIOD </li></ul><ul><li>ILLNESS PER...
Terminologies <ul><li>ETIOLOGY  </li></ul><ul><li>EPIDEMIOLOGY </li></ul><ul><li>INCIDENCE  </li></ul><ul><li>PREVALENCE  ...
FUNDAMENTALS OF STANDARD PRECAUTION <ul><li>HANDWASHING </li></ul><ul><li>GLOVES </li></ul><ul><li>MASKS, GOGGLES, FACE SH...
ISOLATION <ul><li>It is necessary when a person is known or suspected to be infected with pathogens that can be transmitte...
Transmission-Based Precautions    <ul><li>Airborne </li></ul><ul><li>Droplets </li></ul><ul><li>Contact  </li></ul>
AIRBORNE <ul><li>PRIVATE ROOM </li></ul><ul><li>NEGATIVE AIR PRESSURE </li></ul><ul><li>VENTILATION SAFEGUARDS air from ro...
 
DROPLET <ul><li>PRIVATE ROOM </li></ul><ul><li>WEAR MASK IF WORKING WITHIN 3 FEET </li></ul><ul><li>WEAR MASKS UPON ENTRY ...
CONTACT <ul><li>PRIVATE ROOM </li></ul><ul><li>WEAR GLOVES </li></ul><ul><li>GLOVES ARE REMOVED BEFORE  EXITING FROM THE R...
OTHER TYPE OF ISOLATION <ul><li>AFB ISOLATION </li></ul><ul><li>STRICT ISOLATION </li></ul><ul><li>RESPIRATORY ISOLATION <...
AFB ISOLATION <ul><li>VISITORS REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><ul><li>MASKS ARE TO BE WORN I...
STRICT ISOLATION <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-necessary,...
RESPIRATORY ISOLATION <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-neces...
WOUND AND SKIN PRECAUTIONS <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-...
ENTERIC PRECAUTIONS <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-necessa...
PROTECTIVE ISOLATION <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-necess...
DIAGNOSTIC TOOLS <ul><li>COLLECTION OF SPECIMEN </li></ul><ul><li>PRINCIPLES </li></ul><ul><li>TYPES OF SPECIMEN COLLECTIO...
LABORATORY TESTS <ul><li>MICROSCOPY </li></ul><ul><li>CULTURE </li></ul><ul><li>ANTIBIOTIC SUSCEPTIBILITY TESTING </li></u...
DISORDERS <ul><li>CNS DISEASES </li></ul><ul><li>GIT DISEASES </li></ul><ul><li>RESPIRATORY DISEASE </li></ul><ul><li>BLOO...
CNS
Tetanus <ul><li>Clostridium tetani </li></ul><ul><li>MOT = wound setting </li></ul><ul><li>IP = 3 -21 days </li></ul><ul><...
Tetanus <ul><li>Wound Infection </li></ul><ul><li>FATAL INFECTION OF THE CNS </li></ul><ul><li>TOXIN-NEUROTOXIN </li></ul>
PATHOPHYSIOLOGY: <ul><li>SETTING OF WOUND ---- ENTRANCE OF C.T. ---- RELEASES TETANUS TOXIN ---- TETANOSPASMIN (CNS), TETA...
<ul><li>Trismus – lock jaw </li></ul><ul><li>Risus sardonicus - maskface </li></ul><ul><li>Risorius - grinsmile </li></ul>...
 
Immunization <ul><li>DPT (0.5 ml IM) 1 – 1 ½ months old 2 -  after 4 weeks 3 – after 4 weeks </li></ul><ul><li>1 st  boost...
3 types of patients w/ skin wounds post exposure prophylaxis <ul><li>(+) immunization as a child w/ boosters but last shot...
Management <ul><li>1. Anticonvulsant, muscle relaxants,  </li></ul><ul><li>antibiotics, wound cleansing and  debridement, ...
Rabies/Lyssa (Zoonotic) <ul><li>Rhabdovirus/filterable virus </li></ul><ul><li>MOT = Bite from warm blooded animals  </li>...
Rabies/Lyssa (Zoonotic) <ul><li>Hydrophobia (fear of choking) </li></ul><ul><li>Aerophobia (laryngospasm) </li></ul><ul><l...
 
Category of bites <ul><li>I – intact skin (lick)  </li></ul><ul><li>II – mucosal, non bleeding wounds, abrasions </li></ul...
Rabies/Lyssa (Zoonotic) <ul><li>Observe dog for maniachal s/sx </li></ul><ul><li>Active-rabies vaccine </li></ul><ul><li>P...
AFTER THE BITE <ul><li>WASH WITH SOAP AND WATER </li></ul><ul><li>GIVE ANTIBIOTICS AND ANTITETANUS </li></ul><ul><li>OBSER...
Immunization <ul><li>Rabies vaccine (5 shots) IM (2 ml deltoid)  0, 3, 7, 14, 28 days ID (0.1 ml deltoid) 0, 3, 7 days (0....
4 STAGES <ul><li>1. prodrome - fever, headache, paresthesia,  </li></ul><ul><li>2. encephalitic – excessive motor activity...
RESPONSIBLE PET OWNERSHIP <ul><li>HAVE PET IMMUNIZED AT 3 MONTHS AND EVERY YEAR AFTER </li></ul><ul><li>NEVER ALLOW PETS T...
Poliomyelitis Infantile Paralysis <ul><li>Polio virus, Legio debilitans </li></ul><ul><ul><li>Legio brunhilde (fatal) </li...
Poliomyelitis Infantile Paralysis <ul><li>Assymetrical paralysis </li></ul><ul><li>Hayne’s sign - head drop </li></ul><ul>...
Poliomyelitis Infantile Paralysis <ul><li>I – abortive or inapparent </li></ul><ul><li>II – meningitis (non-paralytic) </l...
 
 
Meningitis Menigococcemia <ul><li>Neisseria meningitides (bacteria) </li></ul><ul><li>MOT = droplets </li></ul><ul><li>IP ...
Meningitis Menigococcemia <ul><li>Immunocompetent are susceptible </li></ul><ul><li>Petechiae (volar/palm of hands) EARLY ...
Menigococcemia <ul><li>S/sx:  </li></ul><ul><li>Meningococcemia – spiking fever, chills, arthralgia, petechial rash  </li>...
Menigococcemia <ul><li>Dx: CT/ MRI, CSF analysis, CSF gram stain, CSF and blood culture </li></ul><ul><li>Mgmt: antibiotic...
Encephalitis <ul><li>Arbo virus (arthropod borne virus) </li></ul><ul><li>MOT = bite from mosquito (St. Louise) </li></ul>...
Encephalitis <ul><li>S/sx: fever, abdominal pain, sore throat, respiratory symptoms, headache, meningeal signs, photophobi...
Leprosy <ul><li>Mycobacterium Leprae, Hansen’s Bacillus  </li></ul><ul><li>MOT = (unknown)  </li></ul><ul><ul><li>may be d...
Leprosy <ul><li>EARLY </li></ul><ul><ul><li>Skin lesion and paresthesia  </li></ul></ul><ul><li>LATE  </li></ul><ul><ul><l...
Leprosy
Leprosy <ul><li>Dx: </li></ul><ul><ul><li>Lepromin Test – ID injection </li></ul></ul><ul><ul><li>Slit Skin Smear  </li></...
Leprosy <ul><li>MDT-RA 4073 (home meds) </li></ul><ul><li>Paucibacillary - 6-9 months 1. Dapsone </li></ul><ul><li>2. Rifa...
Leprosy <ul><li>MDT- two or more drugs </li></ul><ul><li>RA 4073 (home meds) </li></ul><ul><li>Paucibacillary.- 6-9 months...
Leprosy <ul><li>Non - communicable </li></ul><ul><ul><li>After 1 week of medication </li></ul></ul><ul><li>Considered cure...
Red Tide Poisoning <ul><li>Pyromidium Bahamense </li></ul><ul><li>Exotoxin  </li></ul><ul><li>Dinoflagellates  </li></ul><...
Red Tide Poisoning <ul><li>Dx gastric siphoning </li></ul><ul><li>EARLY </li></ul><ul><ul><li>Circumoral numbness  </li></...
CLINICAL MANIFESTATIONS: <ul><li>NUMBNESS OF THE FACE ESPECIALLY AROUND THE MOUTH </li></ul><ul><li>VOMITING, DIZZINESS, H...
MANAGEMENT AND CONTROL MEASURES: <ul><li>NO DEFINITE MEDICATIONS </li></ul><ul><li>INDUCE VOMITING (EARLY INTERVENTION) </...
Botulism <ul><li>Clostridium Botulinum (bacteria) </li></ul><ul><li>Endotoxin  </li></ul><ul><li>MOT  </li></ul><ul><ul><l...
Botulism <ul><li>Dx = gastric siphoning </li></ul><ul><li>EARLY </li></ul><ul><ul><li>VISUAL DIFFICULTY, DYSPHAGIA, DRY MO...
GIT
 
Amoebiasis <ul><li>Entamoeba Hystolitica –protozoan (parasite) </li></ul><ul><li>MOT = 5 F’s, fecal oral route </li></ul><...
Amoebiasis <ul><li>Dx microscopic stool exam or rectal secretions </li></ul><ul><li>(tetra nucleated cyst and trophozoites...
Bacillary Dysentery Shigellosis <ul><li>Shiga bacillus (bacteria) </li></ul><ul><li>s. dysenterae (fatal) </li></ul><ul><l...
Bacillary Dysentery Shigellosis <ul><li>Dx stool exam </li></ul><ul><li>Watery mucoid, bloody with pus feces  </li></ul><u...
Cholera, El Tor <ul><li>Vibrio Coma (inaba, ogawa, hikojima)  </li></ul><ul><li>Vibrio Cholerae  </li></ul><ul><li>Vibrio ...
Cholera, El Tor <ul><li>Dx stool exam </li></ul><ul><li>Rice watery stool with fishy odor </li></ul><ul><li>Washerwoman’s ...
Typhoid Fever <ul><li>Salmonella typhosa (bacteria) </li></ul><ul><li>MOT = same with amoebiasis (5 F’s)  </li></ul><ul><l...
Pathophysiology <ul><li>Oral ingestion </li></ul><ul><li>Bloodstream </li></ul><ul><li>Reticuloendothelial system (lymph n...
Typhoid Fever <ul><li>1st week step ladder (BLOOD) </li></ul><ul><li>2nd week rose spot and fastidial </li></ul><ul><ul><l...
Typhoid Fever <ul><li>Blood (typhi dot)  1st week after </li></ul><ul><li>Stool and urine 2nd week after </li></ul><ul><li...
Typhoid Fever <ul><li>Rose spot (abdominal rashes) </li></ul><ul><li>Step ladder fever to fastidial (peak of fever) typhoi...
Hookworm (Roundworm) <ul><li>Necator Americanus, Ancylostoma Duodenale  </li></ul><ul><li>Skin entry (sole of the feet to ...
Hookworm (Roundworm) <ul><li>IP few weeks to months </li></ul><ul><li>Dx microscopic exam (stool exam) </li></ul><ul><li>P...
Hookworm (Roundworm) <ul><li>Nursing Consideration </li></ul><ul><li>FOLLOW-UP EXAMINATION OF THE STOOL 2 WEEKS AFTER THER...
Ascariasis (Roundworm) <ul><li>Ascaris Lumbricoides </li></ul><ul><li>MOT ingestion of food contaminated by ascaris lumbri...
<ul><li>MOT: ingestion of food contaminated by ascaris eggs   larvae in large intestine penetrate wall towards  lung where...
Ascariasis (Roundworm) <ul><li>Coughing, wheezing and hemoptysis </li></ul><ul><li>IP same with hookworm </li></ul><ul><li...
Tapeworm <ul><li>Taenia Saginata (cattle) </li></ul><ul><li>Taenia Solium (pigs) </li></ul><ul><li>MOT fecal oral route (i...
Pinworm <ul><li>Enterobiasis (nocturnal animation/alive) </li></ul><ul><li>Vermicularis Enterobius </li></ul><ul><li>MOT f...
<ul><li>Thread worm – storgyloidiasis </li></ul><ul><li>Whip worm – trichoniasis voracious eating abdominal pain weight lo...
QUIZ <ul><li>1. hookworm a. taenia s. </li></ul><ul><li>2. ascariasis b. vermicularis    enterobius </li></ul><ul><li>3. p...
<ul><li>5. Common s/sx of worm  infestation? </li></ul><ul><li>6. single most important nursing  consideration prior to  D...
Schistosomias, Snail Fever, Takayama <ul><li>Blood fluke </li></ul><ul><li>Schistosoma japonicum </li></ul><ul><li>S. hema...
Schistosomias, Snail Fever, Takayama <ul><li>Cycle: Egg-larvae (miracidium)-intermediary host (oncomelania quadrasi-tiny s...
Schistosomiasis KEY POINTS! <ul><li>Egg– miracidium– snail– cercaria- human </li></ul><ul><li>Itchiness – liver – intestin...
Mumps <ul><li>Mumps virus/filtrable virus </li></ul><ul><li>MOT = droplets and airborne </li></ul><ul><ul><li>HIGHLY CONTA...
Mumps <ul><li>Unilateral or bilateral parotitis </li></ul><ul><ul><li>Ice collar </li></ul></ul><ul><li>Stimulating foods ...
Respiratory System
Diphtheria <ul><li>Corynebacterium diphtheriae </li></ul><ul><li>Klebsloeffler’s bacillus (bacteria) </li></ul><ul><li>MOT...
Diphtheria <ul><li>Dx = throat swab, MOLONEY, SCHICK </li></ul><ul><li>Pseudomembrane,  Bullneck </li></ul><ul><li>Penicil...
Diphtheria <ul><li>Nursing Considerations: </li></ul><ul><li>OBSERVE CNS, CARDIAC AND KIDNEY COMPLICATIONS </li></ul><ul><...
<ul><li>S/sx: sore throat, fever, “Bull-neck” (Pseudomembrane- gray exudate, foul breath, massive swelling of tonsils and ...
Diphtheria KEY POINTS! <ul><li>Highly contagious </li></ul><ul><li>Pseudomembrane and bullneck </li></ul><ul><li>Immunizat...
Whooping Cough, Pertussis <ul><li>Bordetella pertussis (bacteria) </li></ul><ul><li>B. parapertussis </li></ul><ul><li>B. ...
Whooping Cough, Pertussis <ul><li>Manifestations: </li></ul><ul><li>CATARRHAL (HIGHLY CONTAGIOUS) </li></ul><ul><li>1-2 WE...
Whooping Cough, Pertussis <ul><li>Ferrous iodide to liquefy thicky secretions </li></ul><ul><li>Erythromycin or Ampicillin...
PERTUSSIS key points! <ul><li>Highly contagious </li></ul><ul><li>Thick secretions  </li></ul><ul><li>Cluster of cough </l...
PTB, Koch’s Pulmonary <ul><li>Mycobacterium tubercle </li></ul><ul><li>Tubercle bacillus (bacteria) </li></ul><ul><li>MOT:...
PTB <ul><li>Pathogenesis: </li></ul><ul><li>Transmission into the lungs </li></ul><ul><li>Immune response  macrophage (bac...
 
 
 
PTB, Koch’s Pulmonary <ul><li>Manifestation: </li></ul><ul><li>EARLY WEIGHT LOSS, LISTLESSNESS, VAGUE CHEST PAIN, PLEURISY...
PTB <ul><li>Dx: </li></ul><ul><li>PPD-exposure </li></ul><ul><ul><li>0-4 mm (negative) </li></ul></ul><ul><ul><li>5 mm var...
PTB <ul><li>MDT </li></ul><ul><ul><li>r-orange urine </li></ul></ul><ul><ul><li>i-neuritis and hepatitis </li></ul></ul><u...
PTB <ul><li>CGFNS and NCLEX </li></ul><ul><li>Usual Dose RIE – 9 months to 12 months  2-4 weeks non infectious </li></ul><...
PTB <ul><li>2 weeks after medications – non communicable </li></ul><ul><li>3 successive negative sputum-non communicable <...
PTB <ul><li>category I (new PTB (+) sputum) </li></ul><ul><li>category II (relapsed) </li></ul><ul><li>category III (PTB c...
<ul><li>TREATMENT: </li></ul><ul><li>CATEGORY 1   NEW PTB, (+) SPUTUM GIVE RIPE 2 MONTHS, MAINTENANCE OF RI 4 MONTHS </li>...
Pneumonia <ul><li>Typical </li></ul><ul><ul><li>Community Acquired </li></ul></ul><ul><li>Streptococcus pneumoniae </li></...
Pneumonia <ul><li>Atypical </li></ul><ul><ul><li>Pneumocystis carinii (fungal) </li></ul></ul><ul><ul><li>Aspergillosis (f...
Pneumonia <ul><li>s/sx chest pain, fever with chills,  </li></ul><ul><li>Dx:  </li></ul><ul><ul><li>C&S and XRAY </li></ul...
Pneumonia <ul><li>CARI-health teachings </li></ul><ul><li>Watchout for complications </li></ul><ul><li>Respiratory distres...
Pneumonia <ul><li>Cx: </li></ul><ul><ul><li>pleural effusion  </li></ul></ul><ul><ul><li>Empyema </li></ul></ul><ul><ul><l...
Severe Acute Respiratory Syndrome <ul><li>Coronavirus </li></ul><ul><li>Severe acute respiratory syndrome  </li></ul><ul><...
SARS <ul><li>Dx: sputum C&S CLINICAL </li></ul><ul><li>MANIFESTATIONS: </li></ul><ul><ul><li>FEVER-38 C AND ABOVE CONTINUO...
SARS <ul><li>NURSING CONSIDERATIONS: </li></ul><ul><ul><li>NO SPECIFIC TREATMENT </li></ul></ul><ul><ul><li>ANTIVIRAL AGEN...
SARS <ul><li>NURSING CONSIDERATIONS: </li></ul><ul><ul><li>SEEK IMMEDIATE MEDICAL ATTENTION IF YOU SUSPECT SARS </li></ul>...
BLOOD BORNE DISEASES
Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Acute Febrile Disease </li></ul><ul><li>CAUSATIVE AGENT-FILT...
Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Hyperpyrexia without focal of infection </li></ul><ul><li>TR...
Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Dx: </li></ul><ul><ul><li>ACUTE FEBRILE ILLNESS WITH NO IDEN...
<ul><li>TRIAD (FEVER, RASH, SEVERE HEADACHE/BACKACHE/MYALGIA) </li></ul><ul><li>1ST STAGE, FIRST 4 DAYS HIGH FEVER, ABDOMI...
<ul><li>GRADE 1 (+) TORNIQUET TEST, NO BLEEDING </li></ul><ul><li>GRADE 2 SPONTANEOUS BLEEDING, (+) GRADE 1 </li></ul><ul>...
Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Nursing Considerations </li></ul><ul><li>ANY CONDITION ASSOC...
Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Nursing Considerations </li></ul><ul><li>BLOOD TRANSFUSION <...
Dengue KEY POINTS <ul><li>Day biting aedes aegypti, stagnant </li></ul><ul><li>Fever with no focal of infection </li></ul>...
Malaria, King of Tropical Disease <ul><li>Protozoan plasmodium </li></ul><ul><ul><li>plasmodium ovale - dormant (liver) </...
Malaria, King of Tropical Disease <ul><li>MOT  </li></ul><ul><ul><li>Bite from infected anopheles mosquito or minimus flav...
 
 
Malaria, King of Tropical Disease <ul><li>Nursing Considerations </li></ul><ul><li>Dx:  </li></ul><ul><ul><li>blood extrac...
Malaria, King of Tropical Disease <ul><li>Nursing Considerations </li></ul><ul><li>IV FLUIDS AND ELECTROLYTES </li></ul><u...
Malaria, King of Tropical Disease <ul><li>TRAVELERS TO MALARIA ENDEMIC area SHOULD FOLLOW PREVENTIVE MEASURES- (CHEMOPROPH...
MALARIA key points <ul><li>Night biting anopheles, running water </li></ul><ul><li>Falciparum – fatal </li></ul><ul><li>Ov...
Filariasis, Elephantiasis, Human Lymphatic Filariasis <ul><li>CAUSATIVE AGENT-NEMATODE PARASITE </li></ul><ul><ul><li>MICR...
<ul><li>CLINICAL MANIFESTATIONS: </li></ul><ul><li>ASYMPTOMATIC STAGE </li></ul><ul><ul><li>(+) MICROFILARIAE IN THE BLOOD...
Filariasis, Elephantiasis, Human Lymphatic Filariasis
Filariasis, Elephantiasis, Human Lymphatic Filariasis <ul><li>INCIDENCE-REGION 5,8,11 AND CARAGA, MARINDUQUE, SARANGGANI <...
Nursing Considerations <ul><li>MASS TREATMENT-DOSE IS 6mg/KBW, SINGLE DOSE PER YEAR. </li></ul><ul><li>ENVIRONMENTAL SANIT...
Filariasis KEY POINTS <ul><li>Night biting aedes poecilius, plants </li></ul><ul><li>Chronic, lymphedema </li></ul><ul><li...
Leptospirosis, Weil’s Disease (Zoonotic) <ul><li>Spirochete-leptospira interrogans </li></ul><ul><li>IP 5-6 days </li></ul...
Leptospirosis, Weil’s Disease (Zoonotic) <ul><li>Dx: </li></ul><ul><ul><li>CULTURE OF MICROORGANISMS </li></ul></ul><ul><u...
CLINICAL MANIFESTATIONS <ul><li>EARLY = fever and headache </li></ul><ul><li>LEPTOSPIREMIC PHASE = vasculitis </li></ul><u...
NURSING CONSIDERATIONS <ul><li>PENICILLIN OR DOXYCYCLINE (IMMEDIATELY) </li></ul><ul><li>ERYTHROMYCIN IF ALLERGIC TO PENIC...
PREVENTION AND CONTROL <ul><li>AVOIDANCE OF EXPOSURE TO URINE  AND TISSUES FROM INFECTED ANIMALS (FLOOD) </li></ul><ul><li...
LEPTOSPIROSIS key points <ul><li>Spirochette, rat, urine and feces </li></ul><ul><li>Skin penetration, ingestion </li></ul...
ERUPTIVE FEVER
Measles, Rubeola, 7 Day Fever, Hard Red Measle <ul><li>Paramyxo virus </li></ul><ul><li>MOT = droplets and airborne </li><...
Measles, Rubeola, 7 Day Fever, Hard Red Measle <ul><li>Rashes: </li></ul><ul><li>Maculopapular </li></ul><ul><li>Cephaloca...
Measles, Rubeola, 7 Day Fever, Hard Red Measle <ul><li>Rashes: maculopapaular, cephalocaudal (hairline and behind the ears...
<ul><li>PS  koplik’s spot   </li></ul><ul><li>Characteristic: stimsons, photophobia (typical complaint) </li></ul><ul><li>...
German Measles, Rubella, Rotheln Disease, 3 Day Measles <ul><li>RNA rubella virus </li></ul><ul><li>MOT = droplets and air...
German Measles, Rubella, Rotheln Disease, 3 Day Measles <ul><li>Rashes: </li></ul><ul><li>Maculopapular </li></ul><ul><li>...
German Measles, Rubella, Rotheln Disease, 3 Day Measles <ul><li>Rashes: Maculopapular, Diffuse/not confluent, No desquamat...
<ul><li>PS  forschheimer’s   </li></ul><ul><li>Characteristic: cervical lymphadenopathy </li></ul><ul><li>Fever: low grade...
Chicken Pox,  Varicella <ul><li>Herpes Zoster Virus  </li></ul><ul><li>Varicella Zoster Virus </li></ul><ul><li>MOT = drop...
 
Chicken Pox,  Varicella <ul><li>Rashes: Maculopapulovesicular (covered areas), Centrifugal, starts on face and trunk and s...
Chicken Pox,  Varicella <ul><li>Dx = Tzanck smear (scraping of ulcer for staining) </li></ul><ul><li>Rashes: </li></ul><ul...
Small Pox,  Variola <ul><li>Pox virus </li></ul><ul><li>MOT = droplets and airborne </li></ul><ul><ul><li>PC until all cru...
 
Small Pox,  Variola <ul><li>Rashes </li></ul><ul><ul><li>Maculopapulovesiculopustular </li></ul></ul><ul><ul><li>Centripet...
CONTACT
Pediculosis <ul><li>Blood sucking lice </li></ul><ul><li>Pediculus humanus </li></ul><ul><li>p. capitis-scalp </li></ul><u...
 
 
Scabies <ul><li>Sarcoptes scabie </li></ul><ul><li>Pruritus (excreta of mites) </li></ul><ul><li>Mites come-out from burro...
 
Conjunctivitis <ul><li>Children </li></ul><ul><li>Viral-hygiene and rest </li></ul><ul><li>Bacterial-yellow, green or whit...
STD
Gonorrhea (bacteria) <ul><li>Neisseria gonorrheae (gram positive) </li></ul><ul><li>IP 3 -7 days </li></ul><ul><li>Asympto...
 
Syphilis (bacteria) <ul><li>Treponema pallidum (spirochete) </li></ul><ul><li>IP 10-90 days </li></ul><ul><li>Painless, cl...
Primary  – painless chancre Secondary  – generalized    rash Tertiary  - gumma
Syphilis (bacteria) <ul><li>Primary-chancre-most infectious </li></ul><ul><li>Secondary-generalized macular papular rash i...
Chlamydia (bacteria) <ul><li>Chlamydia trachomatis </li></ul><ul><li>IP 2-10 days </li></ul><ul><li>Maybe asymptomatic </l...
Chlamydia (bacteria)
Chlamydia (bacteria) <ul><li>Drugs: </li></ul><ul><li>Azithromycin (Zithromax) 1 g orally one dose </li></ul><ul><li>Eryth...
Herpes Genitalis (virus) <ul><li>HSV 2 </li></ul><ul><li>Painful sexual intercourse </li></ul><ul><li>Painful lesion (cerv...
Genital Warts, Condyloma Acuminatum (virus) <ul><li>HPV type 6 & 11, papilloma virus </li></ul><ul><li>Single or multiple ...
Genital Warts, Condyloma Acuminatum (virus) <ul><li>Mgmt:  </li></ul><ul><li>Laser treatment is more effective </li></ul><...
Candidiasis, Moniliasis <ul><li>Yeast or fungus </li></ul><ul><li>Cheesy white discharge </li></ul><ul><li>Extreme itchine...
Trichomoniasis <ul><li>Parasite </li></ul><ul><li>Trichomona vaginalis </li></ul><ul><li>Yellow gray frothy vaginal discha...
Prevention  <ul><li>A abstinence </li></ul><ul><li>B be faithful </li></ul><ul><li>C condom </li></ul><ul><li>D do it your...
<ul><li>TORCHS </li></ul><ul><li>T toxoplasmosis </li></ul><ul><li>O others Papilloma virus - STD   Gonorrhea - STD  Varic...
HIV
HIV and AIDS <ul><li>Retrovirus (HIV1 & HIV2) </li></ul><ul><li>Attacks and kills CD4+ lymphocytes (T-helper) </li></ul><u...
 
 
HIGH RISK GROUP <ul><li>Homosexual or bisexual </li></ul><ul><li>Intravenous drug users </li></ul><ul><li>BT recipients be...
MOT <ul><li>Sexual intercourse (oral, vaginal and anal) </li></ul><ul><li>Exposure to contaminated blood, semen, breast mi...
 
HIV TEST <ul><li>Elisa </li></ul><ul><li>Western Blot </li></ul><ul><li>Rapid hiv test </li></ul><ul><ul><li>Suds hiv-1 </...
How to Diagnose <ul><li>HIV+ 2 consecutive positive ELISA and  1 positive Western Blot Test </li></ul><ul><li>AIDS+ HIV+ C...
<ul><li>Exhibits one or more of the ff: </li></ul><ul><li>Extreme fatigue </li></ul><ul><li>Intermittent fever </li></ul><...
 
HIV CLASSIFICATION  <ul><li>CATEGORY 1 – CD4+ 500 OR MORE </li></ul><ul><li>CATEGORY 2 – CD4+ 200-499 </li></ul><ul><li>CA...
Management <ul><li>Prevention of spread (safe sex) </li></ul><ul><li>Universal precautions </li></ul><ul><li>Health Educat...
DRUGS <ul><li>1. Nucleoside Reverse Transcriptase Inhibitors NRTI’s </li></ul><ul><ul><li>INTERFERES WITH DNA CHAIN </li><...
DRUGS <ul><ul><li>2. Non-nucleoside Reverse Transcriptase Inhibitors NNRTI’s </li></ul></ul><ul><ul><li>- BINDS TO REVERSE...
DRUGS <ul><li>3. Protease Inhibitors PI </li></ul><ul><li>BLOCK VIRUS ABILITY TO BREAK DOWN LARGER PROTEIN MOLECULES </li>...
Hepatitis
 
Types of Hepatitis <ul><li>Hepa A – fecal oral route </li></ul><ul><li>Hepa B – body fluids </li></ul><ul><li>Hepa C – non...
<ul><li>Hepatitis A </li></ul><ul><li>Hepa A virus </li></ul><ul><li>Infectious hepa </li></ul><ul><li>Fecal oral route </...
<ul><li>Hepatitis B </li></ul><ul><li>Hepa B virus </li></ul><ul><li>Serum hepa </li></ul><ul><li>Blood recipients, hemodi...
<ul><li>DX </li></ul><ul><li>Elevated AST or SGPT (specific) and ALT or SGOT </li></ul><ul><li>Increased IgM during acute ...
<ul><li>Manifestations: </li></ul><ul><li>Stage I  pre-icteric for 1-21 days Anorexia, nausea and vomiting, LBM, weight lo...
jaundice
Manifestations <ul><li>CHO – fatigue </li></ul><ul><li>CHON – toxicity (latent phase) </li></ul><ul><li>Fats – bile, fat i...
<ul><li>Management: </li></ul><ul><li>Rest </li></ul><ul><li>Diet: - high CHON 75-100 g/day - high CHO – energy - low fat ...
Other diseases
Lyme disease <ul><li>Named for the Connecticut town, 1975 </li></ul><ul><li>Appears in summer or early fall </li></ul><ul>...
<ul><li>s/sx: may take years to fully develop </li></ul><ul><li>*Skin lesion “erythema chronicum migrans” </li></ul><ul><l...
Lyme disease <ul><li>Dx:  – biopsy, antibody titer, ELISA, Western Blot </li></ul><ul><li>Mgmt: </li></ul><ul><li>symptoma...
Toxoplasmosis ZOONOTIC <ul><li>Toxoplasma gondii, parasite </li></ul><ul><li>Affects birds, mammals ie cats </li></ul><ul>...
<ul><li>S/sx:  Toxoplasmosis </li></ul><ul><li>Malaise, fever,  myalgia, headache, fatigue, sore throat, lymphadenopathy <...
Toxoplasmosis <ul><li>Dx: serology, CT scan </li></ul><ul><li>Mgmt: </li></ul><ul><li>4-6 weeks of sulfonamide and pyrimet...
<ul><li>TORCHS </li></ul><ul><li>T toxoplasmosis </li></ul><ul><li>O others Papilloma virus - STD   Gonorrhea - STD  Varic...
Ebola ZOONOTIC <ul><li>Filoviruses, 1960 </li></ul><ul><li>Unknown reservoir </li></ul><ul><li>Viral replication takes pla...
<ul><li>Ebola </li></ul><ul><li>S/sx: frontal and temporal headache, malaise, myalgia, nausea, vomiting, fever, conjunctiv...
Bird Flu ZOONOTIC <ul><li>Avian influenza, virus  </li></ul><ul><li>Occur naturally among birds (intestines) </li></ul><ul...
Bird Flu <ul><li>MOT:  </li></ul><ul><li>saliva, nasal secretions, and feces </li></ul><ul><li>direct contact with infecte...
<ul><li>Bird Flu   </li></ul><ul><li>S/sx: Influenza-like symptoms  </li></ul><ul><li>Fever, Cough, sore throat,  </li></u...
Foot and Mouth Disease ZOONOTIC <ul><li>Aphthovirus   </li></ul><ul><li>Hosts - cattle, buffaloes, </li></ul><ul><li>sheep...
<ul><li>Foot and Mouth Disease </li></ul><ul><li>s/sx:  Very rarely develop mild    clinical signs </li></ul><ul><li>malai...
Infectious Mononucleosis <ul><li>3 hallmarks fever sore throat swollen cervical lymph nodes </li></ul><ul><li>(+) heteroph...
EBV <ul><li>Caused by EBV epstein-barr virus </li></ul><ul><li>Or cytomegalovirus </li></ul><ul><li>Lodges in the salivary...
EBV <ul><li>Virus invades the B cells of lymphoid tissue </li></ul><ul><li>As the B cells die virus is released in the blo...
EBV <ul><li>Diagnostic WBC count abnormally high (+) heterophil antibodies Indirect immunoflourescent (+) EBV  (specific) ...
EBV <ul><li>Management </li></ul><ul><li>Symptomatic </li></ul><ul><li>ASA </li></ul><ul><li>Steroids </li></ul>
Gas Gangrene <ul><li>Clostridium  perfringens welchii novyi </li></ul><ul><li>Deep wound (bronzed or blackened wound) </li...
Gas Gangrene <ul><li>CS </li></ul><ul><li>Incision and Drainage </li></ul><ul><li>Debridement </li></ul><ul><li>Hyperbaric...
Anthrax (Zoonotic) <ul><li>Bacillus anthracis (gram negative) </li></ul><ul><li>Cattle, sheep, goat and pig </li></ul><ul>...
<ul><li>Anthrax  </li></ul><ul><li>Inhalation- URTI-fever-3-5 days-lower infection (alveoli)-metabolic acidosis-hypoxia  <...
Lyme Disease <ul><li>Named for the Connecticut town, 1975 </li></ul><ul><li>Appears in summer or early fall </li></ul><ul>...
Lyme Disease <ul><li>Caused by spirochete borrelia burgdorferi </li></ul><ul><li>Carried by “deer ticks” </li></ul><ul><li...
Lyme Disease <ul><li>Signs and symptoms may take years to fully develop </li></ul><ul><li>Stage 1 = site, red lesion, it m...
Lyme Disease <ul><li>Stage 2 = meningitis and cranial nerve palsy also cardiac symptoms may appear extreme neck flexion </...
Lyme Disease <ul><li>Diagnostic antibody titer ELISA Western Blot IgM AST WBC ESR </li></ul>
Lyme Disease <ul><li>Management </li></ul><ul><li>14-28 day oral tetracycline or doxycycline </li></ul><ul><li>Children – ...
Toxoplasmosis (Zoonotic) <ul><li>Toxoplasma gondii </li></ul><ul><li>Affecting birds and mammals </li></ul><ul><li>Transmi...
Toxoplasmosis <ul><li>Malaise, fever,  myalgia, headache, fatigue and sore throat </li></ul><ul><li>Fulminant = vomiting, ...
Toxoplasmosis <ul><li>Management </li></ul><ul><li>4-6 weeks of sulfonamide and pyrimethamine (take folic acid to countera...
Ebola and Marburg Viruses (Zoonotic) <ul><li>Filoviruses, 1960 </li></ul><ul><li>Biological weapons </li></ul><ul><li>Extr...
Ebola <ul><li>MOT not known </li></ul><ul><li>Diagnosis = febrile and hemorrhagic fever from Asia and Africa (travellers) ...
 
Ebola <ul><li>Rapid onset of symptoms profound hemorrhage organ failure and shock </li></ul><ul><li>90% mortality, recover...
Bird Flu (Zoonotic) <ul><li>Avian influenza  </li></ul><ul><li>Infection caused by avian (bird) influenza (flu) viruses.  ...
Bird Flu <ul><li>MOT = saliva, nasal secretions, and feces </li></ul><ul><li>direct contact with infected waterfowl or oth...
Bird Flu <ul><li>Low and high extremes of virulence  </li></ul><ul><li>The “low pathogenic” form may go undetected and usu...
Bird Flu <ul><li>Human infection with avian influenza viruses </li></ul><ul><li>There are many different subtypes of type ...
Bird Flu <ul><li>Usually, “avian influenza virus” refers to influenza A viruses found chiefly in birds </li></ul><ul><li>I...
Bird Flu <ul><li>“ Human influenza virus” usually refers to those subtypes that spread widely among humans. </li></ul><ul>...
Bird Flu <ul><li>During an outbreak of avian influenza among poultry, there is a possible risk to people who have contact ...
Bird Flu <ul><li>Influenza-like symptoms  </li></ul><ul><li>Fever </li></ul><ul><li>Cough </li></ul><ul><li>sore throat </...
Bird Flu <ul><li>Avian Influenza A (H5N1)  </li></ul><ul><li>Avian influenza A (H5N1) in Asia and Europe </li></ul><ul><li...
Bird Flu <ul><li>Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia, China, Ind...
Bird Flu <ul><li>Human cases of influenza A (H5N1) infection have been reported in Cambodia, China, Indonesia, Thailand, a...
Bird Flu <ul><li>Human health risks during the H5N1 outbreak </li></ul><ul><li>H5N1 virus does not usually infect people, ...
Bird Flu <ul><li>No one can predict when a pandemic might occur. However, experts from around the world are watching the H...
Bird Flu <ul><li>Treatment and vaccination for H5N1 virus in humans </li></ul><ul><li>The H5N1 virus that has caused human...
Bird Flu <ul><li>Treatment and vaccination for H5N1 virus in humans </li></ul><ul><li>There currently is no commercially a...
Foot and Mouth Disease (Zoonotic) <ul><li>Picornaviridae, genus  Aphthovirus   </li></ul><ul><li>One of the most contagiou...
Foot and Mouth Disease <ul><li>Hosts   </li></ul><ul><li>Bovidae (cattle, zebus, domestic buffaloes, yaks), sheep, goats, ...
Foot and Mouth Disease <ul><li>Transmission   </li></ul><ul><li>Direct or indirect contact (droplets)  </li></ul><ul><li>A...
Foot and Mouth Disease <ul><li>Sources of virus  </li></ul><ul><li>Incubating and clinically affected animals  </li></ul><...
Foot and Mouth Disease <ul><li>Occurrence </li></ul><ul><li>FMD is endemic in parts of Asia, Africa, the Middle East and S...
Foot and Mouth Disease <ul><li>PREVENTION AND CONTROL </li></ul><ul><li>Sanitary prophylaxis </li></ul><ul><li>Protection ...
Foot and Mouth Disease <ul><li>PREVENTION AND CONTROL </li></ul><ul><li>Medical prophylaxis </li></ul><ul><li>Inactivated ...
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Nursing Lecture on Communicable Disease

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  • Humans normally do not acquire FMD, but the serotypes that have been isolated include O (most commonly), C and rarely A. Humans can act as a fomite and transmit FMD to other animal species. As mentioned previously, humans can harbor the FMD virus in their respiratory tract for 1-2 days. Also, if their boots, clothing or vehicles become contaminated they can spread the virus to susceptible animals. Also, if humans ingest unprocessed milk or dairy products from infected animals, they are at risk for contracting infection. This too has very low incidence.
  • Transcript of "Nursing Lecture on Communicable Disease"

    1. 1. Brought to you by : http://1nurses.com
    2. 2. Disclaimer <ul><li>All information and pictures presented in this slideshow were meant for EDUCATIONAL purposes only. 1Nurses.com does not claim any liability from the use of this slide and does not guarantee any action that might result from the use of this material. 1Nurses.com does not claim any ownership for the images and articles presented in this report. All articles and Images are the respective Copyright of the respective owners. </li></ul>
    3. 3. <ul><li>COMMUNICABLE DISEASE </li></ul><ul><li>Is any disease that can be transmitted directly or indirectly from one person to another </li></ul>
    4. 4. <ul><li>INFECTION </li></ul><ul><li>Is a condition caused by the entry and multiplication of pathogenic microorganisms within the host body. </li></ul><ul><li>It is also an invasion of an organisms (bacteria, helminths, fungi, parasite, ricketsia and prion) </li></ul>
    5. 5. FACTORS AFFECTING RISK OF INFECTION <ul><li>AGE </li></ul><ul><li>HEREDITY </li></ul><ul><li>LEVEL OF STRESS </li></ul><ul><li>NUTRITIONAL STATUS </li></ul><ul><li>CURRENT MEDICAL THERAPY </li></ul><ul><li>PRE-EXISTING DISEASE </li></ul><ul><li>IMMUNIZATION STATUS </li></ul>
    6. 6. IMMUNITY <ul><li>THE QUALITY OF BEING INSUSCEPTIBLE TO OR UNAFFECTED BY A PARTICULAR DISEASE. </li></ul>
    7. 7. TYPES OF IMMUNITY <ul><li>INNATE = within the HOST Immune System </li></ul><ul><li>ACQUIRED = inoculation and disease Active Passive </li></ul>
    8. 8. <ul><li>IMMUNE SYSTEM PROTECTION AGAINST ANTIGEN OR DISEASES BY A SYSTEM OF ANTIBODY PRODUCTION </li></ul><ul><li>ANTIBODY PRODUCED BY LYMPHOCYTES IN RESPONSE TO ANTIGEN. </li></ul><ul><li>ANTIGEN TRIGGERING AGENT OF THE IMMUNE SYSTEM </li></ul>
    9. 9. IMMUNOGLOBULINS <ul><li>IgG MOST PREVALENT ANTIBODY 80%, PRODUCE LATER IN THE IMMUNE RESPONSE, ONLY Ig THAT CAN CROSS THE PLACENTA </li></ul><ul><li>IgA FOUND IN COLOSTRUM , TEARS, SALIVA, SWEAT </li></ul><ul><li>IgM PRINCIPAL ANTIBODY OF BLOOD, QUICKLY PRODUCED IN RESPONSE TO AN ANTIGEN, RESPONDS TO ARTIFICIAL IMMUNIZATION </li></ul><ul><li>IgE ALLERGIC REACTION </li></ul><ul><li>IgD UNKNOWN, ANTIGEN RECEPTOR, FOUND IN THE SURFACE OF B CELLS </li></ul>
    10. 10. IMMUNIZATION <ul><li>A PROCESS BY WHICH RESISTANCE TO AN INFECTIOUS DISEASE IS INDUCED OR AUGMENTED. </li></ul><ul><li>ACTIVE AND PASSIVE IMMUNIZATION </li></ul>
    11. 11. EPI <ul><li>Hepa b 3 shots, 0-1-6 mo, im, 0.5 ml, vas. lateralis </li></ul><ul><li>Bcg 1 at birth, id, 0.05 ml, right arm </li></ul><ul><li>Bcg 2 at 6 y/o, id, 0.1 ml, left arm </li></ul><ul><li>Dpt 3 shots, 6 weeks old, 4 weeks interval im, 0.5 ml, vas. lateralis </li></ul><ul><li>Opv 3x, same with dpt, oral gtts, 2-3 months </li></ul><ul><li>Measles 1x, 9 mo, sq, 0.5 ml, right arm </li></ul>
    12. 12. Active Immunity <ul><li>ANTIBODIES ARE PRODUCED BY THE BODY IN RESPONSE TO INFECTION. ANTIGEN IS INTRODUCED, LONG DURATION </li></ul><ul><li>EXAMPLE: </li></ul><ul><ul><li>NATURAL ACTIVE = DISEASE </li></ul></ul><ul><ul><li>ARTIFICIAL ACTIVE = VACCINES </li></ul></ul>
    13. 13. ARTIFICIAL ACTIVE <ul><li>ANTIGENS (VACCINES OR TOXOIDS) ARE ADMINISTERED TO STIMULATE ANTIBODY PRODUCTION. REINFORCED BY BOOSTER DOSE TO INCREASE IMMUNITY. </li></ul><ul><li>KILLED VACCINES PERTUSSIS VACCINE, TYPHOID VACCINE </li></ul><ul><li>LIVE VACCINES ATTENUATED, WEAKENED SABIN, MEASLES </li></ul><ul><li>TOXOID INACTIVATED BACTERIAL TOXIN-TETANUS, DIPHTHERIA </li></ul>
    14. 14. Artificial Active
    15. 15. Artificial Active
    16. 16. Artificial Active
    17. 17. PASSIVE IMMUNITY <ul><li>ANTIBODIES ARE PRODUCED BY ANOTHER SOURCE. ANTIBODIES ARE INTRODUCED, SHORT DURATION </li></ul><ul><li>Example: </li></ul><ul><ul><li>NATURAL PASSIVE = MOTHER </li></ul></ul><ul><ul><li>ARTIFICIAL PASSIVE = GLOBULINS </li></ul></ul>
    18. 18. ARTIFICIAL PASSIVE <ul><li>IMMUNE SERUM (ANTIBODY) FROM ANIMAL OR HUMAN IS INJECTED. PROVIDE IMMEDIATE PROTECTION (DIPHTHERIA ANTITOXIN, TETANUS ANTITOXIN) SKIN-TESTING IS A MUST. </li></ul>
    19. 19. CONDITIONS BEFORE AN INFECTION DEVELOPS <ul><li>Sufficient number of microorganisms </li></ul><ul><li>Virulence of microorganisms </li></ul><ul><li>Resistance of the of the host </li></ul><ul><li>Immunity of the host </li></ul><ul><li>Cycle of infection must be completed </li></ul>
    20. 20. THE INFECTION PROCESS CYCLE <ul><li>Agent (bacteria or virus) </li></ul><ul><li>Reservoir (fomites or living things) </li></ul><ul><li>Portal of Exit </li></ul><ul><li>Mode of Transmission (direct or indirect) </li></ul><ul><li>Portal of Entry </li></ul><ul><li>The Host </li></ul>
    21. 21. STAGES OF AN INFECTIOUS PROCESS <ul><li>INCUBATION PERIOD </li></ul><ul><li>PRODROMAL PERIOD </li></ul><ul><li>ILLNESS PERIOD (PATHOGNOMONIC SIGN) </li></ul><ul><li>CONVALESCENT PERIOD </li></ul>
    22. 22. Terminologies <ul><li>ETIOLOGY </li></ul><ul><li>EPIDEMIOLOGY </li></ul><ul><li>INCIDENCE </li></ul><ul><li>PREVALENCE </li></ul><ul><li>ENDEMIC </li></ul><ul><li>EPIDEMIC </li></ul><ul><li>PANDEMIC </li></ul><ul><li>SPORADIC </li></ul>
    23. 23. FUNDAMENTALS OF STANDARD PRECAUTION <ul><li>HANDWASHING </li></ul><ul><li>GLOVES </li></ul><ul><li>MASKS, GOGGLES, FACE SHIELDS </li></ul><ul><li>AIR FILTERS </li></ul><ul><li>GOWNNS </li></ul><ul><li>ISOLATION </li></ul><ul><li>STRICT ISOLATION </li></ul><ul><li>CONTACT ISOLATION </li></ul><ul><li>RESPIRATORY ISOLATION </li></ul><ul><li>TUBERCULOSIS ISOLATION </li></ul><ul><li>ENTERIC PRECAUTION </li></ul><ul><li>DRAINAGE/SECRETION PRECAUTION </li></ul><ul><li>BLOOD/BODY FLUIDS PRECAUTION </li></ul>
    24. 24. ISOLATION <ul><li>It is necessary when a person is known or suspected to be infected with pathogens that can be transmitted by direct or indirect contact. </li></ul><ul><li>The principle behind isolation technique is to create a physical barrier that prevents the transfer of infectious agents. To do this you have to know how the organisms are transmitted. </li></ul>
    25. 25. Transmission-Based Precautions <ul><li>Airborne </li></ul><ul><li>Droplets </li></ul><ul><li>Contact </li></ul>
    26. 26. AIRBORNE <ul><li>PRIVATE ROOM </li></ul><ul><li>NEGATIVE AIR PRESSURE </li></ul><ul><li>VENTILATION SAFEGUARDS air from room is not recirculated to other areas </li></ul><ul><li>DOOR SHOULD BE KEPT CLOSED </li></ul><ul><li>BARRIER TO SMALL PARTICLES masks HEPA high efficiency particulate air </li></ul><ul><li>COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT </li></ul>
    27. 28. DROPLET <ul><li>PRIVATE ROOM </li></ul><ul><li>WEAR MASK IF WORKING WITHIN 3 FEET </li></ul><ul><li>WEAR MASKS UPON ENTRY INTO THE ROOM </li></ul><ul><li>COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT </li></ul>
    28. 29. CONTACT <ul><li>PRIVATE ROOM </li></ul><ul><li>WEAR GLOVES </li></ul><ul><li>GLOVES ARE REMOVED BEFORE EXITING FROM THE ROOM </li></ul><ul><li>HANDS ARE WASHED THOROUGHLY </li></ul><ul><li>NOTHING IS TOUCHED BEFORE EXITING THE ROOM </li></ul><ul><li>GOWN IS WORN WHEN ENTERING THE ROOM </li></ul><ul><li>REMOVE GOWN CAUTIOUSLY BEFORE LEAVING THE ROOM </li></ul><ul><li>PATIENT CARE ITEMS SHOULD BE RESTRICTED TO SINGLE PATIENT </li></ul>
    29. 30. OTHER TYPE OF ISOLATION <ul><li>AFB ISOLATION </li></ul><ul><li>STRICT ISOLATION </li></ul><ul><li>RESPIRATORY ISOLATION </li></ul><ul><li>WOUND AND SKIN ISOLATION </li></ul><ul><li>ENTERIC ISOLATION </li></ul><ul><li>PROTECTIVE OR REVERSE ISOLATION </li></ul>
    30. 31. AFB ISOLATION <ul><li>VISITORS REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><ul><li>MASKS ARE TO BE WORN IN THE PATIENT’S ROOM </li></ul></ul><ul><ul><li>GOWNS ARE INDICATED TO PREVENT CLOTHING CONTAMINATION </li></ul></ul><ul><ul><li>GLOVES ARE INDICATED FOR BODY FLUIDS AND NON-INTACTSKIN </li></ul></ul><ul><ul><li>HANDWASHING-after touching the patient or potentially contaminated articles and after removing gloves </li></ul></ul><ul><ul><li>articles should be discarded, cleaned or sent for decontamination and reprocessing </li></ul></ul><ul><ul><li>room is to remain closed </li></ul></ul><ul><ul><li>patient is to wear mask during transport </li></ul></ul>
    31. 32. STRICT ISOLATION <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-necessary, door must be kept closed </li></ul><ul><li>GOWNS-must be worn by all persons entering the room </li></ul><ul><li>MASKS- must be worn by all persons entering the room </li></ul><ul><li>HANDS-must be washed on entering and leaving room </li></ul><ul><li>GLOVES-must be worn by all persons entering the room </li></ul><ul><li>ARTICLES-must be discarded, or wrapped before being sent to CENTRAL SUPPLY for disinfection or sterilization </li></ul>
    32. 33. RESPIRATORY ISOLATION <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-necessary, door must be kept closed </li></ul><ul><li>GOWNS-gowns not necessary </li></ul><ul><li>MASKS- must be worn by all persons entering the room if susceptible disease </li></ul><ul><li>HANDS-must be washed on entering and leaving room </li></ul><ul><li>GLOVES-not necessary </li></ul><ul><li>ARTICLES-those contaminated with secretions must be disinfected </li></ul><ul><li>CAUTION-all persons susceptible to the specific disease should be excluded from the area, susceptibles must wear masks </li></ul>
    33. 34. WOUND AND SKIN PRECAUTIONS <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-desirable </li></ul><ul><li>GOWNS-must be worn by all persons having direct contact with the patient </li></ul><ul><li>MASKS- during dressing changes </li></ul><ul><li>HANDS-must be washed on entering and leaving room </li></ul><ul><li>GLOVES-must be worn by all persons having direct contact with infected area </li></ul><ul><li>ARTICLES-instruments, dressing, linens </li></ul>
    34. 35. ENTERIC PRECAUTIONS <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-necessary FOR CHILDREN ONLY </li></ul><ul><li>GOWNS- must be worn by all persons having direct contact with the patient </li></ul><ul><li>MASKS- not necessary </li></ul><ul><li>HANDS-must be washed on entering and leaving room </li></ul><ul><li>GLOVES-must be worn by all persons having direct contact with patient or articles contaminated with fecal material </li></ul><ul><li>ARTICLES-special precautions necessary for articles contaminated with urine and feces, must be disinfected or discarded </li></ul>
    35. 36. PROTECTIVE ISOLATION <ul><li>VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM </li></ul><ul><li>PRIVATE ROOM-necessary, door must be kept closed </li></ul><ul><li>GOWNS- must be worn by all persons entering room </li></ul><ul><li>MASKS- - must be worn by all persons entering room </li></ul><ul><li>HANDS-must be washed on entering and leaving room </li></ul><ul><li>GLOVES-must be worn by all persons having direct contact with patient </li></ul>
    36. 37. DIAGNOSTIC TOOLS <ul><li>COLLECTION OF SPECIMEN </li></ul><ul><li>PRINCIPLES </li></ul><ul><li>TYPES OF SPECIMEN COLLECTION </li></ul><ul><ul><li>BLOOD </li></ul></ul><ul><ul><li>URINE </li></ul></ul><ul><ul><li>STOOL </li></ul></ul><ul><ul><li>SPUTUM </li></ul></ul><ul><ul><li>WOUNDS </li></ul></ul><ul><ul><li>THROAT </li></ul></ul>
    37. 38. LABORATORY TESTS <ul><li>MICROSCOPY </li></ul><ul><li>CULTURE </li></ul><ul><li>ANTIBIOTIC SUSCEPTIBILITY TESTING </li></ul><ul><li>WHITE BLOOD CELL COUNT </li></ul><ul><li>IMMUNOLOGIC TEST </li></ul>
    38. 39. DISORDERS <ul><li>CNS DISEASES </li></ul><ul><li>GIT DISEASES </li></ul><ul><li>RESPIRATORY DISEASE </li></ul><ul><li>BLOOD BORNE DISEASES </li></ul><ul><li>ERUPTIVE FEVER DISEASES </li></ul><ul><li>CONTACT DISEASE </li></ul><ul><li>SEXUALLY TRANSMITTED DISEASES </li></ul><ul><li>TORCHS </li></ul><ul><li>HIV AND AIDS </li></ul><ul><li>HEPATITIS </li></ul>
    39. 40. CNS
    40. 41. Tetanus <ul><li>Clostridium tetani </li></ul><ul><li>MOT = wound setting </li></ul><ul><li>IP = 3 -21 days </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = TT </li></ul></ul><ul><ul><li>Passive = TAT and TIG </li></ul></ul><ul><ul><li>Natural = active none, passive (+) </li></ul></ul>
    41. 42. Tetanus <ul><li>Wound Infection </li></ul><ul><li>FATAL INFECTION OF THE CNS </li></ul><ul><li>TOXIN-NEUROTOXIN </li></ul>
    42. 43. PATHOPHYSIOLOGY: <ul><li>SETTING OF WOUND ---- ENTRANCE OF C.T. ---- RELEASES TETANUS TOXIN ---- TETANOSPASMIN (CNS), TETANOLYSIN (BLOOD) ---- ABSORBED BY MOTOR NERVE ENDINGS ---- SYNAPSE (CONNECTION BETWEEN NEURONS) ---- MYONEURAL JUNCTION ---- ACETYLCHOLINE DISTURBANCE IN THE TRANSMISSION OF NERVE IMPULSE </li></ul>
    43. 44. <ul><li>Trismus – lock jaw </li></ul><ul><li>Risus sardonicus - maskface </li></ul><ul><li>Risorius - grinsmile </li></ul><ul><li>Dx wound and blood extraction (non specific) </li></ul>
    44. 46. Immunization <ul><li>DPT (0.5 ml IM) 1 – 1 ½ months old 2 - after 4 weeks 3 – after 4 weeks </li></ul><ul><li>1 st booster – 18 mos </li></ul><ul><li>2 nd booster – 4-6 yo </li></ul><ul><li>subsequent booster – every 10 yrs thereafter </li></ul><ul><li>TT (0.5 ml IM) TT1 - 6 months within preg TT2 - one month after TT1 TT3 to TT5 - every succeeding preg or every year </li></ul><ul><li>TAT (horse) and TIG (human) </li></ul>
    45. 47. 3 types of patients w/ skin wounds post exposure prophylaxis <ul><li>(+) immunization as a child w/ boosters but last shot > 10 yrs – give TT </li></ul><ul><li>2. (-) immunization - TT + TIG/TAT </li></ul><ul><li>3. (+) tetanus – TIG/TAT + TT + Abx + wound cleansing + supportive therapy </li></ul>
    46. 48. Management <ul><li>1. Anticonvulsant, muscle relaxants, </li></ul><ul><li>antibiotics, wound cleansing and debridement, hyperbaric chamber </li></ul><ul><li>2. Active-DPT and tetanus toxoid </li></ul><ul><li>3. Passive-TIG and TAT, placental immunity </li></ul>
    47. 49. Rabies/Lyssa (Zoonotic) <ul><li>Rhabdovirus/filterable virus </li></ul><ul><li>MOT = Bite from warm blooded animals </li></ul><ul><li>Canine (human) and sylvatic (animals) </li></ul><ul><li>IP = 10 days to several years </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = rabies vaccine </li></ul></ul><ul><ul><li>Passive = HRIG, ERIG </li></ul></ul><ul><ul><li>Natural = active none, passive none </li></ul></ul>
    48. 50. Rabies/Lyssa (Zoonotic) <ul><li>Hydrophobia (fear of choking) </li></ul><ul><li>Aerophobia (laryngospasm) </li></ul><ul><li>Bite from warm blooded animals </li></ul><ul><li>Encephalitis/meningitis/respiratory paralysis </li></ul>
    49. 52. Category of bites <ul><li>I – intact skin (lick) </li></ul><ul><li>II – mucosal, non bleeding wounds, abrasions </li></ul><ul><li>III – bleeding bites and above neck, stray dogs, laceration, multiple bites </li></ul>
    50. 53. Rabies/Lyssa (Zoonotic) <ul><li>Observe dog for maniachal s/sx </li></ul><ul><li>Active-rabies vaccine </li></ul><ul><li>Passive-rabies immunoglobulin </li></ul><ul><li>Dx </li></ul><ul><li>History taking </li></ul><ul><li>Quarantine the dog </li></ul><ul><li>Staining of brain tissue (dog) (+) Negri bodies </li></ul>
    51. 54. AFTER THE BITE <ul><li>WASH WITH SOAP AND WATER </li></ul><ul><li>GIVE ANTIBIOTICS AND ANTITETANUS </li></ul><ul><li>OBSERVE DOG FOR 14 DAYS, IF IT DIES CONSULT DOCTOR </li></ul><ul><li>IF DOG SHOWS SUGGESTIVE OF RABIES, KILL THE DOG IMMEDIATELY AND BRING HEAD FOR LAB EXAM (+) NEGRI BODIES SUBMIT FOR IMMUNIZATION WHILE WAITING FOR RESULTS </li></ul><ul><li>IF DOG IS NOT AVAILABLE FOR OBSERVATION SUBMIT FOR IMMUNIZATION </li></ul>
    52. 55. Immunization <ul><li>Rabies vaccine (5 shots) IM (2 ml deltoid) 0, 3, 7, 14, 28 days ID (0.1 ml deltoid) 0, 3, 7 days (0.1 ml deltoid 2 shots) 30, 90 days (0.1 ml deltoid single shot) </li></ul><ul><li>Rabies immunoglobulin (HRIG and ERIG) IM (0.2 x kg) single shot wound 40% deltoid 60% </li></ul>
    53. 56. 4 STAGES <ul><li>1. prodrome - fever, headache, paresthesia, </li></ul><ul><li>2. encephalitic – excessive motor activity, hypersensitivity to bright light, loud noise, hypersalivation, dilated pupils </li></ul><ul><li>3. brainstem dysfunction – dysphagia, hydrophobia, apnea </li></ul><ul><li>4. death/recovery </li></ul>
    54. 57. RESPONSIBLE PET OWNERSHIP <ul><li>HAVE PET IMMUNIZED AT 3 MONTHS AND EVERY YEAR AFTER </li></ul><ul><li>NEVER ALLOW PETS TO ROAM IN THE STREET </li></ul><ul><li>LEASHED YOUR DOG </li></ul><ul><li>YOUR PET ACTION IS YOUR RESPONSIBILITY </li></ul>
    55. 58. Poliomyelitis Infantile Paralysis <ul><li>Polio virus, Legio debilitans </li></ul><ul><ul><li>Legio brunhilde (fatal) </li></ul></ul><ul><ul><li>Legio lansing </li></ul></ul><ul><ul><li>Legio leon </li></ul></ul><ul><li>MOT = Fecal oral route (common) and droplets </li></ul><ul><li>IP = 7-12 days </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = OPV </li></ul></ul><ul><ul><li>Passive = none </li></ul></ul><ul><ul><li>Natural = active (+), passive none </li></ul></ul>
    56. 59. Poliomyelitis Infantile Paralysis <ul><li>Assymetrical paralysis </li></ul><ul><li>Hayne’s sign - head drop </li></ul><ul><li>Poker’s sign - opisthotonus </li></ul><ul><li>Landry’s sign - ascending paralysis </li></ul><ul><li>Pandy’s Test – increased in CSF CHON </li></ul>
    57. 60. Poliomyelitis Infantile Paralysis <ul><li>I – abortive or inapparent </li></ul><ul><li>II – meningitis (non-paralytic) </li></ul><ul><li>III – paralytic (anterior horn of spinal cord) </li></ul><ul><li>IV – bulbar (encephalitis) </li></ul>
    58. 63. Meningitis Menigococcemia <ul><li>Neisseria meningitides (bacteria) </li></ul><ul><li>MOT = droplets </li></ul><ul><li>IP = 1-2 days </li></ul><ul><li>IMMUNITY = xxx </li></ul>
    59. 64. Meningitis Menigococcemia <ul><li>Immunocompetent are susceptible </li></ul><ul><li>Petechiae (volar/palm of hands) EARLY </li></ul><ul><li>Opisthotonus MENIGEAL IRRITATION </li></ul><ul><li>Brudzinski MENINGEAL IRRITATION </li></ul><ul><li>Kernigs MENINGEAL IRRITATION </li></ul><ul><li>Increased ICP BRAIN </li></ul><ul><li>Seizure BRAIN </li></ul>
    60. 65. Menigococcemia <ul><li>S/sx: </li></ul><ul><li>Meningococcemia – spiking fever, chills, arthralgia, petechial rash </li></ul><ul><li>Fulminant Meningococcemia (Waterhouse Friderichsen) – septic shock; hypotension, tachycardia, enlarging petecchial rash, adrenal insufficiency </li></ul><ul><li>Meningitis – most common; nuchal rigidity, brudzinski, kernigs, Photophobia, confusion </li></ul>
    61. 66. Menigococcemia <ul><li>Dx: CT/ MRI, CSF analysis, CSF gram stain, CSF and blood culture </li></ul><ul><li>Mgmt: antibiotics (Pen G, ceftriaxone), steroids, anticonvulsants, Rifampin for close contacts of meningococcemia </li></ul>
    62. 67. Encephalitis <ul><li>Arbo virus (arthropod borne virus) </li></ul><ul><li>MOT = bite from mosquito (St. Louise) </li></ul><ul><li>IP = xxx </li></ul><ul><li>IMMUNITY = xxx </li></ul>
    63. 68. Encephalitis <ul><li>S/sx: fever, abdominal pain, sore throat, respiratory symptoms, headache, meningeal signs, photophobia, Seizure (lacrosse), SIADH w/ hypoNa (St Louis) </li></ul><ul><li>Dx: CSF analysis </li></ul><ul><li>r/o other CNS disease, CT scan, MRI </li></ul><ul><li>Mgmt: nonspecific; control seizures </li></ul>
    64. 69. Leprosy <ul><li>Mycobacterium Leprae, Hansen’s Bacillus </li></ul><ul><li>MOT = (unknown) </li></ul><ul><ul><li>may be due to prolonged skin-skin contact (common) </li></ul></ul><ul><ul><li>or droplets </li></ul></ul><ul><li>IP = years to decades </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = BCG </li></ul></ul><ul><ul><li>Passive = none </li></ul></ul><ul><ul><li>Natural = none </li></ul></ul>
    65. 70. Leprosy <ul><li>EARLY </li></ul><ul><ul><li>Skin lesion and paresthesia </li></ul></ul><ul><li>LATE </li></ul><ul><ul><li>Lagopthalmos </li></ul></ul><ul><ul><li>Madarosis </li></ul></ul><ul><ul><li>Gynecomastia </li></ul></ul><ul><ul><li>Saddle Nose </li></ul></ul><ul><ul><li>Contractures </li></ul></ul>
    66. 71. Leprosy
    67. 72. Leprosy <ul><li>Dx: </li></ul><ul><ul><li>Lepromin Test – ID injection </li></ul></ul><ul><ul><li>Slit Skin Smear </li></ul></ul><ul><li>Dapsone-Lamprene-Rifampicin </li></ul><ul><li>Dapsone-don’t give to anemic </li></ul><ul><li>Lamprene-dry skin, hyperpigmentation (lasting) </li></ul><ul><li>Rifampicin-renal and liver toxicity </li></ul>
    68. 73. Leprosy <ul><li>MDT-RA 4073 (home meds) </li></ul><ul><li>Paucibacillary - 6-9 months 1. Dapsone </li></ul><ul><li>2. Rifampicin </li></ul><ul><li>Multibacillary- 12-24 months </li></ul><ul><li>1. Dapsone – mainstay; hemolysis, agranulocytosis </li></ul><ul><li>2. Clofazimine – reddish skin pimentation, intestinal toxicity </li></ul><ul><li>3. Rifampicin – bactericidal; renal and liver toxicity </li></ul>
    69. 74. Leprosy <ul><li>MDT- two or more drugs </li></ul><ul><li>RA 4073 (home meds) </li></ul><ul><li>Paucibacillary.- 6-9 months </li></ul><ul><li>Multibacillary.- 12-24 months </li></ul><ul><li>Tuberculoid – high resistant, less severe (+LT) </li></ul><ul><li>Lepromatous – most severe, low resistant (-LT) </li></ul>
    70. 75. Leprosy <ul><li>Non - communicable </li></ul><ul><ul><li>After 1 week of medication </li></ul></ul><ul><li>Considered cured </li></ul><ul><ul><li>After completing the course of treatment </li></ul></ul>
    71. 76. Red Tide Poisoning <ul><li>Pyromidium Bahamense </li></ul><ul><li>Exotoxin </li></ul><ul><li>Dinoflagellates </li></ul><ul><ul><li>Plankton </li></ul></ul><ul><ul><li>Algae </li></ul></ul><ul><li>MOT = Ingestion of contaminated bi-valve shellfish </li></ul><ul><li>IP = within 30 minutes </li></ul><ul><li>IMMUNITY = xxx </li></ul>
    72. 77. Red Tide Poisoning <ul><li>Dx gastric siphoning </li></ul><ul><li>EARLY </li></ul><ul><ul><li>Circumoral numbness </li></ul></ul><ul><ul><li>nausea and vomiting </li></ul></ul><ul><li>LATE </li></ul><ul><ul><li>Bulbar paralysis and metabolic acidosis </li></ul></ul><ul><li>Mgmt: emesis/gastric lavage + activated charcoal, supportive </li></ul>
    73. 78. CLINICAL MANIFESTATIONS: <ul><li>NUMBNESS OF THE FACE ESPECIALLY AROUND THE MOUTH </li></ul><ul><li>VOMITING, DIZZINESS, HEADACHE </li></ul><ul><li>TINGLING SENSATION, WEAKNESS </li></ul><ul><li>RAPID PULSE, DIFFICULTY OF SPEECH (ATAXIA), DYSPHAGIA, RESPI PARALYSIS, DEATH. </li></ul>
    74. 79. MANAGEMENT AND CONTROL MEASURES: <ul><li>NO DEFINITE MEDICATIONS </li></ul><ul><li>INDUCE VOMITING (EARLY INTERVENTION) </li></ul><ul><li>DRINKING PURE COCONUT MILK (WEAKENS TOXIC EFFECT) DON’T GIVE DURING LATE STAGE IT MAY WORSEN THE CONDITION. </li></ul><ul><li>NaHCO3 SOLUTION (25 GRAMS IN ½ GLASS OF WATER) </li></ul><ul><li>RESPIRATORY SUPPORT </li></ul><ul><li>AVOID USING VINEGAR IN COOKING SHELLFISH AFFECTED BY RED TIDE (15X virulence) </li></ul><ul><li>TOXIN OF RED TIDE IS NOT TOTALLY DESTROYED IN COOKING. </li></ul><ul><li>AVOID TAHONG, TALABA, HALAAN, KABIYA, ABANIKO. WHEN RED TIDE IS ON THE RISE. </li></ul>
    75. 80. Botulism <ul><li>Clostridium Botulinum (bacteria) </li></ul><ul><li>Endotoxin </li></ul><ul><li>MOT </li></ul><ul><ul><li>canned foods </li></ul></ul><ul><ul><li>Ingestion of contaminated foods) </li></ul></ul><ul><li>IP = 12-36H canned food, 4-14 days wound </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = xxx </li></ul></ul><ul><ul><li>Paiive = botulinum antitoxin </li></ul></ul><ul><ul><li>Natural = xxx </li></ul></ul>
    76. 81. Botulism <ul><li>Dx = gastric siphoning </li></ul><ul><li>EARLY </li></ul><ul><ul><li>VISUAL DIFFICULTY, DYSPHAGIA, DRY MOUTH </li></ul></ul><ul><li>LATE </li></ul><ul><ul><li>VOMITING, CONSTIPATION/DIARRHEA </li></ul></ul><ul><ul><li>DESCENDING SYMMETRICAL FLACCID </li></ul></ul><ul><ul><li>BULBAR PARALYSIS </li></ul></ul>
    77. 82. GIT
    78. 84. Amoebiasis <ul><li>Entamoeba Hystolitica –protozoan (parasite) </li></ul><ul><li>MOT = 5 F’s, fecal oral route </li></ul><ul><li>IP = 2-4 weeks </li></ul><ul><li>IMMUNITY = xxx </li></ul>
    79. 85. Amoebiasis <ul><li>Dx microscopic stool exam or rectal secretions </li></ul><ul><li>(tetra nucleated cyst and trophozoites) </li></ul><ul><li>Diarrhea and constipation (non dysenteric) </li></ul><ul><li>Blood streaked, diarrhea and watery mucoid, abd’l cramps (dysenteric) </li></ul><ul><li>Extra amoebiasis-penile, vagina, spleen, liver, anal, lungs and meninges </li></ul><ul><li>Metronidazole (Flagyl) </li></ul>
    80. 86. Bacillary Dysentery Shigellosis <ul><li>Shiga bacillus (bacteria) </li></ul><ul><li>s. dysenterae (fatal) </li></ul><ul><li>s. flexneri (common in the Philippines) </li></ul><ul><li>s. boydii </li></ul><ul><li>s. sonnei </li></ul><ul><li>MOT = same with amoebiasis </li></ul><ul><li>IP = 1-7 days </li></ul><ul><li>IMMUNITY = xxx </li></ul>
    81. 87. Bacillary Dysentery Shigellosis <ul><li>Dx stool exam </li></ul><ul><li>Watery mucoid, bloody with pus feces </li></ul><ul><li>Tenesmus = rectal prolapse </li></ul><ul><li>Chloramphenicol, Tetracycline </li></ul>
    82. 88. Cholera, El Tor <ul><li>Vibrio Coma (inaba, ogawa, hikojima) </li></ul><ul><li>Vibrio Cholerae </li></ul><ul><li>Vibrio El Tor (bacteria) </li></ul><ul><li>MOT = same with amoebiasis </li></ul><ul><li>IP = few hours to 5 days </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = cholera vaccine </li></ul></ul><ul><ul><li>Passive = none </li></ul></ul><ul><ul><li>Natural = none </li></ul></ul>
    83. 89. Cholera, El Tor <ul><li>Dx stool exam </li></ul><ul><li>Rice watery stool with fishy odor </li></ul><ul><li>Washerwoman’s appearance </li></ul><ul><li>Severe dehydration </li></ul><ul><li>Chloramphenicol </li></ul>
    84. 90. Typhoid Fever <ul><li>Salmonella typhosa (bacteria) </li></ul><ul><li>MOT = same with amoebiasis (5 F’s) </li></ul><ul><li>IP = 1-3 weeks </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = vaccine </li></ul></ul><ul><ul><li>Passive = xxx </li></ul></ul><ul><ul><li>Natural = lifetime immunity </li></ul></ul>
    85. 91. Pathophysiology <ul><li>Oral ingestion </li></ul><ul><li>Bloodstream </li></ul><ul><li>Reticuloendothelial system (lymph node, spleen, liver) </li></ul><ul><li>Bloodstream </li></ul><ul><li>Gallbladder </li></ul><ul><li>Peyer’s patches of SI </li></ul><ul><li>necrosis and ulceration </li></ul>
    86. 92. Typhoid Fever <ul><li>1st week step ladder (BLOOD) </li></ul><ul><li>2nd week rose spot and fastidial </li></ul><ul><ul><li>typhoid pyschosis (URINE & STOOL) </li></ul></ul><ul><li>3rd week (complications) intestinal bleeding, </li></ul><ul><ul><li>perforation, peritonitis, encephalitis, </li></ul></ul><ul><li>4th week (lysis) decreasing S?SX </li></ul><ul><li>5th week (convalescent) </li></ul>
    87. 93. Typhoid Fever <ul><li>Blood (typhi dot) 1st week after </li></ul><ul><li>Stool and urine 2nd week after </li></ul><ul><li>Chloramphenicol </li></ul>
    88. 94. Typhoid Fever <ul><li>Rose spot (abdominal rashes) </li></ul><ul><li>Step ladder fever to fastidial (peak of fever) typhoid psychosis </li></ul><ul><li>Peyer’s patches of small intestine </li></ul><ul><li>May stay in the gallbladder (hiding area) </li></ul>
    89. 95. Hookworm (Roundworm) <ul><li>Necator Americanus, Ancylostoma Duodenale </li></ul><ul><li>Skin entry (sole of the feet to blood steam then into the lungs then ascends to the pharynx where it is swallowed and attached into the intestinal mucosa and subsists on the blood of the host) </li></ul><ul><li>Anemia, abd’l cramps, abd’l distention, perforation to peritinotis to septicemia </li></ul>
    90. 96. Hookworm (Roundworm) <ul><li>IP few weeks to months </li></ul><ul><li>Dx microscopic exam (stool exam) </li></ul><ul><li>Pyrantel Pamoate and Mebendazole </li></ul><ul><li>Note: don’t give drug without (+) stool exam members of the family must be examined and treated also. </li></ul>
    91. 97. Hookworm (Roundworm) <ul><li>Nursing Consideration </li></ul><ul><li>FOLLOW-UP EXAMINATION OF THE STOOL 2 WEEKS AFTER THERAPY </li></ul><ul><li>NUTRITION COUNSELING AND IRON SUPPLEMENTS </li></ul><ul><li>FAMILY MEMBERS AND CLOSE CONTACTS SHOULD BE EXAMINED AND TREATED FOR PARASITES </li></ul><ul><li>EDUCATE PUBLIC ABOUT DANGERS OF CONTAMINATED SOIL </li></ul><ul><li>IMPORTANCE OF WEARING SHOES </li></ul><ul><li>DEWORMING </li></ul>
    92. 98. Ascariasis (Roundworm) <ul><li>Ascaris Lumbricoides </li></ul><ul><li>MOT ingestion of food contaminated by ascaris lumbricoides GIT to LUNGS and other ORGANS </li></ul>
    93. 99. <ul><li>MOT: ingestion of food contaminated by ascaris eggs larvae in large intestine penetrate wall towards lung where larvae grow and coughed up intestine larvae mature and passed out in feces </li></ul>
    94. 100. Ascariasis (Roundworm) <ul><li>Coughing, wheezing and hemoptysis </li></ul><ul><li>IP same with hookworm </li></ul><ul><li>Drug: same with hookworm </li></ul><ul><li>Dx same with hookworm </li></ul>
    95. 101. Tapeworm <ul><li>Taenia Saginata (cattle) </li></ul><ul><li>Taenia Solium (pigs) </li></ul><ul><li>MOT fecal oral route (ingestion of food contaminated by the agent) </li></ul><ul><li>Dx: Stool Exam </li></ul><ul><li>S/Sx diarrhea, abdominal discomfort, anemia </li></ul>
    96. 102. Pinworm <ul><li>Enterobiasis (nocturnal animation/alive) </li></ul><ul><li>Vermicularis Enterobius </li></ul><ul><li>MOT fecal oral route </li></ul><ul><li>S/sx Itchiness at the anal area (eggs of the agent causes the itchiness) </li></ul><ul><li>Dx tape test at night time (agents release their eggs during night time) </li></ul>
    97. 103. <ul><li>Thread worm – storgyloidiasis </li></ul><ul><li>Whip worm – trichoniasis voracious eating abdominal pain weight loss </li></ul><ul><li>Flat worm - paragonimiasis </li></ul>
    98. 104. QUIZ <ul><li>1. hookworm a. taenia s. </li></ul><ul><li>2. ascariasis b. vermicularis enterobius </li></ul><ul><li>3. pinworm c. ascaris lumbricoides </li></ul><ul><li>4. tapeworm d. necator americanus </li></ul>
    99. 105. <ul><li>5. Common s/sx of worm infestation? </li></ul><ul><li>6. single most important nursing consideration prior to DEWORMING? </li></ul><ul><li>7. MOT of hookworm infestation? </li></ul><ul><li>8. distinct s/sx of PINWORM infestation? </li></ul><ul><li>9. WHIPWORM infestation s/sx? </li></ul><ul><li>10. LUNG FLUKE infestation? </li></ul>
    100. 106. Schistosomias, Snail Fever, Takayama <ul><li>Blood fluke </li></ul><ul><li>Schistosoma japonicum </li></ul><ul><li>S. hematobium </li></ul><ul><li>S. mansoni </li></ul><ul><li>MOT skin entry (cercaria) travel in to the blood stream where they will infiltrate the liver, from liver to intestines </li></ul>
    101. 107. Schistosomias, Snail Fever, Takayama <ul><li>Cycle: Egg-larvae (miracidium)-intermediary host (oncomelania quadrasi-tiny snail)-cercaria </li></ul><ul><li>Itchiness at the site </li></ul><ul><li>RUQ pain (hepatomegaly) </li></ul><ul><li>Intestine infiltration-abd’l cramps, diarrhea with blood </li></ul><ul><li>Praziquantel </li></ul><ul><li>Dx COPT (stool exam) </li></ul>
    102. 108. Schistosomiasis KEY POINTS! <ul><li>Egg– miracidium– snail– cercaria- human </li></ul><ul><li>Itchiness – liver – intestines </li></ul><ul><li>Praziquantel </li></ul><ul><li>COPT </li></ul><ul><li>PREVENTION </li></ul><ul><li>Samar and Leyte </li></ul>
    103. 109. Mumps <ul><li>Mumps virus/filtrable virus </li></ul><ul><li>MOT = droplets and airborne </li></ul><ul><ul><li>HIGHLY CONTAGIOUS </li></ul></ul><ul><li>IP 12-16 days </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = MMR </li></ul></ul><ul><ul><li>Passive = mumps Ig </li></ul></ul><ul><ul><li>Natural = active =lifetime </li></ul></ul>
    104. 110. Mumps <ul><li>Unilateral or bilateral parotitis </li></ul><ul><ul><li>Ice collar </li></ul></ul><ul><li>Stimulating foods cause severe pain </li></ul><ul><li>Bilateral orchitis and oophoritis </li></ul><ul><ul><li>Active spermatogenesis </li></ul></ul><ul><ul><li>Sterility </li></ul></ul><ul><li>Steroids </li></ul><ul><li>Supporter </li></ul>
    105. 111. Respiratory System
    106. 112. Diphtheria <ul><li>Corynebacterium diphtheriae </li></ul><ul><li>Klebsloeffler’s bacillus (bacteria) </li></ul><ul><li>MOT = droplets and airborne </li></ul><ul><ul><li>HIGHLY CONTAGIOUS </li></ul></ul><ul><li>IP 2-5 days </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = DPT </li></ul></ul><ul><ul><li>Passive = DAT </li></ul></ul><ul><ul><li>Natural = xxx </li></ul></ul>
    107. 113. Diphtheria <ul><li>Dx = throat swab, MOLONEY, SCHICK </li></ul><ul><li>Pseudomembrane, Bullneck </li></ul><ul><li>Penicillin or erythromycin </li></ul><ul><li>Resp Acidosis with hypoxemia </li></ul><ul><li>Cx: myocarditis, septicemia </li></ul>
    108. 114. Diphtheria <ul><li>Nursing Considerations: </li></ul><ul><li>OBSERVE CNS, CARDIAC AND KIDNEY COMPLICATIONS </li></ul><ul><li>PSEUDOMEMBRANOUS MAY LEAD TO RESP. OBSTRUCTION </li></ul><ul><li>ISOLATION UNTIL 2 NEGATIVE CULTURE AT 24 HOUR INTERVAL </li></ul><ul><li>F&E RESUSCITATION </li></ul><ul><li>PARENTS OR SIBLINGS WHO HAVE NEVER IMMUNIZED SHOULD RECEIVE A DOSE OF DIPH. ANTI-TOXIN </li></ul><ul><li>ATTENTION TO NASOPHARYNGEAL DISCHARGE </li></ul><ul><li>ANTIBIOTICS-PENICILLIN, ERYTHROMYCIN IF ALLERGIC TO PENICILLIN </li></ul>
    109. 115. <ul><li>S/sx: sore throat, fever, “Bull-neck” (Pseudomembrane- gray exudate, foul breath, massive swelling of tonsils and uvula, thick speech, cervical lymphadenopathy, swelling of submandibular and anterior neck), obstruction of respiratory tract </li></ul><ul><li>Dx: Schick test - susceptibility to diphtheria toxin </li></ul><ul><li>Moloney - sensitivity to diphtheria toxoid </li></ul><ul><li>Throat swab (K tellurite and Loeffler’s coagulated blood serum) </li></ul><ul><li>Mgmt: Diphtheria antitoxin (Skin test), Penicillin,erythromycin, rifampicin, clindamycin </li></ul>
    110. 116. Diphtheria KEY POINTS! <ul><li>Highly contagious </li></ul><ul><li>Pseudomembrane and bullneck </li></ul><ul><li>Immunization best intervention PREVENTION </li></ul><ul><li>Obstruction and myocarditis </li></ul><ul><li>Isolation technique </li></ul>
    111. 117. Whooping Cough, Pertussis <ul><li>Bordetella pertussis (bacteria) </li></ul><ul><li>B. parapertussis </li></ul><ul><li>B. bronchiseptica </li></ul><ul><li>Hemophilus bacillus </li></ul><ul><li>MOT = droplets and airborne </li></ul><ul><ul><li>HIGHLY CONTAGIOUS </li></ul></ul><ul><li>IP 3-21 days </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = DPT </li></ul></ul><ul><ul><li>Passive = xxx </li></ul></ul><ul><ul><li>Natural = xxx </li></ul></ul>
    112. 118. Whooping Cough, Pertussis <ul><li>Manifestations: </li></ul><ul><li>CATARRHAL (HIGHLY CONTAGIOUS) </li></ul><ul><li>1-2 WEEKS, CORYZA, SNEEZING, DRY COUGH, FEVER, ANOREXIA </li></ul><ul><li>PAROXYSMAL </li></ul><ul><li>4-6 WEEKS, SEVERE VIOLENT COUGHING ATTACKS IN CLUSTERS, THAT ENDS IN WHOOP (NOISY SPASM OF INSPIRATION) RESULTING TO CYANOSIS, VOMITING, EXHAUSTION. </li></ul>
    113. 119. Whooping Cough, Pertussis <ul><li>Ferrous iodide to liquefy thicky secretions </li></ul><ul><li>Erythromycin or Ampicillin </li></ul><ul><li>Bordet gengao (agar for culture) </li></ul><ul><li>Catarrhal stage (highly contagious) </li></ul><ul><li>Clusters of cough that ends with a whoop </li></ul><ul><li>Prostration </li></ul>
    114. 120. PERTUSSIS key points! <ul><li>Highly contagious </li></ul><ul><li>Thick secretions </li></ul><ul><li>Cluster of cough </li></ul><ul><li>Extreme exhaustion </li></ul><ul><li>HYPOXIA </li></ul><ul><li>PREVENTION is still the BEST intervention </li></ul><ul><li>IMMUNIZATION </li></ul>
    115. 121. PTB, Koch’s Pulmonary <ul><li>Mycobacterium tubercle </li></ul><ul><li>Tubercle bacillus (bacteria) </li></ul><ul><li>MOT: Airborne/droplets </li></ul><ul><li>INCUBATION-DEPENDS ON HOST RESISTANCE </li></ul><ul><li>RISK FACTORS: DECREASED BODY RESISTANCE MALNUTRITION, POVERTY, OVERCROWDING, STEROID THERAPY, CHEMOTHERAPY </li></ul>
    116. 122. PTB <ul><li>Pathogenesis: </li></ul><ul><li>Transmission into the lungs </li></ul><ul><li>Immune response macrophage (bacilli) creating a lesion </li></ul><ul><li>Tubercle formation scar or spot </li></ul><ul><li>Dissemination </li></ul><ul><li>EPTB </li></ul>
    117. 126. PTB, Koch’s Pulmonary <ul><li>Manifestation: </li></ul><ul><li>EARLY WEIGHT LOSS, LISTLESSNESS, VAGUE CHEST PAIN, PLEURISY, ANOREXIA, FEVER, NIGHT SWEATS </li></ul><ul><li>LATE PULMONARY HEMORRHAGE, EXPECTORATION OF PURULENT SPUTUM, DYSPNEA, HEMOPTYSIS (CAVITARY SPREAD) </li></ul>
    118. 127. PTB <ul><li>Dx: </li></ul><ul><li>PPD-exposure </li></ul><ul><ul><li>0-4 mm (negative) </li></ul></ul><ul><ul><li>5 mm variable </li></ul></ul><ul><ul><li>> 10 mm (positive) </li></ul></ul><ul><li>Chest xray-cavitary lesion </li></ul><ul><li>Sputum-confirmatory </li></ul>
    119. 128. PTB <ul><li>MDT </li></ul><ul><ul><li>r-orange urine </li></ul></ul><ul><ul><li>i-neuritis and hepatitis </li></ul></ul><ul><ul><li>p-hyperuricemia </li></ul></ul><ul><ul><li>e-impairment of vision </li></ul></ul><ul><ul><li>s-8th cranial nerve damage </li></ul></ul>
    120. 129. PTB <ul><li>CGFNS and NCLEX </li></ul><ul><li>Usual Dose RIE – 9 months to 12 months 2-4 weeks non infectious </li></ul><ul><li>Drug Resistant Tuberculosis RIE+ (2 nd line drug) STREPTOMYCIN PYRAZINAMIDE CAPREOMYCIN PARA-AMINOSALICYLIC ACID CYCLOSERINE </li></ul>
    121. 130. PTB <ul><li>2 weeks after medications – non communicable </li></ul><ul><li>3 successive negative sputum-non communicable </li></ul><ul><li>rifampicin-prophylactic </li></ul>
    122. 131. PTB <ul><li>category I (new PTB (+) sputum) </li></ul><ul><li>category II (relapsed) </li></ul><ul><li>category III (PTB case (-) sputum) </li></ul><ul><li>short course – 6-9 months </li></ul><ul><li>long course – 9-12 months </li></ul><ul><li>DOTS- direct observe treatment short course </li></ul><ul><ul><li>Case finding </li></ul></ul><ul><ul><li>Home meds (members of the family) </li></ul></ul><ul><ul><li>Referrals </li></ul></ul><ul><ul><li>Follow-up </li></ul></ul>
    123. 132. <ul><li>TREATMENT: </li></ul><ul><li>CATEGORY 1 NEW PTB, (+) SPUTUM GIVE RIPE 2 MONTHS, MAINTENANCE OF RI 4 MONTHS </li></ul><ul><li>CATEGORY 2 PREVIOUSLY TREATED WITH RELAPSES GIVE RIPES 1ST 2 MONTHS, REPS 1 MONTH, MAINTENANCE RIE 5 MONTHS </li></ul><ul><li>CATEGORY 3 NEW PTB (-) SPUTUM FOR 3X GIVE RIP 2 MONTHS, MAINTENACE RI 2 MONTHS </li></ul>
    124. 133. Pneumonia <ul><li>Typical </li></ul><ul><ul><li>Community Acquired </li></ul></ul><ul><li>Streptococcus pneumoniae </li></ul><ul><ul><li>Hospital Acquired </li></ul></ul><ul><li>Staphylococcus aureus, Pseudomonas aeruginosa </li></ul><ul><ul><li>Elderly </li></ul></ul><ul><li>Hemophilus influenzae type B </li></ul>
    125. 134. Pneumonia <ul><li>Atypical </li></ul><ul><ul><li>Pneumocystis carinii (fungal) </li></ul></ul><ul><ul><li>Aspergillosis (fungal) Azole, </li></ul></ul><ul><ul><li>SARS </li></ul></ul>
    126. 135. Pneumonia <ul><li>s/sx chest pain, fever with chills, </li></ul><ul><li>Dx: </li></ul><ul><ul><li>C&S and XRAY </li></ul></ul><ul><ul><li>Productive cough pneumococcal – purulent, rusty sputum staphylococcal – yellow, blood streaked klebsiella species – red, gelatinous sputum mycoplasmal – non productive, mucoid sputum </li></ul></ul><ul><ul><li>ABG </li></ul></ul><ul><ul><li>Pulse Oximetry </li></ul></ul>
    127. 136. Pneumonia <ul><li>CARI-health teachings </li></ul><ul><li>Watchout for complications </li></ul><ul><li>Respiratory distress </li></ul><ul><li>In 24 hours death will occur RESPIRATORY SUPPORT! </li></ul>
    128. 137. Pneumonia <ul><li>Cx: </li></ul><ul><ul><li>pleural effusion </li></ul></ul><ul><ul><li>Empyema </li></ul></ul><ul><ul><li>consolidation Diminished Lung Sound: egophony CHANGE IN VOICE bronchophony CLARITY OF VOICE whispered pectoriloquy AUSCULTATE </li></ul></ul>
    129. 138. Severe Acute Respiratory Syndrome <ul><li>Coronavirus </li></ul><ul><li>Severe acute respiratory syndrome </li></ul><ul><li>IP: 2-7 days </li></ul><ul><li>MOT: respiratory droplet/person to person contact </li></ul><ul><li>Risk Factors: </li></ul><ul><ul><li>History of recent travel to </li></ul></ul><ul><ul><ul><li>China </li></ul></ul></ul><ul><ul><ul><li>Hong Kong </li></ul></ul></ul><ul><ul><ul><li>Taiwan </li></ul></ul></ul><ul><ul><li>Close contact </li></ul></ul><ul><ul><ul><li>w/ ill persons </li></ul></ul></ul><ul><ul><ul><li>with a hx of recent travel to such areas </li></ul></ul></ul><ul><ul><li>Health workers </li></ul></ul>
    130. 139. SARS <ul><li>Dx: sputum C&S CLINICAL </li></ul><ul><li>MANIFESTATIONS: </li></ul><ul><ul><li>FEVER-38 C AND ABOVE CONTINUOUS FOR 7-10 DAYS </li></ul></ul><ul><ul><li>CHILLS HEADACHE, GENERAL FEELING OF DISCOMFORT, BODY ACHES, DRY PRODUCTIVE COUGH WITH HYPOXEMIA (RESP. ACIDOSIS) </li></ul></ul><ul><ul><li>DYSPNEA RELATED TO LOSS OF AERATING SURFACE </li></ul></ul>
    131. 140. SARS <ul><li>NURSING CONSIDERATIONS: </li></ul><ul><ul><li>NO SPECIFIC TREATMENT </li></ul></ul><ul><ul><li>ANTIVIRAL AGENT-OSELTAMIVIR OR RIBAVIRIN </li></ul></ul><ul><ul><li>CLOSE SUPERVISION/OBSERVATION </li></ul></ul><ul><ul><li>PROPHYLACTIC ANTIBIOTIC </li></ul></ul><ul><ul><li>AVOID INFECTED AREAS IDENTIFIED BY WHO (HONGKONG, GUANDONG, SHANXI, CHINA, HANOI, VIETNAM, TORONTO, CANADA, SINGAPORE) </li></ul></ul>
    132. 141. SARS <ul><li>NURSING CONSIDERATIONS: </li></ul><ul><ul><li>SEEK IMMEDIATE MEDICAL ATTENTION IF YOU SUSPECT SARS </li></ul></ul><ul><ul><li>WEAR FACE MASK N95, BRA MASK (HONGKONG), </li></ul></ul><ul><ul><li>DON’T GO TO WORK OR SCHOOL </li></ul></ul><ul><ul><li>OBSERVE PERSONAL HYGIENE </li></ul></ul><ul><ul><li>HANDWASHING (5 MINUTES) </li></ul></ul><ul><ul><li>BUILD UP BODY RESISTANCE (PROPER DIET) </li></ul></ul><ul><ul><li>DIET (HIGH IN CHON, CHO, VIT C, D , E , A, MINERAL ZINC (INCREASE BODY RESISTANCE) </li></ul></ul>
    133. 142. BLOOD BORNE DISEASES
    134. 143. Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Acute Febrile Disease </li></ul><ul><li>CAUSATIVE AGENT-FILTRABLE VIRUS </li></ul><ul><ul><li>DENGUE VIRUS TYPE 1,2,3,4, </li></ul></ul><ul><ul><li>CHIKUNGUNYA VIRUS </li></ul></ul><ul><li>MOT (Mode of Transmission) bite from: </li></ul><ul><ul><li>Aedes aegypti </li></ul></ul><ul><ul><li>Aedes albopictus </li></ul></ul><ul><ul><li>Culex fatigans </li></ul></ul><ul><li>IP (Incubation Period) 1 week </li></ul>
    135. 144. Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Hyperpyrexia without focal of infection </li></ul><ul><li>TRIAD: fever, rashes and muscle pain </li></ul><ul><li>Bleeding to hypovolemic shock </li></ul><ul><li>ASA (Aspirin) is contraindicated </li></ul><ul><li>Watchout for bleeding </li></ul><ul><li>PLATELET is being attack </li></ul>
    136. 145. Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Dx: </li></ul><ul><ul><li>ACUTE FEBRILE ILLNESS WITH NO IDENTIFIABLE FOCUS OF INFECTION </li></ul></ul><ul><ul><li>Internal and external sign of bleeding </li></ul></ul><ul><ul><li>Torniquet Test or Rumpel Lead Test </li></ul></ul><ul><ul><li>Platelet count </li></ul></ul><ul><ul><li>PT (Prothrombin Time) </li></ul></ul><ul><ul><li>APTT (Activated Partial Thromboplastin Time) </li></ul></ul><ul><ul><li>Bleeding time </li></ul></ul><ul><ul><li>Coagulation time </li></ul></ul>
    137. 146. <ul><li>TRIAD (FEVER, RASH, SEVERE HEADACHE/BACKACHE/MYALGIA) </li></ul><ul><li>1ST STAGE, FIRST 4 DAYS HIGH FEVER, ABDOMINAL PAIN, HEADACHE, FLUSHING, VOMITING, EPISTAXIS </li></ul><ul><li>2ND STAGE, 4-7 DAYS TOXIC OR HEMORRHAGIC STAGE LOWERING OF BODY TEMP., SEVERE ABDOMINAL PAIN, VOMITING, GIT BLEEDING-HEMATEMESIS, MELENA, NARROW BP, SHOCK </li></ul><ul><li>3RD STAGE, 7-10 DAYS </li></ul><ul><li>CONVALESCENT OR RECOVERY STAGE SIGN OF PLASMA LEAKAGE PLEURAL EFFUSION, ASCITES, HYPOPROTEINEMIA HERMAN’S SIGN </li></ul>
    138. 147. <ul><li>GRADE 1 (+) TORNIQUET TEST, NO BLEEDING </li></ul><ul><li>GRADE 2 SPONTANEOUS BLEEDING, (+) GRADE 1 </li></ul><ul><li>GRADE 3 CIRCULATORY FAILURE,,DECREASED BP, RAPID WEAK PULSE, NARROWING OF PULSE PRESSURE, COLD CLAMMY SKIN, RESTLESSNESS </li></ul><ul><li>GRADE 4 PROFOUND SHOCK, UNDETECTABLE BP AND PULSE </li></ul>
    139. 148. Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Nursing Considerations </li></ul><ul><li>ANY CONDITION ASSOCIATED WITH BLEEDING IS ENOUGH CAUSE FOR ALARM </li></ul><ul><li>FOR FEVER DON’T GIVE ASA </li></ul><ul><li>RAPID REPLACEMENTS OF FLUIDS IS THE MOST IMPORTANT TREATMENT </li></ul><ul><li>GIVE ORESOL/HYDRITE </li></ul><ul><li>VIT C TO PROMOTE CAPILLARY INTEGRITY </li></ul>
    140. 149. Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease <ul><li>Nursing Considerations </li></ul><ul><li>BLOOD TRANSFUSION </li></ul><ul><ul><li>IV CRYSTALLOIDS (PLAIN LRS, PLAIN 0.9 NSS) </li></ul></ul><ul><ul><li>DEXTRAN (COLLOIDS) </li></ul></ul><ul><ul><li>PLATELETS </li></ul></ul><ul><ul><li>FRESH FROZEN PLASMA </li></ul></ul><ul><ul><li>CRYOPRECIPITATE </li></ul></ul><ul><ul><li>WHOLE BLOOD </li></ul></ul><ul><li>NO KNOWN IMMUNIZATION (VACCINE CURRENTLY UNDERWAY) </li></ul>
    141. 150. Dengue KEY POINTS <ul><li>Day biting aedes aegypti, stagnant </li></ul><ul><li>Fever with no focal of infection </li></ul><ul><li>Bleeding is imminent when fever subsides </li></ul><ul><li>Fluid replacement </li></ul><ul><li>BT </li></ul><ul><li>platelets </li></ul>
    142. 151. Malaria, King of Tropical Disease <ul><li>Protozoan plasmodium </li></ul><ul><ul><li>plasmodium ovale - dormant (liver) </li></ul></ul><ul><ul><li>plasmodium vivax - benign </li></ul></ul><ul><ul><li>plasmodium malariae - mild but resistant </li></ul></ul><ul><ul><li>plasmodium falciparum - malignant (cerebral malaria) </li></ul></ul><ul><li>P. VIVAX AND OVALE MAY HAVE RECCURENCE OF SYMPTOMS </li></ul><ul><ul><li>tertian-febrile paroxysm q24H-48H </li></ul></ul><ul><ul><li>quartan-febrile paroxysm q48H-72H </li></ul></ul>
    143. 152. Malaria, King of Tropical Disease <ul><li>MOT </li></ul><ul><ul><li>Bite from infected anopheles mosquito or minimus flavire (night biting) </li></ul></ul><ul><ul><li>Blood Transfusion </li></ul></ul><ul><ul><li>Sexual cycle </li></ul></ul><ul><ul><ul><li>sporogony (mosquito) </li></ul></ul></ul><ul><ul><ul><li>gametes is the infective stage </li></ul></ul></ul><ul><ul><li>Asexual cycle </li></ul></ul><ul><ul><ul><li>schizogony (human) </li></ul></ul></ul><ul><li>IP (Incubation Period) 5-6 days </li></ul>
    144. 155. Malaria, King of Tropical Disease <ul><li>Nursing Considerations </li></ul><ul><li>Dx: </li></ul><ul><ul><li>blood extraction (extract blood at the height of fever) </li></ul></ul><ul><li>Fever, chills, profuse sweating-convulsion </li></ul><ul><li>Anemia and fluid and electrolytes imbalance, hepatomegaly, splenomegaly, rigor, headache and diarrhea. </li></ul><ul><li>Chloroquine and Primaquine drug of choice </li></ul><ul><li>Chloroquine for pregnant women </li></ul><ul><li>For resistant plasmodium-use chemo drug </li></ul><ul><li>RBC is being attack </li></ul>
    145. 156. Malaria, King of Tropical Disease <ul><li>Nursing Considerations </li></ul><ul><li>IV FLUIDS AND ELECTROLYTES </li></ul><ul><li>Blackwater Fever – hemolysis and hemoglobinuria </li></ul><ul><li>Sickle Cell Trait – provides natural resistance </li></ul><ul><li>DECREASE FLUIDS IN CEREBRAL EDEMA </li></ul><ul><li>ASSISTED VENTILATION IN PULMONARY EDEMA </li></ul><ul><li>DIALYSIS IN RENAL FAILURE </li></ul><ul><li>BT IN ANEMIA </li></ul>
    146. 157. Malaria, King of Tropical Disease <ul><li>TRAVELERS TO MALARIA ENDEMIC area SHOULD FOLLOW PREVENTIVE MEASURES- (CHEMOPROPHYLAXIS CHLOROQUINE MAY BE TAKEN 1 WEEK BEFORE ENTERING ENDEMIC AREA) </li></ul><ul><li>SOAKING OF MOSQUITO NET IN AN INSECTICIDE SOLUTION </li></ul><ul><li>BIO PONDS FOR FISH </li></ul><ul><li>ON STREAM CLEARING (TO EXPOSE THE BREEDING STREAM TO SUNLIGHT) </li></ul><ul><li>VECTORS PEAK BITING AT NIGHT 9PM-3AM </li></ul><ul><li>PLANTING OF NEEM TREE (REPELLENT EFFECT) </li></ul><ul><li>ZOOPROPHYLAXIS (DEVIATE MOSQUITO BITES FROM MAN TO ANIMALS) </li></ul><ul><li>INFECTED MOTHER CAN STILL CONTINUE BREAST FEEDING </li></ul>
    147. 158. MALARIA key points <ul><li>Night biting anopheles, running water </li></ul><ul><li>Falciparum – fatal </li></ul><ul><li>Ovale and vivax – exacerbate </li></ul><ul><li>Sporogony – sexual – mosquito </li></ul><ul><li>Schizogony – asexual – human </li></ul><ul><li>Chloroquine </li></ul><ul><li>Seizure, fluid and elec loss </li></ul><ul><li>Rbc and liver </li></ul>
    148. 159. Filariasis, Elephantiasis, Human Lymphatic Filariasis <ul><li>CAUSATIVE AGENT-NEMATODE PARASITE </li></ul><ul><ul><li>MICROFILARIAE OR FILARIAL WORMS </li></ul></ul><ul><ul><li>WUCHERERIA BRONCOFTI </li></ul></ul><ul><ul><li>BRUGIA MALAYI </li></ul></ul><ul><ul><li>BRUGIA TIMORI </li></ul></ul><ul><li>MOT </li></ul><ul><ul><li>Bite from aedes poecilius (night biting) </li></ul></ul><ul><ul><li>Invade the lymph vessel, obstructing the lymphatic channel-leads to edema and may infiltrate the reproductive organs. </li></ul></ul><ul><li>IP 8-16 months </li></ul>
    149. 160. <ul><li>CLINICAL MANIFESTATIONS: </li></ul><ul><li>ASYMPTOMATIC STAGE </li></ul><ul><ul><li>(+) MICROFILARIAE IN THE BLOOD </li></ul></ul><ul><ul><li>NO CLINICAL S/SX </li></ul></ul><ul><li>ACUTE STAGE </li></ul><ul><ul><li>LYMPHADENITIS (LYMPH NODES) </li></ul></ul><ul><ul><li>LYMPHANGITIS (LYMPH VESSELS) </li></ul></ul><ul><ul><li>GENETALIA-FUNICULITIS, EPIDYDIMITIS, ORCHITIS </li></ul></ul><ul><li>CHRONIC STAGE </li></ul><ul><ul><li>HYDROCOELE </li></ul></ul><ul><ul><li>LYMPHEDEMA (UPPER AND LOWER EXTREMITIES) </li></ul></ul><ul><ul><li>ELEPHANTIASIS </li></ul></ul>
    150. 161. Filariasis, Elephantiasis, Human Lymphatic Filariasis
    151. 162. Filariasis, Elephantiasis, Human Lymphatic Filariasis <ul><li>INCIDENCE-REGION 5,8,11 AND CARAGA, MARINDUQUE, SARANGGANI </li></ul><ul><li>Drug: Diethyl Carbamazine Citrate or Hetrazan 6mg/KgBW one dose every year </li></ul><ul><li>Dx: </li></ul><ul><ul><li>NBE nocturnal blood exam (night) </li></ul></ul><ul><ul><li>ICT immunochromatographic test (day) </li></ul></ul>
    152. 163. Nursing Considerations <ul><li>MASS TREATMENT-DOSE IS 6mg/KBW, SINGLE DOSE PER YEAR. </li></ul><ul><li>ENVIRONMENTAL SANITATION </li></ul><ul><li>PERSONAL HYGIENE </li></ul><ul><li>MOSQUITO NETS </li></ul><ul><li>LONG SLEEVES, LONG PANTS AND SOCKS </li></ul><ul><li>INSECT REPELLENT </li></ul><ul><li>SCREENING OF HOUSES </li></ul><ul><li>HEALTH EDUCATION </li></ul>
    153. 164. Filariasis KEY POINTS <ul><li>Night biting aedes poecilius, plants </li></ul><ul><li>Chronic, lymphedema </li></ul><ul><li>HETRAZAN </li></ul><ul><li>ICT and NBE </li></ul><ul><li>Lymphatic vessel obstruction </li></ul>
    154. 165. Leptospirosis, Weil’s Disease (Zoonotic) <ul><li>Spirochete-leptospira interrogans </li></ul><ul><li>IP 5-6 days </li></ul><ul><li>MOT (Mode of Transmission) </li></ul><ul><li>Skin penetration = flood </li></ul><ul><li>INGESTION OF CONTAMINATED FOOD </li></ul><ul><li>SKIN, MUCUS MEMBRANE, ABRADED SKIN, CONJUNCTIVA </li></ul><ul><li>INHALATION </li></ul><ul><li>AFTER PENETRATION LEPTOSPIRES ENTER THE BLOOD STREAM AND ARE CARRIED TO ALL PARTS OF THE BODY INCLUDING </li></ul><ul><ul><li>Liver, kidneys and CSF </li></ul></ul>
    155. 166. Leptospirosis, Weil’s Disease (Zoonotic) <ul><li>Dx: </li></ul><ul><ul><li>CULTURE OF MICROORGANISMS </li></ul></ul><ul><ul><li>BLOOD AND CSF EXAMINATION (FIRST WEEK) </li></ul></ul><ul><ul><li>URINE EXAM- AFTER 10 DAYS </li></ul></ul><ul><ul><li>MICROSCOPIC AGGLUTINATION TEST (MAT) A RISE IN ANTIBODY TITER </li></ul></ul>
    156. 167. CLINICAL MANIFESTATIONS <ul><li>EARLY = fever and headache </li></ul><ul><li>LEPTOSPIREMIC PHASE = vasculitis </li></ul><ul><ul><li>HEPATITIS, JAUNDICE, SKIN HEMORRHAGE, FEVER, CHILLS, RENAL FAILURE, MENINGITIS WITH MENTAL STATUS CHANGE, MUSCULAR PAIN, NAUSEA AND VOMITING, COUGH AND CHEST PAIN </li></ul></ul><ul><li>IMMUNE PHASE </li></ul><ul><ul><li>APPEARANCE OF CIRCULATING IgM </li></ul></ul>
    157. 168. NURSING CONSIDERATIONS <ul><li>PENICILLIN OR DOXYCYCLINE (IMMEDIATELY) </li></ul><ul><li>ERYTHROMYCIN IF ALLERGIC TO PENICILLIN </li></ul><ul><li>FLUID AND ELECTROLYTE BALANCE </li></ul><ul><li>ENSURE ADEQUATE RENAL PERFUSION TO PREVENT ARF </li></ul><ul><li>IF AZOTEMIA IS SEVERE OR PROLONGED (CONSIDER DIALYSIS) </li></ul><ul><li>DISEASE IS USUALLY SHORT LIVED AND MILD BUT SEVERE INFECTION CAN DAMAGE KIDNEYS, LIVER, CNS AND RESPIRATORY SYSTEM </li></ul><ul><li>MOST SERIOUS FORM IS CALLED WEIL’S DISEASE </li></ul><ul><li>PRIMARILY A DISEASE OF DOMESTICATED AND WILD ANIMALS </li></ul>
    158. 169. PREVENTION AND CONTROL <ul><li>AVOIDANCE OF EXPOSURE TO URINE AND TISSUES FROM INFECTED ANIMALS (FLOOD) </li></ul><ul><li>RODENT CONTROL </li></ul><ul><li>VACCINATION OF ANIMALS </li></ul><ul><li>HYGIENIC CONDITIONS IN SLAUGHTERHOUSES, FARM YARD BUILDINGS AND BATHING POOLS </li></ul><ul><li>USE OF PROTECTIVE CLOTHING AND BOOTS </li></ul><ul><li>CHEMOPROPHYLAXIS (DOXYCYCLINE 200 mg PO ONCE A WEEK </li></ul><ul><li>SUPPORTIVE MANAGEMENT </li></ul><ul><li>ALL PATIENT SUSPECTED TO HAVE LEPTO, MILD OR SEVERE SHOULD BE ADMITTED </li></ul>
    159. 170. LEPTOSPIROSIS key points <ul><li>Spirochette, rat, urine and feces </li></ul><ul><li>Skin penetration, ingestion </li></ul><ul><li>Fever and headache </li></ul><ul><li>Liver, kidneys and CSF </li></ul><ul><li>Doxycycline </li></ul>
    160. 171. ERUPTIVE FEVER
    161. 172. Measles, Rubeola, 7 Day Fever, Hard Red Measle <ul><li>Paramyxo virus </li></ul><ul><li>MOT = droplets and airborne </li></ul><ul><ul><li>PC 4 days before and 5 days after rash </li></ul></ul><ul><ul><li>HIGHLY CONTAGIOUS </li></ul></ul><ul><li>IP 7-14 days </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = measles vaccine, MMR </li></ul></ul><ul><ul><li>Passive = measles Ig </li></ul></ul><ul><ul><li>Natural = lifetime </li></ul></ul>
    162. 173. Measles, Rubeola, 7 Day Fever, Hard Red Measle <ul><li>Rashes: </li></ul><ul><li>Maculopapular </li></ul><ul><li>Cephalocaudal </li></ul><ul><li>With desquamation </li></ul><ul><li>Pruritus </li></ul>
    163. 174. Measles, Rubeola, 7 Day Fever, Hard Red Measle <ul><li>Rashes: maculopapaular, cephalocaudal (hairline and behind the ears to trunk and limbs), confluent, desquamation, pruritus </li></ul>
    164. 175. <ul><li>PS koplik’s spot </li></ul><ul><li>Characteristic: stimsons, photophobia (typical complaint) </li></ul><ul><li>Fever: high fever </li></ul><ul><li>CX pneumonia, meningitis </li></ul>
    165. 176. German Measles, Rubella, Rotheln Disease, 3 Day Measles <ul><li>RNA rubella virus </li></ul><ul><li>MOT = droplets and airborne </li></ul><ul><ul><li>PC 5 days before and 5 days after rash </li></ul></ul><ul><ul><li>HIGHLY CONTAGIOUS </li></ul></ul><ul><li>IP = 10-21 days </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = MMR </li></ul></ul><ul><ul><li>Passive = rubella Ig </li></ul></ul><ul><ul><li>Natural = lifetime </li></ul></ul>
    166. 177. German Measles, Rubella, Rotheln Disease, 3 Day Measles <ul><li>Rashes: </li></ul><ul><li>Maculopapular </li></ul><ul><li>Diffuse </li></ul><ul><li>No desquamation </li></ul>
    167. 178. German Measles, Rubella, Rotheln Disease, 3 Day Measles <ul><li>Rashes: Maculopapular, Diffuse/not confluent, No desquamation, spreads from the face downwards </li></ul>
    168. 179. <ul><li>PS forschheimer’s </li></ul><ul><li>Characteristic: cervical lymphadenopathy </li></ul><ul><li>Fever: low grade fever </li></ul><ul><li>CX rare </li></ul><ul><li>CX to pregnant women: </li></ul><ul><li>1st tri-congenital anomalies </li></ul><ul><li>2nd tri-abortion </li></ul><ul><li>3rd tri-pre mature delivery </li></ul>
    169. 180. Chicken Pox, Varicella <ul><li>Herpes Zoster Virus </li></ul><ul><li>Varicella Zoster Virus </li></ul><ul><li>MOT = droplets and airborne </li></ul><ul><ul><li>PC one day before rash and 6 days after first crop of vesicles </li></ul></ul><ul><ul><li>HIGHLY CONTAGIOUS </li></ul></ul><ul><li>IP 14-21 days </li></ul><ul><li>IMMUNITY </li></ul><ul><ul><li>Active = varicella vaccine </li></ul></ul><ul><ul><li>Passive = xxx </li></ul></ul><ul><ul><li>Natural = lifetime </li></ul></ul>
    170. 182. Chicken Pox, Varicella <ul><li>Rashes: Maculopapulovesicular (covered areas), Centrifugal, starts on face and trunk and spreads to entire body </li></ul><ul><li>Leaves a pitted scar (pockmark) </li></ul>
    171. 183. Chicken Pox, Varicella <ul><li>Dx = Tzanck smear (scraping of ulcer for staining) </li></ul><ul><li>Rashes: </li></ul><ul><ul><li>Maculopapulovesicular (covered areas) </li></ul></ul><ul><ul><li>Centrifugal </li></ul></ul><ul><ul><li>Leaves a pitted scar (pockmark) </li></ul></ul><ul><li>CX furunculosis, erysipelas, meningoencephalitis </li></ul><ul><li>Dormant: remain at the dorsal root ganglion and may recur as shingles </li></ul>
    172. 184. Small Pox, Variola <ul><li>Pox virus </li></ul><ul><li>MOT = droplets and airborne </li></ul><ul><ul><li>PC until all crust disappear </li></ul></ul><ul><ul><li>HIGHLY CONTAGIOUS </li></ul></ul><ul><li>IP 1-3 weeks </li></ul><ul><li>ERADICATED </li></ul><ul><li>BIOLOGIC WEAPON </li></ul>
    173. 186. Small Pox, Variola <ul><li>Rashes </li></ul><ul><ul><li>Maculopapulovesiculopustular </li></ul></ul><ul><ul><li>Centripetal </li></ul></ul><ul><li>CX same with chicken pox </li></ul><ul><li>Differential Dx </li></ul><ul><li>Paul’s test - instilling of vesicular fluid of small pox into the cornea if keratitis develops its small pox </li></ul>
    174. 187. CONTACT
    175. 188. Pediculosis <ul><li>Blood sucking lice </li></ul><ul><li>Pediculus humanus </li></ul><ul><li>p. capitis-scalp </li></ul><ul><li>p. palpebrarum-eyelids and eyelashes </li></ul><ul><li>p. pubis-pubic hair </li></ul><ul><li>p. corporis-body </li></ul><ul><li>Drugs: Lindane (Kwell) topical </li></ul><ul><li>Permethrin (Nix) topical </li></ul><ul><li>CX impetigo to AGN, RHD, SLE </li></ul><ul><li>MOT skin contact </li></ul>
    176. 191. Scabies <ul><li>Sarcoptes scabie </li></ul><ul><li>Pruritus (excreta of mites) </li></ul><ul><li>Mites come-out from burrows to mate at night </li></ul><ul><li>Drugs: Permethrin (Nix) cream </li></ul><ul><li>Sulfur soap </li></ul><ul><li>Linens: wash with hot water </li></ul><ul><li>MOT skin contact </li></ul>
    177. 193. Conjunctivitis <ul><li>Children </li></ul><ul><li>Viral-hygiene and rest </li></ul><ul><li>Bacterial-yellow, green or white pus, photophobia-antibiotic eyedrops or ointment </li></ul><ul><li>Chlamydial –cough, history of maternal infection-antibiotic </li></ul><ul><li>Herpetic-pain, photophobia, skin lesions-antiviral agents </li></ul><ul><li>Allergic-itching, watery discharge-antihistamine </li></ul><ul><li>S/Sx </li></ul><ul><li>From mild pruritus to severe drainage, burning, hyperemia and chemosis (edema) </li></ul><ul><li>Pink eye-infectious conjunctivitis </li></ul><ul><li>MOT direct contact with eye secretions </li></ul>
    178. 194. STD
    179. 195. Gonorrhea (bacteria) <ul><li>Neisseria gonorrheae (gram positive) </li></ul><ul><li>IP 3 -7 days </li></ul><ul><li>Asymptomatic in women </li></ul><ul><li>Mucopurulent discharge </li></ul><ul><li>Painful urination </li></ul><ul><li>DX: </li></ul><ul><li>gram stain of cervical secretions </li></ul><ul><li>Drugs: single dose only </li></ul><ul><li>Ceftriaxone (Rocephin) 125 mg IM </li></ul><ul><li>Ofloxacin (Floxin) 400 mg orally </li></ul><ul><li>CX: </li></ul><ul><li>PID, ectopic pregnancy and infertility </li></ul><ul><li>Ophthalmia neonatorum and sepsis (infant) vaginal birth </li></ul>
    180. 197. Syphilis (bacteria) <ul><li>Treponema pallidum (spirochete) </li></ul><ul><li>IP 10-90 days </li></ul><ul><li>Painless, clean chancre </li></ul><ul><li>DX: </li></ul><ul><li>Non specific VDRL </li></ul><ul><li>Confirmed by-antitreponemal antibody tests </li></ul><ul><li>Dark-field examination of lesion </li></ul>
    181. 198. Primary – painless chancre Secondary – generalized rash Tertiary - gumma
    182. 199. Syphilis (bacteria) <ul><li>Primary-chancre-most infectious </li></ul><ul><li>Secondary-generalized macular papular rash including palms and soles (condylomata lata) </li></ul><ul><li>Tertiary-neurosyphilis-permanent damage (insanity) (gumma) </li></ul><ul><li>Drugs: </li></ul><ul><li>Primary and secondary </li></ul><ul><li>Pen G </li></ul><ul><li>Tertiary </li></ul><ul><li>IV Pen G </li></ul>
    183. 200. Chlamydia (bacteria) <ul><li>Chlamydia trachomatis </li></ul><ul><li>IP 2-10 days </li></ul><ul><li>Maybe asymptomatic </li></ul><ul><li>Gray white discharge </li></ul><ul><li>Burning and itchiness at the urethral opening </li></ul><ul><li>DX: </li></ul><ul><li>Antigen detection test on cervical smear </li></ul><ul><li>Urinalysis </li></ul>
    184. 201. Chlamydia (bacteria)
    185. 202. Chlamydia (bacteria) <ul><li>Drugs: </li></ul><ul><li>Azithromycin (Zithromax) 1 g orally one dose </li></ul><ul><li>Erythromycin and Ofloxacin </li></ul><ul><li>CX: </li></ul><ul><li>PID </li></ul><ul><li>Ectopic pregnancy </li></ul><ul><li>Fetus transmittal (vaginal birth) </li></ul>
    186. 203. Herpes Genitalis (virus) <ul><li>HSV 2 </li></ul><ul><li>Painful sexual intercourse </li></ul><ul><li>Painful lesion (cervix, vagina, perineum, glans penis) </li></ul><ul><li>DX: </li></ul><ul><li>Viral culture </li></ul><ul><li>Pap smear (shows cellular changes) </li></ul><ul><li>Tzanck smear (scraping of ulcer for staining) </li></ul><ul><li>Drugs: </li></ul><ul><li>Anti viral-acyclovir (zovirax) </li></ul><ul><li>CX: </li></ul><ul><li>Meningitis </li></ul><ul><li>Neonatal infection (vaginal birth) </li></ul>
    187. 204. Genital Warts, Condyloma Acuminatum (virus) <ul><li>HPV type 6 & 11, papilloma virus </li></ul><ul><li>Single or multiple soft, fleshy painless growth of the vulva, vagina, cervix, urethra, or anal area </li></ul><ul><li>Vaginal bleeding, discharge, odor and dyspareunia </li></ul><ul><li>DX: </li></ul><ul><li>Pap smear-shows cellular changes (koilocytosis) </li></ul><ul><li>Acetic acid swabbing (will whiten lesion) </li></ul><ul><li>Management: </li></ul><ul><li>Laser treatment is more effective </li></ul><ul><li>CX: </li></ul><ul><li>Neoplasia </li></ul><ul><li>Neonatal laryngeal papillomatosis (vaginal birth) </li></ul>
    188. 205. Genital Warts, Condyloma Acuminatum (virus) <ul><li>Mgmt: </li></ul><ul><li>Laser treatment is more effective </li></ul><ul><li>CX: </li></ul><ul><li>Neoplasia </li></ul><ul><li>Neonatal laryngeal papillomatosis (vaginal birth) </li></ul>
    189. 206. Candidiasis, Moniliasis <ul><li>Yeast or fungus </li></ul><ul><li>Cheesy white discharge </li></ul><ul><li>Extreme itchiness </li></ul><ul><li>DX: </li></ul><ul><li>KOH (wet smear indicate positive result) </li></ul><ul><li>Drugs: </li></ul><ul><li>Monistat </li></ul><ul><li>Diflucan </li></ul><ul><li>CX: </li></ul><ul><li>Oral thrush to baby (vaginal birth) </li></ul>
    190. 207. Trichomoniasis <ul><li>Parasite </li></ul><ul><li>Trichomona vaginalis </li></ul><ul><li>Yellow gray frothy vaginal discharge </li></ul><ul><li>Foul smelling </li></ul><ul><li>Drugs: Metronidazole (Flagyl) </li></ul><ul><li>CX: PROM </li></ul>
    191. 208. Prevention <ul><li>A abstinence </li></ul><ul><li>B be faithful </li></ul><ul><li>C condom </li></ul><ul><li>D do it yourself </li></ul><ul><li>“ One stick one hole” </li></ul><ul><li>Both partners must be treated </li></ul>
    192. 209. <ul><li>TORCHS </li></ul><ul><li>T toxoplasmosis </li></ul><ul><li>O others Papilloma virus - STD Gonorrhea - STD Varicella zoster – chicken pox Hepa B HIV Measles Mumps </li></ul><ul><li>R rubella </li></ul><ul><li>C cytomegalovirus – hemolytic anemia, hydro/microcephalus </li></ul><ul><li>H herpes genitalis - STD </li></ul><ul><li>S syphilis - STD </li></ul>
    193. 210. HIV
    194. 211. HIV and AIDS <ul><li>Retrovirus (HIV1 & HIV2) </li></ul><ul><li>Attacks and kills CD4+ lymphocytes (T-helper) </li></ul><ul><li>Capable of replicating the lymphocytes undetected by the immune system </li></ul><ul><li>Immunity declines and opportunistic microbes sets in </li></ul>
    195. 214. HIGH RISK GROUP <ul><li>Homosexual or bisexual </li></ul><ul><li>Intravenous drug users </li></ul><ul><li>BT recipients before 1985 </li></ul><ul><li>Sexual contact with HIV+ </li></ul><ul><li>Babies of mothers who are HIV+ </li></ul>
    196. 215. MOT <ul><li>Sexual intercourse (oral, vaginal and anal) </li></ul><ul><li>Exposure to contaminated blood, semen, breast milk and other body fluids </li></ul><ul><li>placenta </li></ul>
    197. 217. HIV TEST <ul><li>Elisa </li></ul><ul><li>Western Blot </li></ul><ul><li>Rapid hiv test </li></ul><ul><ul><li>Suds hiv-1 </li></ul></ul><ul><ul><li>Results are obtained in less than 10 minutes </li></ul></ul><ul><ul><li>Color indicator similar to pregnancy test </li></ul></ul><ul><ul><li>Positive result needs a confirmatory test </li></ul></ul>
    198. 218. How to Diagnose <ul><li>HIV+ 2 consecutive positive ELISA and 1 positive Western Blot Test </li></ul><ul><li>AIDS+ HIV+ CD4+ count below 500/ml Exhibits one or more of the ff: (next slide) </li></ul><ul><li>Full blown AIDS CD4 is less than 200/ml </li></ul>
    199. 219. <ul><li>Exhibits one or more of the ff: </li></ul><ul><li>Extreme fatigue </li></ul><ul><li>Intermittent fever </li></ul><ul><li>Night sweats </li></ul><ul><li>Chills </li></ul><ul><li>Lymphadenopathy </li></ul><ul><li>Enlarged spleen </li></ul><ul><li>Anorexia </li></ul><ul><li>Weight loss </li></ul><ul><li>Severe diarrhea </li></ul><ul><li>Apathy and depression </li></ul><ul><li>PTB </li></ul><ul><li>Kaposis sarcoma </li></ul><ul><li>Pneumocystis carinii </li></ul><ul><li>AIDS dementia </li></ul>
    200. 221. HIV CLASSIFICATION <ul><li>CATEGORY 1 – CD4+ 500 OR MORE </li></ul><ul><li>CATEGORY 2 – CD4+ 200-499 </li></ul><ul><li>CATEGORY 3 – CD4+ LESS THAN 200 </li></ul>
    201. 222. Management <ul><li>Prevention of spread (safe sex) </li></ul><ul><li>Universal precautions </li></ul><ul><li>Health Education </li></ul><ul><li>Symptomatic intervention </li></ul><ul><li>No known cure </li></ul><ul><li>Prevent CD4 reduction </li></ul>
    202. 223. DRUGS <ul><li>1. Nucleoside Reverse Transcriptase Inhibitors NRTI’s </li></ul><ul><ul><li>INTERFERES WITH DNA CHAIN </li></ul></ul><ul><li>Zidovudine (AZT) </li></ul><ul><li>SE – NEUROPATHY AND RASH </li></ul>
    203. 224. DRUGS <ul><ul><li>2. Non-nucleoside Reverse Transcriptase Inhibitors NNRTI’s </li></ul></ul><ul><ul><li>- BINDS TO REVERSE TRANSCRIPTASE AND BLOCKS RNA AND DNA REPLICATION </li></ul></ul><ul><li>Ritonavir (Norvir) </li></ul><ul><li>SE – RASH, HEPATOTOXICITY, BONE MARROW DEPRESSION </li></ul>
    204. 225. DRUGS <ul><li>3. Protease Inhibitors PI </li></ul><ul><li>BLOCK VIRUS ABILITY TO BREAK DOWN LARGER PROTEIN MOLECULES </li></ul><ul><li>Indinavir (Crixivan) </li></ul><ul><li>SE – HEPATOTOXICITY, NV, ABDOMINAL PAIN, RENAL CALCULI </li></ul>
    205. 226. Hepatitis
    206. 228. Types of Hepatitis <ul><li>Hepa A – fecal oral route </li></ul><ul><li>Hepa B – body fluids </li></ul><ul><li>Hepa C – non A non B, BT, body fluids </li></ul><ul><li>Hepa D – hypodermic, body fluids </li></ul><ul><li>Hepa E – fecal oral route, fatal and common among pregnant women </li></ul><ul><li>Hepa G – body fluids (HIV) </li></ul>
    207. 229. <ul><li>Hepatitis A </li></ul><ul><li>Hepa A virus </li></ul><ul><li>Infectious hepa </li></ul><ul><li>Fecal oral route </li></ul><ul><li>Short incubation (3-5 weeks) </li></ul><ul><li>Poor sanitation </li></ul><ul><li>Worldwide distribution </li></ul><ul><li>Spread from person-person </li></ul><ul><li>Food handlers, contaminated water </li></ul><ul><li>Mortality 1%, with full recovery </li></ul><ul><li>Enteric precautions </li></ul><ul><li>Active Immunity (Havrix) </li></ul><ul><li>Passive Immunity (HAIg) </li></ul><ul><li>(+) ANTI HAV – INFECTED </li></ul><ul><li>(+) Igm ANTI HAV – RECENT INFECTION (ANTIBODY) </li></ul>
    208. 230. <ul><li>Hepatitis B </li></ul><ul><li>Hepa B virus </li></ul><ul><li>Serum hepa </li></ul><ul><li>Blood recipients, hemodialysis, IV drug users, sexually active homosexual, tattoing and health care workers (high risk) </li></ul><ul><li>Blood and other body fluids route </li></ul><ul><li>Long incubation (2-5 months) </li></ul><ul><li>Worldwide distribution </li></ul><ul><li>Main cause of liver cirrhosis and liver cancer </li></ul><ul><li>(+) HBsAg indicates acute, chronic and carrier </li></ul><ul><li>Active Immunity (hevac-B) </li></ul><ul><li>Passive Immunity (HBIg) </li></ul><ul><li>85% full recovery, 15% lifetime carrier </li></ul>
    209. 231. <ul><li>DX </li></ul><ul><li>Elevated AST or SGPT (specific) and ALT or SGOT </li></ul><ul><li>Increased IgM during acute phase </li></ul><ul><li>HBsAg (+) or REACTIVE = INFECTED maybe acute, chronic or carrier </li></ul><ul><li>HBeAg (+) = highly infectious </li></ul><ul><li>HBcAg found only in the liver cells </li></ul><ul><li>Anti-HBc (+) = acute infection </li></ul><ul><li>Anti-HBe (+) = reduced infectiousness </li></ul><ul><li>Anti-HBs (+) = with antibodies (FROM vaccine or disease) </li></ul><ul><li>Blood Chem. Analysis (to monitor progression) </li></ul><ul><li>Liver biopsy (to detect progression to CA) </li></ul>
    210. 232. <ul><li>Manifestations: </li></ul><ul><li>Stage I pre-icteric for 1-21 days Anorexia, nausea and vomiting, LBM, weight loss RUQ pain, fatty food intolerance, fever, chills and headache </li></ul><ul><li>Satge II icteric for 2-6 weeks Jaundice, pruritus, weight gain, ascites, dark-tea colored urine (urobilirubin) ADEK deficiency </li></ul><ul><li>Stage III pre coma NH3 level increases with decreasing LOC Flapping tremors or asterixis </li></ul><ul><li>Stage IV recovery </li></ul>
    211. 233. jaundice
    212. 234. Manifestations <ul><li>CHO – fatigue </li></ul><ul><li>CHON – toxicity (latent phase) </li></ul><ul><li>Fats – bile, fat intolerance, ADEK </li></ul><ul><li>Bilirubin – jaundice, kernicterus (children) </li></ul><ul><li>Deamination – NH3 increases </li></ul><ul><li>Synthesis CHON – immunocompetent </li></ul><ul><li>Cirrhosis and Cancer - complications </li></ul>
    213. 235. <ul><li>Management: </li></ul><ul><li>Rest </li></ul><ul><li>Diet: - high CHON 75-100 g/day - high CHO – energy - low fat - high calorie 2,500-3,000 cal/day - increase vit A, E if there is steatorrhea </li></ul><ul><li>Bile sequestrants – to reduce pruritus Cholestryamine (Questran) </li></ul><ul><li>Avoid hepatotoxic drugs Acetaminophen, Sedatives, ASA </li></ul><ul><li>Give Antiviral and Interferon </li></ul>
    214. 236. Other diseases
    215. 237. Lyme disease <ul><li>Named for the Connecticut town, 1975 </li></ul><ul><li>Appears in summer or early fall </li></ul><ul><li>Spirochete, Borrelia burgdorferi </li></ul><ul><li>Carried by “deer ticks” </li></ul><ul><li>Pahogenesis: </li></ul><ul><li>Tick injects spirochete-laden saliva into the blood stream or deposits fecal matter on the skin </li></ul><ul><li>disseminate to other skin sites or travel into the blood stream and lymphatic system </li></ul>
    216. 238. <ul><li>s/sx: may take years to fully develop </li></ul><ul><li>*Skin lesion “erythema chronicum migrans” </li></ul><ul><li>Early localized (Stage 1) = lesion with bright red outer rim with white center, itchy, may sting or burn; fatigue, headache, chills, fever, sore throat and muscle joint pain </li></ul><ul><li>Early disseminated (Stage 2) = meningitis, extreme neck flexion and cranial nerve palsy, cardiac symptoms, brief attacks of arthritis </li></ul><ul><li>Late (Stage 3) = Chronic arthritis, Behavioral changes, depression and psychosis </li></ul><ul><li>Cardiac, neurologic, arthritis (complications) </li></ul>
    217. 239. Lyme disease <ul><li>Dx: – biopsy, antibody titer, ELISA, Western Blot </li></ul><ul><li>Mgmt: </li></ul><ul><li>symptomatic </li></ul><ul><li>14-28 day oral tetracycline or doxycycline </li></ul><ul><li>Children – oral Penicillin </li></ul><ul><li>Late stage: IV or IM antibiotics </li></ul><ul><li>Vaccine – Immulyme, Lymerix </li></ul>
    218. 240. Toxoplasmosis ZOONOTIC <ul><li>Toxoplasma gondii, parasite </li></ul><ul><li>Affects birds, mammals ie cats </li></ul><ul><li>Infected person may carry the organism for life (reactivation is possible) </li></ul><ul><li>Pathogenesis: </li></ul><ul><li>ingestion of cyst from uncooked meat / fecal oral route from infected cats (feces) </li></ul><ul><li>Quickly multiply in the GIT </li></ul><ul><li>Distributed to CNS, lymphatic tissue, skeletal muscle, myocardium, retina and placenta </li></ul>
    219. 241. <ul><li>S/sx: Toxoplasmosis </li></ul><ul><li>Malaise, fever, myalgia, headache, fatigue, sore throat, lymphadenopathy </li></ul><ul><li>Fulminant = vomiting, cough and dyspnea, hyperpyrexia, delirium and seizures, encephalopathy, meningitis </li></ul><ul><li>Infants = hydrocephalus and microcephalus, seizure, jaundice later strabismus, blindness, epilepsy, mental retardation </li></ul>
    220. 242. Toxoplasmosis <ul><li>Dx: serology, CT scan </li></ul><ul><li>Mgmt: </li></ul><ul><li>4-6 weeks of sulfonamide and pyrimethamine (take folic acid to counteract drug’s adverse effects) </li></ul>
    221. 243. <ul><li>TORCHS </li></ul><ul><li>T toxoplasmosis </li></ul><ul><li>O others Papilloma virus - STD Gonorrhea - STD Varicella zoster – chicken pox Hepa B HIV Measles Mumps </li></ul><ul><li>R rubella </li></ul><ul><li>C cytomegalovirus – hemolytic anemia, hydro/microcephalus </li></ul><ul><li>H herpes genitalis - STD </li></ul><ul><li>S syphilis - STD </li></ul>
    222. 244. Ebola ZOONOTIC <ul><li>Filoviruses, 1960 </li></ul><ul><li>Unknown reservoir </li></ul><ul><li>Viral replication takes place in almost all organs </li></ul><ul><li>90% mortality, recovery is often prolonged </li></ul><ul><li>BIOLOGICAL WEAPON </li></ul><ul><li>IP: 3-9 days </li></ul><ul><li>MOT: direct contact w/ blood, vomitus, urine, stool, semen </li></ul><ul><li>probably aerosol transfer during later stages </li></ul>
    223. 245. <ul><li>Ebola </li></ul><ul><li>S/sx: frontal and temporal headache, malaise, myalgia, nausea, vomiting, fever, conjunctivitis, watery diarrhea (3 rd day), lethargy, nonpruritic maculpapular rash, desaquammation, hemorrhagic manifestations (5 th day) </li></ul><ul><li>Dx: history </li></ul><ul><li>Symptomatic intervention </li></ul><ul><li>Report suspected EBOLA case </li></ul><ul><li>Health workers = advised to wear cap, goggles, mask, gown, gloves and shoe covers </li></ul>
    224. 246. Bird Flu ZOONOTIC <ul><li>Avian influenza, virus </li></ul><ul><li>Occur naturally among birds (intestines) </li></ul><ul><li>but some types very contagious among birds </li></ul><ul><li>Influenza A (H5N1) virus– deadly to birds and has caused human illness and death in Asia </li></ul><ul><li>Person to person transmission rare </li></ul>
    225. 247. Bird Flu <ul><li>MOT: </li></ul><ul><li>saliva, nasal secretions, and feces </li></ul><ul><li>direct contact with infected waterfowl or other infected poultry </li></ul><ul><li>contact with surfaces (such as dirt or cages) or materials (such as water or feed) contaminated with virus </li></ul>
    226. 248. <ul><li>Bird Flu </li></ul><ul><li>S/sx: Influenza-like symptoms </li></ul><ul><li>Fever, Cough, sore throat, </li></ul><ul><li>muscle aches, eye infections, </li></ul><ul><li>Pneumonia </li></ul><ul><li>Mgmt: </li></ul><ul><li>* resistant to amantadine and rimantadine – comon influenza drugs </li></ul><ul><li>* oseltamavir and zanamavir - under study </li></ul>
    227. 249. Foot and Mouth Disease ZOONOTIC <ul><li>Aphthovirus </li></ul><ul><li>Hosts - cattle, buffaloes, </li></ul><ul><li>sheep, goats, swine </li></ul><ul><li>IP: 2-4 days </li></ul><ul><li>MOT: contact w/ infected animals </li></ul><ul><li>Ingestion of unprocessed milk or dairy products from infected animals </li></ul><ul><ul><li>Humans act as transmitter to animals </li></ul></ul><ul><ul><li>Harbor virus in respiratory tract for 1-2 days </li></ul></ul><ul><ul><li>Contaminated boots, clothing, vehicles </li></ul></ul><ul><ul><li>Spread to susceptible animals </li></ul></ul>
    228. 250. <ul><li>Foot and Mouth Disease </li></ul><ul><li>s/sx: Very rarely develop mild clinical signs </li></ul><ul><li>malaise, fever, vomiting, red ulcerative lesions of oral tissues, vesicular lesions skin </li></ul><ul><li>Dx: Virus isolation or antibody identification required for diagnosis </li></ul><ul><li>Mgmt: supportive care </li></ul>
    229. 251. Infectious Mononucleosis <ul><li>3 hallmarks fever sore throat swollen cervical lymph nodes </li></ul><ul><li>(+) heterophil antibodies </li></ul><ul><li>No major complications </li></ul><ul><li>Self limiting </li></ul><ul><li>“ Kissing Disease” </li></ul><ul><li>Incubation period is 10-50 days </li></ul>
    230. 252. EBV <ul><li>Caused by EBV epstein-barr virus </li></ul><ul><li>Or cytomegalovirus </li></ul><ul><li>Lodges in the salivary glands </li></ul><ul><li>Spread via oropharyngeal route </li></ul><ul><li>Kissing (intimate) </li></ul><ul><li>Contagious before symptoms start until fever subsides </li></ul>
    231. 253. EBV <ul><li>Virus invades the B cells of lymphoid tissue </li></ul><ul><li>As the B cells die virus is released in the blood </li></ul><ul><li>Causing fever and other symptoms </li></ul><ul><li>Antiviral antibodies in the blood fights the virus </li></ul><ul><li>They disappear in the blood and lodges in to the salivary glands </li></ul>
    232. 254. EBV <ul><li>Diagnostic WBC count abnormally high (+) heterophil antibodies Indirect immunoflourescent (+) EBV (specific) </li></ul>
    233. 255. EBV <ul><li>Management </li></ul><ul><li>Symptomatic </li></ul><ul><li>ASA </li></ul><ul><li>Steroids </li></ul>
    234. 256. Gas Gangrene <ul><li>Clostridium perfringens welchii novyi </li></ul><ul><li>Deep wound (bronzed or blackened wound) </li></ul><ul><li>Necrosis of muscle tissue </li></ul><ul><li>Pain and Anemia </li></ul>
    235. 257. Gas Gangrene <ul><li>CS </li></ul><ul><li>Incision and Drainage </li></ul><ul><li>Debridement </li></ul><ul><li>Hyperbaric oxygenation </li></ul><ul><li>Amputation </li></ul><ul><li>SEPSIS </li></ul>
    236. 258. Anthrax (Zoonotic) <ul><li>Bacillus anthracis (gram negative) </li></ul><ul><li>Cattle, sheep, goat and pig </li></ul><ul><li>Biological weapons </li></ul>
    237. 259. <ul><li>Anthrax </li></ul><ul><li>Inhalation- URTI-fever-3-5 days-lower infection (alveoli)-metabolic acidosis-hypoxia </li></ul><ul><li>GIT- ingestion of contaminated carcasses-severe gastroenteritis-bloody stools-perforation-peritoniitis-septicemia </li></ul><ul><li>Skin- most common-direct/indirect-itchiness-papule-vesicle-depressed black eschars-painless-septicemia-death </li></ul>
    238. 260. Lyme Disease <ul><li>Named for the Connecticut town, 1975 </li></ul><ul><li>Appears in summer or early fall </li></ul><ul><li>Skin lesion “ erythema chronicum migrans ” </li></ul><ul><li>Cardiac, neurologic, arthritis (complications) </li></ul>
    239. 261. Lyme Disease <ul><li>Caused by spirochete borrelia burgdorferi </li></ul><ul><li>Carried by “deer ticks” </li></ul><ul><li>Tick injects spirochete-laden saliva into the blood stream or deposits fecal matter on the skin </li></ul><ul><li>Spirochetes disseminate to other skin sites or travel into the blood stream and lymphatic system </li></ul>
    240. 262. Lyme Disease <ul><li>Signs and symptoms may take years to fully develop </li></ul><ul><li>Stage 1 = site, red lesion, it may itch, sting or burn lesion has white center, bright red outer rim rash is accompanied with fatigue, headache, chills, fever, sore throat and muscle joint pain severe headache may suugest meningeal irritation </li></ul>
    241. 263. Lyme Disease <ul><li>Stage 2 = meningitis and cranial nerve palsy also cardiac symptoms may appear extreme neck flexion </li></ul><ul><li>Stage 3 = Chronic arthritis </li></ul><ul><li>Note: may change the behavior, depression and psychosis </li></ul>
    242. 264. Lyme Disease <ul><li>Diagnostic antibody titer ELISA Western Blot IgM AST WBC ESR </li></ul>
    243. 265. Lyme Disease <ul><li>Management </li></ul><ul><li>14-28 day oral tetracycline or doxycycline </li></ul><ul><li>Children – oral Penicillin </li></ul><ul><li>Late stage: IV or IM antibiotics </li></ul><ul><li>symptomatic </li></ul>
    244. 266. Toxoplasmosis (Zoonotic) <ul><li>Toxoplasma gondii </li></ul><ul><li>Affecting birds and mammals </li></ul><ul><li>Transmitted to humans by ingestion of uncooked meat and fecal oral route from infected cats (feces) </li></ul><ul><li>Quickly multiply in the GIT </li></ul><ul><li>Disseminate to the CNS, lymphatic tissue, skeletal muscle, myocardium, retina and placenta </li></ul>
    245. 267. Toxoplasmosis <ul><li>Malaise, fever, myalgia, headache, fatigue and sore throat </li></ul><ul><li>Fulminant = vomiting, cough and dyspnea, hyperpyrexia, delirium and seizures </li></ul><ul><li>Infants = hydrocephalus and microcephalus, seizure, jaundice later strabismus, blindness, epilepsy, mental retardation </li></ul><ul><li>Infected person may carry the organism for life (reactivation is possible) </li></ul>
    246. 268. Toxoplasmosis <ul><li>Management </li></ul><ul><li>4-6 weeks of sulfonamide and pyrimethamine (take folic acid to counteract drug’s adverse effects) </li></ul>
    247. 269. Ebola and Marburg Viruses (Zoonotic) <ul><li>Filoviruses, 1960 </li></ul><ul><li>Biological weapons </li></ul><ul><li>Extreme virulence </li></ul><ul><li>Reservoir not yet confirmed </li></ul><ul><li>Exposure to unrecognized host </li></ul><ul><li>Insect bites </li></ul><ul><li>Asia and Africa (animals) </li></ul>
    248. 270. Ebola <ul><li>MOT not known </li></ul><ul><li>Diagnosis = febrile and hemorrhagic fever from Asia and Africa (travellers) </li></ul><ul><li>Health workers = advised to wear cap, goggles, mask, gown, gloves and shoe covers </li></ul>
    249. 272. Ebola <ul><li>Rapid onset of symptoms profound hemorrhage organ failure and shock </li></ul><ul><li>90% mortality, recovery is often prolonged </li></ul><ul><li>No known antiviral drugs </li></ul><ul><li>Symptomatic intervention </li></ul><ul><li>Report suspected EBOLA case </li></ul>
    250. 273. Bird Flu (Zoonotic) <ul><li>Avian influenza </li></ul><ul><li>Infection caused by avian (bird) influenza (flu) viruses. </li></ul><ul><li>Occur naturally among birds </li></ul><ul><li>Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them </li></ul><ul><li>However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them. </li></ul>
    251. 274. Bird Flu <ul><li>MOT = saliva, nasal secretions, and feces </li></ul><ul><li>direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus. </li></ul>
    252. 275. Bird Flu <ul><li>Low and high extremes of virulence </li></ul><ul><li>The “low pathogenic” form may go undetected and usually causes only mild symptoms (such as ruffled feathers and a drop in egg production) </li></ul><ul><li>The highly pathogenic form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90-100% often within 48 hours. </li></ul>
    253. 276. Bird Flu <ul><li>Human infection with avian influenza viruses </li></ul><ul><li>There are many different subtypes of type A influenza viruses. These subtypes differ because of changes in certain proteins on the surface of the influenza A virus (hemagglutinin [HA] and neuraminidase [NA] proteins). There are 16 known HA subtypes and 9 known NA subtypes of influenza A viruses. Many different combinations of HA and NA proteins are possible. Each combination represents a different subtype. All known subtypes of influenza A viruses can be found in birds. </li></ul>
    254. 277. Bird Flu <ul><li>Usually, “avian influenza virus” refers to influenza A viruses found chiefly in birds </li></ul><ul><li>Infections with these viruses can occur in humans </li></ul><ul><li>The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans </li></ul><ul><li>However, confirmed cases of human infection from several subtypes of avian influenza infection have been reported since 1997 </li></ul><ul><li>Most cases of avian influenza infection in humans have resulted from contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretion/excretions from infected birds </li></ul><ul><li>The spread of avian influenza viruses from one ill person to another has been reported very rarely, and transmission has not been observed to continue beyond one person. </li></ul>
    255. 278. Bird Flu <ul><li>“ Human influenza virus” usually refers to those subtypes that spread widely among humans. </li></ul><ul><li>There are only three known A subtypes of influenza viruses (H1N1, H1N2, and H3N2) currently circulating among humans. </li></ul><ul><li>It is likely that some genetic parts of current human influenza A viruses came from birds originally. </li></ul><ul><li>Influenza A viruses are constantly changing, and they might adapt over time to infect and spread among humans. </li></ul>
    256. 279. Bird Flu <ul><li>During an outbreak of avian influenza among poultry, there is a possible risk to people who have contact with infected birds or surfaces that have been contaminated with secretions or excretions from infected birds. </li></ul>
    257. 280. Bird Flu <ul><li>Influenza-like symptoms </li></ul><ul><li>Fever </li></ul><ul><li>Cough </li></ul><ul><li>sore throat </li></ul><ul><li>muscle aches </li></ul><ul><li>eye infections </li></ul><ul><li>Pneumonia </li></ul><ul><li>severe respiratory diseases </li></ul>
    258. 281. Bird Flu <ul><li>Avian Influenza A (H5N1) </li></ul><ul><li>Avian influenza A (H5N1) in Asia and Europe </li></ul><ul><li>Influenza A (H5N1) virus – also called “H5N1 virus” – is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them. </li></ul>
    259. 282. Bird Flu <ul><li>Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. At that time, more than 100 million birds in the affected countries either died from the disease or were killed in order to try to control the outbreaks. By March 2004, the outbreak was reported to be under control. Since late June 2004, however, new outbreaks of influenza H5N1 among poultry were reported by several countries in Asia (Cambodia, China [Tibet], Indonesia, Kazakhstan, Malaysia, Mongolia, Russia [Siberia], Thailand, and Vietnam). It is believed that these outbreaks are ongoing. Influenza H5N1 infection also has been reported among poultry in Turkey and Romania and among wild migratory birds in Croatia. </li></ul>
    260. 283. Bird Flu <ul><li>Human cases of influenza A (H5N1) infection have been reported in Cambodia, China, Indonesia, Thailand, and Vietnam. For the most current information about avian influenza and cumulative case numbers </li></ul>
    261. 284. Bird Flu <ul><li>Human health risks during the H5N1 outbreak </li></ul><ul><li>H5N1 virus does not usually infect people, but more than 130 human cases have been reported by the World Health Organization since January 2004. Most of these cases have occurred as a result of people having direct or close contact with infected poultry or contaminated surfaces; however, a few cases of human-to-human spread of H5N1 have occurred. </li></ul>
    262. 285. Bird Flu <ul><li>No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily and widely from person to person. </li></ul>
    263. 286. Bird Flu <ul><li>Treatment and vaccination for H5N1 virus in humans </li></ul><ul><li>The H5N1 virus that has caused human illness and death in Asia is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir and zanamavir, would probably work to treat influenza caused by H5N1 virus, but additional studies still need to be done to demonstrate their effectiveness. </li></ul>
    264. 287. Bird Flu <ul><li>Treatment and vaccination for H5N1 virus in humans </li></ul><ul><li>There currently is no commercially available vaccine to protect humans against H5N1 virus that is being seen in Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine to protect humans against H5N1 virus began in April 2005, and a series of clinical trials is under way. </li></ul>
    265. 288. Foot and Mouth Disease (Zoonotic) <ul><li>Picornaviridae, genus Aphthovirus </li></ul><ul><li>One of the most contagious animal diseases, with important economic losses </li></ul><ul><li>Low mortality rate in adult animals, but often high mortality in young due to myocarditis </li></ul>
    266. 289. Foot and Mouth Disease <ul><li>Hosts </li></ul><ul><li>Bovidae (cattle, zebus, domestic buffaloes, yaks), sheep, goats, swine, all wild ruminants and suidae. Camelidae (camels, dromedaries, llamas, vicunas) have low susceptibility </li></ul>
    267. 290. Foot and Mouth Disease <ul><li>Transmission </li></ul><ul><li>Direct or indirect contact (droplets) </li></ul><ul><li>Animate vectors (humans, etc.) </li></ul><ul><li>Inanimate vectors (vehicles, implements) </li></ul><ul><li>Airborne, especially temperate zones (up to 60 km overland and 300 km by sea) </li></ul>
    268. 291. Foot and Mouth Disease <ul><li>Sources of virus </li></ul><ul><li>Incubating and clinically affected animals </li></ul><ul><li>Breath, saliva, faeces, and urine; milk and semen (up to 4 days before clinical signs) </li></ul><ul><li>Meat and by-products in which pH has remained above 6.0 </li></ul><ul><li>Carriers: particularly cattle and water buffalo; convalescent animals and exposed vaccinates (virus persists in the oropharynx for up to 30 months in cattle or longer in buffalo, 9 months in sheep). African Cape buffalo are the major maintenance host of SAT serotypes </li></ul>
    269. 292. Foot and Mouth Disease <ul><li>Occurrence </li></ul><ul><li>FMD is endemic in parts of Asia, Africa, the Middle East and South America (sporadic outbreaks in free areas) </li></ul><ul><li>Incubation Period </li></ul><ul><li>2-14 days </li></ul>
    270. 293. Foot and Mouth Disease <ul><li>PREVENTION AND CONTROL </li></ul><ul><li>Sanitary prophylaxis </li></ul><ul><li>Protection of free zones by border animal movement control and surveillance </li></ul><ul><li>Slaughter of infected, recovered, and FMD-susceptible contact animals </li></ul><ul><li>Disinfection of premises and all infected material (implements, cars, clothes, etc.) </li></ul><ul><li>Destruction of cadavers, litter, and susceptible animal products in the infected area </li></ul><ul><li>Quarantine measures ( Code Chapter 2.1.1.) </li></ul>
    271. 294. Foot and Mouth Disease <ul><li>PREVENTION AND CONTROL </li></ul><ul><li>Medical prophylaxis </li></ul><ul><li>Inactivated virus vaccine containing an adjuvant. Immunity: 6 months after two initial vaccinations, 1-month apart, depending on the antigenic relationship between vaccine and outbreak strains </li></ul>
    272. 295. Your #1 Nurses’Portal http://1nurses.com

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