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Communicable Diseases

  1. 1. Community Health Nursing Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN COMMUNITY HEALTH NURSING Communicable Disease Lecturer: Mark Fredderick R. Abejo RN, MAN EPI TARGET DISEASES Disease Causative Agent Mode of Clinical Manifestation Reservoir Diagnostic Exam Treatment Nursing Implication Transmission Tuberculosis Mycobacterium Droplet Infection General weakness Man Sputum Exam DOTS Pointers for teaching Loss of weight, cough and 3 sample are taken on Anti-TB drugs: “Primary Complex” is Tuberculosis ( inhalation of bacilli wheeze which does not And with 24 hrs: - patient is required less than 3 years old from patient who respond to antibiotic to take the Ant-Tb coughs and sneeze) therapy. Diseased Cattle - spot sample (1st drugs in the - any child who does Fever and night sweat visit) presence of a health Rifampicin: taken not return to normal Abdominal swelling with a (Bovine TB) befor meals, causes red care provider to hard painless mass and free - early morning health after measles or ensure compliance urine urine Degree of fluid whooping cough. specimen to treatment Hemoptysis and chest pain Communicability regimen Isoniazide: causes Painful firm or soft Most hazardous - spot sample peripheral neuritis, swelling in a group of period: first 6-12 Depends upon: superficial lymph nodes. given with Vit.B6 months after Note: (2nd visit) infection - num.of bacilli Pyrazinamide: cause Highest in risk of In young children the only Note: at least 2 hyperurucemia developing: under 3 - virulence of bacilli sample are sign of pulmonary TB may be Anti-TB drugs: years old positive Ethambutol: causes stunted growth or failure to - environmental
  2. 2. Community Health Nursing Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN conditions thrive (RIPES) optic neuritis/ blurring of vision Chest Xray Rifampicin Mantoux Test Isoniazid Streptomycin: cause - .1 cc injection of Pyrazinamide tinnitus, loss of PDD and 48-72 Ethambutol hearing balance, hours reading Streptomycin damage to 8th cranial nerve * 10 mm + 5 mm + (HIV pt.) Note: After 2-4 weeks of treatment, patient is no longer contagious
  3. 3. Community Health Nursing Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN The National Tuberculosis Control Program Increase and sustain support and financing for TB control activities Vision: A country where Tb is no longer a public health problem Strategies: Mission: Ensure that TB DOTS services are available, accessible and affordable to the communities in collaboration with the LGU’s Facilitate implementation of TB-DOTS Center certification and accreditation and other partners Build TB coalitions among different sectors Goal: To reduce prevalence and mortality from TB by half the year Advocate for counterpart input from local government units 2015 ( Millennium Development Goal ) Mobilize/extend other resources to address program limitations Targets: Objective D: 1. Cure at least 85% of the sputum smear- positive TB patient discovered. 2. Detect at least 70% of the estimated new sputum smear-positive TB cases. Strengthen management (technical and operational) of TB control services at all levels NTP Objectives and Strategies Strategies: Objective A: Enhance managerial capability of all NTP program managers at all levels Establish an efficient data management system for both public and private sectors. Improve access to and quality of services provided to TB patients, TB symptomatics and Implement a standardized recording and reporting system. communities by health care institutions and providers Conduct regular monitoring and evaluation at all levels. Advocate for political support through effective local governance Strategies: Enhance quality of TB diagnosis. KEY POLICIES Ensure TN patient’s treatment compliance. Ensure public and private health care providers adherence to the implementation of national Case Finding standards of care for TB patients. Improve access to services through innovative service delivery mechanisms for patients living in 1. DSSM ( Direct Sputum Smear Microscopy ) shall be the primary diagnostic challenging areas. tool in NTP case finding. Note: No TB diagnosis shall be made based on Xray result alone likewise result of PDD skin test (Mantoux Test) Objective B: 2. All TB symptomatic identified shall undergo DSSM for diagnosis before start of Enhance the health-seeking behavior on TB by communities, especially the TB treatment symptomatics Note: Only contraindication for sputum collection is hemoptysis Strategies: 3. After three sputum specimen yielding negative result X-ray and culture are necessary Develop effective, appropriate and culturally-responsive IEC/communication materials. Note: Diagnosis based on Xray shall be made by the TB DiagnosticCommittee. Organize barangay advocacy groups 4. Only trained medical technologist or microscopist shall perform DSSM. Objective C:
  4. 4. Community Health Nursing Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Patients with the following conditions shall be recommended for hospitalization: massive hemoptysis RECOMMENDED CATEGORY OF TREATMENT REGIMEN pleural effusion military TB ( TB of the Spine “Pot’s Disease”) TB meningitis TB pneumonia Category Type of TB Patient Treatment Regimen and those requiring surgical intervention Intensive Continuation Total Phase Phase Period Anti-TB drugs: New smear positive (RIPES) PTB New smear positive Rifampicin PTB with extensive Isoniazid I parenchymal lesion 2 RIPE 4 RI 6 mos. Pyrazinamide EPTB and Severe Ethambutol concomitant HIV Streptomycin disease Treatment Failure Relapse Two Formulation of Anti-TB Drugs II Return after default 2 RIPES /1 5 RIE 8 mos. RIPE 1. Fixed-Dose Combination ( FDCs) – two or more first line anti-TB drugs are combined in one tablet. There are 2,3, or 4 drug fixed dose combinations. New smear- 2. Single Drug Formulation (SDF) – each drug is prepared individually. Isoniazid, negative PTB Pyrazinamide and Ethambuto are in tablet form while Rifampicin is in capsule form and III With minimal 2 RIP 4 RI 6 streptomycin is injectable. parenchymal lession mos. Chronic ( still Refer to Specialized facility smear-positive after IV supervised re- or DOTS Plus Center refer treatment ) to City Provincial NTP Coordinator
  5. 5. Community Health Nursing Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Categories II : 2 RIPES / RIPE / 4RIE (FDC) DOSAGE PER CATEGORY OF TRATMENT REGIMEN A. Fixed-Dose Combination Formulation Body Intensive Continuation Phase Weight Phase The number of tablets of FDCs per patient will depend on the body weight. First Two (2) Months 3rd Month FDC-B E ( RI ) 400 mg Categories I and III : 2 RIPE / 4 RI ( FDC) FDC-A Streptomycin FDC-A (RIPE) (RIPE) Body Weight (kg) No.of tablets per day No. of tablets per day 30 – 37 2 0.75 g 2 2 1 Intensive Phase Continuation Phase 38 – 54 3 0.75 g 3 3 2 ( 2 months ) ( 4 months ) 55 – 70 4 0.75 g 4 4 3 FDC-A ( RIPE) FDC-B (RI) More 5 0.75 g 5 5 3 30 - 37 2 2 than 70 38 – 54 3 3 55 – 70 4 4 B. Single Dose Formulation ( SDF ) More than 70 5 5 Simply add 1 tablet of Isoniazid ( 100mg) , Pyrazinamide (500mg) and Ethambutol ( 400mg) each for the patient weighing more than 50kg before treatment initiation. Modify drug dosage within acceptable limits according to patient’s body weight, particularly those weighing less than 30 kg at the time of diagnosis.
  6. 6. Community Health Nursing Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Categories I and III: 2 RIPE / 4 RI (SDF) Anti-TB Drugs No. of tablets per day No. of tablets per day Drug Dosage per Kg. Body Weight Intensive Phase Continuation Phase ( 2 months ) ( 4 months ) Anti-TB Drugs Dose per Kg Body Weight and Maximum Dose Rifampicin 1 1 Isoniazid 1 1 Rifampicin 5 ( 4 – 6 ) mg/kg and not to exceed 400 mg daily Pyrazinamide 2 Isoniazid 10 ( 8 – 12 ) mg/kg and not to exceed 600 mg daily Ethambutol 2 Pyrazinamide 25 ( 20 – 30 ) mg/kg and not to exceed 2 mg daily Ethambutol 15 ( 15 – 20 ) mg/kg and not to exceed 1.2 g daily Categories II: 2 RIPES / 1 RIPE / 5 RIE Streptomycin 15 ( 12 – 18 ) mg/kg and not to exceed 1 g daily Anti-TB Drugs No. of Tablets / Vial per day No.of Tablets per day D.O.T.S ( Directly-Observed Treatment Shortcourse ) “TuTok Gamutan” Intensive Phase Continuation Phase (3months ) ( 5 months ) 5 Elements of D.O.T.S First 2 months 3rd months Sustained political commitment Access to quality-assured sputum microscopy Rifampicin 1 1 1 Standardized short-course chemotherapy for all cases of TB Uninterrupted supply of essential drugs Isoniazid 1 1 1 Recording and reporting system enabling outcome assessment of all patients and assessment of overall program performance. Pyrazinamide 2 2 Ethambutol 2 2 2 Streptomycin 1 vial per day Note: 56 vials of Streptomycin for two months
  7. 7. Community Health Nursing Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN MANAGEMENT OF CHILDREN WITH TB Management Prevention For children with exposure to TB BCG vaccination shall be given to all infants. Should undergo physical examination and PDD testing (Mantoux Test) BCG vaccine is moderately effective. It has a protective efficacy of: A child with productive cough shall be referred for DSSM, if found positive, treatment 50 % against any TB disease shall be started immediately. PDD testing shall no longer needed. Children without sign/symptoms of TB but with positive Mantoux Test and those with 64 % against TB meningitis symptoms of TB but negative Mantoux Test shall referred for chest x-ray examination. 74 % against death from TB For children with signs and symptoms of TB Case Finding A child to have signs and symptoms of TB with either known or unknown exposure Cases of TB in children are reported and identified in two instances: shall be referred for Mantoux test. - The patient sought consultation. For children with known contact but with negative Mantoux and those unknown contact - The patient was reported to have been exposed to an adult with TB but with positive Mantoux shall be referred for chest x-ray examination. For a negative x-ray report, Mantoux test shall be repeated after 3 months. All TB symptomatic children 0-9 years old, except sputum positive child shall subject to PDD Chemoprophylaxis of Isoniazid for 3 months shall be given to children less than 5 years testing old with negative chest x-ray after which Mantoux test shall be repeated - Only trained nurse and midwife shall do the PDD test and recording - Testing and reading shall be conducted once a week either on Monday or Tuesday. Treatment Note: 10 children shall be gathered for testing to avoid wastage. D.O.T.S will still be followed just like in adult Short course regimen: A child shall be suspected as having TB and considered symptomatic if with any three (3) of the - at least 3 anti-TB drugs for 2 months ( intensive phase ) following sign and symptoms: - 2 anti-TB drugs for 4 months ( continuation phase ) cough and wheezing for 2 weeks or more * For Extra Pulmonary TB Cases: unexplained fever for 2 weeks or more - 4 anti-TB drugs for 2 months ( intensive phase ) loss of appetite, loss of weight, failure to gain weight - 2 anti-TB drugs for 10 months ( continuation phase ) failure to respond to a 2 weeks of appropriate antibiotic therapy failure to regain state of health 2 weeks after a viral infection or after having measles. Domiciliary treatment shall be the preferred mode of care No treatment shall be initiated unless the patient and health worker has agreed upon a caseholding mechanism for treatment compliance. A child shall be clinically diagnosed or confirmed of having TB if he has any three (3) of the following condition: positive history of exposure to an adult/ adolescent TB case presence of sign and symptoms suggestive of TB positive Mantoux Test abnormal chest radiograph suggestive of TB
  8. 8. Community Health Nursing Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Treatment Regimen Continuation Phase A. Pulmonary TB Rifampicin 10-15 mg/kg body weight 10 months Isoniazid Drugs Daily Dose (mg/kg per body weight ) Duration 10-15 mg/kg body weight Intensive Phase Rifampicin 10-15 mg/kg body weight 2 months Isoniazid Pyrazinamide 10-15 mg/kg body weight Public Health Nurse Responsibilities ( Childhood TB ) 20-30 mg/kg body weight Continuation Phase 1. Interview and open treatment cards for identified TB children. 2. Perform Mantoux testing and reading to eligible children Rifampicin 10-15 mg/kg body weight 4 months 3. Maintain NTP records Isoniazid 4. Manage requisition and distribution of drugs 10-15 mg/kg body weight 5. Assist the physician in supervising the other health workers of the RHU in the proper implementation of the policies and guidelines on TB in children. 6. Assist in the training of other health workers on Mantoux testing and reading. B. Extra Pulmonary TB Drugs Daily Dose (mg/kg per body weight ) Duration Intensive Phase Rifampicin 10-15 mg/kg body weight Isoniazid Pyrazinamide 10-15 mg/kg body weight 20-30 mg/kg body weight 2 months Plus Ethambutol OR 15-25 mg/kg body weight Streptomycin 20-30 mg/kg body weight
  9. 9. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN EPI TARGET DISEASES Disease Causative Agent Mode of Clinical Manifestation Reservoir Diagnostic Treatment Nursing Implication Transmission Exam Diphteria it is an Corynebacterium Respiratory Nasal Man Schick’s Test Antibiotics Isolate patient until acute pharyngitis, acute Droplets 2-3 cultures taken at nasopharyngitis diphtheriae dryness of the upper - test for the least 24hrs apart are lip susceptibility to negative or acute laryngitis with serosanguinous Diptheria Pen G Potassium Small frequent secretion in the nose Erythromycin feeding Pseudo membrane – Promote absolute grayish white in color rest with leathery Use ice collar to Pharyngeal Moloney Test consistency in the relieve pain of sore throat and on the tonsil “Bullneck” throat - for hyper- appearance because of May put on soft diet sensitivity to the enlarge cervical Diptheria toxin lymph nodes. Laryngeal sore throat hoarseness brassy metallic cough Pertussis Bordetella Pertussis Airborne – droplet At first, the infected child may have a - 100 days cough Primarily by direct common cold with contact with he runny nose, sneezing - Whooping cough discharge from and mild cough Bordet-Gengou Erythromycin Place the patient on Intermittent episode Agar Plate Ampicillin NPO during respiratory mucous - “tuspirina” of paroxysmal cough Man paroxysmal stage to membranes of followed by a whoop - used for culture prevent aspiration infected person ending vomiting medium - is given 5-7 days Position prone for infants and upright for older
  10. 10. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Neonatal Tetanus Clostridium Tetani Unhygienic cutting Assess the NEWBORN of umbilical cord for a history of all 3 of the following: Blood Culture Penicillin Prevention Erythromycin - which produces the Tetracycline exotoxins: Improper handling of cord stump esp. Normal suck and cry CSF analysis Aseptic handling of Tetanolysin when treated with for the first 2 days of - administered within the neonatal Tetanospasmin contaminated life 4 hours of injury umbilical cord Onset of illness Tetanus Toxiod substance between 3 and 28 immunization for days mothers Inability to suck Active immunization followed by stiffness of DPT of the body and convulsion Soil Intestinal In OLDER CHILDREN, canal of the following may be animal observed: Man Trismus – lockjaw Opisthotonus – arching of the neck and back Ridus Sardonicus – sardonic smile
  11. 11. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Poliomyelitis 3 Types of Polio Virus Fecal-oral route Abortive - did not Throat swab Strict Isolation progress to systemic Hot moist compress “Infantile Paralysis” Type I Brunhilde infection Man to relieve spasm Type II Lansing Type III Leon Oral route through Stool exam pharyngeal Use protective secretion Non-paralytic – slight devices: involvement of the CNS - handroll to prevent Lumbar exam claw hand Contact with infected person Poker spine or stiffness of the spinal Pandy’s test column - for CSF analysis Spasms of the - trochanter roll, to hamstring prevent outer rotation With paresis of femur - footboard Paralytic – severe involvement of CNS Hoyne’s Sign – head falls back when he is in supine with shoulder elevated Paralysis Head log/drop Tripod position – extend his arm behind for support when he sits up Kernig’s sign Brudzinski sign
  12. 12. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Hepatitis B Prodromal/pre-icteric - it is liver infection Hepa B Virus 3 P’s Symptoms of URTI Liver Function Increase CHO caused by the B type of Weight loss Test Moderate fat hep.virus. Anorexia Man Low CHON RUQ pain It attacks livers the Person to person Malaise liver often resulting in Icteric Observed universal inflammation Parenteral precaution Jaundice Placental Acholic stool bile-colored urine 3 C’s Measles Paramyxo Virus Droplet Conjunctivitis Observe respiratory Coryza isolation Cough Man Should kept out of Koplik’s spot – bluish school for at least 4 gray spot on the buccal days after rash mucosa. appear For Photophobic, darkened room, Generalized blotch rash sunglasses
  13. 13. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN DISEASES TRANSMITTED THROUGH FOOD AND WATER Disease Causative Agent Mode of Transmission Pathognomonic Sign Management and Treatment Prevention Cholera Vibrio cholera Fecal-oral route Rice watery stool Diagnostic Test:  Proper handwashing Vibrio coma 5 Fs Stool culture  Proper food and water Other names: Ogawa and Inaba Period of sanitation El tor bacteria Incubation Period: Communicability: Treatment:  Immunization of Chole-vac Few hours to 5 days; 7-14 days after onset, Oral rehydration solution (ORESOL) Usually 3 days occasionally 2-3 IVF months Drug-of-Choice: tetracycline (use straw; can cause staining of teeth). Oral tetracycline should be administered with meals or after milk. Amoebic Entamoeba histolytica Fecal-oral route · Abdominal Metronidazole (Flagyl)  Proper handwashing Dysentery Protozoan (slipper- cramping * Avoid alcohol because of its Antabuse effect  Proper food and water shaped · Bloody mucoid stool can cause vomiting sanitation body) · Tenesmus - feeling of incomplete defecation Shigellosis Shigella bacillus Fecal-oral route · Abdominal Drug-of-Choice: Co-trimoxazole  Proper handwashing Sh-dysenterae – most cramping  Proper food and water Other names: infectious 5 Fs: Finger, Foods, · Bloody mucoid stool Diet: Low fiber, plenty of fluids, easily sanitation Bacillary Sh-flesneri – common Feces, Flies, · Tenesmus - feeling digestible  Fly control dysentery in Fomites of incomplete foods the Philippines defecation Sh-connei Incubation Period: Sh-boydii 1 day, usually less than 4 days Typhoid fever Salmonella typhosa Fecal-oral route · Rose Spots in the Diagnostic Test:  Proper handwashing (plural, typhi) 5 Fs abdomen – due to  Proper food and water bleeding caused by Typhi dot – confirmatory test; specimen is feces sanitation Incubation Period: perforation of the Widal’s test – agglutination of the patient’s Usual range 1 to 3 Peyer’s patches serum weeks, average 2 · Ladderlike fever weeks Drug-of-Choice: Chloramphenicol
  14. 14. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Hepatitis A Hepatitis A Virus Fecal-oral route · Fever Prophylaxis: “IM” injection of gamma globulin  Proper handwashing 5 Fs · Anorexia (early sign) Hepatitis A vaccine  Proper food and water Other names: · Headache Hepatitis immunoglobulin sanitation Hepatitis / Incubation Period: · Jaundice (late sign) Avoid alcohol  Proper disposal of urine Epidemic 15-50 days, · Clay-colored stool Complete bed rest – to reduce the breakdown of and feces Hepatitis / depending on dose, · Lymphadenopathy fats for metabolic needs of liver  Separate and proper Catarrhal Jaundice average 20-30 days Low-fat diet; increase carbohydrates (high in cleaning of articles used by sugar) patient In convalescent period, patient may have difficulty with maintaining a sense of well-being. Paralytic Dinoflagellates Ingestion of raw of · Numbness of face Treatment:  Avoid eating shellfish Shellfish Phytoplankton inadequately cooked especially around the such as tahong, talaba, Poisoning (PSP I seafood usually mouth 1. No definite treatment halaan, kabiya, abaniko Red tide bivalve mollusks · Vomiting and 2. Induce vomiting during red tide season poisoning) during red tide dizziness 3. Drink pure coconut milk – weakens the season · Headache toxic effect  Don’t mix vinegar to · Tingling 4. Sodium bicarbonate solution (25 grams in ½ shellfish it will increase Incubation Period: sensation/paresthesia glass of water) toxic effect 15 times 30 minutes to and Advised only in the early stage of illness greater several hours after eventful paralysis of because paralysis can lead to aspiration ingestion hands · Floating sensation NOTE: Persons who survived the first 12 hours and after weakness ingestion have a greater chance of survival. · Rapid pulse · Dysphonia · Dysphagia · Total muscle paralysis leading to respiratory arrest and death
  15. 15. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN DISEASES CAUSED BY VIRUS Disease Causative Agent Mode of Transmission Pathognomonic Sign Management and Treatment Prevention Chickenpox Human (alpha) herpes Droplet spread Vesiculo-pustular No specific diagnostic exam  Case over 15 years of age virus 3 (varicella-zoster Direct contact rashes Treatment is supportive. should be investigated to Other names: virus), a member of the Indirect through articles Centrifugal eliminate possibility of Varicella Herpesvirus group freshly soiled by appearance of Drug-of-choice: smallpox. discharges of infected rashes – rashes which Acyclovir / Zovirax ® (orally to reduce the  Report to local authority Period of persons begin on the trunk and number of lesions; topically to lessen the  Isolation Communicability: spread peripherally pruritus)  Concurrent disinfection of From as early as 1 to 2 Incubation Period: and more abundant on throat and nose discharges days before the rashes 2-3 weeks, commonly covered NEVER give ASPIRIN. Aspirin when given to  Exclusion from school for appear until the lesions 13 to 17 days body parts children with viral infection may lead to 1 week after eruption first have crusted. Pruritus development of REYE’S SYNDROME. appears  Avoid contact with Nursing Diagnoses: susceptibles Disturbance in body image Impairment of skin integrity German Rubella virus or Droplet Forscheimer spots – Diagnostic Test: MMR vaccine (live Measles RNAcontaining red pinpoint patches Rubella Titer (Normal value is 1:10); below 1:10 attenuated virus) Togavirus Incubation Period: on the oral cavity indicates susceptibility to Rubella. - Derived from chick Other Names: (Pseudoparamyxovirus) Three (3) days Maculopapular rashes embryo Rubella Headache Instruct the mother to avoid pregnancy for three Contraindication: Three-day German measles is Low-grade fever months after receiving MMR vaccine. - Allergy to eggs Measles teratogenic infection, Sore throat - If necessary, given in can cause congenital Enlargement of MMR is given at 15 months of age and is given divided or fractionated heart disease and posterior cervical and intramuscularly. doses and epinephrine congenital postauricular should be at the bedside. cataract. Herpes Zoster Herpes zoster virus Droplet Painful vesiculo- Treatment is supportive and symptomatic Avoidance of mode of (dormant varicella Direct contact from pustular Acyclovir to lessen the pain transmission Other names: zoster secretion lesions on limited Shingles virus) portion of the body Cold sores (trunk and shoulder) Low-grade fever
  16. 16. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Mumps Mumps virus, a Direct contact Painful swelling in Supportive and symptomatic  MMR vaccine member front of the ear, angle Sedatives – to relieve pain from orchitis  Isolate mumps cases Other name: of family Source of infection: of the jaws and down Cortisone – for inflammation Epidemic Parotitis Paramyxoviridae Secretions of mouth and the neck nose Diet: Soft or liquid as tolerated Fever Support the scrotum to avoid orchitis, edema, Incubation Period: Malaise and atrophy 12 to 26 days, usually Loss of appetite 18 days Dark glasses for photophobia Swelling of one or both testicles (orchitis) in some boys Influenza Influenza virus Direct contact Sudden onset Supportive and symptomatic  Avoid use of common A – most common Fever with chills Keep patient warm and free from drafts towels, glasses, and eating Other name: B – less severe wesDroplet infection or by Headache TSB for fever utensils La Grippe C – rare articles freshly soiled Myalgia / arthralgia Boil soiled clothing for 30 minutes before  Cover mouth and nose with nasopharyngeal during cough and sneeze Period of discharges Communicability: Immunization: Probably limited to 3 Airborne Flujob/Flushot – effective days from clinical onset Incubation Period: for 6 months to 1 year Short, usually 24 – 72 hours
  17. 17. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN DISEASES CAUSED BY BACTERIA Disease Causative Agent Mode of Transmission Pathognomonic Sign Management and Treatment Prevention Pneumonia Bacteria: Droplet Rusty sputum Diagnosis:  Avoid mode of Pneumococcus, Fever and chills Based on signs and symptoms transmission Types: streptococcus Incubation Period: Chest pain Dull percussion on affected lung  Build resistance a. Community pneumoniae, 2 – 3 days Chest indrawing Sputum examination – confirmatory  Turn to sides Acquired staphylococcus aureus, Rhinitis/common cold Chest x-ray  Proper care of influenza Pneumonia (CAP) Klebsiella pneumonia Productive cough cases b. Hospital / (Friedlander’s bacilli) Fast respiration Management: Nosocomial Vomiting at times Bedrest c. Atypical Virus: Convulsions may occur Adequate salt, fluid, calorie, and vitamin intake Haemophilus Flushed face Tepid sponge bath for fever influenzae Dilated pupils Frequent turning from side to side Highly colored urine Antibiotics based on CARI of the DOH Fungi: Pneumonocystis with reduced chlorides Oxygen inhalation carinii pneumonia and increased urates Suctioning Expectorants / mucolytics Bronchodilators Oral/IV fluids CPT Streptococcal Group A beta hemolytic Droplet Sudden onset Diagnosis:  Avoid mode of sore throat streptococcus High grade fever with Throat swab and culture transmission Complication: chills Other name: Other diseases: Rheumatic Heart Enlarged and tender Treatment: erythromycin Pharyngitis Scarlet fever Disease cervical lymph nodes Tonsillitis St. Anthony fire Inflamed tonsils with Care: Puerperal sepsis mucopurulent exudates Bed rest Imoetigo Headache Oral hygiene with oral antiseptic or with saline Acute Dysphagia gargle (1 glass of warm water + 1 tsp rock salt) glomerulonephritis Ice collar Rheumatic Heart Disease
  18. 18. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Meningitis Meningococcus Direct (Droplet) A. Sudden Onset Diagnostic Test:  Respiratory Isolation Neisseria meningitides - high fever Lumbar puncture or Lumbar tap - reveals CSF Other name: Incubation Period: accompanied WBC and protein, low glucose; contraindicated Cerebrospinal 2 - 10 days by chills for increased ICP for danger of cranial fever - sore throat, headache, herniation prostration (collapse) Hemoculture – to rule out meningococcemia B. entrance into the Treatment: bloodstream leading to Osmotic diuretic (Mannitol) – to reduce ICP and septicemia relieve cerebral edema; Alert: fastdrip to prevent (meningococcemia) crystallization a. rash, petchiae, Anti-inflammatory (Dexamethasone) – to purpura relieve cerebral edema C. Symptoms of Antimicrobial (Penicillin) menigeal Anticonvulsany (Diazepam / Valium) irritation - nuchal rigidity (stiff Complications: neck) – earliest sign Hydrocephalus - Kernig’s sign – when Deafness (Refer the child for audiology testing) knees are flexed, it and mutism cannot Blindness be extended - Brudzinski signs – pain on neck flexion withautomatoc flexion of the knees - convulsion - poker soine (poker face / flat affect) - Increased ICP (Cushing’s triad: hypertension, bradycardia, bradypnea) and widening pulse pressure
  19. 19. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN VECTOR-BORNE DISEASES Disease Causative Agent Mode of Transmission Pathognomonic Sign Management and Treatment Prevention Malaria Plasmodium Parasites: Bite of infected Cold Stage: severe, Early diagnosis – identification of a patient *CLEAN Technique Vivax anopheles mosquito recurrent chills (30 with malaria as soon as he is seen through *Insecticide – treatment of Falciparum (most fatal; Night time biting minutes to 2 hours) clinical and/or microscopic method mosquito net most common in the High-flying Clinical method – based on signs and *House Spraying (night Philippines) Rural areas Hot Stage: fever (4-6 symptoms of the patient and the history of his time fumigation) Ovale Clear running water hours) having visited a malaria-endemic area *On Stream Seeding – Malariae Microscopic method – based on the construction of bio-ponds Wet Stage: Profuse examination of the blood smear of patient for fish propagation (2-4 sweating through microscope fishes/m2 for immediate Episodes of chills, (done by the medical technologist) impact; 200-400/ha. for a fevers, and profuse QBC/quantitative Buffy Coat – fastest delayed effect) sweating are Malarial Smear – best time to get the *On Stream Clearing – associated with rupture specimen is at height of fever because the cutting of vegetation of the red blood cells. microorganisms are very active and easily overhanging along stream identified banks - intermittent chills *Avoid outdoor night and Chemoprophylaxis activities (9pm – 3am) sweating Only chloroquine should be given (taken at *Wearing of clothing that - anemia / pallor weekly intervals starting from 1-2 weeks before covers arms and legs in the - tea-colored urine entering the endemic area). In pregnant women, evening - malaise it is given throughout the duration of *Use mosquito repellents - hepatomegaly pregnancy. *Zooprophylaxis – typing - splenomegaly of domestic animals like - abdominal pain and Treatment: the carabao, cow, etc near enlargement Blood Schizonticides - drugs acting on sexual human dwellings to - easy fatigability blood stages of the parasites which are deviate mosquito bites responsible from man to these animals for clinical manifestations Intensive IEC campaign 1. QUININE – oldest drug used to treat malaria; from the bark of Cinchona tree; NURSING CARE: ALERT: Cinchonism – quinine toxicity 1. TSB (Hot Stage) 2. CHLOROQUINE 2. Keep patent warm 3. PRIMAQUINE – sometimes can also be (Cold Stage) given as chemoprophylaxis 3. Change wet clothing 4. FANSIDAR – combination of (Wet Stage) pyrimethamine and sulfadoxine 4. Encourage fluid intake 5. Avoid drafts
  20. 20. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Filariasis Wuchereria bancrofti Bite of Aedes poecillus Asymptomatic Stage: Diagnosis  CLEAN Technique Brugia malayi (primarily) Presence of Physical examination, history taking,  Use of mosquito repellents Other names: Brugia timori Aedes flavivostris microfilariae observation of major and minor signs and  Anytime fumigation Elephantiasis – nematode parasites (secondary) in the blood but no symptoms  Wear a long sleeves, pants Endemic in 45 out clinical signs and and socks of 78 provinces Incubation period: symptoms of disease Laboratory examinations Highest 8 – 16 months Nocturnal Blood Examination (NBE) – blood prevalence rates: Acute Stage: are taken from the patient at his residence or in Regions 5, 8, 11 Lymphadenitis hospital after 8:00 pm and CARAGA Lymphangitis Immunochromatographic Test (ICT) – rapid Affectation of male assessment method; an antigen test that can be Genitalia. done at daytime Chronic Stage: (10-15 Treatment: years from onset of Drug-of-Choice: Diethylcarbamazine Citrate first (DEC) or Hetrazan attack) Hydrocele Lymphedema Elephantiasis Shistosomiasis Schistosoma mansoni Contact with the Diarrhea Diagnostic Test: Dispose the feces properly S. haematobium infected freshwater with Bloody stools (on and COPT or cercum ova precipitin test (stool not reaching body of water Other Names: S. japonicum (endemic cercaria and penetrates off dysentery) exam) Use molluscides Snail Fever in the Philippines) the skin Enlargement of Prevent exposure to Bilharziasis abdomen Treatment: contaminated water (e.g. Endemic in 10 Vector: Oncomelania Splenomegaly Drug-of-Choice: PRAZIQUANTEL use rubber boots) regions and 24 Quadrasi Hepatomegaly (Biltracide) Apply 70% alcohol provinces Anemia / pallor Oxamniquine for S. mansoni immediately to skin to kill High prevalence: weakness Metrifonate for S. haematobium surface cercariae Regions 5, 8, 11 *Death is often due to hepatic complication Allow water to stand 48-72 hours before use Dengue Dengue virus 1, 2, 3, Bite of infected Classification (WHO): Diagnostic Test: 4 o’clock habit Hemorrhagic and 4 and Chikungunya mosquito (Aedes Torniquet test (Rumpel Leads Test / capillary Chemically treated Fever virus Aegypti) - characterized Grade I: fragility test) – PRESUMPTIVE; positive when mosquito net Types 1 and 2 are by black and white a. flu-like symptoms 20 or more oetechiae per 2.5 cm square or 1 Larva eating fish Other names: common in the stripes b. Herman’s sign inch square are observed Environmental sanitation H-fever Philippines Daytime biting c. (+) tourniquet sign Platelet count – CONFIRMATORY; (Normal Antimosquito soap Low flying is Neem tree (eucalyptus) Stagnant clear water 150 - 400 x 103 / mL) Urban
  21. 21. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN Period of Incubation Period: Grade II: Treatment:  Eliminate vector communicability: Uncertain. Probably 6 a. manifestations of Supportive and symptomatic  Avoid too many hanging Unknown. Presumed to days to 1 week Grade Paracetamol for fever clothes inside the house be on the 1st week of Manifestations: I plus spontaneous Analgesic for pain  Residual spraying with illness up to when the First 4 days: bleeding Rapid replacement of body fluids – most insecticide virus is still present in Febrile/Invasive Stage b. e.g. petechiae, important  Daytime fumigation the - starts abruptly as fever ecchymosis purpura, treatment  Use of mosquito repellants blood - abdominal pain gum ORESOL  Wear long sleeves, pants, Occurrence is sporadic - headache bleeding, Blood tansfusion and socks throughout the year - vomiting hematemesis, Diet: low-fat, low-fiber, non-irritating,  For the control of H-fever, Epidemic usually occur - conjunctival infection melena noncarbonated. knowledge of the natural during the rainy seasons -epistaxis Grade III: Noodle soup may be given. ADCF history of the disease is (June to November) 4th – 7th days: a. manifestations of (Avoid Dark-Colored Foods) important. Peak months: Toxic/Hemorrhagic Grade ALERT! No Aspirin  Environmental control is September Stage II plus beginning of the most appropriate and October - decrease in circulatory failure primary prevention temperature b. hypotension, approach and control of - severe abdominal pain tachycardia, tachypnea Hfever. - GIT bleeding Grade IV: - unstable BP (narrowed a. manifestations of pulse pressure) Grade - shock III plus shock (Dengue - death may occur Shock Syndome) 7th – 10th days: Recovery/Convalescent Stage - appetite regained - BP stable
  22. 22. Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN DISEASES TRANSMITTED BY ANIMALS Disease Causative Agent Mode of Transmission Pathognomonic Sign Management and Treatment Prevention Leptospirosis Leptospira interrogans Through contact of the Leptospiremic Phase Diagnosis  Protective clothing, bacterial spirochete skin, especially open - leptospires are present Clinical manifestations boots and gloves Other Names: RAT is the main host. wounds with water, in blood and CSF Culture of organism  Eradication of rats - Weil’s Disease moist soil or vegetation - onset of symptoms is Examination of blood and CSF during the first  Segregation of domestic - Mud Fever Although pig, cattle, infected with urine of abrupt week of illness and urine after the 10th day animals - Trench Fever rabbits, hare, skunk, the infected host - fever Leptospira agglutination test  Awareness and early - Flood Fever and other wild animals - headache diagnosis - Spirochetal can also serve as Incubation Period: - myalgia Treatment:  Improved education of Jaundice reservoir 7-19 days, average of - nausea Penicillins and other related B-lactam antibiotics people - Japanese 10 days - vomiting Tetracycline (Doxycycline)  Avoid wading or Seven Days Occupational disease - cough Erythromycin swimming in water fever affecting veterinarians, - chest pain contaminated with urine miners, farmers, sewer Most common complication: kidney failure of infected animals. workers, abattoir Immune Phase  Concurrent disinfection workers, - correlates with the of articles soiled with etc appearance of circulating urine. IgM Rabies Rhabdovirus of the Bite or scratch (very Sense of apprehension Diagnosis:  Have pet immunized at 3 genus rare) of rabid animal Headache history of bite of animal months of age and every Other Names: lyssavirus Non-bite means: Fever culture of brain of rabid animal year thereafter Lyssa Degeneration and leaking, scratch, organ Sensory change near site demonstration of negri bodies  Never allow pets to roam Hydrophobia necrosis transplant (cornea), of animal bite the streets Le Rage of brain – formation of inhalation/airborne Spasms of muscles of Management:  Take care of your pet negri bodies (bats) deglutition on attempts to *Wash wound with soap immediately. swallow Antiseptics National Rabies Two kinds of Rabies: Source of infection: Fear of e.g. povidone iodine or alcohol may be applied Prevention and Control a. Urban or canine – saliva of infected water/hydrophobia *Antibiotics and anti-tetanus immunization Program transmitted by dogs animal or human Paralysis *Post exposure treatment: local wound  Goal: Human rabies is b. Sylvatic – disease of Delirium treatment, active immunization (vaccination) and liminated in the wild animals and bats Incubation period: Convulsions passive immunization (administration of rabies Philippines and the which sometimes 2 – 8 weeks, can be “FATAL once signs and immunoglobulin) country is declared spread years depending on symptoms appear” *Consult a veterinarian or trained personnel to rabiesfree to dogs, cats, and severity of wounds, site observe the pet for 14 days livestock of wound as distance *Without medical intervention, the rabies victim from brain, amount of would usually last only for 2 to 6 days. Death is virus introduced, and often due to respiratory paralysis. protection provided by clothing