Polio or poliomyelitis is first known to have occurred nearly 6,000 years ago, as evidenced by the withered and deformed limbs of certain Egyptian mummies. Polio was epidemic in the United States and the world in the 20th century, especially in the 1940s and 1950s. Poliomyelitis is a highly infectious viral disease, which mostly affects young children; the virus is transmitted by person-to-person spread mainly through the fecal-oral route, or, less frequently, by a common vehicle (e.g. contaminated food or water) and multiplies in the intestine, from where it can invade the nervous system and can cause paralysis. Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. Etiology Polioviruses are enteroviruses within the Picornaviridae family. Direct contact. Poliovirus can be transmitted through direct contact with someone infected with the virus. Ingestion. Less commonly, it can be transmitted through contaminated food and water. Clinical Manifestations Most patients infected with poliovirus develop inapparent infections and are frequently asymptomatic. Nonspecific symptoms. Fever, headache, nausea, vomiting, abdominal pain, and oropharyngeal hyperemia are observed in mild cases and usually resolve within a few days. Nonparalytic poliomyelitis. Nonparalytic poliomyelitis is characterized by the symptoms described above in addition to the following: nuchal rigidity, more severe headache, back, and lower extremity pain, and meningitis with lymphocytic pleocytosis (usually). Assessment and Diagnostic Findings To confirm the diagnosis, a sample of throat secretions, stool or a colorless fluid that surrounds your brain and spinal cord (cerebrospinal fluid) is checked for poliovirus. Viral cultures. Obtain specimens from the cerebrospinal fluid (CSF), stool, and throat for viral cultures in patients with suspected poliomyelitis infection. Serum antibody. Obtain acute and convalescent serum for antibody concentrations against the 3 polioviruses. IG titer. A 4-fold increase in the immunoglobulin G (IgG) antibody titers or a positive anti-immunoglobulin M (IgM) titer during the acute stage is diagnostic. Medical Management The treatment of poliomyelitis is mainly supportive. Physical therapy. Physical therapy is indicated in cases of paralytic disease; in paralytic disease, it provide frequent mobilization to avoid the development of chronic decubitus ulcerations; active and passive motion exercises are indicated during the convalescent stage. Total hip arthroplasty. Total hip arthroplasty is a surgical therapeutic option for patients with paralytic sequelae of poliomyelitis who develop hip dysplasia and degenerative disease. Diet. Because patients with poliomyelitis are prone to develop constipation, a diet rich in fiber is usually indicated. Pharmacologic Management No antiviral agents are effective against poliovirus.

1. PRESENTATION ON POLIOMYLITIS
AND SARS
PRESENTED by :
annushree
Bsc. Nursing 2nd year
COLLEGE OF NURSING
SGPGIMS , Lucknow

2. Content
Poliomyelitis
1. Definition
2. Causative agents
3. Transmission
4. Sign and Symptom
5. Pathophysiology
6. Diagnosis
7. Types of polio
8. Preventive measures
 Immunization
 Inactivated polio vaccine(IPV)
 Oral polio vaccine(OPV)
 Nursing Diagnosis

3. .

4. Poliomyelitis
 It is a crippling and potentially deadly infections disease caused by poliovirus .
 It start as a primary infection of human alimentary track.
 This virus spreads from human to human , infects brain and spinal cord leading to
paralysis.
 Since the inception of Global Polio eradications initiative (1988) , the incidence of
Poliomyelitis came down by 99%.

5. Causative agent
 Poliomyelitis is an acute viral infection used by poliovirus .It has 3 serotype 1 , 2
and 3 and most outbreaks occurs due to type 1 virus.
 Man is the only known reservoir of infection.

6. AGENT
POLIOVIRUS

7. ENVIRONMENTAL FACTOR
Rainy seasons
Contaminated water

8. Host factor
 All age groups are susceptible but children are more prone.
 In India polio is the disease of infancy and childhood , about 50% of cases are
reported in infancy.
 The most vulnerable age is 6 months to 3 year.
 Sex differences have been noted in the ratio of 3:1 ie 3 male to 1 female.

9. Transmission
 Fecal-oral route
Contamination by
1. Direct
Fingers
2 . Indirect
Water , milk , other food items , flies and
Articles of daily use.
 Droplet infection

10. Incubation period
 7-14 days
(Ranges from 3-35 days)

11. Clinical manifestation
• Nonspecific symptoms. Fever, headache, nausea, vomiting, abdominal pain, and
oropharyngeal hyperemia are observed in mild cases and usually resolve within a
few days.
• Nonparalytic poliomyelitis. Nonparalytic poliomyelitis is characterized by the
symptoms described above in addition to the following: nuchal rigidity, more severe
headache, back, and lower extremity pain, and meningitis with lymphocytic
pleocytosis (usually).

12. Other Symptoms
 Difficulty in swallowing
 Weak or diminished tendon reflexes before the onset of paralysis.
 Paralysis start at the hip and descending to the distal parts.
 Weakness or loss of voice.
 Death can occur due to Respiratory insufficiency.

13. ,

16. Diagnosis
 Viral cultures. Obtain specimens from the cerebrospinal fluid (CSF), stool, and
throat for viral cultures in patients with suspected poliomyelitis infection.
 Serum antibody. Obtain acute and convalescent serum for antibody
concentrations against the 3 polioviruses.
 IG titer. A 4-fold increase in the immunoglobulin G (IgG) antibody titers or a
positive anti-immunoglobulin M (IgM) titer during the acute stage is diagnostic.

17. Etiology
 Polioviruses are enteroviruses family.
 Direct contact. Poliovirus can be transmitted through direct contact with someone
infected with the virus.
 Ingestion. Less commonly, it can be transmitted through contaminated food and
water.

18. Types of Polio
.

21. .

22. Paralytic syndrome
 This most serious form of the disease is rare. Initial signs and symptoms of
paralytic polio, such as fever and headache, often mimic those of nonparalytic
polio. Within a week, however, other signs and symptoms appear, including:
 Loss of reflexes
 Severe muscle aches or weakness
 Loose and floppy limbs (flaccid paralysis)

23. .

24. Post-polio syndrome
 Post-polio syndrome is a cluster of disabling signs and symptoms that affect some
people years after having polio. Common signs and symptoms include:
 Progressive muscle or joint weakness and pain
 Fatigue
 Muscle wasting (atrophy)
 Breathing or swallowing problems
 Sleep-related breathing disorders, such as sleep apnea
 Decreased tolerance of cold temperatures

25. Prevention
 Most effective prevention is IMMUNISATION. Since once effected cannot be cured.
 Two types of vaccine
Inactivated polio vaccine (IPV)
Oral polio vaccine (OPV)

26. Vaccination

27. Inactivated polio vaccine (IPV)
 Also called as “SALK VACCINE”
 It has three strains of Inactivated poliovirus types.
 Given intramuscular injection.
 Given by trained health personnel to administer vaccine

28. Advantages
 It does not have risk of vaccine – associated polio paralysis since not a live
vaccine.
 Does not have exceptional protective immune response.
Disadvantages
 Induces very low level of immunity in the intestine.
 Its is costly 5 times more than OPV.
 Need a well trained health personnel to administer vaccine.

29. Oral polio vaccine (OPV)
 Also called as “Trivalent oral polio vaccine “
 It has mixture of live , attenuated (weekend) strains of all 3types of poliovirus.
 When child infected this prevents transmission of poliovirus to Nervous system.
 It triggers local , mucosal immune response in the mucosal membrane of intestine ,
this is the major reason for mass campaigns with OPV can quickly stop person to
person transmission.

30. Advantages
 Administered orally , does not need trained personal .
 Comparatively inexpensive.
 Safe , effective and brings long lasting immune to all three types of poliovirus.
Disadvantages
 The live attenuated vaccine virus OPV may induce paralysis in rare cases.
 Virus is the vaccine may inherently change and start to flow in population.

31. OPV Schedule
AGE
 At birth
 6 weeks
 10 weeks
 14 weeks
 16-24 months
ORDER OF DOSE
 Zero polio dose
 1st dose
 2nd dose
 3rd dose
 Booster dose
ROUTE AND QUANTITY
 Given orally 2 drops

33. Pulse polio Immunization program
 India began its Pulse polio Immunization program in 1995.
 All the children in the age group of 0-5 years are administered polio drops under
national immunization schedule round every year .
 About 172 million of children are immunized during each National immunization
Day (NID).
 WHO on 24th February 2012 removed India from the list of countries with active
endemic wild poliovirus transmission.

34. Nursing Diagnosis
• Ineffective breathing pattern related to muscle paralysis as evidenced by respiratory
rate .
• Acute pain related to the infection that attacks the nerve as evidenced by the facial
grimace.
• Impaired physical mobility related to paralysis as evidenced by the physical
examination.
• Imbalanced nutrition: less than body requirement related to anorexia, nausea, and
vomiting evidenced by decrease in body weight .
• Ineffective thermoregulation related to the infection process as evidenced by
changes in body tempresture.
• Anxiety in children and families related to disease conditions as evidenced by facial
expression.

35. Nursing Interventions
 The following are the nursing interventions for a patient with polio:
• Nutrition. Encourage frequent small meals to promote nutritional and fluid intake;
maintain nasogastric tube feeding, if ordered; hyperalimentation may be necessary
to ensure adequate nutrition, and eliminate unpleasant odors from the environment
during meals.
• Thermoregulation. Reduce or eliminate the sources of heat loss in infants, and
monitor the body temperature.
• Airway clearance. Assess respiratory rate, rhythm, depth, effort, and breath
sounds; and elevate the head of the bed to promote the optimum level of activity
for best possible lung expansion.
• Pain. Administer analgesics as prescribed, and educate the patient on diversional
activities to reduce the pain.

36. SARS

37. .
SARS
1. Definition
2. Causative agents
3. Epidemiological triad of SARS
4. Transmission
5. Incubation period
6. Clinical symptoms
7. Pathophysiology
8. Diagnosis
9. Management
10. Prevention and Control
11. Nursing Diagnosis

38. Severe acute respiratory syndrome (SARS)
 Severe acute respiratory syndrome (SARS) is a viral respiratory disease caused by a
SARS-associated coronavirus.
 Can cause symptoms from common cold to more severe disease such
as pneumonia and eventually it may lead to death especially those in vulnerable
groups such as the elderly, the very young, and people with an underlying chronic
health condition.

40. Causative Agent
 SARS caused by corona virus known as SARS associated corona virus .
 SARS thought to be an animal virus from uncertain animal reservoir perhaps bats
that spread to other animals.
 SARS virus is present in the nasal and throat secretions urine and stool of the cases.

41. Agent
Corona virus

42. Environment
 An airborne disease .
 Survives longer period in cold .
 Survives longer time in cold .

43. Host
 Most often the cases are health care workers due
to their involvement in procedure which generate
aerosol.
 Children are rarely affected.
 Men are effected more than women.

44. Clinical symptoms of SARS
 SARS begins with high fever (100.4 F)
 Other symptoms headache , discomfort , body aches .
 There maybe diarrhea in some patients .
 After 2-7 days dry cough may appear .
 Most often patient develop pneumonia .

45. Other symptoms
 Fever
 Dry cough
 Shortness of breath
 Other symptoms may include:
 Sore throat
 Runny nose
 Diarrhea
 Fatigue/tiredness
 Difficulty of breathing (in severe cases)

46. Pathophysiology
.

48. Diagnosis
 Enzyme linked immunosorbent assay (ELISA ) and Immunofluorescent assay (IFA)
 Conventional reverse transcriptase PCR (RT- PCR )

50. Transmission
 Mainly SARS seems to spread by close person to person contact and most rapidly
by respiration droplets ( droplets spread ) produced when infected person coughs
or sneezes .
 Droplets are propelled a short distance ( generally upto 8 feets ) through air and
deposited on the mucous membrane of mouth nose or eyes of persons who are
nearly .
 The virus also can spread when a person touches a surface or object contaminated
with infectious droplets and then touches his or her mouth , nose , or eye.

51. Incubation period
2-7 days generally 3-5 days .

52. Prevention and Control of
SARS
.

53. Early detection of Infected persons
 Focus the attention on people with the history of contact with
SARS or travel in SARS area .
 Isolation of people with suspected symptoms .
 Information , education and communication (IEC ) activities to
create awareness .

54. Containment of Infection
 Segregate the suspected cases until diagnosis is established .
 Visits must be prohibited .
 Provide maximize natural ventilation , open window and use of exhaust
fans .
 Concurrent disinfection of secretions , linens and utensils of the patients .

55. Personal Protective Measures
 Respiratory protection by N-95 masks .
 Protect eyes with goggles .
 Contact protection by use of gown and gloves .
 Hand hygiene is the fundamental preventive measure .
 Hand washes properly often every contacts with the cases .
 No aerosol therapies .

56. .

57. .

58. Others
 Limit the movement of the patients .
 Advice patients to use protective attire gown , mask.
 Advice the house hold contacts .
 Be vigilant for fever and respiratory symptoms .
 Strictly adopt protective attire with special reference to hand
hygiene .
 Disposable gloves should be used.

61. Treatment
 There is no cure or vaccine for SARS and treatment should be supportive and
based on the patient’s symptoms.
 Controlling outbreaks relies on containment measures including:
 prompt detection of cases through good surveillance networks and including an
early warning system;
 isolation of suspected of probably cases;
 tracing to identify both the source of the infection and contacts of those who are
sick and may be at risk of contracting the virus;

62. Medical Management
• Hand hygiene. Wash hands often with soap and water for at least 20 seconds; if
water and soap are not available, use an alcohol-based hand sanitizer.
• Keep hands off your face. Avoid touching the eyes, nose, and mouth with
unwashed hands.
• Maintain social distancing. Avoid close contact with people at least 3 feet (1
meter) who are sick, and stay at home when you are sick.
• Proper cough and sneeze etiquette. Cover your cough or sneeze with a tissue,
then throw the tissue in the trash.
• Supportive care. People infected with COVID-19 should receive supportive care
to help relieve symptoms.

63. Nursing Diagnosis
• Impaired breathing pattern related to shortness of breaths evidenced by
respiratory rate .
• Hyperthermia related to increase in metabolic rate as evidenced by the increase
body tempresture.
• . Infection related to failure to avoid pathogen secondary to exposure to infected
person .
• Anxiety related to unknown etiology of the disease as evidenced by the facial
expression .
• Deficient knowledge related to unfamiliarity with disease transmission information
as evidenced by lot of questions asked by the patient.

64. Nursing interventions
 Monitor vital signs. Monitor the patient’s temperature; the infection usually begins with a high
temperature; monitor the respiratory rate of the patient as shortness of breath is another common
symptom.
 Monitor O2 saturation. Monitor the patient’s O2 saturation because respiratory compromise
results in hypoxia.
 Maintain respiratory isolation. Keep tissues at the patient’s bedside; dispose secretions properly;
intsruct the patient to cover mouth when coughing or sneezing; use masks, and advise those
entering the room to wear masks as well; place respiratory stickers on chart, linens, and so on.
 Enforce strict hand hygiene. Teach the patient and folks to wash hands after coughing to reduce
or prevent the transmission of the virus.
 Manage hyperthermia. Use appropriate therapy for elevated temperature to maintain
normothermia and reduce metabolic needs.
 Educate the patient and folks. Provide information on disease transmission, diagnostic testing,
disease process, complications, and protection from the virus.

65. BIBLIOGRAPHY
 Textbook of preventive and Social Medicine
K. PARK , Edition 21st
 Textbook of Community Health Nursing -1
SHYAMALA D MANIVANNAN