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INFECTIONS
Chain of InfectionSusceptible hostPortal of EntryEtiologic Agent (microorganism)ReservoirMethod of transmission from reser...
Pathogens• Bacteria    – Aerobic    – Anaerobic• Viruses    - intracellular parasite capable of reproducing outside of a l...
Reservoir  -where the pathogen lives and multiplies      – Endogenous      – Exogenous• Mode of Transmission      – Direct...
Host Factors• Factors that enable a host to resist infections:  • Physical barriers  • Hostile environment created by stom...
Portal of Entry• Respiratory Tract• GI Tract• Genitourinary Tract• Skin and mucous membrane• Bloodstream
Stages of Infectious Process• Incubation period       – period begins with active replication but with no symptoms• Prodro...
FACTORS AFFECTING RISK              OF INFECTION•   AGE•   HEREDITY•   LEVEL OF STRESS•   NUTRITIONAL STATUS•   CURRENT ME...
Standard precautions•   Blood•   All body fluids, secretions, excretions,•   Non-intact skin•   Mucous membranes• Essentia...
Infection Control and Prevention
Infection Control in In-Patient Health               Care Agencies•   Hand Hygiene•   Patient Placement•   Protective Equi...
Infection Control In Community –               Based Setting•   Sanitation•   Proper Disposal of Waste•   Food Preparation...
Pharmacology• Check for:      – History of hypersensitivity.      – Age and childbearing status of the client.      – Rena...
COMMUNICABLE DISEASE – Is any disease that can be transmitted directly or   indirectly from one person to another
INFECTION – Is a condition caused by the entry and   multiplication of pathogenic microorganisms   within the host body. –...
ISOLATION– It is necessary when a person is known or  suspected to be infected with pathogens that can  be transmitted by ...
Transmission-Based Precautions  –Airborne  –Droplets  –Contact
AIRBORNE– PRIVATE ROOM– NEGATIVE AIR PRESSURE– VENTILATION SAFEGUARDS air from room is not  recirculated to other areas– D...
DROPLET•    – PRIVATE ROOM    – WEAR MASK IF WORKING WITHIN 3 FEET    – WEAR MASKS UPON ENTRY INTO THE ROOM    – COVER MOU...
CONTACT– PRIVATE ROOM– WEAR GLOVES– GLOVES ARE REMOVED BEFORE EXITING FROM  THE ROOM– HANDS ARE WASHED THOROUGHLY– NOTHING...
AFB ISOLATION – VISITORS REPORT TO NURSES’ STATION BEFORE   ENTERING ROOM   • MASKS ARE TO BE WORN IN THE PATIENT’S ROOM  ...
STRICT ISOLATION– VISITORS-REPORT TO NURSES’ STATION BEFORE  ENTERING ROOM– PRIVATE ROOM-necessary, door must be kept clos...
RESPIRATORY ISOLATION – VISITORS-REPORT TO NURSES’ STATION BEFORE   ENTERING ROOM – PRIVATE ROOM-necessary, door must be k...
WOUND AND SKIN PRECAUTIONS– VISITORS-REPORT TO NURSES’ STATION BEFORE  ENTERING ROOM– PRIVATE ROOM-desirable– GOWNS-must b...
ENTERIC PRECAUTIONS– VISITORS-REPORT TO NURSES’ STATION BEFORE  ENTERING ROOM– PRIVATE ROOM-necessary FOR CHILDREN ONLY– G...
PROTECTIVE ISOLATION– VISITORS-REPORT TO NURSES’ STATION BEFORE  ENTERING ROOM– PRIVATE ROOM-necessary, door must be kept ...
Airborne Diseases
Diphtheria– Corynebacterium diphtheriae– Klebsloeffler’s bacillus (bacteria)– MOT = droplets and airborne   • HIGHLY CONTA...
– Dx = throat swab, MOLONEY, SCHICK– Pseudomembrane, Bullneck– Penicillin or erythromycin– Resp Acidosis with hypoxemia– C...
Nursing Considerations:– OBSERVE CNS, CARDIAC AND KIDNEY COMPLICATIONS– PSEUDOMEMBRANOUS MAY LEAD TO RESP.  OBSTRUCTION– I...
Diphtheria KEY POINTS!– Highly contagious– Pseudomembrane and bullneck– Immunization best intervention PREVENTION– Obstruc...
Measles, Rubeola, 7 Day Fever, Hard           Red Measle– Paramyxo virus– MOT = droplets and airborne   • PC 4 days before...
– Rashes:– Maculopapular– Cephalocaudal– With desquamation– Pruritus
• Rashes: maculopapaular, cephalocaudal (hairline and  behind the ears to trunk and  limbs), confluent, desquamation, prur...
– PS koplik’s spot– Characteristic: stimsons, photophobia (typical  complaint)– Fever: high fever– CX pneumonia, meningitis
German Measles, Rubella, Rotheln    Disease, 3 Day Measles– RNA rubella virus– MOT = droplets and airborne   • PC 5 days b...
– Rashes:– Maculopapular– Diffuse– No desquamation
– Rashes: Maculopapular, Diffuse/not confluent, No      desquamation, spreads from the face downwards•
Chicken Pox, Varicella– Herpes Zoster Virus– Varicella Zoster Virus– MOT = droplets and airborne   • PC one day before ras...
– Rashes: Maculopapulovesicular (covered areas),  Centrifugal, starts on face and trunk and spreads  to entire body– Leave...
– Dx = Tzanck smear (scraping of ulcer for staining)– Rashes:   • Maculopapulovesicular (covered areas)   • Centrifugal   ...
Meningitis Menigococcemia– Neisseria meningitides (bacteria)– MOT = droplets– IP = 1-2 days– IMMUNITY = xxx
– Immunocompetent are susceptible– Petechiae (volar/palm of hands) EARLY– Opisthotonus MENIGEAL IRRITATION– Brudzinski MEN...
– S/sx:  – Meningococcemia – spiking fever, chills, arthralgia,    petechial rash  – Fulminant Meningococcemia (Waterhouse...
– Dx: CT/ MRI, CSF analysis, CSF gram stain, CSF and  blood culture– Mgmt: antibiotics (Pen G, ceftriaxone), steroids,  an...
Amoebiasis– Entamoeba Hystolitica –protozoan (parasite)– MOT = 5 F’s, fecal oral route– IP = 2-4 weeks– IMMUNITY = xxx
– Dx microscopic stool exam or rectal secretions– (tetra nucleated cyst and trophozoites)– Diarrhea and constipation (non ...
Typhoid Fever– Salmonella typhosa (bacteria)– MOT = same with amoebiasis (5 F’s)– IP = 1-3 weeks– IMMUNITY   • Active = va...
Pathophysiology– Oral ingestion– Bloodstream– Reticuloendothelial system (lymph node, spleen,  liver)– Bloodstream– Gallbl...
– 1st week step ladder (BLOOD)– 2nd week rose spot and fastidial   • typhoid pyschosis (URINE & STOOL)– 3rd week (complica...
– Blood (typhi dot) 1st week after– Stool and urine 2nd week after– Chloramphenicol
– Rose spot (abdominal rashes)– Step ladder fever to fastidial (peak of fever)  typhoid psychosis– Peyer’s patches of smal...
BLOOD BORNE DISEASES
RABIES
CONTENTS:
What is rabies? (DEFINITION & ETIOLOGY)•   Is an acute infectious disease of warm-blooded animals and    humans characteri...
The Rabies VirusRV – a neurotropic filterable virus present in thesaliva of rabid animals. It has a preferrence for       ...
How do you get rabies? (MODE & MEDIA OF TRANSMISSION, IMMUNITY)•All warm-blooded mammals are susceptible. Natural immunity...
How do you know if an animal has rabies?• Animals with rabies may act differently from  healthy animals.• Some signs of ra...
How do you know if one has rabies?                         (DIAGNOSIS)•There is yet no way of immediately knowing who had ...
EPIDEMIOLOGYRABIES INCIDENCE:WORLDWIDE:35, 000-50, 000 cases/ year(WHO)
EPIDEMIOLOGYPHILIPPINES: 350-450 cases/ year             5-7 per million populationDOG BITE INCIDENCE: 140, 000- 560, 000/...
• Based on the report from NCDPC (2004), the  six regions with the most number of rabies  cases are Western Visayas, Centr...
STAGES OF RABIES INFECTIONRabies virus   Entry into the body                                     INCUBATI0N PERIOD        ...
RABIES CLASSIFICATIONANIMAL RABIES• There are two common types of rabies. One type is "furious" rabies.  Animals with this...
HUMAN RABIES• Humans also have a “furious” type, the  classic foaming of the mouth,  aggression, apprehension & hydrophobi...
DIFFERENT STAGES OF RABIES                INFECTION                      C                                         B      ...
INVASION STAGE•   Also called PRODOME PERIOD; Prodrome – symptom indicative of an    approaching disease•    2-10 DAYS•   ...
• Fever,headache malaise sore throat  anorexia increased sensitivity (bright  lights, loud noises) increased muscle  refle...
EXCITATION STAGE•   Also called ACUTE NEUROLOGICAL PHASE;    hyperactivity•   2 – 10 DAYS•   Imminent thoraco-lumbar invol...
Tick me!
PARALYTIC STAGE-also called DEPRESSION PHASE• Gradual weakness of muscle groups    – muscle spasms cease    – OCULAR PALSY...
• Ears: VERTIGO . Middle ear disease . Early  symptom, but may develop @ any period• Neck stiffness• (+) Babinski [lesions...
• Hydrophobia and aerophobia gone, but still has  some difficulty swallowing• General arousal (PNS stimulation)• Bladder &...
MANAGEMENTNURSING INTERVENTIONS• HIGH RISK FOR INFECTION TRANSMISSION          » provide patient isolation          » hand...
• KNOWLEDGE DEFICIT (about the disease,  cause of infection and preventive measures)           »assess patient’s and famil...
• ALTERED BODY TEMPERATURE:  FEVER RELATED TO THE PRESENCE  OF INFECTION. Since fever is  continuous, provide other modes ...
• DEHYDRATION related to refusal to take in  fluids secondary to throat spasms and fear of  spasmodic attacks.           »...
IMMUNIZATION ACTIVE IMMUNIZATION- induce antibody and T-cell production in order  to neutralize the rabies virus in the bo...
PASSIVE IMMUNIZATION- RIG (Rabies Immune Globulins)- provide the immediate availability of antibodies   at the site of exp...
VACCINATION        (Intradermal Schedule)   Day of      PVRV/PCECV             SiteImmunization   DAY 0          0.1 ml   ...
Intramuscular ScheduleDay of         PVRV     PCECV    SiteImmunizationDay 0          0.5 ml   1.0 ml   One deltoid/      ...
MANAGEMENT OF RABIES PATIENT• Once symptoms start, treatment should center  on comfort care, using sedation & avoidance of...
2. SUPPORTIVE CARE- Pts w/ confirmed rabies should receive adequate   sedation & comfort care in an appropriate   medical ...
3. INFECTION CONTROL a. Patient should be admitted in a quiet, draft-     free, isolation room b. HLCR workers & relatives...
Tetanus
• Tetanus  – Clostridium tetani  – MOT = wound setting  – IP = 3 -21 days  – IMMUNITY     • Active = TT     • Passive = TA...
– Wound Infection– FATAL INFECTION OF THE CNS– TOXIN-NEUROTOXIN
• PATHOPHYSIOLOGY:  – SETTING OF WOUND ---- ENTRANCE OF C.T. ----    RELEASES TETANUS TOXIN ---- TETANOSPASMIN    (CNS), T...
– Trismus – lock jaw– Risus sardonicus - maskface– Risorius - grinsmile– Dx wound and blood extraction (non specific)
• Immunization  – DPT (0.5 ml IM) 1 – 1 ½ months old 2 - after 4    weeks 3 – after 4 weeks  – 1 st booster – 18 mos  – 2 ...
• Management  – 1. Anticonvulsant, muscle relaxants,  – antibiotics, wound cleansing and debridement,    hyperbaric chambe...
VECTOR-BORNE  DISEASES
DENGUE HEMORRHAGIC FEVER
IINTRODUCTION:    Philippine Hemorrhagic Fever was first reported in 1953. In    1958, hemorrhagic became a notifiable dis...
WHO case definition for DHF:• fever or history of recent fever• thrombocytopenia (platelet count equal to or less than 100...
Occurrence:     Dengue occurrence is sporadic throughout the year.     Epidemic usually occurs during the rainy seasons Ju...
Notifiable Diseases and Deaths by Cause in             the Philippines (2001 – 2004)                     2001             ...
INCIDENCE OF DENGUE HEMORRHAGIC FEVER IN           CEBU CITY (YEAR 2007)  Selected     Number of New Cases           Numbe...
• The DOH reported 70,204 dengue cases for  week ending September 10, 2011. This was  over 24,000 cases less or 25.87% low...
Reservoir / Source of Infection:           • Some source is a vector mosquito, the Aedes           Aegypti or the common h...
Mode of Transmission: Mosquito bite (Aedis Aegypti)Incubation Period:        Probably 6 days to one weekPeriod of         ...
Diagnostic Test:   1.) Tourniquet Test (Rumpel Leads Tests)   • Inflate the blood pressure cuff on the upper arm to      a...
Clinical Manifestations (Public Health Nursing inthe Philippines, 2007):An acute febrile infection of sudden onset with 3 ...
• 7th-10th day (convalescent or recovery   stage)   -generalized flushing with intervening areas of   blanching, appetite ...
Grading of Dengue Fever:The severity of DHF is categorized into four grades:• grade I, without overt bleeding but positive...
MANAGEMENT
• Promote rest• Medication  –Paracetamol – for    fever and muscle    pains.  –Analgesic – for    headache  –DON’T GIVE AS...
• Rapid replacement of body  fluids is the most important  treatment   – Give ORESOL to replace     fluid as in moderate  ...
• For hemorrhage  – Keep patient at rest during    bleeding periods  – For epistaxis – maintain an    elevated position of...
• Provide support during the  transfusion therapy• Diet   – Low fat, low fiber, non-     irritating, non-carbonated   – No...
PREVENTION
• Eliminate vector by:   –Changing water and scrubbing sides     of lower vases once a week   –Destroy breeding places of ...
OTHER PRECAUTIONS:• When outdoors in an area where  dengue fever has been found  –Use a mosquito repellant  –Dress in prot...
• Keeping unscreened windows and  doors closed• Keeping window and door screens  repaired• Use of mosquito nets
MALARIA• Malaria, King of Tropical       – P. VIVAX AND OVALE  Disease                           MAY HAVE RECCURENCE      ...
– MOT   • Bite from infected anopheles mosquito or minimus     flavire (night biting)   • Blood Transfusion   • Sexual cyc...
– Nursing Considerations– Dx:   • blood extraction (extract blood at the height of fever)– Fever, chills, profuse sweating...
– Nursing Considerations– IV FLUIDS AND ELECTROLYTES– Blackwater Fever – hemolysis and hemoglobinuria– Sickle Cell Trait –...
– TRAVELERS TO MALARIA ENDEMIC area SHOULD FOLLOW  PREVENTIVE MEASURES- (CHEMOPROPHYLAXIS CHLOROQUINE  MAY BE TAKEN 1 WEEK...
Filariasis, Elephantiasis, Human         Lymphatic Filariasis– CAUSATIVE AGENT-NEMATODE PARASITE  •   MICROFILARIAE OR FIL...
CLINICAL MANIFESTATIONS:– ASYMPTOMATIC STAGE   • (+) MICROFILARIAE IN THE BLOOD– NO CLINICAL S/SX– ACUTE STAGE   • LYMPHAD...
– INCIDENCE-REGION 5,8,11 AND CARAGA,  MARINDUQUE, SARANGGANI– Drug: Diethyl Carbamazine Citrate or Hetrazan  6mg/KgBW one...
Nursing Considerations– MASS TREATMENT-DOSE IS 6mg/KBW, SINGLE  DOSE PER YEAR.– ENVIRONMENTAL SANITATION– PERSONAL HYGIENE...
Schistosomias, Snail Fever, Takayama – Blood fluke – Schistosoma japonicum – S. hematobium – S. mansoni – MOT skin entry (...
– Cycle: Egg-larvae (miracidium)-intermediary host  (oncomelania quadrasi-tiny snail)-cercaria– Itchiness at the site– RUQ...
– Egg– miracidium– snail– cercaria- human– Itchiness – liver – intestines– Praziquantel– COPT– PREVENTION– Samar and Leyte
HIV and AIDS– Retrovirus (HIV1 & HIV2)– Attacks and kills CD4+ lymphocytes (T-helper)– Capable of replicating the lymphocy...
HIGH RISK GROUP– Homosexual or bisexual– Intravenous drug users– BT recipients before 1985– Sexual contact with HIV+– Babi...
MOT– Sexual intercourse (oral, vaginal and anal)– Exposure to contaminated blood, semen, breast  milk and other body fluid...
HIV TEST– Elisa– Western Blot– Rapid hiv test   •   Suds hiv-1   •   Results are obtained in less than 10 minutes   •   Co...
How to Diagnose– HIV+ 2 consecutive positive ELISA and 1 positive  Western Blot Test– AIDS+ HIV+ CD4+ count below 500/ml E...
– Exhibits one or more of   –   Weight loss  the ff:                   –   Severe diarrhea– Extreme fatigue           –   ...
• HIV CLASSIFICATION  – CATEGORY 1 – CD4+ 500 OR MORE  – CATEGORY 2 – CD4+ 200-499  – CATEGORY 3 – CD4+ LESS THAN 200
• Management  – Prevention of spread (safe sex)  – Universal precautions  – Health Education  – Symptomatic intervention  ...
Communicable diseases immunologic
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Transcript of "Communicable diseases immunologic"

  1. 1. INFECTIONS
  2. 2. Chain of InfectionSusceptible hostPortal of EntryEtiologic Agent (microorganism)ReservoirMethod of transmission from reservoir to (Source) susceptible hostPortal of exit
  3. 3. Pathogens• Bacteria – Aerobic – Anaerobic• Viruses - intracellular parasite capable of reproducing outside of a living cell.• Mycoplasma – similar to bacteria and have no cell wall – resistant to antibiotics that inhibit cell wall synthesis• Rickettsiae & Chlamydia - rigid cell wall; with some feature of both bacteria and viruses. – Chlamydia- transmitted by direct contact – Rickettsiae- infect cells of arthropods and are transmitted by these vectors.• Fungi - self-limited, affecting the skin and subcutaneous tissue.• Parasites
  4. 4. Reservoir -where the pathogen lives and multiplies – Endogenous – Exogenous• Mode of Transmission – Direct contact – Indirect contact• Vector – Droplet or airborne transmission
  5. 5. Host Factors• Factors that enable a host to resist infections: • Physical barriers • Hostile environment created by stomach acid secretions, urine & vaginal secretions. • Antimicrobial factors e.g. saliva, tears • Respiratory defenses • Specific and nonspecific immune responses to pathogenic invasion. • Age • Nutrition
  6. 6. Portal of Entry• Respiratory Tract• GI Tract• Genitourinary Tract• Skin and mucous membrane• Bloodstream
  7. 7. Stages of Infectious Process• Incubation period – period begins with active replication but with no symptoms• Prodromal stage – Symptoms first appear• Acute phase – proliferation and dissemination of pathogens• Convalescent stage - containment of infection and pathogens are eliminated• Resolution – total elimination of pathogens without residual manifestationNosocomial infection– Infection acquired in a health care setting.– Typically manifest after 48 hrs.– UTI most common type
  8. 8. FACTORS AFFECTING RISK OF INFECTION• AGE• HEREDITY• LEVEL OF STRESS• NUTRITIONAL STATUS• CURRENT MEDICAL THERAPY• PRE-EXISTING DISEASE• IMMUNIZATION STATUS
  9. 9. Standard precautions• Blood• All body fluids, secretions, excretions,• Non-intact skin• Mucous membranes• Essential elements: • Use barrier protection • Prevent inadvertent percutaneous exposure, dispose of needles • Immediate and thorough hand washing
  10. 10. Infection Control and Prevention
  11. 11. Infection Control in In-Patient Health Care Agencies• Hand Hygiene• Patient Placement• Protective Equipment• Proper disposal of Soiled Equipment
  12. 12. Infection Control In Community – Based Setting• Sanitation• Proper Disposal of Waste• Food Preparation• Report CD Occurrence
  13. 13. Pharmacology• Check for: – History of hypersensitivity. – Age and childbearing status of the client. – Renal function – Hepatic function – Site of infection• Classification of antimicrobial preparations: – Bacteriostatic – Bactericidal
  14. 14. COMMUNICABLE DISEASE – Is any disease that can be transmitted directly or indirectly from one person to another
  15. 15. INFECTION – Is a condition caused by the entry and multiplication of pathogenic microorganisms within the host body. – It is also an invasion of an organisms (bacteria, helminths, fungi, parasite, ricketsia and prion)
  16. 16. ISOLATION– It is necessary when a person is known or suspected to be infected with pathogens that can be transmitted by direct or indirect contact.– 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.
  17. 17. Transmission-Based Precautions –Airborne –Droplets –Contact
  18. 18. AIRBORNE– PRIVATE ROOM– NEGATIVE AIR PRESSURE– VENTILATION SAFEGUARDS air from room is not recirculated to other areas– DOOR SHOULD BE KEPT CLOSED– BARRIER TO SMALL PARTICLES masks HEPA high efficiency particulate air– COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT
  19. 19. DROPLET• – PRIVATE ROOM – WEAR MASK IF WORKING WITHIN 3 FEET – WEAR MASKS UPON ENTRY INTO THE ROOM – COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT
  20. 20. CONTACT– PRIVATE ROOM– WEAR GLOVES– GLOVES ARE REMOVED BEFORE EXITING FROM THE ROOM– HANDS ARE WASHED THOROUGHLY– NOTHING IS TOUCHED BEFORE EXITING THE ROOM– GOWN IS WORN WHEN ENTERING THE ROOM– REMOVE GOWN CAUTIOUSLY BEFORE LEAVING THE ROOM– PATIENT CARE ITEMS SHOULD BE RESTRICTED TO SINGLE PATIENT
  21. 21. AFB ISOLATION – VISITORS REPORT TO NURSES’ STATION BEFORE ENTERING ROOM • MASKS ARE TO BE WORN IN THE PATIENT’S ROOM • GOWNS ARE INDICATED TO PREVENT CLOTHING CONTAMINATION • GLOVES ARE INDICATED FOR BODY FLUIDS AND NON- INTACTSKIN • HANDWASHING-after touching the patient or potentially contaminated articles and after removing gloves • articles should be discarded, cleaned or sent for decontamination and reprocessing • room is to remain closed • patient is to wear mask during transport
  22. 22. STRICT ISOLATION– VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM– PRIVATE ROOM-necessary, door must be kept closed– GOWNS-must be worn by all persons entering the room– MASKS- must be worn by all persons entering the room– HANDS-must be washed on entering and leaving room– GLOVES-must be worn by all persons entering the room– ARTICLES-must be discarded, or wrapped before being sent to CENTRAL SUPPLY for disinfection or sterilization
  23. 23. RESPIRATORY ISOLATION – VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM – PRIVATE ROOM-necessary, door must be kept closed – GOWNS-gowns not necessary – MASKS- must be worn by all persons entering the room if susceptible disease – HANDS-must be washed on entering and leaving room – GLOVES-not necessary – ARTICLES-those contaminated with secretions must be disinfected – CAUTION-all persons susceptible to the specific disease should be excluded from the area, susceptibles must wear masks
  24. 24. WOUND AND SKIN PRECAUTIONS– VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM– PRIVATE ROOM-desirable– GOWNS-must be worn by all persons having direct contact with the patient– MASKS- during dressing changes– HANDS-must be washed on entering and leaving room– GLOVES-must be worn by all persons having direct contact with infected area– ARTICLES-instruments, dressing, linens
  25. 25. ENTERIC PRECAUTIONS– VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM– PRIVATE ROOM-necessary FOR CHILDREN ONLY– GOWNS- must be worn by all persons having direct contact with the patient– MASKS- not necessary– HANDS-must be washed on entering and leaving room– GLOVES-must be worn by all persons having direct contact with patient or articles contaminated with fecal material– ARTICLES-special precautions necessary for articles contaminated with urine and feces, must be disinfected or discarded
  26. 26. PROTECTIVE ISOLATION– VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM– PRIVATE ROOM-necessary, door must be kept closed– GOWNS- must be worn by all persons entering room– MASKS- - must be worn by all persons entering room– HANDS-must be washed on entering and leaving room– GLOVES-must be worn by all persons having direct contact with patient
  27. 27. Airborne Diseases
  28. 28. Diphtheria– Corynebacterium diphtheriae– Klebsloeffler’s bacillus (bacteria)– MOT = droplets and airborne • HIGHLY CONTAGIOUS– IP 2-5 days– IMMUNITY • Active = DPT • Passive = DAT • Natural = xxx
  29. 29. – Dx = throat swab, MOLONEY, SCHICK– Pseudomembrane, Bullneck– Penicillin or erythromycin– Resp Acidosis with hypoxemia– Cx: myocarditis, septicemia
  30. 30. Nursing Considerations:– OBSERVE CNS, CARDIAC AND KIDNEY COMPLICATIONS– PSEUDOMEMBRANOUS MAY LEAD TO RESP. OBSTRUCTION– ISOLATION UNTIL 2 NEGATIVE CULTURE AT 24 HOUR INTERVAL– F&E RESUSCITATION– PARENTS OR SIBLINGS WHO HAVE NEVER IMMUNIZED SHOULD RECEIVE A DOSE OF DIPH. ANTI-TOXIN– ATTENTION TO NASOPHARYNGEAL DISCHARGE– ANTIBIOTICS-PENICILLIN, ERYTHROMYCIN IF ALLERGIC TO PENICILLIN
  31. 31. Diphtheria KEY POINTS!– Highly contagious– Pseudomembrane and bullneck– Immunization best intervention PREVENTION– Obstruction and myocarditis– Isolation technique
  32. 32. Measles, Rubeola, 7 Day Fever, Hard Red Measle– Paramyxo virus– MOT = droplets and airborne • PC 4 days before and 5 days after rash • HIGHLY CONTAGIOUS– IP 7-14 days– IMMUNITY • Active = measles vaccine, MMR • Passive = measles Ig • Natural = lifetime
  33. 33. – Rashes:– Maculopapular– Cephalocaudal– With desquamation– Pruritus
  34. 34. • Rashes: maculopapaular, cephalocaudal (hairline and behind the ears to trunk and limbs), confluent, desquamation, pruritus
  35. 35. – PS koplik’s spot– Characteristic: stimsons, photophobia (typical complaint)– Fever: high fever– CX pneumonia, meningitis
  36. 36. German Measles, Rubella, Rotheln Disease, 3 Day Measles– RNA rubella virus– MOT = droplets and airborne • PC 5 days before and 5 days after rash • HIGHLY CONTAGIOUS– IP = 10-21 days– IMMUNITY • Active = MMR • Passive = rubella Ig • Natural = lifetime
  37. 37. – Rashes:– Maculopapular– Diffuse– No desquamation
  38. 38. – Rashes: Maculopapular, Diffuse/not confluent, No desquamation, spreads from the face downwards•
  39. 39. Chicken Pox, Varicella– Herpes Zoster Virus– Varicella Zoster Virus– MOT = droplets and airborne • PC one day before rash and 6 days after first crop of vesicles • HIGHLY CONTAGIOUS– IP 14-21 days– IMMUNITY • Active = varicella vaccine • Passive = xxx • Natural = lifetime
  40. 40. – Rashes: Maculopapulovesicular (covered areas), Centrifugal, starts on face and trunk and spreads to entire body– Leaves a pitted scar (pockmark)
  41. 41. – Dx = Tzanck smear (scraping of ulcer for staining)– Rashes: • Maculopapulovesicular (covered areas) • Centrifugal • Leaves a pitted scar (pockmark)– CX furunculosis, erysipelas, meningoencephalitis– Dormant: remain at the dorsal root ganglion and may recur as shingles
  42. 42. Meningitis Menigococcemia– Neisseria meningitides (bacteria)– MOT = droplets– IP = 1-2 days– IMMUNITY = xxx
  43. 43. – Immunocompetent are susceptible– Petechiae (volar/palm of hands) EARLY– Opisthotonus MENIGEAL IRRITATION– Brudzinski MENINGEAL IRRITATION– Kernigs MENINGEAL IRRITATION– Increased ICP BRAIN– Seizure BRAIN
  44. 44. – S/sx: – Meningococcemia – spiking fever, chills, arthralgia, petechial rash – Fulminant Meningococcemia (Waterhouse Friderichsen) – septic shock; hypotension, tachycardia, enlarging petecchial rash, adrenal insufficiency• Meningitis – most common; nuchal rigidity, brudzinski, kernigs, Photophobia, confusion
  45. 45. – Dx: CT/ MRI, CSF analysis, CSF gram stain, CSF and blood culture– Mgmt: antibiotics (Pen G, ceftriaxone), steroids, anticonvulsants, Rifampin for close contacts of meningococcemia
  46. 46. Amoebiasis– Entamoeba Hystolitica –protozoan (parasite)– MOT = 5 F’s, fecal oral route– IP = 2-4 weeks– IMMUNITY = xxx
  47. 47. – Dx microscopic stool exam or rectal secretions– (tetra nucleated cyst and trophozoites)– Diarrhea and constipation (non dysenteric)– Blood streaked, diarrhea and watery mucoid, abd’l cramps (dysenteric)– Extra amoebiasis- penile, vagina, spleen, liver, anal, lungs and meninges– Metronidazole (Flagyl)
  48. 48. Typhoid Fever– Salmonella typhosa (bacteria)– MOT = same with amoebiasis (5 F’s)– IP = 1-3 weeks– IMMUNITY • Active = vaccine • Passive = xxx • Natural = lifetime immunity
  49. 49. Pathophysiology– Oral ingestion– Bloodstream– Reticuloendothelial system (lymph node, spleen, liver)– Bloodstream– Gallbladder– Peyer’s patches of SI– necrosis and ulceration
  50. 50. – 1st week step ladder (BLOOD)– 2nd week rose spot and fastidial • typhoid pyschosis (URINE & STOOL)– 3rd week (complications) intestinal bleeding, • perforation, peritonitis, encephalitis,– 4th week (lysis) decreasing S?SX– 5th week (convalescent)
  51. 51. – Blood (typhi dot) 1st week after– Stool and urine 2nd week after– Chloramphenicol
  52. 52. – Rose spot (abdominal rashes)– Step ladder fever to fastidial (peak of fever) typhoid psychosis– Peyer’s patches of small intestine– May stay in the gallbladder (hiding area)
  53. 53. BLOOD BORNE DISEASES
  54. 54. RABIES
  55. 55. CONTENTS:
  56. 56. What is rabies? (DEFINITION & ETIOLOGY)• Is an acute infectious disease of warm-blooded animals and humans characterized by an involvement of the nervous system resulting in death.• It is caused by the RABIES VIRUS, a rhabdovirus of the genus lyssavirus.Rabies is a serious disease. Each year, it kills more than50,000 people and millions of animals around the world.Rabies is a big problem in Asia, Africa, and Central and SouthAmerica. In the United States, rabies has been reported inevery state except Hawaii. Any mammal can get rabies.Raccoons, skunks, foxes, bats, dogs, and cats can get rabies.Cattle and humans can also get rabies. Only mammals can getrabies. Animals that are not mammals -- such asbirds, snakes, and fish -- do not get rabies. Rabies is causedby a virus. An animal gets rabies from saliva, usually from abite of an animal that has the disease.
  57. 57. The Rabies VirusRV – a neurotropic filterable virus present in thesaliva of rabid animals. It has a preferrence for Rod-shapednerve tissues. rabies viruses colored for Virus – minute organism not visible effect with ordinary light microscopy. It is parasitic in that it is entirely dependent on nutrients inside cells for its metabolic and reproductive needs. Can only be seen by use of eclectron microscopy. Consists of DNA or RNA covered with a protein Parts of the rabies covering called capsid. A rhabdovirus virus of the genus lyssavirus. Neurotropic – viruses that reproduce in nerve tissue Filterable virus – virus causing RHABDOVIRUS: any group of rod-shaped infectious disease, the essential This is a RNA viruses with 1 important member, elements of which are so photograph of tiny that rabies virus, pathogenic to man. The they retain infectivity aftervirus under the virus has a predilection for tissue of RHABDO: from Greek passing through a filter of the electron mucus-secreting glands and the Central rhabdos, "rod" Berkefeld type. microscope Nervous System. All warm-blooded
  58. 58. How do you get rabies? (MODE & MEDIA OF TRANSMISSION, IMMUNITY)•All warm-blooded mammals are susceptible. Natural immunity in man isunknown.•You get rabies through the saliva of an infected animal by an exposure toan open break in the skin such as bites, open wound or scratch andinhalation of infectious aerosols such as from bats.•In some cases, it is transmitted through organ transplants (cornealtransplant), from an infected person.•The virus gets transmitted through saliva, tears, semen, some liquor(amniotic fluid, CST) but not blood, urine or stool. You get rabies from the saliva of a rabid animal, usually from a bite. The rabies virus is spread through saliva. You cannot get rabies by petting an animal. You may get rabies from a scratch if the animal, such as a cat, was licking its paw before it scratched you. (Remember that the rabies virus is found in the saliva of an animal).
  59. 59. How do you know if an animal has rabies?• Animals with rabies may act differently from healthy animals.• Some signs of rabies in animals are:  changes in an animal’s behavior  general sickness (fever, restlessness)  problems swallowing  increased drooling  aggression (biting at inanimate objects, aimless running)• Wild animals may move slowly or may act as if they are tame. Some wild animals (foxes, raccoons, skunks) that normally avoid porcupines, may even try to bite these prickly rodents.• A pet that is usually friendly may snap at you or may try to bite.
  60. 60. How do you know if one has rabies? (DIAGNOSIS)•There is yet no way of immediately knowing who had acquiredrabies virus. No tests are available to diagnose rabies in humansbefore the onset of clinical disease.•The most reliable test for rabies in patients who have clinical signsof the disease is a DIRECT IMMUNOFLUORESCENT STUDY of afull thickness biopsy of the skin taken from the back of the neckabove the hair line.•The RAPID FLUORESCENT FOCUS INHIBITION TESTis used to measure rabies-neutralizing antibodies inserum. This test has the advantage of providing resultswithin 24 hours. Other tests of antibodies may take aslong as 14•days.
  61. 61. EPIDEMIOLOGYRABIES INCIDENCE:WORLDWIDE:35, 000-50, 000 cases/ year(WHO)
  62. 62. EPIDEMIOLOGYPHILIPPINES: 350-450 cases/ year 5-7 per million populationDOG BITE INCIDENCE: 140, 000- 560, 000/ year200-800 per 100, 000 population/ yearAGE MOST AFFECTED: 5-14 year age group (53% of cases)BITING ANIMALS: (SLH STUDY 1982- 2002) DOGS: 98% PET: 88% STRAY: 10% CATS: 2%
  63. 63. • Based on the report from NCDPC (2004), the six regions with the most number of rabies cases are Western Visayas, Central Luzon, Bicol, Central Visayas, Ilocos and Cagayan Valley• Data shows that 53.7 percent of animal bite patients are children• Dogs remain the principal animal source of rabies
  64. 64. STAGES OF RABIES INFECTIONRabies virus Entry into the body INCUBATI0N PERIOD (20 – 90 days) INVASION (0 – 10 days) EXCITEMENT (2 – 7 days) PARALYTIC COMA (5 – 14 days) DEATH
  65. 65. RABIES CLASSIFICATIONANIMAL RABIES• There are two common types of rabies. One type is "furious" rabies. Animals with this type are hostile, may bite at objects, and have an increase in saliva. In the movies and in books, rabid animals foam at the mouth. In real life, rabid animals look like they have foam in their mouth because they have more saliva. The second and more common form is known as paralytic or "dumb" rabies. The dog pictured below has this type. An animal with "dumb" rabies is timid and shy. It often rejects food and has paralysis of the lower jaw and muscles.• Another two types of rabies. One type is “urban” rabies. The type of rabies in domestic dogs and cats. The other type is called “ sylvatic” rabies. These type came from wild animals such as bats, weasels, skunks and moles & voles.
  66. 66. HUMAN RABIES• Humans also have a “furious” type, the classic foaming of the mouth, aggression, apprehension & hydrophobia, and the “dumb” type, progressive paralysis of the body until they couldn’t breathe anymore.
  67. 67. DIFFERENT STAGES OF RABIES INFECTION C B A A T TD S SOGS VIRUS IN SALIVA INHALED AEROSOLS VIRUS IN SALIVA INVASION PHASE INVASION PHASE PARALY SIS EXCITEMENT PARALY SIS DEATH DEATH
  68. 68. INVASION STAGE• Also called PRODOME PERIOD; Prodrome – symptom indicative of an approaching disease• 2-10 DAYS• Sensory changes on the site of entry. Pain: dull, constant pain referable to the nervous pathways proximal to the location of the wound or itching, intermittent, stabbing pains radiating distally to the region of inoculation. In general, sensitivity is the early symptom which may be ascribed to the stimulative action of the virus affecting groups of neurons, esp. sensory system. Though there is apt to be decreased sensitivity to local pain e.g. needle introduction, patient may complain bitterly of drafts & bed clothes which produce a general stimulation Tick me!
  69. 69. • Fever,headache malaise sore throat anorexia increased sensitivity (bright lights, loud noises) increased muscle reflex irritability, tics and muscle tone• Overactive facial expression
  70. 70. EXCITATION STAGE• Also called ACUTE NEUROLOGICAL PHASE; hyperactivity• 2 – 10 DAYS• Imminent thoraco-lumbar involvement (SNS): pupillary dilation, lacrimation increased thick saliva production / foaming of mouth, excessive perspiration, increased HR• Anxiety: increased nervousness, insomnia, apprehension; a strong desire to be up, wandering aimlessly about, and Fear: a sense of impending doom• Hydrophobia (perhaps, SNS stimulation: depresses GI activity > inhibits esophageal, gastric & intestinal function) > violent expulsion of fluids, drooling (in attempt not to swallow) > dehydration and parched mouth & tongue• Pronounced muscular stimulation & general tremor• Mania (tearing of clothes & bedding, cases of biting & fighting rare but may occur) and Hallucinations with lucid intervals (normal mental function in which patient is well-oriented & answers questions intelligently)• Convulsions( besides r/t pronounced muscular stimulation, further precipitated by sensory stimuli – sight, sound, name of water > throat spasms > choking > apnea, cyanois, gasping Sympathetic nervous system• > death, but if patient survive excitement phase… Tick me Parasympathetic nervous system Tick me 1st! next!
  71. 71. Tick me!
  72. 72. PARALYTIC STAGE-also called DEPRESSION PHASE• Gradual weakness of muscle groups – muscle spasms cease – OCULAR PALSY – strabismus, ocular incoordination, nystagmus, diplopia, central type partial blindness > responds poorly to light, @ times pupil is constricted or unequal (parasympathetic involvement) – Oro-facial: FACIAL & MASSETER PALSY > difficulty closing eyes & mouth, face expressionless – Oral: Weakness of muscles of phonation > hoarsness & loss of voice• Loss of tendon reflexes, always precedes weakness of extremity• Corneal reflex decreased or absent, dry
  73. 73. • Ears: VERTIGO . Middle ear disease . Early symptom, but may develop @ any period• Neck stiffness• (+) Babinski [lesions of pyramidal tract], ( - ) Kernig’s ( - ) Brudzinski’s• Cardiac: shifts from tachycardia (100 – 120bpm) @ bed rest to bradycardia (40 -60 bpm)• Respi: Cheyne-Stokes > breathing pattern characterized by a periodic 10 – 6- sec of apnea followed by gradual increasing depth and frequency of respiration• Local sensation (pin prick, heat, cold) diminished• Incoordination
  74. 74. • Hydrophobia and aerophobia gone, but still has some difficulty swallowing• General arousal (PNS stimulation)• Bladder & intestinal retention and obstipation (damage to to innervation of the musculature of intestine & bladder)(SNS damage) in some cases, patient shows period of recovery, this apparent remission is followed by progressive• Ascending, flaccid paralysis of extremities until it reaches the respiratory muscle• Apathy, stupor• Complications: Pneumothorax, thrombosis, secondary infections
  75. 75. MANAGEMENTNURSING INTERVENTIONS• HIGH RISK FOR INFECTION TRANSMISSION » provide patient isolation » handwashing. Wash hands before and after each patient contact and following procedures that offer contamination risk while caring for an individual patient. Handwashing technique is important in reducing transient flora on outer epidermal layers of skin. » Wear gloves when handling fluids and other potential contaminated articles. Dispose of every after patient care. Gloves provide effective barrier protection. Contaminated gloves becomes a potential vehicle for the transfer of organisms.
  76. 76. • KNOWLEDGE DEFICIT (about the disease, cause of infection and preventive measures) »assess patient’s and family’s level of knowledge on the disease including concepts, beliefs and known treatment. »Provide pertinent data about the disease: »organism and route of transmission »treatment goals and process »community resources if necessary »allow opportunities for questions and discussions
  77. 77. • ALTERED BODY TEMPERATURE: FEVER RELATED TO THE PRESENCE OF INFECTION. Since fever is continuous, provide other modes to reduce discomfort. »If patient is still well oriented, Inform the relation of fever to the disease process. The presence of virus in the body … »Monitor temperature at regular intervals »Provide a well ventilated environment free from drafts and wind.
  78. 78. • DEHYDRATION related to refusal to take in fluids secondary to throat spasms and fear of spasmodic attacks. »Assess level of dehydration of patient. »Maintain other routes of fluid introduction as prescribed by the physician e.g. parenteral routes »Moisten parched mouth with cotton or gauze dipped in water but not dripping.
  79. 79. IMMUNIZATION ACTIVE IMMUNIZATION- induce antibody and T-cell production in order to neutralize the rabies virus in the body. It induces an active immune response in 7-10 days after vaccination, which may persist for one year or more provided primary immunization is completed.TYPES: a. PVRV (Purified Vero Cell Rabies Vaccine) b. PCEVC (Purified Chick Embryo Cell Vaccine)
  80. 80. PASSIVE IMMUNIZATION- RIG (Rabies Immune Globulins)- provide the immediate availability of antibodies at the site of exposure before it is physiologically possible for the pt.to begin producing his own antibodies after vaccination.- Important for pts. w/ Cat III exposuresTypes: a. HRIG (Human Rabies Immune Globulins) b. Highly Purified Antibody Antigen Binding fragments c. ERIG (Equine Rabies Immune Globulins)
  81. 81. VACCINATION (Intradermal Schedule) Day of PVRV/PCECV SiteImmunization DAY 0 0.1 ml L & R deltoids/ anterolateral thighs of infants DAY 3 0.1 ml L & R deltoids/ anterolateral thighs of infants DAY 7 0.1 ml L & R deltoids / anterolateral thighs of infants DAY 28/30 0.1 ml L & R deltoids/ anterolateral thighs of infants
  82. 82. Intramuscular ScheduleDay of PVRV PCECV SiteImmunizationDay 0 0.5 ml 1.0 ml One deltoid/ anterolateral thigh of infantsDay 3 0.5 ml 1.0 ml SameDay 7 0.5 ml 1.0 ml SameDay 14 0.5 ml 1.0 ml SameDay 28 0.5 ml 1.0 ml same
  83. 83. MANAGEMENT OF RABIES PATIENT• Once symptoms start, treatment should center on comfort care, using sedation & avoidance of intubation & life support measures once diagnosis is certain1. MEDICATIONSa. Diazepamb. Midazolamc. Haloperidol + Dipenhydramine
  84. 84. 2. SUPPORTIVE CARE- Pts w/ confirmed rabies should receive adequate sedation & comfort care in an appropriate medical facility. a. Once rabies diagnosis has been confirmed, invasive procedures must be avoided b. Provide suitable emotional and physical support c. Discuss & provide important info. to relatives concerning transmission of dse. & indication for PET of contacts d. Honest gentle communication concerning prognosis should be provided to relatives of pt
  85. 85. 3. INFECTION CONTROL a. Patient should be admitted in a quiet, draft- free, isolation room b. HLCR workers & relatives in contact w/ pt should wear proper personal protective equipment (gown, gloves, mask, goggles)4. DISPOSAL OF DEAD BODIES
  86. 86. Tetanus
  87. 87. • Tetanus – Clostridium tetani – MOT = wound setting – IP = 3 -21 days – IMMUNITY • Active = TT • Passive = TAT and TIG • Natural = active none, passive (+)
  88. 88. – Wound Infection– FATAL INFECTION OF THE CNS– TOXIN-NEUROTOXIN
  89. 89. • PATHOPHYSIOLOGY: – 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
  90. 90. – Trismus – lock jaw– Risus sardonicus - maskface– Risorius - grinsmile– Dx wound and blood extraction (non specific)
  91. 91. • Immunization – DPT (0.5 ml IM) 1 – 1 ½ months old 2 - after 4 weeks 3 – after 4 weeks – 1 st booster – 18 mos – 2 nd booster – 4-6 yo – subsequent booster – every 10 yrs thereafter – TT (0.5 ml IM) TT1 - 6 months within preg TT2 - one month after TT1 TT3 to TT5 - every succeeding preg or every year – TAT (horse) and TIG (human)
  92. 92. • Management – 1. Anticonvulsant, muscle relaxants, – antibiotics, wound cleansing and debridement, hyperbaric chamber – 2. Active-DPT and tetanus toxoid – 3. Passive-TIG and TAT, placental immunity
  93. 93. VECTOR-BORNE DISEASES
  94. 94. DENGUE HEMORRHAGIC FEVER
  95. 95. IINTRODUCTION: Philippine Hemorrhagic Fever was first reported in 1953. In 1958, hemorrhagic became a notifiable disease in the country and was later reclassified as Dengue Hemorrhagic Fever.What is DengueHemorrhagic Fever? • A severe mosquito transmitted viral illness endemic in the tropics. • It is characterized by increased vascular permeability, hypovolemia and abnormal blood clotting mechanisms.
  96. 96. WHO case definition for DHF:• fever or history of recent fever• thrombocytopenia (platelet count equal to or less than 100 x 10 /cu mm)• hemorrhagic manifestations such as petechiae or overt bleedingphenomena, and• evidence of plasma leakage due to increase vascular permeabilityInfectious Agent / Etiologic Agent: Flaviviruses; Dengue Virus Types 1, 2, 3, and 4
  97. 97. Occurrence: Dengue occurrence is sporadic throughout the year. Epidemic usually occurs during the rainy seasons June – November. Peak months are September and October. DHF are observed most exclusively among children of the indigenous population under 15 years of age. Occurrence is greatest in the areas of high Aedis Aegypti prevalence.
  98. 98. Notifiable Diseases and Deaths by Cause in the Philippines (2001 – 2004) 2001 2002 2003 2004Notifiable Diseases Reported Reported Reported Reported Cases Deaths Cases Deaths Cases Deaths Cases Deaths Dengue Fever 23,235 13,187 18,039 15,838 Source: National Statistics Office
  99. 99. INCIDENCE OF DENGUE HEMORRHAGIC FEVER IN CEBU CITY (YEAR 2007) Selected Number of New Cases Number of Deaths YearCommunicable Disease: total male female total male femaleDengue / DHF 43, 350 … … 416 … … 2007 Source: Department of Health Region VII
  100. 100. • The DOH reported 70,204 dengue cases for week ending September 10, 2011. This was over 24,000 cases less or 25.87% lower than for the same period last year. In addition, the number of cases in July and August (the peak months for dengue) was 52% lower than last year. A total of 396 deaths were reported for this year, which is lower than last year’s number of 620.
  101. 101. Reservoir / Source of Infection: • Some source is a vector mosquito, the Aedes Aegypti or the common household mosquito • The infected person
  102. 102. Mode of Transmission: Mosquito bite (Aedis Aegypti)Incubation Period: Probably 6 days to one weekPeriod of Presumed to be on the 1st week of illness – when virus is stillCommunicability: present in the bloodSusceptibility and All persons are susceptible. Both sexes are equally affected. The ageresistance: groups predominantly affected are the preschool age and school age. Adults and infants are not exempted. Peak age affected 5-9 years. Susceptibility is universal. Acquired immunity may be temporary but usually permanent.
  103. 103. Diagnostic Test: 1.) Tourniquet Test (Rumpel Leads Tests) • Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes • Release cuff and make an imaginary 2.5 cm square or 1 inch just below the cuff, at the antecubital fossa • Count the number of petechiae inside the box • A test is (+) when 2 or more petechiae per 2.5 cm square or 1 inch square are observed 2.) A con firmed diagnosis is established by culture of the virus, polymerase-chain-reaction (PCR) tests, or serologic assays.
  104. 104. Clinical Manifestations (Public Health Nursing inthe Philippines, 2007):An acute febrile infection of sudden onset with 3 stages:• 1st-4th day (febrile or invasive stage)-high fever, abdominal pain and headache; later flushing whichmay be accompanied by vomiting, conjunctiva infection andepistaxis.• 4th-7th day (toxic or hemorrhagic stage)-lowering of temperature, severe abdominal pain, vomiting andfrequent bleeding from gastrointestinal tract in the form ofhematemesis or melena. Unstable blood pressure, narrow pulsepressure and shock. Death may occur. Tourniquet test which may bepositive may become negative due to low or vasomotor collapse.
  105. 105. • 7th-10th day (convalescent or recovery stage) -generalized flushing with intervening areas of blanching, appetite regained and blood pressure already stable.• Dengue shock syndrome is defined as denguehemorrhagic fever plus:*Weak rapid pulse,*Narrow pulse pressure (less than 20 mm Hg) or,*Cold, clammy skin and restlessness
  106. 106. Grading of Dengue Fever:The severity of DHF is categorized into four grades:• grade I, without overt bleeding but positive for tourniquet test• grade II, with clinical bleeding diathesis such as petechiae, epistaxis andhematemesis• grade III, circulatory failure manifested by a rapid and weak pulse withnarrowing pulse pressure (20 mmHg) or hypotension, with the presence ofcold clammy skin and restlessness; and• Grade IV, profound shock in which pulse and blood pressure are notdetectable. It is note-worthy that patients who are in threatened shock orshock stage, also known as dengue shock syndrome, usually remainconscious.* Grade III and IV are considered to be Dengue Shock Syndrome
  107. 107. MANAGEMENT
  108. 108. • Promote rest• Medication –Paracetamol – for fever and muscle pains. –Analgesic – for headache –DON’T GIVE ASPIRIN
  109. 109. • Rapid replacement of body fluids is the most important treatment – Give ORESOL to replace fluid as in moderate dehydration at 75ml/kg in 4-6 hours or up to 2-3L in adults. Continue ORS intake until paient’s condition improves. – Intravenous fluid
  110. 110. • For hemorrhage – Keep patient at rest during bleeding periods – For epistaxis – maintain an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through an ice bag over the forehead. – For melena – ice bag over the abdomen.
  111. 111. • Provide support during the transfusion therapy• Diet – Low fat, low fiber, non- irritating, non-carbonated – Noodle soup may be given• Observe signs of deterioration (shock) such as low pulse, cold clammy perspiration, prostration.
  112. 112. PREVENTION
  113. 113. • Eliminate vector by: –Changing water and scrubbing sides of lower vases once a week –Destroy breeding places of mosquito by cleaning surroundings –Proper disposal of rubber tires, empty bottles and cans –Keep water containers covered
  114. 114. OTHER PRECAUTIONS:• When outdoors in an area where dengue fever has been found –Use a mosquito repellant –Dress in protective clothing-long- sleeved shirts, long pants, socks, and shoes
  115. 115. • Keeping unscreened windows and doors closed• Keeping window and door screens repaired• Use of mosquito nets
  116. 116. MALARIA• Malaria, King of Tropical – P. VIVAX AND OVALE Disease MAY HAVE RECCURENCE OF SYMPTOMS – Protozoan plasmodium • tertian-febrile paroxysm • plasmodium ovale - q24H-48H dormant (liver) • quartan-febrile paroxysm • plasmodium vivax - q48H-72H benign • plasmodium malariae - mild but resistant • plasmodium falciparum - malignant (cerebral malaria)
  117. 117. – MOT • Bite from infected anopheles mosquito or minimus flavire (night biting) • Blood Transfusion • Sexual cycle – sporogony (mosquito) – gametes is the infective stage • Asexual cycle – schizogony (human)– IP (Incubation Period) 5-6 days
  118. 118. – Nursing Considerations– Dx: • blood extraction (extract blood at the height of fever)– Fever, chills, profuse sweating-convulsion– Anemia and fluid and electrolytes imbalance, hepatomegaly, splenomegaly, rigor, headache and diarrhea.– Chloroquine and Primaquine drug of choice– Chloroquine for pregnant women– For resistant plasmodium-use chemo drug– RBC is being attack
  119. 119. – Nursing Considerations– IV FLUIDS AND ELECTROLYTES– Blackwater Fever – hemolysis and hemoglobinuria– Sickle Cell Trait – provides natural resistance– DECREASE FLUIDS IN CEREBRAL EDEMA– ASSISTED VENTILATION IN PULMONARY EDEMA– DIALYSIS IN RENAL FAILURE– BT IN ANEMIA
  120. 120. – TRAVELERS TO MALARIA ENDEMIC area SHOULD FOLLOW PREVENTIVE MEASURES- (CHEMOPROPHYLAXIS CHLOROQUINE MAY BE TAKEN 1 WEEK BEFORE ENTERING ENDEMIC AREA)– SOAKING OF MOSQUITO NET IN AN INSECTICIDE SOLUTION– BIO PONDS FOR FISH– ON STREAM CLEARING (TO EXPOSE THE BREEDING STREAM TO SUNLIGHT)– VECTORS PEAK BITING AT NIGHT 9PM-3AM– PLANTING OF NEEM TREE (REPELLENT EFFECT)– ZOOPROPHYLAXIS (DEVIATE MOSQUITO BITES FROM MAN TO ANIMALS)– INFECTED MOTHER CAN STILL CONTINUE BREAST FEEDING
  121. 121. Filariasis, Elephantiasis, Human Lymphatic Filariasis– CAUSATIVE AGENT-NEMATODE PARASITE • MICROFILARIAE OR FILARIAL WORMS • WUCHERERIA BRONCOFTI • BRUGIA MALAYI • BRUGIA TIMORI– MOT • Bite from aedes poecilius (night biting) • Invade the lymph vessel, obstructing the lymphatic channel-leads to edema and may infiltrate the reproductive organs.– IP 8-16 months
  122. 122. CLINICAL MANIFESTATIONS:– ASYMPTOMATIC STAGE • (+) MICROFILARIAE IN THE BLOOD– NO CLINICAL S/SX– ACUTE STAGE • LYMPHADENITIS (LYMPH NODES) • LYMPHANGITIS (LYMPH VESSELS) • GENETALIA-FUNICULITIS, EPIDYDIMITIS, ORCHITIS– CHRONIC STAGE • HYDROCOELE • LYMPHEDEMA (UPPER AND LOWER EXTREMITIES) • ELEPHANTIASIS
  123. 123. – INCIDENCE-REGION 5,8,11 AND CARAGA, MARINDUQUE, SARANGGANI– Drug: Diethyl Carbamazine Citrate or Hetrazan 6mg/KgBW one dose every year– Dx: • NBE nocturnal blood exam (night) • ICT immunochromatographic test (day)
  124. 124. Nursing Considerations– MASS TREATMENT-DOSE IS 6mg/KBW, SINGLE DOSE PER YEAR.– ENVIRONMENTAL SANITATION– PERSONAL HYGIENE– MOSQUITO NETS– LONG SLEEVES, LONG PANTS AND SOCKS– INSECT REPELLENT– SCREENING OF HOUSES– HEALTH EDUCATION
  125. 125. Schistosomias, Snail Fever, Takayama – Blood fluke – Schistosoma japonicum – S. hematobium – S. mansoni – MOT skin entry (cercaria) travel in to the blood stream where they will infiltrate the liver, from liver to intestines
  126. 126. – Cycle: Egg-larvae (miracidium)-intermediary host (oncomelania quadrasi-tiny snail)-cercaria– Itchiness at the site– RUQ pain (hepatomegaly)– Intestine infiltration-abd’l cramps, diarrhea with blood– Praziquantel– Dx COPT (stool exam)
  127. 127. – Egg– miracidium– snail– cercaria- human– Itchiness – liver – intestines– Praziquantel– COPT– PREVENTION– Samar and Leyte
  128. 128. HIV and AIDS– Retrovirus (HIV1 & HIV2)– Attacks and kills CD4+ lymphocytes (T-helper)– Capable of replicating the lymphocytes undetected by the immune system– Immunity declines and opportunistic microbes sets in
  129. 129. HIGH RISK GROUP– Homosexual or bisexual– Intravenous drug users– BT recipients before 1985– Sexual contact with HIV+– Babies of mothers who are HIV+
  130. 130. MOT– Sexual intercourse (oral, vaginal and anal)– Exposure to contaminated blood, semen, breast milk and other body fluids– placenta
  131. 131. HIV TEST– Elisa– Western Blot– Rapid hiv test • Suds hiv-1 • Results are obtained in less than 10 minutes • Color indicator similar to pregnancy test • Positive result needs a confirmatory test
  132. 132. How to Diagnose– HIV+ 2 consecutive positive ELISA and 1 positive Western Blot Test– AIDS+ HIV+ CD4+ count below 500/ml Exhibits one or more of the ff: (next slide)– Full blown AIDS CD4 is less than 200/ml
  133. 133. – Exhibits one or more of – Weight loss the ff: – Severe diarrhea– Extreme fatigue – Apathy and depression– Intermittent fever – PTB– Night sweats – Kaposis sarcoma– Chills – Pneumocystis carinii– Lymphadenopathy – AIDS dementia– Enlarged spleen– Anorexia
  134. 134. • HIV CLASSIFICATION – CATEGORY 1 – CD4+ 500 OR MORE – CATEGORY 2 – CD4+ 200-499 – CATEGORY 3 – CD4+ LESS THAN 200
  135. 135. • Management – Prevention of spread (safe sex) – Universal precautions – Health Education – Symptomatic intervention – No known cure – Prevent CD4 reduction
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