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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 property of their respective owners.

MEASLES An acute, highly communicable viral disease with prodromal fever, conjunctivitis, coryza, cough and small spots with white centers on an erythematous base on the buccal mucosa (Koplik spots)

An acute, highly communicable viral disease with prodromal fever, conjunctivitis, coryza, cough and small spots with white centers on an erythematous base on the buccal mucosa (Koplik spots)

Causative agent: Measles virus, a member of the genus Morbilivirus of the family Paramyxoviridae

Measles virus, a member of the genus Morbilivirus of the family Paramyxoviridae

Incidence: Endemic in all large cities of the world recurring in epidemic form every 2 years usually occurs during cold weather.

Endemic in all large cities of the world recurring in epidemic form every 2 years usually occurs during cold weather.

Mode of transmission: Direct contact with nasal and throat secretions Droplet infection Less commonly, by articles freshly soiled with nose and throat secretions

Direct contact with nasal and throat secretions

Droplet infection

Less commonly, by articles freshly soiled with nose and throat secretions

Incubation period: 9- 20 days Average: 10 days

9- 20 days

Average: 10 days

Period of communicability: Ranges from 3 to 4 days before the onset of the symptoms to 5 days after the rash appearance

Ranges from 3 to 4 days before the onset of the symptoms to 5 days after the rash appearance

Stages 1. Incubation period (average of 10 days) 2. Pre-eruptive stage or stage of invasion (3-6 days) 3. Eruptive stage 4. Desquamation Stage

1. Incubation period (average of 10 days)

2. Pre-eruptive stage or stage of invasion (3-6 days)

3. Eruptive stage

4. Desquamation Stage

Pre-eruptive stage or stage of invasion from the appearance of the first sign/symptoms to the earliest evidence of the eruption. fever, severe cold frequent sneezing profuse nasal discharge eyes are red and swollen, with mucopurulent discharge (lids stick together) Stimsons sign: (puffiness of lower eyelids with definite line of congestion on the conjunctivae)

from the appearance of the first sign/symptoms to the earliest evidence of the eruption.

fever, severe cold

frequent sneezing

profuse nasal discharge

eyes are red and swollen, with mucopurulent discharge (lids stick together)

Stimsons sign: (puffiness of lower eyelids with definite line of congestion on the conjunctivae)

Pre-eruptive stage or stage of invasion redness of both ear drums vomiting, drowsiness hard dry cough Koplik’s spot (appears on 2nd day): small, bright red macules or papules with tiny bluish-white specks on the center and can be found on the buccal cavity maculopapular rashes (seen late in 4th day), occurs first on the cheeks or at the hairline true measles rash: slightly elevated small red papules, dry and hot sensation to touch

redness of both ear drums

vomiting, drowsiness

hard dry cough

Koplik’s spot (appears on 2nd day): small, bright red macules or papules with tiny bluish-white specks on the center and can be found on the buccal cavity

maculopapular rashes (seen late in 4th day), occurs first on the cheeks or at the hairline

true measles rash: slightly elevated small red papules, dry and hot sensation to touch

Eruptive stage Characterized by a general intensification of all local constitutional symptoms of the pre-eruptive stages with the appearance of bronchitis and loose bowels Maculo-papular rashes starting from head to feet Irritability and restlessness Red and swollen throat Enlargement of cervical glands Fever subsides

Characterized by a general intensification of all local constitutional symptoms of the pre-eruptive stages with the appearance of bronchitis and loose bowels

Maculo-papular rashes starting from head to feet

Irritability and restlessness

Red and swollen throat

Enlargement of cervical glands

Fever subsides

Desquamation Stage follows after the rashes fade, dry, and feel off follows the order of distribution seen in the formation of eruption

follows after the rashes fade, dry, and feel off

follows the order of distribution seen in the formation of eruption

Summary Cough, colds, coryza (3C’s) 3 rd day: Characteristic red blotchy rash appears on the 3 rd to 7 th day Rash begins on the face  becomes generalized, lasts 4 – 7 days Ends in desquamation

Cough, colds, coryza (3C’s)

3 rd day: Characteristic red blotchy rash appears on the 3 rd to 7 th day

Rash begins on the face  becomes generalized, lasts 4 – 7 days

Ends in desquamation

Diagnostic exam: No specific diagnostic exam except only for the presence of leukopenia

No specific diagnostic exam except only for the presence of leukopenia

Prevention: Education of parents regarding the disease Passive immunization of infants and children (gamma-globulin) Active immunization (1st year of life)

Education of parents regarding the disease

Passive immunization of infants and children (gamma-globulin)

Active immunization (1st year of life)

Vaccine storage: Freeze – dried measles vaccine is relatively stable and can be stored in a freezer or at refrigerator temperatures with safety  for a year or more Reconstituted vaccine should be kept at refrigerator temperatures and discarded  after 8 hours Both vaccine should be protected from prolonged exposure to ultraviloent light  which may inactivate the vaccine

Freeze – dried measles vaccine is relatively stable and can be stored in a freezer or at refrigerator temperatures with safety  for a year or more

Reconstituted vaccine should be kept at refrigerator temperatures and discarded  after 8 hours

Both vaccine should be protected from prolonged exposure to ultraviloent light  which may inactivate the vaccine

Management: 1. Drugs – Antibiotics for secondary bacterial infection) 2. Isolation 3. Meticulous skin care - warm alcohol cup to prevent pressure sores 4. Good oral and nasal hygiene – increase oral fluids 5. Proper care of the eyes - screen to avoid direct light: wear dark glasses 6. Ears should be cleaned after bath, bath if there discharges – patient should lie the affected ear down or towards the bed 7. Give ample of fluids during febrile stage

1. Drugs – Antibiotics for secondary bacterial infection)

2. Isolation

3. Meticulous skin care - warm alcohol cup to prevent pressure sores

4. Good oral and nasal hygiene – increase oral fluids

5. Proper care of the eyes - screen to avoid direct light: wear dark glasses

6. Ears should be cleaned after bath, bath if there discharges – patient should lie the affected ear down or towards the bed

7. Give ample of fluids during febrile stage

Complications: 1. Otitis media death rate is highest in the 1st 2 years of life. 2. Bronchopneumonia after 4 yrs. uncommon 3. Severe bronchitis overall mortality rate-less than 4%

1. Otitis media

death rate is highest in the 1st 2 years of life.

2. Bronchopneumonia

after 4 yrs. uncommon

3. Severe bronchitis

overall mortality rate-less than 4%

GERMAN MEASLES An acute infectious disease characterized by mild constitutional symptoms, rose colored macular eruption which may resembles measles and enlargement and tenderness of lymph nodes

An acute infectious disease characterized by mild constitutional symptoms, rose colored macular eruption which may resembles measles and enlargement and tenderness of lymph nodes

Causative agent: Rubella virus (family Togaviridae; genus Rubivirus)

Rubella virus (family Togaviridae; genus Rubivirus)

Incidence: Occurs mostly in spring and seen mostly in children over 5 years of age

Occurs mostly in spring and seen mostly in children over 5 years of age

Mode of transmission: Contact with nasopharyngeal secretions of infected people Droplet spread or direct contact with patients

Contact with nasopharyngeal secretions of infected people

Droplet spread or direct contact with patients

Incubation period: Period of 14 – 21 days

Period of 14 – 21 days

Period of communicability: 7 days before to 5 days after the rashes appears Infants with CRS may shed virus for months after birth

7 days before to 5 days after the rashes appears

Infants with CRS may shed virus for months after birth

Clinical manifestations: fever loss of appetite enlargement of lymph nodes sweating leucopenia vomiting (in some cases) headache, mild sore throat desquamation follows the rash

fever

loss of appetite

enlargement of lymph nodes

sweating

leucopenia

vomiting (in some cases)

headache, mild sore throat

desquamation follows the rash

Clinical manifestations: enanthem of uvula with tiny red spots rash (cardinal symptom) accompanied with cervical adenitis begins on the face including the area around the mouth oval, pale rose-red papules about the size of a pinhead covers the body within 24 hours and gone by the end of 4th day

enanthem of uvula with tiny red spots

rash (cardinal symptom) accompanied with cervical adenitis

begins on the face including the area around the mouth

oval, pale rose-red papules about the size of a pinhead

covers the body within 24 hours and gone by the end of 4th day

Prevention: vaccination 1. Gammaglobulin – given to pregnant women with negative history and who have been exposed in the first trimester of pregnancy. 2. Included in MMR given at 15 months to the baby.

1. Gammaglobulin – given to pregnant women with negative history and who have been exposed in the first trimester of pregnancy.

2. Included in MMR given at 15 months to the baby.

Management: 1. Isolation – (Catarrhal stage) to prevent infection to others 2. Bed rest for first few days 3. Meticulous skin care especially after the rash fades 4. Good oral and nasal hygiene (use petroleum jelly if lips become dry) 5. No special diet is necessary / increase fluid intake

1. Isolation – (Catarrhal stage) to prevent infection to others

2. Bed rest for first few days

3. Meticulous skin care especially after the rash fades

4. Good oral and nasal hygiene (use petroleum jelly if lips become dry)

5. No special diet is necessary / increase fluid intake

Complications: 1. Otitis media 2. Encephalitis 3. Congenital defects for babies whose mother were exposed in early pregnancy

1. Otitis media

2. Encephalitis

3. Congenital defects for babies whose mother were exposed in early pregnancy

VARICELLA A very contagious acute disease usually occurring in small children, characterized by the appearance of vesicles, frequently preceded by papules , occasionally followed by pustules but ending in crusting

A very contagious acute disease usually occurring in small children, characterized by the appearance of vesicles, frequently preceded by papules , occasionally followed by pustules but ending in crusting

Causative agent: Varicella zoster virus

Varicella zoster virus

Incidence: Occurs before the 6th year especially in winter

Occurs before the 6th year especially in winter

Mode of transmission: From person to person by direct contact Droplet or airborne spread of vesicle fluid or secretions of the respiratory tract Indirectly through articles freshly soiled by discharges from vesicles and mucous membranes of infected people

From person to person by direct contact

Droplet or airborne spread of vesicle fluid or secretions of the respiratory tract

Indirectly through articles freshly soiled by discharges from vesicles and mucous membranes of infected people

Incubation period: 2 – 3 weeks Commonly 14 – 16 days

2 – 3 weeks

Commonly 14 – 16 days

Period of communicability: Highly contagious from 2 days prior to rash to 6 days after rash erupts Patient remain contagious until the lesion have crusted completely

Highly contagious from 2 days prior to rash to 6 days after rash erupts

Patient remain contagious until the lesion have crusted completely

Clinical Manifestations: Slight fever: first to appear Body malaise, muscle pain Eruption (maculopapular) then progresses to vesicle (3-4 days)  begins on trunk and spreads to extremities and face (even on the scalp, throat and mucus membranes) Intense pruritus Vesicles ended as a granular scab Irritability

Slight fever: first to appear

Body malaise, muscle pain

Eruption (maculopapular) then progresses to vesicle (3-4 days)

 begins on trunk and spreads to extremities and face (even on the scalp, throat and mucus membranes)

Intense pruritus

Vesicles ended as a granular scab

Irritability

Prevention: 0.5 mL SC varicella vaccine And for immunization of children up to 12 years of age who have not had varicella

0.5 mL SC varicella vaccine

And for immunization of children up to 12 years of age who have not had varicella

Management: 1. Drugs Penicillin: can be used when the crusts are severe or infected to prevent scarring or secondary invasion Acyclovir, Immunosin – anti virus Hydrocortisone lotion 1% for itching 2. Isolation in a room by itself 3. Provide a well-ventilated, warm room to the patient 4. Warm bath should be given daily to relieve itching (may use baking soda) 5. Avoid injuring the lesions by using soft absorbent towel and the patient should be potted dry instead of rubbed dry 6. Maintain good oral hygiene. If lesions are found in the mouth or nasal passages, antiseptic prep may be used

1. Drugs

Penicillin: can be used when the crusts are severe or infected to prevent scarring or secondary invasion

Acyclovir, Immunosin – anti virus

Hydrocortisone lotion 1% for itching

2. Isolation in a room by itself

3. Provide a well-ventilated, warm room to the patient

4. Warm bath should be given daily to relieve itching (may use baking soda)

5. Avoid injuring the lesions by using soft absorbent towel and the patient should be potted dry instead of rubbed dry

6. Maintain good oral hygiene. If lesions are found in the mouth or nasal passages, antiseptic prep may be used

Complications: 1. Pneumonia 2. Nephritis 3. Encephalitis 4. Impetigo 5. Pitting or scarring of the skin

1. Pneumonia

2. Nephritis

3. Encephalitis

4. Impetigo

5. Pitting or scarring of the skin

HERPES ZOSTER Acute viral infection of the peripheral nervous system due to reactivation of varicella zoster virus. The consequence of a reactivation of latent VZV from the dorsal root ganglia. Contagious to anyone who has not had varicella or who is immunosuppressed.

Acute viral infection of the peripheral nervous system due to reactivation of varicella zoster virus.

The consequence of a reactivation of latent VZV from the dorsal root ganglia.

Contagious to anyone who has not had varicella or who is immunosuppressed.

HERPES ZOSTER Occurs at all ages, but its incidence is highest among individuals in the 6 th through the 8 th decades of life Approximately 2 % of patients with herpes zoster will develop a second episode of infection Factors responsible for the reactivation of VZV are not known

Occurs at all ages, but its incidence is highest among individuals in the 6 th through the 8 th decades of life

Approximately 2 % of patients with herpes zoster will develop a second episode of infection

Factors responsible for the reactivation of VZV are not known

Clinical manifestations Neuralgic pain Malaise Burning sensation Fever Cluster of skin vesicles along course of peripheral sensory nerves ( unilateral and found in trunk, thorax or face): appears 3-4 days.

Neuralgic pain

Malaise

Burning sensation

Fever

Cluster of skin vesicles along course of peripheral sensory nerves ( unilateral and found in trunk, thorax or face): appears 3-4 days.

HERPES ZOSTER

Management: 1. Drugs Analgesics Corticosteroids Anti virals (acyclovir, famcyclovir, valacyclovir) 2. Isolate client 3. Apply drying lotions (calamine) 4. Administer medications as ordered 5. Instruct client on preventive measures

1. Drugs

Analgesics

Corticosteroids

Anti virals (acyclovir, famcyclovir, valacyclovir)

2. Isolate client

3. Apply drying lotions (calamine)

4. Administer medications as ordered

5. Instruct client on preventive measures

SCABIES A parasitic infection of the skin caused by a mite Penetration is visible as papules, vesicles or tiny linear burrows containing the mites or their eggs Lesions are prominent around finger webs, anterior surfaces of wrists and elbows, anterior axillary folds, belt portion of the buttocks

A parasitic infection of the skin caused by a mite

Penetration is visible as papules, vesicles or tiny linear burrows containing the mites or their eggs

Lesions are prominent around finger webs, anterior surfaces of wrists and elbows, anterior axillary folds, belt portion of the buttocks

SCABIES In infants, the head, neck, palms, and soles may be involved; these areas are usually spared in older individuals Common in individuals living in areas of poverty where cleanliness is lacking

In infants, the head, neck, palms, and soles may be involved; these areas are usually spared in older individuals

Common in individuals living in areas of poverty where cleanliness is lacking

Causative Agent: Sarcoptes scabiei, a mite

Sarcoptes scabiei, a mite

Mode of transmission: Direct contact with infested skin and can be acquired during sexual contact Transfer from undergarments and bedclothes occurs only if these have been contaminated by infested people immediately beforehand

Direct contact with infested skin and can be acquired during sexual contact

Transfer from undergarments and bedclothes occurs only if these have been contaminated by infested people immediately beforehand

Clinical Manifestations: Intense itchiness especially at night, but complications are limited to lesions secondarily infected by scratching Sites: Interdigital areas Flexors surface of the wrist and palms Nipples Umbilicus Axillary folds Groin or gluteal folds Penis and scrotum

Intense itchiness especially at night, but complications are limited to lesions secondarily infected by scratching

Sites:

Interdigital areas

Flexors surface of the wrist and palms

Nipples

Umbilicus

Axillary folds

Groin or gluteal folds

Penis and scrotum

Diagnostic Examination: Presence on skin of female mites and ova upon skin biopsy or scraping

Presence on skin of female mites and ova upon skin biopsy or scraping

Medical Management: Lindane solution (Kwell) Crotamiton (Eurax) Anti-histamines – to reduce itchiness.

Lindane solution (Kwell)

Crotamiton (Eurax)

Anti-histamines – to reduce itchiness.

Nursing Interventions: Boiling of linens and clothes Encourage to change clothing and linen frequently Warm shower bath to remove scaling debris or crusts Putting on a gown and gloves for health care provider

Boiling of linens and clothes

Encourage to change clothing and linen frequently

Warm shower bath to remove scaling debris or crusts

Putting on a gown and gloves for health care provider

LEPROSY (Hansen’s Disease) Chronic bacterial infection characterized by the appearance of nodules in the skin or mucous membrane, and by changes in the nerves leading to anesthesia or paralysis

Chronic bacterial infection characterized by the appearance of nodules in the skin or mucous membrane, and by changes in the nerves leading to anesthesia or paralysis

Causative agent: Mycobacterium leprae (acid fast bacilli) The organism has not been grown in bacteriologic media or cell cultures It can be grown in mouse foot pads

Mycobacterium leprae (acid fast bacilli)

The organism has not been grown in bacteriologic media or cell cultures

It can be grown in mouse foot pads

Incubation Period: Ranges from 9 months to 20 years The average is probably 4 years for tuberculoid leprosy and twice that for lepromatous leprosy

Ranges from 9 months to 20 years

The average is probably 4 years for tuberculoid leprosy and twice that for lepromatous leprosy

Period of Communicability Clinical and laboratory evidence suggest that infectiousness is loss in most instances with 3 months of continuous and regular treatment with dapsone or clofazimine or within 3 days of treatment with rifampin

Clinical and laboratory evidence suggest that infectiousness is loss in most instances

with 3 months of continuous and regular treatment with dapsone or clofazimine

or within 3 days of treatment with rifampin

Mode of transmission: Exact mode of transmission is not clearly established Prolonged intimate skin-to-skin contact and to Nasopharyngeal secretions

Exact mode of transmission is not clearly established

Prolonged intimate skin-to-skin contact and to Nasopharyngeal secretions

TYPES: 1. Tuberculoid 2. Lepromatous 3. Intermediate

1. Tuberculoid

2. Lepromatous

3. Intermediate

Tuberculoid Type Shows high resistance to Hansen’s bacilli Patient can mount a cell –mediated defense against the bacilli. 1 – 2 skin lesions only which are well defined, elevated and hypopigmented (+) Lepromin test

Shows high resistance to Hansen’s bacilli

Patient can mount a cell –mediated defense against the bacilli.

1 – 2 skin lesions only which are well defined, elevated and hypopigmented

(+) Lepromin test

Lepromatous Type Minimal resistance to the multiplication Severest form Patient cannot mount a cell – mediated immune response Acid fast bacilli are found everywhere ( - ) Lepromin test Clinical manifestations include: Leonine facies – facial skin are thickened Saddle nose deformity – nasal cartilage can be destroyed Infertility – secondary to internal testicular damage

Minimal resistance to the multiplication

Severest form

Patient cannot mount a cell – mediated immune response

Acid fast bacilli are found everywhere

( - ) Lepromin test

Clinical manifestations include:

Leonine facies – facial skin are thickened

Saddle nose deformity – nasal cartilage can be destroyed

Infertility – secondary to internal testicular damage

Clinical Manifestations: Early Stage: “CLUMP” C - changes in skin color (red or white) L - lesion is hyposthetic and loss of sweating U - ulcers that do not heal M - muscle weakness or paralysis P – painful and thickened nerves

Early Stage: “CLUMP”

C - changes in skin color (red or white)

L - lesion is hyposthetic and loss of sweating

U - ulcers that do not heal

M - muscle weakness or paralysis

P – painful and thickened nerves

Clinical Manifestations: Late Symptoms: “CLISM” C – clawing of fingers and toes L – “leonine” appearance (due to thickened skin of the forehead and face) I – inability to close eyelids (lagophthalmos) S – sinking of nose bridge (saddle nose) M – madarosis (loss of eyebrows)

Late Symptoms: “CLISM”

C – clawing of fingers and toes

L – “leonine” appearance (due to thickened skin of the forehead and face)

I – inability to close eyelids (lagophthalmos)

S – sinking of nose bridge (saddle nose)

M – madarosis (loss of eyebrows)

Clinical Manifestations: Cardinal Symptoms: “PPP” P – presence of hansen’s bacilli on skin biopsy P – presence of localized areas of anesthesia P – peripheral nerve enlargement

Cardinal Symptoms: “PPP”

P – presence of hansen’s bacilli on skin biopsy

P – presence of localized areas of anesthesia

P – peripheral nerve enlargement

Diagnostic Examinations: Skin biopsy Skin smear test Lepromin test – (+) test develops a nodule on site of inoculation (1st – 3rd week ) Nerve involvement with acid – fast bacilli is pathognomonic of leprosy

Skin biopsy

Skin smear test

Lepromin test – (+) test develops a nodule on site of inoculation (1st – 3rd week )

Nerve involvement with acid – fast bacilli is pathognomonic of leprosy

Medical Management: Multiple drug therapy (MDT) (Rifampicin, Dapsone, and Clofazimine) over 6 – 9 months period or 18 – 30 months period

Multiple drug therapy (MDT)

(Rifampicin, Dapsone, and Clofazimine) over 6 – 9 months period or 18 – 30 months period

Nursing Interventions: Full diet A daily cleansing bath and change of clothing Skin care Self care, exercise, and physical therapy TSB for fever

Full diet

A daily cleansing bath and change of clothing

Skin care

Self care, exercise, and physical therapy

TSB for fever

Prevention: Separate infants from lepromatous parents at birth Segregate and treat patients with open lesions Public health supervision

Separate infants from lepromatous parents at birth

Segregate and treat patients with open lesions

Public health supervision

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