Rabies is a fatal viral disease affecting the central nervous system caused by the Lyssavirus. It is transmitted primarily through animal bites, especially from rabid dogs which account for 99% of human cases in India. There are three main forms - urban rabies transmitted by domestic dogs, wildlife rabies perpetuated by animals like jackals and foxes, and bat rabies spread by vampire bats. Symptoms include malaise, headache and pain at the bite site followed by neurological symptoms like fear of water and light, increased salivation and spasms. Diagnosis involves identifying a history of animal bite and detecting the virus. Treatment is supportive and vaccination is given as post-exposure prophylaxis. Nursing care focuses on

2. 
INTRODUCTION

3. 
Rabies or hydrophobia is an
acute, highly fatal viral disease
of the central nervous system,
caused by Lyssavirus
DEFINITION

4. 
 In India, about 15 million people are bitten by animals
 In india 25,000–30,000 human deaths from rabies
annually.
INCIDENCE

5. 
 Lyssavirus is a bullet shaped RNA virus.
 It belongs to the family rabdoviridae
AGENT FACTORS

6. 
Lassa virus

7. 
3 epidemiological forms
1. Urban rabies
2. Wild life rabies
3. Bat rabies
RESERVOIRS OF
INFECTION

8. 
 The transfer of infection from wild life to domestic dogs
results in the creation of urban cycle and is responsible for
99% of human cases in India
Urban rabies

9. 
 The wild life is perpetuated by the jackal, fox and other
wild life carriers.
Wild life rabies

10. 
 In Latin American countries and U.S.A vampire bat
is an important host and vector of rabies
Bat rabies

11. 
Source of infection to man is the
saliva of rabid animal. In dogs and cats,
the virus may be present in the saliva for
3-4 days before the onset of clinical
symptoms and during the course of
illness till death.
SOURCE OF
INFECTION

12. 
All warm blooded animals including
man are susceptible to rabies. Laboratory
staff working with rabies virus,
veterinarians, dog handlers, hunters
faces higher risk of rabies than general
public.
HOST FACTORS

13. 
1.Animal bites
2.Licks
3.Aerosols
4.Person-to-person
MODE OF
TRANSMISSION

14. 
 In India most of the human rabies cases have resulted
from dog-bites. Transmission to man is particularly
through rabid dog bites. As a prerequisite for
transmission, the saliva of the dog must contain the virus
at the time of bite. It may also occur from other animals
beside dog like cat, sheep, goat, monkey, horse.
Animal bites

15. 
Dogs have the habit of licking.
Licks on abraded skin and mucosa
can transmit the disease.
Licks

16. 
 Aerosol or respiratory transmission is found only in
certain caves harbouring rabies infected bats.
Aerosols

17. 
 Man to man transmission, although rare is possible.
 A case of a child biting his parent is in record
 There is also reports of transmission of rabies by corneal
and organ transplants.
Person-to-person

18. 
 3-8 weeks
 The incubation period in man is highly variable,
commonly 3-8 weeks, but may vary from 4 days to
many years.
INCUBATION PERIOD

19. 
Bite
Entryof rabies virus in man
Virus replicate in muscle or connective tissue cells at the site of introduction
Virus attaches to nerve endings
PATHOPHYSIOLOGY

20. 
Enters peripheral nerves
Spreads centripetally via peripheral nerves towards CNS
Infects CNS
Virus spreads centrifugally in peripheral nerves to many tissues
Invades skeletal, myocardial muscle, adrenal glands, skin
Contd..

21. 
 Duration of illness 2-3 days rarely 5-6 days
 PRODROMAL SYMPTOMS
 Headache
 Malaise
 Sore throat
 Slight fever lasting for 3-4 days
 Pain and tingling at the site of bite
CLINICAL FEATURES

22. 
 widespread excitation and stimulation of all parts of nervous
system
1. Intolerance to noise
2. Intolerance to bright light
3. Intolerance to cold draught of air
4. Aerophobia
5. Increased reflexes
6. Muscle spasms
7. Dilatation of pupils
8. Increased perspiration
SPECIFIC SYMPTOMS

23. 
1. Salivation
2. Lacrimation
3. Mental changes due to fear of death, anger, irritability
and depression
4. Symptoms progressively aggravate
5. All attempts at swallowing liquid become unsuccessful
6. Mere sight or sound of water provoke spasm of muscles
of deglutination- hydrophobia
7. Patient may die abruptly during one of the convulsion or
may pass on to the stage of paralysis or coma
Contd…

24. 
 History of bite by a rabid animal
 Signs and symptoms
 Detection of rabies antigen
 Using immunofluroscence of skin biopsy
 Virus neutralizing antibodies appear in CSF and
serum after 7-10 days of illness
 Virus isolation from saliva, CSF and other secretions
DIAGNOSIS

25. 
 Nervous tissue vaccines
 Duck embryo vaccine
 Cell culture vaccines
 Human diploid cell vaccine (HDCV)
Non- human origin-second generation vaccines
TREATMENT

26. 
Intramuscular schedule

VACCINE
ADMINISTRATION
 Schedule consist of 6 doses (1 ml each) on days 0, 3,7,14 and 28 and a booster dose on
day 90.
 Injections are given IM on deltoid and must not be given to buttocks
Dose: one dose, IM dose into deltoid (1ml)
Day 0 3 7 14 28

27. 
 2 site ID method
0.5 ml of Purified Vero Cell Vaccine (PVRV)
1 ml of Purified Chick Embryo Cell Vaccine (PCECV)
1 ml of Purified Duck Embryo Vaccine (PDEV)
Volume of ID dose is one-fifth of IM dose per site. ie if IM dose is 0.5 ml, ID dose is 0.1
ml.
Dose: 1, ID dose = one fifth of IM dose
Day 0 3 7 28 90
Sites X2 X2 X2 X1 X1
Intradermal schedule

28. 
 8 site ID method
Human Diploid Cell Vaccine (HDCV) and Purified Chick Embryo Cell Vaccine
(PCECV)
On day 0--- 0.1 ml of reconstituted vaccine is given at each of 8 sites.
Sites are deltoid, lateral thigh, supra scapular region and lower quadrant of abdomen
On day 7--- 0.1 ml of vaccine is given at each of 4 sites over deltoid and thighs.
On days 28 and 90--- 0.1 ml of vaccine is given at one site, over deltoid
Dose 0.1ml ID per site
Day 0 7 28 90
Sites X8 X4 X1 X1
8 site ID method

29. 
 The patient should be isolated in quiet room protected as far as
possible from external stimuli such as bright light, noise or cold
draughts which may precipitate spasms or convulsions
 Relieve anxiety and pain by liberal use of sedatives.
 Ensure hydration and diuresis
 Intensive therapy in the form of respiratory and cardiac support may
be given
 Nursing personnel attending rabid patient should be warned against
possible risk of contamination and should wear face masks, gloves,
goggles and aprons to protect themselves
 Pre- exposure prophylaxis with 2-3 doses of HDC vaccine is reco
GENERAL
MANAGEMENT

30. 
 POST- EXPOSURE PROPHYLAXIS
 Local treatment of wound
 1. Cleansing
 2. Chemical treatment
 3. Suturing
 4. Anti rabies serum
 5. Antibiotics and anti tetanus measure
 6. Observe the animal for 10 days
PREVENTION

31. 
 1. Horse anti rabies serum
 2. Human rabies immunoglobulin
ANTI RABIES SERUM

32. 
 laboratory staff working with rabies virus,
veterinarians, animal handlers and wild- life officers
 1ml cell culture vaccine, IM on days 0, 7 and 28
PRE-EXPOSURE
PROPHYLAXIS

33. 
 1 ml, IM doses of human diploid cell vaccine on days
0, 3 and 7.
POST EXPOSURE
PROPHYLAXIS

34. 
ASSESSMENT
 ask for a history of bite by an animal
 - assess whether he has undergone immediate
prophylactic measures
 - assess for characteristics like photophobia,
hydrophobia etc
 - check for the presence of antigen
NURSING
MANAGEMENT

35. 
 1. Hyperthermia related to infectious process as
evidenced by elevated body temperature more than
100 degree farenheit
 2. Acute pain related to tissue injury at the site of
bite as evidenced by pain scale score more than 7
 3. Fatigue related to bacterial invasion of central
nervous system as evidenced by inability to perform
ADLs
 4. Risk for injury related to confusion
NURSING DIAGNOSIS

36. 
Malaria

37. 
 Malaria is a protozoal disease caused by infection
with parasites of the genus Plasmodium and
transmitted to man by infected female Anopheles
mosquito
DEFINITION

38. 
Female anophelous
mosquito

39. 
 300-500 million clinical cases each year.
INCIDENCE

40. 
1. P.vivax,
2. P. falciparum
3. P. malariae,
4. P. ovale.
AGENT FACTORS

41. 
 Age- malaria affects all ages
 Gender- males are more frequently affected because of the
outdoor life they lead
 Pregnancy-pregnancy increases risk of malaria in women.
Malaria during pregnancy may cause intrauterine death
of foetus, premature labour or abortion
 Socio-economic development- poor socioeconomic status
contributes to malaria
 Occupation - It is predominantly a rural disease and is
related to
HOST FACTORS

42. 
 Season – it is a seasonal disease and has maximum
prevalence from July to November.
 Temperature – malarial parasite develops at the
temperature of 20-30 degree celcius
 Humidity – a relative humidity of 60% is considered
necessary for mosquitoes to live
 Rainfall – rainfall provides opportunities for breeding of
mosquitoes and increases epidemics
 Man-made malaria – burrow pits, garden pools,
irrigation channels, engineering projects led to breeding
of mosquitoes.
ENVIRONMENTAL
FACTORS

43. 
 VECTOR TRANSMISSION
 DIRECT TRANSMISSION
 CONGENITAL MALARIA
MODE OF
TRANSMISSION

44. 
 Usually less than 10 days
 falciparum malaria it is 9-14days
 quarten malaria it is 18-40 days
 vivax it is 8-17
 ovale it is 16-18
INCUBATION PERIOD

45. 
 COLD STAGE
 HOT STAGE
 SWEATING STAGE
CLINICAL FEATURES

46. 
 Demonstration of parasite in blood
 Dipstick (antigen capture) assay for detection of
plasmodium falciparum
DIAGNOSIS

47. 
 Presumptive Treatment
 Radical Treatment
 Treatment of resistant infection
 Severe and Complicated Malaria

48. 
 NURSING DIAGNOSIS
 1. Acute pain related to inflammatory process as
evidenced by pain scale score above 7
 2. Hyperthermia related to infectious process as
evidenced by elevated body temperature
 3. Fatigue related to bacterial invasion as evidenced
by inability to perform ADLs
NURSING
MANAGEMENT

49. 
EVIDENCE BASED
PRACTICE

50. 
SUMMARY

51. 
CONCLUSION

52. 
BIBLIOGRAPHY

53. 
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