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Communicable Disease Handouts

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  • 1. Community Health NursinCommunicable Disease Lecture NotesPrepared by: Mark Fredderick R. Abejo RN,, MAN ► CAUSATIVE/INFECTIOUS AGENT: A. Pathogenicity – ability to cause disease B. Virulence – ( disease severity ) and invasiveness (ability to enter and move through tissue) C. Infective dose – number of organisms needed to initiate infection D. Organisms specificity ( host preference) antigenic variations COMMUNITY HEALTH NURSING E. Elaboration of toxin F. Viability- ability to survive outside the host Communicable Disease G. Invasiveness – ability to penetrate the cell Lecturer: Mark Fredderick R. Abejo RN, MAN ► RESERVOIR natural habitant of the organism that is where resides and multiplies. A. Human – man is the reservoir of the diseases that is more dangerous to humans than to other species.Communicable Disease B. Animal – responsible for infestations with trophozoite,  Is defined as an illness caused by an infectious agent or worms, etc. its toxins, which can be transmitted directly or C. Non-animal – street dust, garden soil, lint from indirectly to a well person. Communicable diseases are bedding. caused either by bacteria or virus.  Sources of infection consist of man, animal, Carrier – harbors the organism but w/o signs of infection contaminated food or water, insects and environmental factors, such as, dust and dirt. Categories of Carrier Incubatory - no signs and symptoms Convalescent – disease subsided Intermittent – occasionally disseminate the infectious organismContagious Infectious Chronic – carrying the infectious organism for years.Easily transmitted Not easily transmittedthrough direct orindirect modeTransmitted via: Transmitted via: ► PORTAL OF EXIT / Mode of Escape from Reservoir: a. Airborne- A. Respiratory tract ( most common in man) measles, a. Blood Transfusion-AIDS, B. Gastrointestinal tract pneumonia Hepatitis B, C. Genito-urinary tract b. Droplet-PTB, D. Open lesions Hepatitis A, b. Sexual Intercourse: multiple sex E. Mechanical escape ( includes bite of insects) Diphtheria partners F. Blood 1) Bacterial-gonorrhea, syphilis, STD ► MODE OF TRANSMISSION it indicates the potential of 2) Viral-AIDS, Hepatitis B the disease; conveyance of the agent to the host; it can be by 3) Fungal-Candidiasis common source transmission, contact source, air-borne 4)Protozoal-Trichomonas transmission. vaginalis There are four main routes of transmission c. Contaminated Article/Equipment -needles and syringes A. By Contact Transmission 1. Direct contact ( person to person ) d. Placental Transfer 2. Indirect contact ( usually an inanimate object) 3. Droplet contact ( from coughing, sneezing, or talking, or talking by an infected person) CHAIN OF INFECTION B. By Vehicle Route ( through contaminated items) 1. Food – salmonellosis 2. Water – shigellosis, legionellosis 3. Drugs – bacteremia resulting from infusion of a contaminated infusion product 4. Blood – hepatitis B, C. Airborne Transmission 1. Droplet of nuclei 2. Dust particle in the air containing the infectious agent 3. Organisms shed into environment from skin, hair, wounds or perineal area. D. Vector borne Transmission, arthropods such as flies, mosquitoes, ticks and others. ► PORTAL OF ENTRY / Mode of Entry of Organisms into Human. A. Respiratory tract B. Gastrointestinal tract C. Genitourinary tract. D. Direct infections of mucous membrane/skin 1CHN Abejo
  • 2. Community Health NursinCommunicable Disease Lecture NotesPrepared by: Mark Fredderick R. Abejo RN,, MAN Mode of Transmission:► SUSCEPTIBLE HOST a person or animal or plant upon Droplet from respiratory tract of an infected person or a which parasite depends for its survival. carrier directly or indirectly. Host Factors: Nursing Assessment: 1. Age, sex, genetic A child with diphtheria usually seeks medical help for one 2. Nutritional status, fitness, environment factors of the following complains (sometimes they are called types). 3. General physical, mental and emotional health 1. Sore throat: 4. Absent or abnormal Ig.  Fever. 5. Status of hematopoetic system, efficacy of the RES.  Difficulty to swallow. 6. Presence of underlying disease DM, lymphoma,  Swelling of the neck. leukemia, neoplasia, granulocytopenia, or uremia.  Exudates or a yellow-gray membrane on 7. Patient treated with certain antimicrobials, tonsils and may be the pharynx. (Membrane corticosteroids, radiations, or immunosuppressive varies from thin to thick one). agents. 2. Croup:  Hoarse or croupy cough and stridor.Control of Communicable Diseases:  Noisy respiration, the child may have severe respiratory distress.Control of Communicable Disease regulated under R.A 3573:  The membrane may cover the vocal cordPublic Health Workers (PHW) to report any occurrence and (When examined with laryngoscope).incidence of communicable diseases 3. Nasal discharge:PHW’s: are members of the health team who are professionals  Purulent, bloody nasal discharge.namely  The membrane can be seen on the nasal 1. Medical Officer (MO)-Physician septum. 2. Public Health Nurse (PHN)-Registered Nurse 3. Rural Health Midwife (RHM)-Registered Midwife- 4. Infected skin ulcer: 4. Dentist  This skin ulcer can be confused with 5. Nutritionist impetigo (skin disease). The membrane is 6. Medical Technologist not always present in diphtheria. 7. Pharmacist 8. Rural Sanitary Inspector (RSI)-must be a sanitary 5. Other sings and symptoms: engineer That could be present (especially in severe cases):  Purulent conjunctivitis.5 Communicable Diseases to be reported weekly and monthly:  Otitis media. 1. Rabies  Ulcerative vulvo-vaginitis. 2. Measles  Toxins from organisms produces fever and 3. Polio malaise. 4. Neonatal Tetanus-children delivered at home by midwives/”hilots” Nursing Consideration: 5. Sexually Transmitted Disease (STD)-all forms 1. Isolate the child (place him in isolating room, use Diarrhea-not a disease but a symptom which should be medical aseptic techniques). Keep the child in isolation reported by PHN monthly until 2 consecutive nose and throat culture are negative (24 hours apart between the two cultures). 2. Bed rest for about 6 weeks for all types except in nasalCommon Communicable Diseases Caused by diphtheria. 3. For respiratory distress (if present): suction to trachea Bacteria and larynx to remove secretions and pieces of membrane, oxygen humidifier. 4. For fever: check vital signs, use 2-3-4 hours schedule; depending on the degree of fever, degree of respiratory1. DIPHTHERIA embarrassment and change in pulse rate. Check blood pressure frequently. 5. For the membrane: Oral hygiene (warm mouth wash, never use tooth brush or swabs because of danger of distracting the membrane leading to bleeding and rapid spread of toxins into blood system. 6. Observe: vital signs, secretion and the need for suction, observe signs and symptoms of paralysis. 7. Tracheostomy and /or intubation trays must be ready at bedside table of the child. If tracheostomy or intubation is done, apply the proper care of tracheostomy or intubation.  In intubation, the child can expel the tube when he coughs, so watch constantly as he can’t call for help. Frequent suctioning of the tube use proper restraints so that he will not remove the tube.Etiology: 8. If myocarditis appears as a complication, Corynebacterium diphtheria (Diphtheria bacillus). guard the child for exhaustion, beside the other nursing care.Incubational Period: 2-5 days or longer. Treatment:  Bed rest.Communicability Period:  Antibiotics. Several hours before onset of the disease until organism  Anti-toxins.disappear from the respiratory tract. 2CHN Abejo
  • 3. Community Health NursinCommunicable Disease Lecture NotesPrepared by: Mark Fredderick R. Abejo RN,, MANPrevention: Nursing Consideration:1. Active immunization: DPT 1. Isolation: Disinfection all utensils. vaccine. 2. Bed rest: keep the child in bed in a well ventilated2. Passive immunization: room. injection with anti-toxins. 3. For paroxysmal stage: Provide;  Calm atmosphere to avoid emotional swings asComplications; laugh and cry causing coughing attacks. Bronchopneumonia.  Avoid dust in the room. Kidney dysfunction.  Oxygen with humidity to relief cyanosis (may Paralysis. use oxygen tent). Myocarditis. 4. For vomiting: Cardiac failure.  Raise head and shoulders of older children to avoid aspiration of vomitus. For young children, place them on abdomen if no one is attending in2. PERTUSSIS (Whooping Cough) the room.  Mouth care.  Small frequent feeding. Refeed the child immediately after vomiting.  Accurate intake and output must be kept. 5. For anorexia:  High caloric soft diet. Encourage the child to eat.  Weight the child daily. 6. If anoxia occurs during paroxysms a tracheo- pharyngeal suction may be needed. So keep the suction machine available. 7. Protect the child from secondary infection, keep him warm. 8. Observe: respiratory distress and convulsions. 9. Observe signs and symptoms of airway obstruction e.g. restlessness, cyanosis, retraction. Treatment:  Symptomatic: sedatives and antispasmodics are important.  Antibiotics are effective if given early (Ampicillin and Erythromycin).Etiology: Gram-negative bacillus. Prevention: 1. Active immunization: DPT vaccine.Incubation Period: 2. Passive immunization: Gamma Globulin. 5-14 days. 3. In exposed immunized children, give an immediate booster dose of pertussis vaccine.Communicability Period: 4-6 weeks from the onset of the disease. Complication:Mode of Transmission:  Otitis media.  Marasmus. Droplet (direct and indirect).  Bronchiectasis.  Encephalitis.  Hemorrhage may occur.  Pneumonia.Nursing Assessment:Three stages: 3. TETANUS (Lock Jaw)a- Catarrhal stage: (coryza or prodormal stage) It lasts 7-14 days.  Mild fever, headache, anorexia.  Sneezing.  Persistent cough with tearing.b- Paroxysmal stage (Spasmodic or whooping stage): Lasts 14-28 days (2-4 weeks).  Paroxysmal cough develops. It is characterized by several sharp coughs in one expiration, followed by one deep inspiration, which may be accompanied by a whoop. Cough is worse at night, interferes with sleep and frequently Etiology: causes vomiting. Clostridium tetanti (tetanus bacillus).  With cough, face becomes flushed and in some instances cyanosis and Incubational Period: dyspnea might occur. 3-21 days.  Anorexia.  Lymphocytosis occurs. Communicability Period: Not communicable from man to man, as the organismc- Convalescent stage: It lasts 21 days. usually live in animal’s intestinal tract.  Cough and vomiting become less. Mode of Transmission: Through a wound as organism is present in soil. 3CHN Abejo
  • 4. Community Health NursinCommunicable Disease Lecture NotesPrepared by: Mark Fredderick R. Abejo RN,, MANNursing Assessment: 4. SCARLET FEVEROnset of the disease is either gradual or acute. 1. Convulsions are the first warning symptoms in children. 2. Excessive irritability and restlessness. 3. Difficulty in swallowing. 4. Stiff neck. 5. Within 24-48 hours, the muscular stiffness progress:  Trismus i.e. tight jaw, inability to open the mouth.  Stiff arm and legs, then entire stiffness of the body.  Swallowing usually becomes impossible.  Resus sardonicus due to spasm of facial muscles. Etiology:  Opisthotonos, i.e., backward arching of the Streptococcus pyogeneous. (Beta hemolytic streptococcus back as a result of the dominance of the extensor group A). muscles of the spine, head draws back.  These ongoing tetanic spasms lasts about 10 Incubational Period: seconds and occurs following a slightest stimuli, 2-5 days. such as, claming the door or bumping the bed. 6. Dyspnea and cyanosis can develop. Communicability Period: 7. Fever 38.5 -40°C. From onset to recover. 8. Constipation may develop. 9. Lumbar puncture reveals increase reveals increase Mode of Transmission: spinal fluid pressure. Droplet infection, direct and indirect.Nursing Consideration: Nursing Assessment: 1. Isolation. 2. Protect the child from any stimuli (auditory or In acute sudden onset: (toxin from the site of infection is tactile stimuli), so place the child in dark, quite absorbed into blood stream). room and minimum handling. 3. If dyspnea and cyanosis are present, give oxygen. Prodromal signs: 4. For tetanic spasm:  Vomiting.  Protect the child from falling.  High fever then it drops when rash appears.  The nurse must be alert for number, duration  Headache. and frequency of convulsion (in relation to  Rapid pulse. sedation administered).  Tongue: white tongue coating desquamates and red  Record any change in trismus or inability to strawberry tongue results. swallow.  Tonsils are red, enlarged, swallow, and may have a patchy whitish exudates on their surface. 5. For inability to swallow:  I.V. therapy for nutrition and fluid balance. Then, rash appears within the first 5 days of the disease. The rash  Gavage feeding may be ordered. So, the nurse will be all over the body but not on the face. The chest and back must report if insertion of the tube causes are affected first, and then the rash moves down-wards involving convulsions. the legs last. The rash fades upon pressure.  Accurate intake and output chart is necessary.  Distinct odor of the skin.  Mouth care if he can open his mouth.  Desquamation i.e., peeling of the skin, is the typical of scarlet fever. Desquamation could occur early at 4-5-6 day 6. For constipation, give enema. or later to 4th week of the disease. It starts at the top of the 7. Check vital signs carefully. body and proceeds downwards. 8. If tracheostomy is performed; care of tracheostomy. Nursing Considerations: 9. Naso-pharyngeal suction is 1. Isolation. done frequently. 2. Bed rest for 12 days and good ventilated room. 3. Keep patient warm, dry and comfortable as possible.Treatment: 4. For the distinct odor which associates with scarlet fever: Antibiotics (Penicillin). daily bath and change linen frequently. Antitoxin. 5. For skin: Tranquilizers.  Lubricate skin well with oil (daily) as Dr. order.  Protect skin under and around the nose and lips withPrevention: ointment. (When nasal discharge is constant).1. Active immunization: DPT vaccine. 6. Nasal aspiration by gentle suction or soft rubber ear2. Passive immunization: Injection of tetanus syringe is essential. immuno-globulin or antitoxin (a few hours 7. If the child is less than 2 years, elevate head and shoulders after a wound occur). to prevent danger of otitis media. 8. Accurate intake and output chart is important.Complication: 9. Diet in the first week: High caloric liquids then soft diet.  Anoxia. Avoid irritant liquid juice “citrus”.  Atelectasis. 10. For constipation, which accompanies scarlet fever enema  Pneumonia. or mild cathartics is needed. 11. If there is pain in cervical lymph nodes, treat with heat in the form of hot packs or cold in the form of ice collar according to doctor’s order. 12. Observe for complications. 4CHN Abejo
  • 5. Community Health NursinCommunicable Disease Lecture NotesPrepared by: Mark Fredderick R. Abejo RN,, MANTreatment: 2. For rash (lesion):  Penicillin.  Cleaning the skin according to doctor’s order  Diet. once or twice daily. Cool sponge bath without soap.  Sedatives for pain.  Change child’s clothes and bed linens daily to prevent skin infection.Prevention:  For itchy lesions, nails must be cut and cleaned. Mittens and gloves to prevent skin scratching.No immunization.  Restraints may be needed to control scratching.  Observe the skin lesions, change in appearanceComplication: and it must be recorded.  Rheumatic fever.  If lesions in mouth, mouth wash.  Glomerulo-Nephritis.  If lesions in genital organ, apply cold  Pneumonia. compresses. 3. For fever:  Check vital signs and record it, especially temperature. Communicable Diseases Caused by Virus  Keep records for the first 7 days of the disease. 4. If secondary infection to skin occurs: intake and out put chart must be kept accurate. 5. Observe for complications and report1. CHICKEN POX (Varicella) immediately to the doctor. This is a highly communicable disease in children. Treatment:  No specific treatment.  To relieve itching, calamine lotion, antihistamine and local aneaethetaic ointment are prescribed.  Antibiotics for secondary infection.  Don’t give aspirin due to high risk of Reye syndrome. Prevention: None Complication:  Abscess.  Encephalitis.  Glomerulonephritis may occur.Etiology: Virus [Varicella- Zoster- Virus (VZV)]. 2. MEASLES (Rubeola)Incubational Period: Most cases occur before adolescent and it occurs more in 10-21 days (2-3 weeks). spring months.Communicability Period: One day before and six days after the appearance of thefirst vesicle.Mode of Transmission: Droplet (direct or indirect). Dry scabs are not infectious.Nursing Assessment:Onset is sudden with:Prodromal Stage:  Mild or light fever.  Anorexia.  Headache.Acute Phase: Etiology:  Rash: Successive crops of macules, papules, vesicles, Paramyxoviridae Virus crusts (vesicles heals by forming the crusts by the end of the two weeks). (Acute Phase). Incubational Period:  Rash appears in successive crops and lesions in all 7-14 days (usually 10-20 days). stages of development at the same time.  Rash is itchy. Communicability Period: 4 days before the appearance of rash to 5days after rashNursing Consideration: appearance.1. Isolation:  Use medical aseptic technique. Mode of Transmission:  Nasal and oral discharge, cloths and linens are Droplet (direct or indirect). currently disinfected.  Keep the child in isolation until all crusts disappear. 5CHN Abejo
  • 6. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Nursing Assessment: 3. GERMAN MEASLES (Rubella)a- Coryza: Primary symptoms which resembles common It is not as communicable as measles. Fetus may contact cold and occur before rash appearance: the disease in uterus if the mother develops the disease during the  Sneezing. pregnancy (1st trimester).  Fever (range from 38.5 to 40°C, tending to be highest just before the appearance of rash).  Brassy or barking cough.  On the 4th day, conjunctivitis and photophobia.  Acute catarrhal inflammation of the mucous membrane of the nose.  Enlarged posterior cervical lymph nodes.b- Koplik’s Spots: Are pathogenic appear on day before rash. Whitish spots resting on a reddish base appear on the inside of the mouth. They can appear and disappear suddenly.c- Rash: Rash appears on 2nd to 5th day and remain about a week.  Appears first on face, behind the ears, on the neck, forehead or cheeks. Then, spread downwards over the rest of the body (trunk, arms, and legs). Etiology:  The rash is pinkish in color, begins with macular Rubella Virus ( Togaviridae, genus: Rubivirus) lesions which progress to the popular type. Then, rash becomes dark in color (brownish color on 5th day). Incubation Period:  Desquamation, which is find usually, follow the rash 14 to 21 days. appearance and then fads (disappear).  Rash is itchy. Communicable Period: During Prodromal period and for 5 days after the rash. Nursing Consideration: 1. Isolation. Mode of Transmission: 2. Bed rest: Occupy the child in bed after acute phase with 1. Direct contact with nose and throat secretions of activities. Explain the reason for being in bed if the child infected persons. is old enough to understand. 2. Indirect via articles freshly contaminated with 3. For photophobia and conjunctivitis: nasopharyngeal secretion.  Subduced light make the child more comfortable. 3. Trans-placenta congenital infection form infected ”Dark room”. mother to the fetus.  Eye care with warm saline solution to remove secretions or crust. Nursing Assessment:  Keep child’s hands away from eyes, examine coma for signs and symptoms of ulceration. Prodromal Stage:  Mild fever (Disappear when rash appear). 4. For fever:  Slight malaise, headache, and anorexia.  Measure the temperature carefully.  Running nose, sore throat.  Antipyretic as doctor’s order.  Rash is faint macular rash. It is small pinpoint pink  Encourage fluids. or pale red macules which are closely grouped to look  Tipped compresses. like scarlet blush (botchy), which fades on pressure. “It begins on face and hairline move to trunk then 5. For itchy rash: Observe degree of itching and apply extremities”. lotion or ointment as doctor’s order. - Rash disappears 6. For Koplik’s spots: Mouth care. Use gargle solution. in 3 days. 7. Carry out the plan of care of complicated cases, such as,  Swelling of posterior cervical and occipital lymph encephalitis (convulsions), dyspnea…. etc. nodes.  No Koplik’s spots or photophobia. Treatment:  Symptomatic. Nursing Consideration:  Antibacterial therapy. 1. Isolation especially form pregnant women. Prevention: 2. Bed rest until fever subsided.a- Active immunization: live attenuated vaccine.b- Passive immunization: Treatment:  Newborn through the mothers  Symptomatic. while they were in uterus.  Gamma-globulin. Prevention: a- Active immunization; live attenuated rubella Complication: virus vaccine.  Otitis media. b- Passive immunization: Gamma- globulin.  Tracheobronchitis.  Imptiago,purpura. Complication:  Lymphoadenitis.  Fetus damage if mother contacts the disease  Pneumonia. during pregnancy.  Encephalitis.  Newborn may have congenital anomalies, such as deafness, mirocephaly, mental retardation.  Encephalitis. 6 CHN Abejo
  • 7. Community Health NursinCommunicable Disease Lecture NotesPrepared by: Mark Fredderick R. Abejo RN,, MAN 5. POLIOMYELITIS (infantile Paralysis)4. MUMPS (Infectious Parotitis) It attacks the brain stem and spinal cord. Mumps is common in children 5-10 years. It is acute virusinfectious disease, which may involve, many organs butcommonly affects the salivary glands (mainly parotids glands).Etiology: Paramyxovirus Virus.Incubational Period: 14-21 days.Communicability Period: One to six days before the first symptoms appears until theswelling disappears. Etiology:Mode of Transmission: Virus. The disease is caused by any one of 3 polioviruses: Direct or indirect contact with salivary secretion of infected a- Type 1 (Brunhilde).person. b- Type 2 (Lansing). c- Type 3 (Leon).Nursing Assessment: Incubational Period:Prodromal stage “Corayza”: 5-14 days.  Low-grade fever.  Vomiting. Communicability Period:  Headache. Latter period of incubational period till the first week of  Malaise and anorexia. acute illness.Acute Phase: Mode of Transmission: 1. Pain in or behind ears and pain on swallowing or Oral contamination by intestinal and pharyngeal secretions chewing. of infected person. 2. Swelling and pain in glands (unilateral or bilateral), which return to normal in 10 days. Predisposing Factors: 3. Orchitis in males and mastitis in female adolescent 1. Fatigue and muscle exertions. may occur. 2. Cortisone administration. 3. Tonsillectomy and adenoectomy.Nursing Consideration: 4. Tooth extraction. 1. Isolation. 5. I.M injection of D.P.T. vaccine. 2. Bed rest until swelling disappears. 3. For fever: Encourage fluids and soft food, avoid food Nursing Assessment: required chewing, and tipped compresses, antipyretics. Severity of nerve involvement can vary from an absence of 4. For glands: all clinical signs of paralysis to complete paralysis. There are  Mouth care and gargle frequently. different possible consequences of infection:  Apply hot or cold compresses for the swelling. Use ice bag (watch weight of the Inapparent Poliomyelitis: (Silent) No signs or bag in order not to increase the pain). symptoms appears. 5. For Orchitis: Support scrotum, use cold compresses Abortive Poliomyelitis: Initial symptoms of upper for 20 minutes, then, remove it for 30 minutes, then, respiratory tract infection: fever, headache, reapply it for 20 minutes…etc. vomiting…etc. 6. For Mastitis: Breast support, use cold compresses. Non-Paralytic Poliomyelitis:Treatment: Problems as those of Aseptic Meningitis Syndrome: Symptomatic.  Stiffness of neck, back and limbs. Sedatives.  Nausea and vomiting become more severe than stage II.  Fever.Prevention:  Increase protein in C.S.F.Active immunization: Live attenuated vaccine. Paralytic Poliomyelitis: This may begin withPassive immunization: Gamma- globulin. manifestations of the abortive or non-paralytic type.  Spinal: paralysis appear within a day or two after theComplication: (rare) above manifestations and 2-5 days from onset of the Sterility disease: Ovaritis inflammation of testicles - Paralysis of limbs is the most common affected Deafness. muscles. 7CHN Abejo
  • 8. Community Health NursinCommunicable Disease Lecture NotesPrepared by: Mark Fredderick R. Abejo RN,, MAN Passive immunization: Gamma- globulin. - Muscles of the chest, abdominal wall, diaphragm, urinary bladder and bowel can be Complication: affected constipation or stool incontinent and  Emotional disturbance. urinary incontinent may occur.  Gastric dilatation.  Hypertension.  Bulbar: More life threatening. It causes damage to cranial nerve nuclei, vital centers of respiration, circulation and temperature control. - It may leads to swallowing problem and regurgitation of fluids from nose and inability to swallow saliva, which puddles in the pharynx. If not aspirated chocking may occur.  Encephalitis: Manifesting as encephalitis, only diagnosed as polioencephalitis if spinal or bulbar affections or both are present: - Convulsion. - Personality disturbances.Nursing Considerations: 1. Isolation and bed rest. 2. In acute stage:  Put the child under close observation.  Notify the doctor about the degree and progress of the paralysis (7or8 days of the disease).  Rate and type of respiration and signs of respiratory distress must be observed and reported.  Oxygen therapy or place the child on respirator when cyanosis occurs.  If tracheostomy is done in case of diaphragmatic paralysis, care of tracheostomy. 3. For paralysis:  Change position frequently. Careful positioning for affected limbs each time he is turned or moved.  To minimize the degree of deformity, correct body alignment and optimum position must be maintained.  Place the child on firm mattress.  Use footboard to prevent foot drop when child is on back. If the child is on abdomen, pull the mattress away from foot of bed and letting feet protrude over the edge to prevent pressure on toes.  Application of heat to affected muscles to relax them. 4. Suction of the pharynx and postural drainage to prevent aspiration of secretions. 5. For swallowing difficulties:  Soft diet if they can swallow with difficulty.  If swallowing is difficult, use gavage feeding. 6. For incontinent:  Skin care and perineal region is padded to provide absorption for excretions. Catheter may be done. 7. For constipation: Use enemas. 8. Treat fever and headache.Treatment: Symptomatic. Physiotherapy.Prevention:Active immunization: Trivalent poliovirus vaccine.(TOPV).  Sabine: Attenuated virus, which is administered orally.  Salk: Killed virus, which is administered by injection.Note: If a child is affected by poliomyelitis, he must receive thevaccine to prevent further infection from the other poliovirustypes. 8CHN Abejo