It's about communicable diseases

1. COMMUNICABLE
DISEASES

2. NURSING MANAGEMENT OF PATIENT
WITH COMMUNICABLE DISEASES
• Overview of infectious disease , The infectious
process
• Nursing assessment : History and Physical
assessment , Diagnostic test
• Tuberculosis
• Diarrheal diseases, Hepatitis A ,E , Typhoid
• Herpes,Chickenpox,Smallpox,Measles,Mumps,
Influenza.

3. • Meningitis
• Gasgangrene
• Leprosy
• Dengue fever,
Plague,Malaria,Chickungunya,Swine flue,Filariasis
• Diphtheria,Pertussis,Tetanus,Poliomyelitis
• COVID-19
• Special infection control
measures,Notification,Isolation,Quarantine,Immu
nization

4. TERMINOLOGIES
• COMMUNICABLE DISEASE
Communicable diseases are illness that spread
from one person to another , or from an animal to a
person , or from a surface or a food. These diseases
are caused by pathogen ,that can be transmitted to
another person.eg …. Common cold , Tuberculosis ,
Leprosy .

5. • NON COMMUNICABLE DISEASES
A non communicable disease is a disease which cannot be
transmitted from one person to another. Such as heart
disease
• INFECTIOUS DISEASES
Infectious diseases are disorders caused by organism
such as bacteria ,virus ,fungi ,parasite ,. some infectious
disease can be passed from person to person.
Many organisms live in and on our bodies .They are
normally harmless or even helpful .But under certain
conditions ,some organism may cause diseases.eg TB ,
Pertussis , STDs , UTI etc

6. • CONTAMINATION
The presence of
infectious agents on a
body surface or in clothes,
beddings , toys , surgical
instruments , or dressings
, or other inanimate
articles or substance
including water ,milk , and
food.
• INFESTATION

7. Scabies -Itchmite

8. For person or animals the lodgement ,development,and
reproduction of arthropods on the surface of the body or in the
clothing. Eg : Lice, Itch mite etc
• HOST
A person or animal including bird and arthropods that affords
sustenance or lodgment to an infectious agent under natural
condition
• EPIDEMIC
The unusual occurrence or sudden outbreak of disease in
community or region
• ENDEMIC
It refers to the constant presence of a disease or infectious
agent with in a given geographic area or population group.

9. • SPORADIC
The word sporadic means scattered about .The disease are so
few and separated widely in space.
• PANDEMIC
An epidemic usually affecting a large proportion of the
population ,occurring over a wide geographic area such as a
section of a nation , the entire nation , continent , or world.
• ZOONOSIS
An infection transmissible under natural condition from
vertebrate animal to man. Eg Rabies , Plague.
• ERADICATION
Termination of all transmission of infection through
surveillance.

10. MODE OF TRANSMISSION OF
COMMUNICABLE DISEASES
Communicable diseases are
transmitted from source of
infection to susceptible
individual in many different
ways, depending on infectious
agent, portal of entry and local
ecological conditions.
• The mode of transmission of
disease may be classified as
below-
A. Direct transmission
B. Indirect transmission

11. DIRECT TRANSMISSION
Direct contact: it refers to
person-to-person spread
of microorganisms through
actual physical contact

12. DIRECT TRANSMISSION
DIRECT CONTACT
DROPLET INFECTION
CONTACT WITH SOIL

13. INOCULATION TO
THE SKIN
/MUCOSA
TRANSPLACENTAL

14. DROPLETINFECTION
This is a direct projection of spray of droplets of saliva and
nasopharyngeal secretions during coughing , sneezing , speaking
,spitting in to surrounding atmosphere. Expelled droplet enter in
to conjuctiva , oro respiratory mucosa , or skin of close contact .
Diameter of 10mm or greater particles are filtered by nose .
Diameter of 5mm or less particles can penetrate deeply and
reach alveoli. Droplet spread up to 30-60cm.

15. CONTACT WITH SOIL
• Direct exposure of
susceptible tissue to the
disease agent in the soil
,compost , or decaying
matter in which it
normally leads a
saprophytic existence .
Eg .. hookworm larvae ,
Tetanus.

16. INOCULATION TO THE SKIN /MUCOSA
• The disease agent may
be inoculated directly in
to the skin or mucosa .
Eg-Rabies by dog bite ,
Hepatitis B by
contaminated needles

17. TRANSPLACENTAL/VERTICAL
• Agent can be
transmitted
transplacentally eg –
TORCH , Hepatitis B ,
AIDS , Syphilis etc..The
disease agent produce
malformation to the
embryo by disturbing its
growth

18. INDIRECT TRANSMISSION
VEHICLE
BORNE
VECTOR
BORNE
AIR BORNE
FOMITE
BORNE
UNCLEAN
HAND AND
FINGERS

19. VEHICLE BORNE TRANSMISSION
• Transmission of infectious agent
through the agency of water,
food ( including fruits,
vegetables, milk , milk products),
ice , blood , plasma and other
biological products.
• Disease transmitted by water
and food : Acute diarrheal
disease, Cholera, Typhoid,
Poliomyelitis, Hepatitis A

20. Disease transmitted by Blood
 Hepatitis B
 HIV
 Cytomegalo virus
 Plasmodium
 Treponema pallidum
Water and food are the most frequent
vehicles for transmission ,because they are
used by everyone.

21. VECTOR BORNE TRANSMISSION
• Vector is defined as an
arthropod or any living
carrier that transport an
infectious agent to a
susceptible individual.
MECHANICAL TRANSMISSION
The infectious agent is only
mechanically transported and there is
no development or multiplication of the
agent with in the vector.
BIOLOGICAL TRANSMISSION
The infectious agent undergo
replication or development or both in
vector and requires an incubation
period before its transmission.

22. AIRBORNE TRANSMISSION
• An airborne transmission is disease
transmission through small particulates that
can be transmitted through the air over time
and distance.
• Many airborne diseases are common and
can have mild or severe symptoms.
• Particles that cause airborne diseases are
small enough to cling to the air.
• They hang on dust particles, moisture
droplets, or on the breath until they are
picked up.

23. FOMITE BORNE TRANSMISSION
• Fomites are inanimate articles or substances
contaminated by the infectious discharges from
a patient capable of harbouring and transferring
the infectious agent to a healthy person.
• Fomites include soiled cloths, towels, linen,
handkerchiefs, cups, spoon, books, toys, drinking
glasses, door handles, syringes, instruments and
surgical dressings.
Ex. Diphtheria, typhoid fever, bacillary dysentery,
hepatitis A, eye and skin infection.

24. UNCLEAN HAND AND FINGERS
• Hands – most common medium by
which pathogenic agents are
transferred to food from the skin,
nose, bowel and from other foods.
• The transmission takes place –
Directly –hand to mouth Indirectly
Ex. Staphylococcal & streptococcal
infections, typhoid fever, hepatitis A,
intestinal parasites

25. EPIDEMIOLOGY
Epidemiology is the branch of medicine which deals
with the incidence, distribution, and possible control of
diseases and other factors relating to health.
Epidemiology is the study and analysis of the
distribution (who, when, and where), patterns and
determinants of health and disease conditions in a
defined population.

26. EPIDEMIOLOGICAL TRIAD
• The epidemiological triad model of
infectious disease causation.
• The triad consists of an agent
(pathogen), a susceptible host, and
an environment (physical, social,
behavioral, cultural, political, and
economic factors) that brings the
agent and host together, causing
infection and disease to occur in the
host.

27. AGENT FACTORS
BIOLOGICAL
AGENT
PHYSICAL
AGENT
CHEMICAL
AGENT
NUTRIENT
AGENT
MECHANICA
L AGENT
The agent is
a microbe .
Disease-
causing
microbes
are bacteria,
virus, fungi,
and
protozoa (a
type of
parasite).
Physical
agents are
noise,
ionizing or
non-ionizing
radiation,
extremes in
temperature
and
pressure,
vibration,
electric and
magnetic
fields.
Endogenous
Urea,
bilirubin,
ketones, uric
acid :
Exogenous
allergens,
metal,fumes
,dust
Protein,
Carbohydrat
e, fat,water,
minerals
and
vitamins
excess or
deficiency :
Anemia,
PEM,
Vitamin
def.,
minerals
def.
Crushing,
tearing,
dislocation

28. HOST FACTORS
DEMOGRAPHIC
FACTORS
BIOLOGICAL
CHARACTERISTIC
SOCIO ECONOMIC
FACTORS
LIFE STYLE RELATED
FACTORS
• Age
• Sex
•Ethnicity
• Blood group
• Enzymes
• Immunology
• Physiology
•Economic
•Education
•Housing
•Occupation
•Exercise
•Smoking
•Eating pattern
•Behaviors

29. ENVIRONMENTAL FACTORS
PHYSICAL ENVIRONMENT BIOLOGICAL
ENVIRONMENT
PSYCHO SOCIAL
ENVIRONMENT
• Air
• Water
• Soil
• Housing
• Climate
• Geography
• Viruses
• Fungi
• Plants
• Insects
• Rodents
• Habits
• Beliefs
• Attitude
• Religions
• Customs

30. TUBERCULOSIS
INTRODUCTION
• Tuberculosis (TB) is one of the most prevalent infections of human beings
and contributes considerably to illness and death around the world.
• It is spread by inhaling tiny droplets of saliva from the coughs or sneezes
of an infected person.
• It is a slowly spreading, chronic, bacterial infection, characterized by
gradual weight loss.
• TB is the world’s second most common cause of death from infectious
disease after HIV/AIDS.

31. DEFINITION
Tuberculosis is the infectious disease primarily affecting lung
parenchyma is most often caused by Mycobacterium Tuberculosis.
It may spread to any part of the body including meninges, kidney,
bones and lymph-nodes.
Multi Drug Resistant TB
Once a strain of M.Tuberculosis develops resistance to two of the most
potent first line anti tubercular drugs ( isoniazid, rifampicin ).It is
called MDR-TB.

32. Extensively drug-resistant TB(XDR-TB)
It occurs when the organism is also resistant to any of the
flouroquinilones plus any injectable antibiotic agent.
Resistance result from several problems, including;
• Incorrect prescribing
• Lack of public health case management etc..

33. TYPES
PULMONARY TUBERCULOSIS
AVIAN TUBERCULOSIS
BOVINE TUBERCULOSIS
MILIARY TUBERCULOSIS/ DISSEMINATED TUBERCULOSIS

34. PULMONARY TB
it is a serious infection caused
by the bacterium
Mycobacterium tuberculosis
(MTB) that involves the lungs
but may spread to other
organs. TB is a contagious
disease that can infect anyone
exposed to MTB.

35. AVIAN TUBERCULOSIS
• Avian tuberculosis is a chronic
wasting disease caused by infection
with the bacteria Mycobacterium
aviumthat can affect a wider range of
bird species and may affect
mammalian species (including
humans, though the serotypes
affecting humans have generally
been different to those isolated from
poultry).

36. BOVINE TUBERCULOSIS
• Mycobacterium bovis is a slow-
growing aerobic bacterium and
the causative agent of
tuberculosis in cattle. It is related
to Mycobacterium tuberculosis,
the bacterium which causes
tuberculosis in humans. M. bovis
can jump the species barrier and
cause tuberculosis-like infection
in humans and other mammals.

37. MILIARY TUBERCULOSIS
• Miliary or disseminated TB occurs
when tubercle bacilli spread
throughout the body, through the
bloodstream, resulting in small
(approximately 1 to 2 mm)
granulomatous lesions.
• Miliary TB is seen more commonly in
infants, children less than 4 years old,
and in immunocompromised people.

38. EXTRAPULMONARY TUBERCULOSIS
• TB involving organs other
than the lungs (e.g., pleura,
lymph nodes, abdomen,
genitourinary tract, skin,
joints and bones, or
meninges ).

39. INCIDENTS
• With the increased incidence of
AIDS, TB has become a great problem
in the U.S., and the world.
• India is the highest TB burden
country in the world, home to 20
percent of cases occurring globally.
• Each year 1.8 million develop TB.
• In India 0.37 million people die
because of TB every year.

40. ETIOLOGY
• Mycobacterium tuberculosis
RISK FACTORS
• Close contact with some one who have active TB.
• Immuno compromised status (elderly, cancer)
• Drug abuse and alcoholism.
• People lacking adequate health care.
• Pre existing medical conditions (diabetes mellitus, chronic renal failure).
• Immigrants from countries with higher incidence of TB.
• Institutionalization (long term care facilities)
• Living in substandard conditions.
• Occupation (health care workers)

41. MODE OF TRANSMISSION
• Usually spread from person to person via airborne
particles expectorated when breathing, talking, singing,
sneezing, and coughing.
• A process of evaporation leaves small droplet nuclei, 1-5
micron in size . Suspended in the air for minutes to
hours.
• These bacteria are then inhaled by another person.

42. FACTORS AFFECTING TRANSMISSION
• Number of organism expelled in to the air
• Concentration of organism(small spaces with limited
ventilation)
• Length of time of exposure
• Immune system of the exposed person.

43. PATHOPHYSIOLOGY
Local inflammatory response
Exudates in the alveoli resulting in broncho pneumonia
Multiplication of bacteria
Exposure to mycobacterium tuberculosis
DROPLET INFECTION Entry as droplet infection in to alveoli and bronchioles

44. 1.INFECTION CLEARS
Formation of granuloma is a defense mechanism aimed at walling off the infection
and preventing further spread. Replication is inhibited and the infection is stopped.
2.PRIMARY TB: If the initial immune
response is not adequate ,the bacteria
replicate and active TB disease occurs.
3.LATENT TB INFECTION :It occurs in a
person does not have active TB
disease.They have positive skin test but
they are asymptomatic.
Granuloma formation
A focus infection is established in inflammatory area . This is called Ghon lesion or
focus. Which represent a calcified TB Granuloma

45. PROGRESSION OF DISEASE
PULMONARY TB
EXTRAPULMONARY TB
MILIARY TB

46. CLINICAL MANIFESTATIONS
PULMONARY TB
• Symptoms do not develop until 2-3week after infections
• Initial dry cough that frequently become productive with
mucoid sputum
• Fatigue
• Malaise
• Anorexia
• Unexplained weight loss
• Low grade fever
• Night sweat
• Late symptoms include ;
• Dyspnea
• Hemoptysis

47. Acute TB
• Sudden high fever
• Chills
• Generalized flu like symptoms
• Pleuritic pain
• Productive cough
In HIV Patients
• Fever
• Cough
• Weight loss
A change in cognitive function may be the only initial sign of TB in an
older patients.

48. DIAGNOSTIC STUDIES
TUBERCULIN SKIN
TEST
INTERFERON GAMMA
RELEASE ASSAY
BACTERIOLOGIC
STUDIES
CHEST X-RAY
TB

49. TUBERCULIN SKIN TEST/MANTOUX TEST
• TST/MANTOUX TEST using purified
protein derivative (PPD)is the standard
method to screen the people for m
tuberculosis.
• The test is administered by injecting 0.1
ml of PPD intradermally on the ventral
surface of the forearm.
• The test is read by inspection and
palpation 48-72hrs later for the
presence or absence of indurations. (A
palpable, raised hardened area or
swelling at the injection site).

50. • Induration at the injection site means the person has exposed to TB and
developed antibodies.
• Antibody formation occurs 2-12 wk after initial exposure to the bacteria
• The indurated area measured and recorded at millimeters.

51. INTRFERON GAMMA RELEASE ASSAY
• The interferon gamma release
assay (IGRA) test is a blood test
used to see whether a person has
been exposed to the tuberculosis
(TB) bacteria.
• The IGRA test is used to diagnose
TB infection.
• This is when the TB bacteria is in
the body but the person is not
experiencing any symptoms
suggestive of TB disease.

52. CHEST X RAY
• Chest x-rays show advanced
pulmonary tuberculosis. There
are multiple light areas
(opacities) of varying size that
run together.
• Chest x-ray may appear normal in
a patient with TB

53. BACTERIOLOGIC STUDIES
• A sputum culture is a test to find germs
(such as TB bacteria) that can cause an
infection.
• A sample of sputum is added to a
substance that promotes the growth of
bacteria.
• If no bacteria grow, the culture is
negative.
• If bacteria grow, the culture is positive.
• It’s also known as an acid-fast bacillus
(AFB) stain or a tuberculosis (TB)
smear.
• The night before the test, drink
lots of fluids, such as water or
tea, to help body make more
sputum over night.
• Collecting sputum in the morning
makes the test more accurate.
More bacterias are present in
the morning.

54. COMPLICATIONS
• Bacterial pneumonia
• Cor pulmonale
• Pneumothorax
• Acute respiratory failure.

55. DRUG THERAPY
ACTIVE TB DISEASE
INITIAL PHASE
CONTINUATION
PHASE

56. FIRST –LINE DRUGS
BACTERICIDAL DRUGS
• Rifampicin ( Rmp)
Powerful bactericidal drug.
It permeates all tissue membranes including the blood-brain barrier and placental barriers.
Used only as oral drug.
• INH
INH rank among the most powerful drug against tuberculosis.
Its action is most marked on rapidly multiplying bacilli.
It gets widely distributed in body including CSF.
It should be given as single dose.

57. • SREPTOMYCIN
It is bactericidal.
it acts entirely on rapidly multiplying bacilli.
it does not permeate cellwall or normal biological membrane such as meninges and pluera
• PYRAZINAMIDE
It is bactericidal
It acts against particularly slow multiplying intra cellular bacilli.
BACTERIOSTATIC DRUG
ETHAMBUTOL
It is bacteriostatic
it is usedin combination of other drugs to prevent the emergence of resisitance to other
drugs.
It is given orally

58. SECOND-LINE DRUGS
• FLUOROQUINOLONES
They are given orally or IV
Ciprofloxacin ,ofloxacin,levofloxacin,moxifloxacin etc are included in this
category.
• ETHIONAMIDE
• CAPREOMYCIN
• KANAMYCIN AND AMIKACIN
• CYCLOSERINE
• THIOACETAZONE
• MACROLIDS (ACITHROMYCIN,CLARITHROMYCIN)
• DELAMANID(DLM)

59. INITIAL PHASE
• INITIAL PHASE CONSIST OF 8 WEEKS(56 DOSES) OF (2 HRZE)
ISONIAZID(H)
RIFAMPICIN(R)
PYRAZINAMIDE (Z)
ETHAMBUTOL (E)
• STREPTOMYCIN IS ADMINISTEREDONLY IN CERTAIN SITUATION LIKE TB MENINGITIS.OR IF ANY FIRST LINE DRUG NEED TO BE
REPLACED.
• CONTINUATION PHASE CONSIST OF 16 WEEKS(112 DOSES) OF(HRE)
ISONIAZID
RIFAMPICIN
ETHAMBUTOL
• ONLY PYRAZINAMIDE WILL BE STOPPED IN THE CONTINUATION PHASE
• THE CP MAY BE EXTEND UP TO 12-24 WEEKS IN SOME CASES SUCH AS CNS TB,SPINAL TB ETC.

60. DAILY DOSE SCHEDULE FOR ADULT AS
PER WEIGHT BAND
WEIGHT CATEGORY NUMBER OF TABLETS(FDC)
INTENSIVE PHASE HRZE CONTINUATION PHASE HRE
25-34 KG 75/150/400/275 75/150/275
2 2
35-49 KG 3 3
50-64 KG 4 4
65-75 KG 5 5
>/=75 KG 6 6

61. NURSING MANAGEMENT
Assessment
• Ask the patient about previous history of TB, chronic illness, or any
immunosuppressive medications.
• Obtain social and occupational history
• Assess the patient for productive cough,nightsweat,temperature
elevation, weight loss, pleuritic chest pain, and abnormal lung sound.
• if the patient has productive cough ,early morning is the ideal time to
collect the sputum specimen.

62. DOTS (DIRECTLY
OBSERVED TREATMENT
SHORT COURSE) :It is a strategy
to ensure cure by providing the most
effective medicine and confirming that it is
taken.
In DOTS during the initial phase of
treatment a health worker or other trained
person watches as the patient swallow the
drugs in his presence.
During continuation phase the drugs are
issued for one week, of which the first dose
is swallowed by the patient in the presence
of health worker

63. • ACUTE CARE
• Patient admitted to the emergency department or respiratory department with
respiratory symptoms should be assessed for the possibility of TB.
• Those strongly suspected having tb should
a)be placed on airborne isolation
B)receive medical check up including sputum smear and culture
C)receive appropriate drug therapy
• High efficiency particulate air (HEPA ) mask are worn whenever entering the
patients room.
• Teach patient to cover the nose and mouth every time they cough, sneeze, or
produce sputum.
• Identify and screen close contact of the person with TB.
• Teach the patient and care giver about importance of prescribed regimen.
• Notification of the public health department is required