educational notes

1. NURSING MANAGEMENT OF
COMMUNICABLE DISEASES
 PRESENTED BY: NEETA CHOUDHARY
 GUIDED BY : MADAM HARJANT KAUR

2. INTRODUCTION
 Communicable Diseases are the major cause
of morbidity and mortality in emergencies
particularly so in complex emergencies.
 Main causes of morbidity and mortality in
emergencies are diarrhoeal diseases, acute
respiratory infections,measles and in areas
where it is endemic malaria.

3. WHAT IS NEEDED DURING AN
EMERGENCY?
o Provision of shelter,water,sanitation,food and
basic health care are the most effective means
of protecting health of those affected by
emergencies.
o A systematic approach to control of
communicable diseases is a key component of
humanitarian response and crucial for the
protection of the health of the population.

4. STAGES OF INFECTION
 INITIAL STAGE:
 Incubation period: Atteck of pathogen on the
tissue of the host.
 ACTIVE DISEASE STAGE :
 Asymptomatic- Resistant power is effected.
 Symptomatic- Effect depend on the pathogen .
 LATENCY STAGE: Infection remain in the
body of the person.

5. MODE OF TRANSMISSION
 Direct transmission – Direct physical contact,
touch, kiss, sexual contact, social contact,
transplantation, inoculatory transmission.
 Indirect transmission – By some medium
(vehicle, formite , hands ,air born ,vector
born).

6. FUNDAMENTAL PRINCIPLES OF
CONTROL OF COMMUNICABLE
DISEASES
 Rapid Assessment
 Prevention
 Surveillance
 Outbreak Control
 Disease
Management

7. Rapid Health Assessment
The objectives should be :
1. To assess the extent of the emergency and the
threat of communicable diseases in the
population
2. To define the type and size of interventions
and priority activities
3. To plan the implementation of these activities
4. To provide information to international
community,donors and the media to mobilize
resources both human and financial.

8. Prevention
 Communicable diseases can be prevented by
appropriate preventive measures which
include:
 Good site planning
 Provision of basic clinical services
 Provision of appropriate shelter
 Clean water supply
 Sanitation
 Mass vaccination against specific diseases
 Regular and sufficient food supply
 Control of vectors

9. Surveillance
 Surveillance is the ongoing systematic
collection,analysis and interpretation of data in
order to plan, implement and evaluate public
health intervention.
 Surveillance system should be simple,
flexible,acceptable and situation specific

10. Objectives of a surveillance
1. Identify public health priorities
2. Monitor the severity of an
emergency by collecting and
analyzing mortality and morbidity
data
3. Detect outbreaks and monitor
response
4. Monitor trends in incidence and
case fatality from major diseases
5. Provide information to ministry of
health,donors to assist in health
programme planning,
implementation and resource
mobilization.

11. Outbreak Control
 An outbreak is occurrence of a number of cases
of a disease that is unusually large or
unexpected for a given place and time.
 Outbreaks and epidemics refer to the one and
same thing.
 Outbreaks in emergency situations can spread
rapidly giving rise to high morbidity and
mortality rates.
 Aim should be to detect and control the
outbreak as early as possible.

12. MAJOR DISEASES WITH EPIDEMIC
POTENTIAL IN EMERGENCY SITUATION
 Cholera
 Meningococcal disease
 Measles
 Shigellosis
 In certain areas the following diseases
have to be included:
 malaria, louse borne typhus, yellow fever,
 trypanosomiasis, leishmaniasis,viral
hemorrhagic
 fever, relapsing fever, typhoid and
hepatitis.

13. STEPS IN THE MANAGEMENT OF A
COMMUNICABLE DISEASE
OUTBREAK
1. Preparation
2. Detection
3. Response
4. Evaluation

14. PREPARATION FOR THE
OUTBREAK
 Strong surveillance system
 Health coordination meetings
 Outbreak response plan for each disease
 Stocks of iv fluids, antibiotics and
vaccines
 Plans for isolation wards
 Laboratory support

15. DETECTION OF OUTBREAK
 Surveillance system with early warning
system for epidemic prone diseases.
 Inform ministry of health and WHO in
case of outbreaks of specific diseases.
 Take appropriate specimens (stool,
CSF or serum) for laboratory
confirmation.
 Include case in the weekly report.

16. RESPONSE TO THE OUTBREAK
 Confirm the outbreak
 Activate the outbreak control team
 Investigate the outbreak
 Control the outbreak

17. EVALUATION
 Assess appropriateness and effectiveness of
containment measures.
 Assess timeliness of outbreak detection and
response.
 Change public health policy if indicated.
 Write and disseminate outbreak report.

18. PREVENTION AND CONTROL OF SPECIFIC
COMMUNICABLE DISEASES
 RESPIRATORY
DISEASES
 RTI
 Tuberculosis
 Measles
 Chickenpox
 Diphtheria
 Meningococcal
Meningitis
 ALIMANTORY
ROUTE INFECTION
 Diarrhoea
 Cholera
 Typhoid
 MUCOCUTANEOUS
ROUTE INFECTION
 STD
 Scabies
 Leishmaniasis
 Trypanosomiasis
 Malaria
 Relapsing fever,Yellow
fever
 MULTIPLE ROUTE
INFECTIONS
 Viral hepatitis
 AIDS

19. RESPIRATORY
DISEASES

20. RESPIRATORY TRACT
INFECTION
 Caused by viruses, ( rhinovirus,adenovirus,
entrovirus, coronavirus), bacteria(
streptococcus,haemophilus influenza,
bordetella pertussis ).
 Incubation period: 1-21 days
 Clinical manifestation:
 Fast breathing

21. RESPIRATORY TRACT
INFECTION
 Nasal flaring
 Cyanosis
 Chest retraction
 Stridor
 Wheezing sound

22. NURSING MANAGEMENT
 Early recognition and treatment
 All children with cough carefully assessed
 Assess signs of malnutrition
 Refer severely malnourished to hospital
 Manage pneumonia with antibiotics
 Follow national treatment protocols
 Supportive measures
 Vaccination

23. TUBERCULOSIS
 Mycobacterium tuberculosis.
 Incubation period: 4-8 weeks.
 Clinical manifestation:
 Pulmonary tuberculosis –
cough for 3 weeks or
more,fever increase in
evening temperature,
 Sweating in night, loss of
appetite
 Weight loss, fatigue, chest
pain ,breathing difficulty.

24. TUBERCULOSIS
 Blood with sputum,
 TB of other organs( intestine, brain,
bones, joints, skin, lymph glands.
 Diagnostic test:
 Symptoms of patient & physical
examination .
 Chest x-ray, sputum culture
 Tuberculin test or MONTOUX test
 Tissue biopsy.

25. NURSING MANAGEMENT
Tuberculosis
 Need for integration with the national TB
control Program and involve local TB
coordinators.
 Use the national TB treatment protocols.
 Cover the local population also.
 DOTS therapy .
 Refer seriously ill patients to local hospitals.
 Laboratory services for sputum smears.

26. MEASLES
 Viral infection.
 Incubation period: 19-14 days
 Clinical manifestation:
 Fever, cough, sneezing,watering eyes
 Kop like spots appear on the mucous
membrane of mouth.
 Eyes may become red & sensitive to light.

27. NURSING MANAGEMENT
Measles
 Routine vaccination
 Measles outbreak response.
 Mass vaccination with measles vaccine is
priority in emergency situations. The ideal
target population being 6 month to 14 years
old although age groups from 6 months to four
years is still acceptable.
 Measles vaccine should be accompanied with
vitamin A administration in children 9 months
to 5 years of age.

28. NURSING MANAGEMENT
MEASLES
 If rashes appear , isolate the patient.

29. CHICKEN POX
 Vericella-zoster virus.
 Incubation period: 2-3 weeks
 Clinical manifestation:
 Fever precede with rashes
 Rashes are maculopapular & later vasicular.

30. DIPHTHERIA
 Corynebacterium dephtheria.
 Incubation period : 2-5 days
 Clinical manifestation:
 Nasal discharge, faucial diphtheria
 Hoarsness,cough, dysnoea,stidor
 Non healing ulcers covered by
psuedomembrane.
 Diagnostic test:
 Shick test.

31. NURSING MANAGEMENT
 Serotherapy, vaccination.
 Isolation
 Provide prophylactic treatment .
 Barrier nursing

32. MENINGOCOCCAL MENINGITIS
 Neisseria meningitidis.
 Incubation period : 3-10 days
 Clinical manifestation:
 Cough, sore throat, myalagia.
 Rashes on( wrist
,ankle,axilla)
 Toxaemia

33. NURSING MANAGEMENT
MENINGOCOCCAL MENINGITIS
 Early detection and control of the outbreak.
 Diagnosis and management of cases.
 Mass vaccination
 Highest risk group for meningococcal
meningitis is children aged 2-10 years and
this should be the priority group during
vaccination campaigns.

34. ALIMENTORY
TRACK INFECTION

35. CHOLERA
 Vibrio-cholra bacteria.
 Incubation period : a few hrs. to 5 days.
 Clinlcal manifestation:
 Diarrhoeal stage
 Dehydration stage
 Convalescence stage
 Diagnostic test:
 Stool test , Ractal swab test ,serum &
contaminated food & water exam, physical
examination.

36. NURSING MANAGEMENT
 Prompt diagnosis and management
 Establish treatment centers with barrier nursing.
 Fecal material and vomit properly disinfected and
disposed.
 Health Education on hygiene,safe water, safe food
and hand washing.
 Promote washing hands with soap and water when
food is being handled.

37. DIARRHOEA
 Caused by (Bacteria,Amoeba,Parasite,Viruses)
 Incubation period: few hrs. to 2-3 days
 Clinical manifestation:
 Abdominal disturbance
 Nausea & vomiting
 Fever,restlessness

38. DIARRHOEA
 Gurgling sound.
 Lack of fluids &
electrolytes in body
,dehydration
 Diagnostic test:
 Case history & symptoms
 Stool,blood examination
 Physical examination

39. NURSING MANAGEMENT
 Provision of safe water
supply
 Supply of adequate quantities
of reasonably clean water is
more important than supply
of small quantities of
microbiologically clean water
 Control of flies, educate
people who manage
food,kitchen manager,
housewives.

40. NURSING MANAGEMENT
 Adequate clean water for personal hygiene and
hand washing.
 Vector control measures to reduce fly
population.
 Disinfect articles contaminated by nasal and
conjunctival discharges.
 In health facilities vigorous hand washing to
avoid cross contamination and proper disposal
of infected material.

41. NURSING MANAGEMENT
 Eliminate habitats of Aedes mosquitoes.
 Personal protection against mosquito bites
during day time.
 Surveys to determine vector density and larval
habitats.
 In an outbreak use larvicide on all potential
habitats of Aedes aegypti.
 Insecticides to reduce vector population.
 Social mobilization to eliminate breeding sites.

42. TYPHOID FEVER
 Salmonella typhi.
 Incubation period: 3 days – 3
weeks
 Clinical manifestation:
 Pink rashes on chest, swelling in
lymph glands
 Fever , headache,restlessness,
loss of appetite, sleeplessness.
 Abdominal pain,constipation or
diarrhoea.

43. TYPHOID FEVER
 Diagnostic test:
 Case history, physical
examination.
 WIDAL test of blood.

44. NURSING MANAGEMENT
Typhoid fever
 Health education, clean water, food inspection,
proper food handling and proper sewage
disposal.
 Early detection and control are important in
prevention of spread.
 WHO guidelines should be consulted.
 Laboratory services are essential to know the
outbreak strain and the anti microbial sensitivity
pattern.

45. NURSING MANAGEMENT
Typhoid fever
 Mass vaccination may be an adjunct for the
control during a sustained high incidence
epidemic.

46. MUCOCUTANEOUS
TRACK INFECTION

47. SEXUALLY TRANSMITTED DISEASES
 Viral,bacteial,protozoal, fungal.& arthropods
agents.
 Incubation period:
 Gonorrohoea 3-9 Days
 Syphilis 10 Days
 Granuloma 1-12 Weeks
 Chancroid 1-8 Days
 AIDS 1-10 Yrs

48. SEXUALLY TRANSMITTED DISEASES
 Clinical manifestation:
 Ulceration, Eruption
 Vaginitis , Urethritis
 Warts
 Neoplasm

49. NURSING MANAGEMENT
 Educate the patient to avoid sexual contact .
 Screening of pregnant mother & blood
donation centers is necessary.
 Counselling to ensure safe sex & introducing
use of condoms as a barrier .
 Health education

50. SCABIES
 Sarcoptes scabei
 Clinical manifestation:
 Non specific excoriated eruption on
hands, breast, buttock
 Itching mostly in night
 Diagnostic test:
 Itch in absence of any disease
 History of contact.

51. NURSING MANAGEMENT
SCABIES
 Isolate the patient
 Educate to apply permethrin 5% cream all over
& left overninght
 Change bed cloths & patients clothing.
 Pregnant & lactating women use melathin in
aqueous base.
 Treat all household members & other close
contacts wether symptomatic or not.

52. LEISHMANIASIS
 Lesishmania parasites.
 Incubation period: 10days –
2yrs.
 Clinical manifestation:
 Fever, enlargement of liver &
spleen
 Aneamia & weight loss.
 Colour of skin hands, legs,
abdomen& face turn dark or
black.

53. LEISHMANIASIS
 Sores on face , painful
 Diagnostic tests:
 Serum examination,
aldehyde test
 Blood examination( ratio of
RBC,WBC, ESR)

54. NURSING MANAGEMENT
Leishmaniasis
 Reinforced surveillance, early detection and
treatment.
 Reduction of animal reservoir.
 Vector control.
 Personal protection with insecticide treated
nets.
 Health promotion and social mobilization.
 Adopt measures to control sand flies.

55. NURSING MANAGEMENT
Leishmaniasis
 1. close the breeding places of sand flies.
 2. keep poultry forms, animal farms far from
homes.
 3.Avoid sleeping on floor.
 4.Keep environment clean.

56. TRYPANOSOMIASIS
 Bite of tse tse fly.
 Clinical features:
 Fever, headache, weakness
 Joint pain , itching,
 Aneamia,oedema(complication)
 Diagnostic test:
 Blood test
 Assessment of symptoms.

57. NURSING MANAGEMENT
Trypanosomiasis
 Human reservoir should be contained
through periodic population screening and
chemo therapy.
 Tsetse fly control.
 Health education on personal protection
against tsetse fly.
 Donation of blood by those living in or have
lived in endemic areas should be prohibited.

58. MALARIA
 Plasmodium sporozoan parasite.
 Incubation period : 10-12 days
 Clinical manifestation:
1) Cold stage
2) Hot stage
3) Wet stage
 Diagnostic test:
 Symptoms, blood test
(For MP)

59. NURSING MANAGEMENT
MALARIA
 Rapid diagnosis and
effective case management.
 Use of insecticide treated
nets.
 Permethrin sprayed blankets
or treated clothing.
 Indoor Residual Spraying.

60. NURSING MANAGEMENT
MALARIA
 Examin blood of all people
suffering from fever.
 Control the source of
mosquitoes: fill pits ,encourage
environmental cleanliness.
 keep the surrounding clean .
 Ensure effective
implementations of anti-malaria
programmes.

61. Relapsing fever (louse-borne)
 Ticks and louse.
 Incubation period: 3-6 days
 Clinical manifestation:
 Recurrent fever.

62. NURSING MANAGEMENT
Relapsing fever (louse-borne)
 Detect and treat all cases and
contacts.
 Population based delousing
program in affected areas.
 Promote personal hygiene.
 Prevent further outbreaks.
 Control body louse
infestation

63. Yellow Fever
 Flavivirus fibricus..
 Incubation period: 3-6 days.
 Clinical manifestation:
 Shivering , high fever,
headache, pain in limbs.
 Jaundice, black vomit,
melena, oliguria
 Shock, unconsciousness.
 Intestinal bleeding.

64. NURSING MANAGEMENT
Yellow Fever
 Personal protection against
mosquito bites.
 Sleeping and living quarters
should be screened.
 Mass vaccination is key to control
of outbreak.
 In urban areas mosquito breeding
sites should be destroyed.

65. MULTIPLE ROUTE
INFECTION

66. HEPATITIS
 Caused by: bacterial & viral
infection.
 Clinical manifestation:
A. Preicteric phase.
B. Icteric phase
C. Post icteric phase.
 Dignostic test:
 Serum exam.,serum bilirubin
& ALT ,ASTor LFT.

67. HEPATITIS
 Liver biopsy.
 Urine examination for bile pigments.

68. NURSING MANAGEMENT
 Enforcement of water and food sanitation.
 For Hepatitis B and C, all blood products
should be screened for the two (and for HIV).
 Vaccination of target population groups for
Hepatitis A recommended.
 Health workers not immune to hepatitis A and
B should be vaccinated.

69. NURSING MANAGEMENT
 Do not use fruits or vegetables, irrigated by
pollution water.
 Be extremely careful in blood transfusion
 Take care in disposal of needles & disposable
syringes.
 Prohibit the community or shared cigarette
,beedi, hukka, etc.and also utensils used by
other.

70. AIDS/ HIV
 Caused by HIV.
 incubation period: some months
to 6 yrs.or even more
 Clinical manifestation:
Weight loss, fever for more then
1 month
Diarrhoea for more than 1
month
Enlargement of lymph glands.

71. AIDS/ HIV
Continuous cough, night sweats.
Repeated atteck of herpes- zoster.
 Dignostic tests:
 Virus isolation
 ELISA & WESTERN BLOT
TEST
 T-4 & T-8 cell count.


72. NURSING MANAGEMENT
 Reduce sexual and mother to child transmission.
 Ensure blood safety
 Universal precautions to be used.
 Physical protection especially of women and
children.
 Protect health care workers.
 Counselling and voluntary testing programs.
 Vaccination of asymptomatic HIV infected children
with EPI vaccines.
 Symptomatic HIV infected children should not be
given BCG or yellow fever vaccine.

73. NURSING MANAGEMENT
 Personal protection against mosquito bites.
 Screen the sleeping and living areas.
 Vaccines are available for travelers.
 Avid tattooing , piercing , acupuncture .
 Psychological support.
 Use disposable syringes.

74. SUMMARIZATION
 INTRODUCTION
 STAGES OF INFECTION
 MODE OF TRANSMISSION
 PRINCIPLES OF CONTROL OF
COMMUNICABLE DISEASES
 STEPS IN MANAGEMENT
 NURSING MANAGEMENT OF SPECIFIC
DISEASES
 RESPIRATORY DISEASES
 RTI
 Tuberculosis

75. SUMMARIZATION
 Measles
 Chickenpox
 Diphtheria
 Meningococcal meningitis
 ALIMENTORY ROUTE INFECTION
 Diarrhoea
 Cholera
 Typhoid

76. SUMMARIZATION
 MUCOCUTANEOUS ROUTE
INFECTION
 STD
 Scabies
 Leishmaniasis
 Malaria
 Relapsing fever, yellow fever

77. SUMMARIZATION
 MULTIPLE ROUTE INFECTION
 Hepatitis
 AIDS

78. BIBLIOGRAPHY
 M.A.Connolly,Communicable disease control in
emergencies (Field manual)- WHO publication .
 WHO-UNICEF “policy statement for mass
immunization campaigns”.Geneva,WHO 1997.
 Reingold AL ,”Outbreak Investigations- a
perspective”.Emerging Infectious Diseases, 1998,
4(1):21-27
 www.google. com