Common Communicable Diseases nadersmadi@hotmail.

com

What is Communicable Disease? Communicable disease is an illness caused by an infectious agent or its toxic products that a re transmitted directly or indirectly to a well person through an agency, and a vector or an inanimate object.

What is infection? Infection invasion and multiplication of microorganisms on the tissues of the host resulti ng to signs and symptoms as well as immunologic response.

The nurse and the Communicable Diseases: 2. 3. 4. The nurse must be knowledgeable of the following: The nature of the specific mic roorganism and its capacity for survival both within and outside the body. The m ost effective method of destruction of the specific organism. How the organism i nvades the host and its route of escape from the body.

4. The incubation period, prodromata, and the length of communicability. 5. How a specific drug alters the clinical signs and the infectious course of the disea se. 6. The most recent methods and concepts of prophylaxis for communicable dise ases. 7. The rationale and control measures, including isolation techniques.

Acquired Immune Deficiency Syndrome (AIDS) Human Immunodeficiency Virus (HIV) ca uses AIDS. - Retrovirus - Belongs to lentevirus, also called slow virus.

Signs and Symptoms: AIDS-related Memory Complex (ARC) loss Altered gait Depression Sleep disorders Chronic diarrhea

Minor Signs: Major Signs Persistent cough for one month Generalized pruritic dermatitis Recurrent herpes zoster Oropharyngeal candidiasis Chronic disseminated herpes simplex Generalized Lymphadenopathy Loss of weight 10% of body weight Chronic diarrhea for more than one month Prolo nged fever for one month

Common Opportunistic Infections Pneumocystis carinii peumonia Oral candidiasis Toxoplasmosis of the CNS Chronic diarrhea/wast ing syndrome Pulmonary/extra-pulmonary tuberculosis Cancers (Kaposis sarcoma, cer vical dysplasia & cancer, Non-Hodgkins lymphoma)

Mode of Transmission Sexual intercourse Blood transfusion and sharing of infected syringes and needles among intravenous drug users Vertical or perinatal transmission (from a pregnant woma n to the fetus during pregnancy, child delivery, or breastfeeding)

Diagnostic Examinations EIA or ELISA Enzyme link immunosorbent assay Particle Agglutination (PA) test Western Blot analysis confirmatory diagno stic test Immunofluorescent test Radio immuno-precipitation assay (RIPA)

Treatment Modalities AIDS Drugs medicines used to treat but not to cure HIV infection. - referred to as anteroviral drugs. - inhibits the reproduction of the virus.

Nursing Management 1. Health Education - know the patient - avoid fear tactics - avoid judgmental and moralistic messages - be consistent and concise - use positive statement - give practical advice

2. Practice universal/standard precaution b. Thorough medical hand washing after every contact with patient and after removing the gown and gloves, and before l eaving the room of an AIDS suspect or known AIDS patient. c. Use of Universal ba rrier or Personal Protective Equipment (PPE).

3. Prevention b. Avoid accidental pricks from sharp instruments contaminated wit h potentially infectious materials from AIDS patient. c. Wear gloves when handli ng blood specimens and other body secretions d. Label blood and other specimens with special warning AIDS Precaution.

4. Blood spills should be cleaned immediately using common household disinfectan ts, like chlorox. 5. Needles should not be bent after use, but should be disposed into a puncture-resistant container. 6. Personal articles should not be shared w ith other members of the family. 7. Patients with active AIDS should be isolated .

Amoebiasis - Protozoal infection of human beings initially involves the colon, but may spre ad to soft tissues, most commonly to the liver or lungs, by contiguity or hemato genous or lymphatic dissemination.

Etiologic Agent Entamoeba histolytica - prevalent in unsanitary areas - common in warm climate - acquired by swallowing - cyst survives a few days outside of the body - cyst passes to th e large intestine and hatch into trophozoites. It passes into the mesenteric vei ns, to the portal vein, to the liver, thereby forming amoebic liver abscess.

Pathology

When the cyst is swallowed, it passes through the stomach unharmed and shows no activity while in an acidic environment. In the alkaline medium of the intestine , metacyst begins to move within the cyst wall. The quadrinucleate amoeba emerge s and divides into amebulas that are swept down into the cecum. Mature cyst in t he large intestines leaves the host in great numbers. The cyst can remain viable and infective in moist and cool environment for at least 12 days and in water f or 30 days.

The cysts are resistant to levels of chlorine normally used for water purification. They are rapidly killed by putrifaction, desiccation, and temperatures below 5 a nd above 40 degrees. Source: human excreta

Incubation Period 3 days severe infection Several months subacute & chronic form 3-4 weeks average * The microorganism is communicable for the entire duration of the illness.

Mode of Transmission Fecal-oral transmission Direct contact sexual contact (orogenital, oroanal & pro ctogenital sexual activity) Indirect contact uncooked leafy vegetables or foods contaminated with E. histolytica cysts.

Clinical Manifestations Acute amoebic dysentery a. slight attack of diarrhea, altered with periods of constipa tion b. diarrhea, watery and foul-smelling stool often containing blood-streaked mucus c. colic and gaseous distention of the lower abdomen d. nausea, flatulenc e, abdominal distention and tenderness in the right iliac region over the colon.

Chronic amoebic dysentery a. attack of dysentery that lasts for several days, usually fo llowed by constipation. b. tenesmus accompanied by the desire to defecate c. ano rexia, weight loss, and weakness d. liver may be enlarged e. watery stool, blood y and mucoid

f. vague abdominal distress, flatulence, constipation or irregularity of bowel g . mild toxemia, constant fatigue & lassitude h. abdomen losses its elasticity wh en pickedup between fingers I. On sigmoidoscopy, scattered ulceration with yello wish and erythematous border

j. The gangrenous type (fatal cases) is characterized by the appearance of large sloughs of intestinal tissues in the stool accompanied by hemorrhage.

Extraintestinal forms Hepatic a. Pain at the upper right quadrant with tenderness of the liver b. jaun dice c. intermittent fever d. loss of weight or anorexia e. abscess may break th rough the lungs, patient coughs anchovy-sauce sputum.

Diagnostic Exam Stool exam (cyst, white and yellow pus with plenty of amoeba) 2. Blood exam ( le ukocytosis) 3. Proctoscopy/Sigmoidoscopy 1.

Treatment Metronidazole (Flagyl)

Tetracycline

Ampicillin,

quinolones, sulfadiazine Streptomycin SO4, Chloramphenicol olytes should be replaced.

Lost fluid and electr

Nursing Management Observe isolation and enteric precaution. Provide health education and instruct patient to: - boil water for drinking or use purified water - avoid washing food from open drum or pail - cover leftover food - wash hands after defecation or b efore eating - avoid ground vegetables

Ascariasis Infection caused by a parasitic roundworm, Ascaris lumbricoides. Mode of Transmission: Transmitted through contaminated fingers put into the mout h. Ingestion of contaminated food and drinks.

Diagnostic tests Stool for Ova demonstration of a fertilized or unfertilized eggs in the stool Kato Tech nics. Abdominal X-ray densed shadow of adult ascaris which looks like strands of spaghetti, dot sign Routine blood counts significant eosinophelia

Treatment Albendazole or Mebendazole Piperazine Citrate Pyrantel Pamoate

Nursing Interventions Isolation is not needed. Preventive measures in each home and in the community should be e nforced. All members of the family must be taught of health matters must be trai ned to wash their hands before handling food, must be taught to was thoroughly a ll fruits and vegetables eaten raw, and must be taught about effective sewage di sposal. Availability of toilet facilities must be ensured. Importance of persona l hygiene should be explained.

Candidiasis - mild superficial fungal infection caused by genus candida. Signs and Symptoms: a. The skin is scaly, erythematous, and papular rash is present, sometimes cove red with exudates appearing below the breasts, between the fingers, and the axil lae, groin, and umbilicus.

b. Nails are red and swollen; the nailbeds are darkened. c. Oropharyngeal mucosa (thrush) cream colored or bluish white patches exude on the tongue, mouth or ph arynx that reveal bloody engorgement when scraped d. Vaginal mucosa white or yel low discharge with pruritus and local excoriation; white or gray raised patches on vaginal walls with local inflammation.

e. Renal system fever, flank pain, dysuria, hematuria, pyuria f. Pulmonary hemop tysis, fever, cough g. Brain headache, nuchal rigidity, seizures h. Eyes blurred vision, orbital or periorbital pain

Diagnosis Stool culture Gram staining of skin, vaginal discharge or scrapings Treatment: Nystati n, for oral thrush Clitrimasole, fluconasole, ketoconasole for mucous membrane & vaginal infection Fluconasole or Amphotericine for systemic infection.

Chickenpox (Varicella) an acute and highly contagious disease of viral etiology, characterized by vesic ular eruptions on the skin and mucous membrane with mild constitutional symptoms . Infectious Agent: Herpesvirus varicellae a DNA containing virus Incubation Per iod 10-21 days or maybe prolonged after passive immunization. -

Mode of Transmission Direct contact shedding of the virus from the vesicles or fomites Airborne (droplet infection) Indirect contact through linens

Clinical Manifestations pre-eruptive malaise Eruptive Stage a. Rash starts from the trunk, then spread to other parts of the body. b. Initial lesions are distinctively red papules where contents be come milky and a pus-like within 4 days. manifestations are mild fever &

c. In adult and bigger children, the lesions are more widespread and more severe . d. Vesicular lesions are very pruritic. e. Celestial map scabs f. Stages of lesi ons: *Macule lesion that is not elevated above the skin surface. *Papule lesion that is elevated above the skin surface with a diameter of about 3 mm.

*Vesicle pop-like eruption filled with fluid. *Pustule vesicle that is infected or filled with pus. *Crust scab or eschar. Secondary lesion caused by the secret ion of vesicle drying on the skin. The scars are superficial, depigmented and ta ke time to fade out.

Complications Secondary infection of the lesions furuncles, cellulitis, skin abscess, erysipelas encephalitis Pneumonia Sepsis Meningo

Treatment Zoverax acyclovir

Oral Oral antihistamine Calamine lotion Antipyretic

Nursing Management Respiratory Isolation is a must until all vesicles have crusted. Prevent secondary infection of the skin lesion through hygienic care of the patient. Linens must be disinfe cted under the sunlight or through boiling. Cut fingers nails short and wash han ds more often. Provide activities to keep child occupied to lessen pruritus.

German Measles (Rubella/Three-day Measles) mild viral illness caused by rubella virus. - Causes mild feverish illness associated with rashes and aches in joints. - Has a terat ogenic effect on the fetus. Incubation Period: 14-21 days

Period of Communicability communicable approximately 1 week before and 4 days after the onset of rashes. A t its worst when the rash is at its peak. Mode of Transmission: 5. Direct contact 6. Air droplets 7. Transplacental transm ission

Clinical Manifestations 1. Prodromal Period a. low grade fever b. headache c. malaise d. mild coryza e. con junctivitis

2. Eruptive Period a. Pinkish rash on the soft palate (Forchheimers spot), en exa nthematous rash that appears first on the face, spreading to the neck, the arms, trunk, and legs b. Eruption appears after the onset of adenopathy c. Children u sually present less or no constitutional symptoms.

d. The rash may last for one to five days and leaves no pigmentation nor desquam ation. e. Testicular pain in young adults. f. Transient polyarthralgia and polya rthritis may occur in adults and occasionally in children.

Nursing Management 1. 2. 3. 4. 5. The patient should be isolated. The patient should be advised to rest in bed unt il fever subsides. The patients room must be darkened to avoid photophobia. The p atient must take mild liquid but nourishing diet. The patients eyes should be irr igated with warm normal saline to relieve irritation.

Prevention Administration of live attenuated vaccine (MMR). Pregnant women should avoid exposure to patients infected with Rubella vi rus. Administration of Immune Serum Globulin one week after exposure to Rubella.

Gonorrhea sexually transmitted bacterial disease involving the mucosal lining of the genit ourinary tract, the rectum, and pharynx. Causative Agent: Neisseria gonorrhoeae Incubation Period: 3-21 days average: 3-5 days

Mode of Transmission Bacteria is transmitted by contact with exudates from the mucous membrane of inf ected persons. 2. Through direct contact with contaminated vaginal secretions of the mother as the baby comes out of the birth canal. 3. May also be transmitted through fomites. 1.

Clinical Manifestations 1. In females a. Burning sensation and frequent urination. b. Yellowish purulent va ginal discharge c. Redness and swelling of the genitals d. Burning sensation and itching of vaginal area e. Urinary frequency and pain on urination

f. Urethritis or cervicitis occurs initially a few days after exposure g. Pregna nt women with gonorrhea may infect the eye of her baby during the passage throug h the birth canal.

2. In males a. Dysuria with purulent discharge from the urethra 2 7 days after e xposure. b. Rectal infection is common in homosexuals. c. Inflammation of the ur ethra can cause stricture that can prevent passage of urine. d. Prostatitis e. P elvic pain and fever

Diagnostic Tests In female culture of specimen taken from the cervix and anal canal (use of Thaye r-Martin medium) 2. In male gram stain 1.

Treatment Modalities Ceftriaxone for uncomplicated gonorrhea in adults Ceftriaxone & Erythromycin for pregnant women lin Direct fluorescent antibody test Aqueous procaine Penicil

Nursing Management All information concerning the patient is considered confidential. 2. The patien t should be isolated until he/she recovers from the disease. 3. Infants born to mothers positive of gonorrhea should be instilled with ophthalmic prophylaxis in to both eyes at the time of birth. 1.

Hepatitis Hepatitis A (Infectious Hepatitis/Catarrhal jaundice) - liver disease caused by the hepatitis A virus. - inflammation of the liver that is not really very sever e & runs an acute course. - starts within 2 6 weeks after contact with the virus , lasts no longer than 2 months.

Period of Communicability The infected patient is capable of transmitting the organism a week before and a wee k after the appearance of symptoms.

Mode of Transmission Ingestion of contaminated drinking water or ice, uncooked fruits and vegetables. ral-fecal pathway. By infected food handlers. Through o

Clinical Manifestations Flu-like illness with chills and high fever Diarrhea, fatigue, and abdominal pain Loss of appetite Nausea, diarrhea, and fever Jaundice and dark-colored urine The infect ion in young children is often mild and asymptomatic

Diagnostic Procedure HAV and HBV complement fixation rate 2. Liver function test to determine the pre sence and extent of liver damage and to check the progress of the liver 3. Bile examination in stool and urine 4. SGOT serum glutamic oxaloacetic transaminase S GPT serum glutamic pyruvic transaminase ALT serum alanine transaminase 5. IgM le vel 1.

Treatment Modalities There is no specific treatment, although bed rest is essential. 2. Diet must be high in carbohydrate, low in fat, and low in protein. 3. Patient must take vitam in B complex. 4. Isoprinosine (methisoprenol) enhance the cell-mediated immunity of the T-lymphocytes. 1.

Nursing Management 1. 2. 3. 4. 5. The patient must be isolated (enteric isolation). Patient should be encouraged t o rest during acute or symptomatic phase. Improve nutritional status. Utilize ap propriate measures to minimize spread of the disease. Observe the patient for me lena and check stool for the presence of blood.

6. Provide optimum skin and oral care. 7. Increase in ability to carry out activ ities: a. encourage the patient to limit activity when fatigued b. assist the cl ient in planning periods of rest and activity c. encourage gradual resumption of activities and mild exercise during recovery

Prevention and Control 1. 2. 3. 4. 5. Hands should be washed thoroughly every after use of toilet. Travelers should av oid water and ice if unsure of their purity. Food handlers should carefully be s creened. Safe preparation and serving of food must be practiced. The public shou ld be educated on the mode of transmission.

Hepatitis B (Serum Hepatitis) - inflammation of the liver caused by hepatitis B virus. - More serious than Hepatitis A due to the possibility of severe complica tions such as massive damage and hepatocarcinoma of the liver.

Incubation Period 50 to 189 days or 2 to 5 months Period of Communicability: The patient is capable of transmitting the virus duri ng the latter part of the incubation period and during the acute phase. The viru s may persist in the blood for many years.

Mode of Transmission Direct contact via infected body fluids. Through contaminated needles and syringes. ough infected blood or body fluids introduced at birth Through sexual contact Thr

HBV transmission does not occur: fecal-oral route o) transmission

By

By food-borne or water-borne transmission

By arthropod (mosquit

Clinical Manifestations Prodromal Period a. Fever, malaise, and anorexia b. Nausea, vomiting, abdominal discomfort , fever, and chills c. Jaundice, dark urine, and pale stools d. Recovery is indi cated by a decline of fever and improved appetite *Fulminant Hepatitis fatal & m anifested by ascitis and bleeding

Diagnostic Procedures 1. 2. 3. 4. 5. 6. 7. Compliment Fixation test Radio-immunoassay-hemaglutinin test Liver function test Bile examination in blood and urine Blood count Serum transaminase SGOT, SGPT, ALT HbsAg

Prevention Blood donors must be screened to exclude carriers. Caution must be observed in giving care to patients with known HBV. Hands and other skin areas must be washed immed iately and thoroughly after contact with body fluids. Avoid injury with sharp ob jects or instruments. Use disposable needles and syringes only once and discard properly.

Avoid sharing of h blood. ious food. lin (HBIg) ep B virus toothbrush, razor, and other instruments that may be contaminated wit Observe safe sex. Have adequate rest, sleep, and exercise, and eat nutrit Hep B vaccine is recommended for pre-exposure. Hepatitis Immune Globu should be administered within 72 hours to those exposed directly to h either by ingestion, by prick or by inoculation.

Influenza an acute viral infectious disease affecting the respiratory system. Etiologic Agent: RNA containing myxoviruses, types A, A-prime, B, and C. Incubat ion Period: 24 to 48 hours

Period of Communicability The disease is communicable until the 5th day of illness and up to seven days in children. Mode of Transmission: 4. Through airborne spread among crowded populations. 5. D roplet 3. Influenza virus persists for hours in dried mucus.

Clinical Manifestations Onset is sudden chilly sensation, hyperpyrexia, malaise, sore throat, coryza, rhinorrh ea, myalgia, and headache. Severe aches and pain usually at the back associated with severe sweating may manifest. Sometimes there are gastrointestinal elements with vomiting.

The worst symptoms usually last from 3 to 5 days before the condition begins to impr ove. Influenza makes everybody feel terrible , but most people recover.

Management 1. 2. 3. Stay at home Drink plenty of fluids Take the following to relieve fever and head ache: a. Paracetamol b. Aspirin, unless contraindicated; should not to be given to children below 16 years old c. Ibuprofen or other anti-inflammatory drugs

4. Sponge down with tepid water 5. Isolate patient to decrease risk of infecting others 6. Limit strenuous activity specially in children 7. Watch out for compl ications especially among people at risk.

Preventive Measures Immunization Avoidance of crowded places Educate the public and health care personnel regarding the bas ic personal hygiene

People who should receive the vaccine annually: a. the elderly b. people who have poor immunity c. those with DM, lung disease, kidney disease, heart disease or liver disease

Leprosy chronic systemic infection characterized by progressive cutaneous lesions. Etiologic Agent: Mycobacterium leprae an acid-fast bacilli that attack cutaneous tissues and peripheral nerves, producing skin lesions, anesthesia, infection, a nd deformities.

Incubation Period: 5 months 8 years Mode of Transmission 4. Through respiratory droplet 5. Through the skin break & mucous membrane

Clinical Manifestations 1. 2. 3. Clawhand, footdrop, and ocular manifestations such as corneal insensitivity, and ulceration, conjunctivitis, photophobia, and blindness develop. Lepromatous lep rosy can invade tissues in every organ of the body. The lesions enlarge and form plagues on nodules on the earlobes, nose, eyebrows, and forehead, giving the pa tient a leonine appearance.

4. Loss of eyebrows and eyelashes. 5. Loss of function of sweat and sebaceous gl ands. 6. Epistaxis, ulceration of the uvula and tonsils, septal perforation and nasal collapse.

Diagnostic Procedures Identification Tissue of the signs and symptoms biopsy Tissue smear Blood tests show increased RBC and ESR; decreased Ca, albumi n, and cholesterol level.

Modalities of Treatment Sulfone therapy apy Multiple Drug Therapy Rehabilitation, recreational and occupational ther

Prevention Report all cases and suspects of leprosy. 2. Newborn infants should be separated from leprous mothers. 3. BCG vaccine may be protective if given during the firs t 6 months of life. 4. Health education should be given as to the mode of transm ission. 1.

Malaria acute and chronic parasitic disease transmitted by the bite of infected mosquito es and it is confined mainly to tropical and subtropical areas. Etiologic Agent: Four species of protozoa: c. Plasmodium falciparum d. Plasmodium vivax e. Plasm odium malariae f. Plasmodium ovale -

The primary vector of malaria is the female Anopheles mosquito. > breeds in clear, f lowing, and shaded streams usually in the mountains > bigger in size than the or dinary mosquito > brown in color > night-biting mosquito > usually does not bite a person in motion > assumes a 36 degree position when it alights on walls, tre es, curtains, and the like.

Incubation Period 12 days for P. Falciparum 14 days for P. vivax and ovale 30 days for P. malariae Pe riod of Communicability: untreated or insufficient treated patient may be the so urce of mosquito infection.

Mode of Transmission Through the bite of an infected female anopheles mosquito. Parenterally through blood tr ansfusion. Occasionally, transmitted from shared contaminated needles. Transplac ental transmission for congenital malaria (rare)

Clinical Manifestations 1. 2. 3. 4. 5. 6. Paroxysms with shaking chills. Rapidly rising fever with severe headache Profuse sweating Myalgia, with feeling of well-being in between Splenomegaly, hepatomeg ally Orthostatic hypotension

7. Paroxysms may last for 12 hours, then, maybe repeated daily or after a day or two. 8. In children: a. fever maybe continuous b. convulsions and gastrointesti nal symptoms are prominent c. splenomegally

9. In cerebral malaria: a. changes in sensorium, severe headache, and vomiting b . Jacksonian or grand mal seizure may occur

Diagnostic Procedure Malarial smear a film of blood is placed on a slide, stained, and examined microscopicall y. Rapid diagnostic test (RDT) blood test for malaria that can be conducted outsi de the laboratory and in the field. - gives a result within 10-15 minutes. - det ect malarial parasite antigen in the blood.

Management Medical a. Anti-malarial drugs - Chloroquine - Quinine - Sulfadoxine for the resistant P . falciparum - Primaquine for relapse of P. vivax & ovale b. Erythrocyte exchang e transfusion for rapid production of high levels of parasites in the blood.

b. c. Nursing Management The patient must be closely monitored. Intake and output shou ld be closely monitored to prevent pulmonary edema. > daily monitoring of patien ts serum bilirubin, BUN creatinine, and parasitic count. > if the patient exhibit s respiratory and renal symptoms, determine the ABG and plasma electrolyte.

c. During the febrile stage, tepid sponges, ice cap on the head will help bring the temperature down. d. Application of external heat and offering hot drinks du ring chilling stage is helpful. e. Provide comfort and psychological support. f. Encourage the patient to take plenty of fluids. g. As the temperature falls and sweating begins, warm sponge baths maybe given.

h. The bed and clothing should be kept dry. ii. Watch for neurologic toxicity (f rom quinine infusion) like muscular twitching, delirium, confusion, convulsion, and coma. j. Evaluate the degree of anemia. k. Watch for any signs especially ab normal bleeding. l. Consider severe malaria as medical emergency that requires c lose monitoring of vital signs.

Prevention and Control Malaria cases should be reported. A thorough screening of all infected persons from mosq uitoes is important. Mosquito breeding places must be destroyed. Homes should be sprayed with effective insecticides which have residual actions on the walls.

Mosquito nets should be used especially when in infected areas. Insect repellents must be applied to the exposed portion of the body. People living in malaria-infested a reas should not donate blood for at least 3 years. Blood donors should be proper ly screened.

Measles an acute, contagious and exanthematous disease that usually affects children whi ch are susceptible to URTI. Etiologic Agent: Filtrable virus that belongs to genus Morbilivirus of the famil y paramyxoviridae. - rapidly inactivated by heat, ultraviolet light, and extreme degrees of acidity and alkalinity.

Incubation Period 10 to 12 days Single attack conveys a lifelong immunity. Period of Communicability: usually lasts about 9 to 10 days, from the beginning of the prodromal symptoms to the fading of the rash.

The disease is communicable 4 days before and 5 days after the appearance of rashes. The disease is most communicable during the height of rash. Sources of Infectio n: - patients blood - Secretions from the eyes, nose and throat.

Mode of Transmission Through direct contact with the droplets spread through coughing & sneezing 2. I ndirect contact (articles or fomites freshly contaminated with respiratory secre tions of infected patients. 1.

Pathognomonic Sign 2. 3. Kopliks spots - inflammatory lesions of the buccal mucous glands with superficial necrosis. They appear on the mucosa of the inner cheek opposite to the second m olars, or near the junction of the gum and the inner cheek. They usually appear 1 to 2 days before the measles rash.

Clinical Manifestations (3 Stages) 1. Pre-eruptive stage a. fever b. catarrhal symptoms (rhinitis, conjunctivitis, pho tophobia, coryza) c. respiratory symptoms start from common colds to persistent coughing d. enanthema sign (Kopliks spot)

2. Eruptive stage a. the rash is usually seen late on the 4th day. b. maculo-pap ular rash appears first on either the cheeks, bridge of the nose, along the hair line, at the temple or at the earlobe. c. the rash is fully developed by the end of the second day and all symptoms are at their maximum at this time.

d. High grade fever comes on and off. e. Anorexia and irritability. f. Abdominal tympanism, pruritus, lethargy g. The throat is red and often extremely sore. h. As fever subsides, coughing may diminish, but more often it hangs on for a week or two, become looser and less metallic.

3. Stage of Convalescence a. rashes fade away in the manner as they erupted. b. fever subsides as eruption disappears. c. when the rashes fade, desquamation beg ins. d. symptoms subside and appetite is restored.

Diagnostic Procedures Nose and throat swab Urinalysis Blood exams (CBC, leukopenia, leukocytosis) t fixation or hemogglutinin test Complemen

Modalities of Treatment Anti-viral drugs (Isoprenosine) Antibiotics if with complication inhalation, IV fluids) Supportive therapy (oxygen

Unfavorable Signals 1. 2. 3. 4. 5. Violent onset with high grade fever Fading eruption with rising fever Hemorrhagi c or black measles Persistence of fever for 10 days or more Slight eruptions acc ompanied by severe symptoms, especially those of encephalitis.

Nursing Management 1. 2. 3. 4. 5. Isolation of the patient is necessary (the room must be quiet, well ventilated, and must have subdued light) Control the patients high temperature with warm or t epid sponges. Skin care is utmost. Provide oral and nasal hygiene. Care of the e yes. The patient is sensitive to light. Keep eyes free of secretions.

Preventive Measures Immunization with: Anti-measles at the age of 9 months, as single dose Mumps, me asles, rubella (MMR) vaccine to be given at 15 months, 2nd dose at 11 to 12 year s. Measles vaccine should not be given to pregnant women or to persons with acti ve tuberculosis, leukemia, lymphoma or depressed immune system.

Meningitis inflammation of the meninges of the brain and spinal cord as a result of viral a nd bacterial infection. (dura mater, the arachnoid & the pia mater) Etiologic Agent: Neisseria meningitides Incubation Period: 1 to 10 days

Mode of Transmission Respiratory droplets through nasopharyngeal mucosa 2. Direct invasion through ot itis media 3. After skull fracture, a penetrating head wound, lumbar puncture & ventricular shunting procedures. 1.

Diagnostic Procedures 1. Lumbar puncture a. Diagnostic purposes - to obtain specimen, the CSF - to take x-ray of the spinal canal and cord b. Th erapeutic purposes - to reduce intra-cranial pressure - to introduce serum and o ther medications - to inject an anesthetic agent

2. Gram staining 3. Smear and blood culture 4. Smear from petechiae 5. Urine cul ture

Classifications: 1. Acute meningococcemia a. invade the bloodstream without involving the meninges b . usually starts with nasopharyngitis followed by sudden onset of high grade fev er with chills, nausea, vomiting, malaise, and headache. c. petechial, purpuric, or ecchymotic hemorrhages scatter over the entire body and mucous membrane.

d. adrenal lesions start to bleed into the medulla which extends to the cortex. e. Waterhouse-friderichsen syndrome combination of meningococcemia and the adren al medullary hemorrhage; rapid development of petechiae to purpuric, & ecchymoti c spots in association with shock. f. short course & usually fatal.

2. Aseptic meningitis - benign syndrome characterized by headache, fever, vomiti ng, and meningeal symptoms. - begins suddenly with fever, alterations in conscio usness, neck & spine stiffness.

- Characteristic sign of meningeal irritation: > Stiff neck or nuchal rigidity > Opisthotonos > (+) Brudzinskis sign > (+) Kernigs sign > Exaggerated and symmetri cal deep tendon reflexes

Sinus arrythmia, irritability, photophobia, diplopia, & other visual problems De lirium, deep stupor, and coma Signs of intra-cranial pressure: > bulging fontane l in infants > nausea & vomiting (projectile) > severe frontal headache > blurri ng vision > alteration in sensorium

Modalities of Treatment Antibiotic therapy & vigorous supportive therapy - ampicillin - cephalosporin (c eftriaxone) - aminoglycosides 2. Digitalis glycoside (Digoxin) is administered t o control arrythmias 1.

3. Manitol is given to decrease cerebral edema. 4. Anticonvulsant or sedative is needed to reduce restlessness & convulsions. 5. Acetaminophen is helpful to rel ieve headache & fever.

Nursing Management Assess neurologic signs often. Observe patients level of consciousness and check for increased intra-cranial pressure. 2. Monitor fluid balance. 3. Watch for adv erse reactions of antibiotics & other drugs. 4. Maintain adequate nutrition & el imination. 1.

5. Ensure patients comfort. 6. Provide reassurance and support to the patient and the family. 7. Follow strict aseptic technique when treating patients with head wounds or skull fractures. 8. Isolation is necessary if nasal culture is positi ve.

Mumps acute viral disease manifested by the swelling of one or both parotid glands, oc casional involvement of other glandular structures, particularly the testes in m ale. Etiologic Agent: Paramyxovirus found in the saliva of infected person Incubation Period: 14-25 days (ave. 18 days)

Period of Communicability 6 days before and 9 days after the onset of parotid gland swelling; 48-hour period immediately preceding onset of swelling is considered the time of highest commu nicability.

Clinical Manifestations 1. 2. 3. 4. 5. Sudden headache earache loss of appetite fever swelling of the parotid gland whi ch is located in front and below the ear.

Treatment Modalities Anti-viral drugs Relief of pain from parotid swelling can be afforded by the application of hot or cold.

Nursing Management 1. Medical Aseptic protective care a. patient should be cared for in a singleoccupa ncy room b. susceptible individuals must use mask and must wash hands regularly. c. oral care and personal hygiene is a must.

2. General Management of the disease a. bedrest is encouraged to avoid complicat ions b. diversional activities for less ill patient 3. Diet a. soft & semisolid foods b. avoid acid foods, like fruit juices.

Pediculosis flattened, wingless insects commonly attack man. Etiologic Agent: 4. Pediculus humanos var. capitis (head lice) 5. Pediculus huma nos var. corporis (body lice) 6. Pdiculus pubis or pubic lice (crab lice)

Feed on human blood & lay their eggs in body hair & clothing fibers. b. After th e nits hatch, the lice must feed within 24 hours otherwise it will die. c. They mature in about 2 3 weeks. d. It injects toxin into the skin that produces mild irritation & a purpuric spot. a.

Clinical Manifestations 1. The head louce a. more common in female than in male. Infects more children than adults. b.Itching is the first & predominant symptom. c. irritation, excoriatio n & crusting & foul smelling mass consisting of matted hair, nits, ova, pus, cru sts, & pediculi results (plica polonica)

2. Body louse a. initial lesions are minute red spots b. spot swells & secondary crust & excoriation is formed on the surrounding skin as a result of scratching .

3. Crab lice a. unusual, persistent itching in the pubic region b. Maculae caeru leae grayish pigmented spots found in the surface of the inner thighs or the abd omen, pea-size to a small coin.

Treatment 1. Head lice a. dusting the scalp with 1% malathion powder is a reliable & convenie nt method b. massage with gamma benzene hexachloride shampoo in the scalp for 4 minutes, then rinse.

2. Body louse a. laundry (dry clean) or boil the clothing & beddings b. good bod y hygiene must be observed always.

3. Crab lice a. apply Kwell or Gamene (Lindane) cream or lotion b. Rub crotamino n (Eurax, Geigy) into the affected area. c. repeat the application of crotaminon after 1 week. d. simultaneously treat the person who had sexual contact with th e patient e. remove remaining nits mechanically.

Pertussis Whooping cough infectious disease characterized by repeated attacks of spasmodic coughing which consists of a series of explosive expirations, typically ending in a long-drawn forced inspiration which produces a crowing sound, the whoop & usu ally followed by vomiting.

Causative Agent Bordetella pertussis Incubation Period: 7 to 14 days Period of C ommunicability: 7 days after exposure to 3 weeks after typical paroxysms.

Mode of Transmission Direct contact & droplet Indirect through soiled linens & other articles contaminated b y respiratory secretions. Sources of infection: secretions from the nose & throa t of infected persons - extremely contagious

Diagnostic Procedures Nasopharyngeal Sputum swabs culture CBC (Leukocytosis)

Modalities of Treatment Supportive therapy a. Fluid & electrolyte replacement b. adequate nutrition c. o xygen therapy 2. Antibiotics (erythromycin & ampicillin) 3. DPT vaccine 1.

Nursing Management Isolation and asepsis should be carried out. Should not leave the patient alone. Suctionin g equipment should be ready at all times for emergency use to avoid airway obstr uction. Sunshine & fresh air are important. Provide warm baths, keep the bed dry & free from soiled linens. Intake & output should be closely monitored.

Poliomyelitis acute infectious disease characterized by changes in the CNS which may result in pathologic reflexes, muscle spasm & paresis or paralysis. - Disease of the lowe r motor neurons. Etiologic Agent: polio virus (Legio debilitans) -

Incubation Period 7 to 21 days for paralytic cases with a repeated range of 3 to 35 days. Period o f Communicability: - first 3 days to 3 months of illness - Most contagious durin g the first few days of active disease, & possibly from 3 to 4 days before that.

Mode of Transmission Direct contact with infected oropharyngeal secretions & feces Person to person transmis sion through healthy carriers Indirect through contaminated articles & flies, co ntaminated water, food & utensils.

Diagnostic Procedures Throat swab Stool culture throughout the disease Culture from the CSF

Modalities of Treatment Analgesics to ease headache, back pain & leg spasm Moist heat application to reduce muscle spasm & pain sary Paralytic polio requires rehabilitation Bed rest is neces

Nursing Management Carry out enteric isolation. Observe patient carefully for signs of paralysis & other neurologic damage Perform a neurologic assessment at least once a day Chec k blood pressure regularly Watch for signs of fecal impaction due to dehydration & immobility. Prevent the occurrence of bed sores.

Wash hands after every contact with patient. Apply hot packs to affected limb to reli eve pain and muscle shortening. Dispose excreta & vomitus properly. Provide emot ional support both to patient & family. Maintain good personal hygiene, oral & s kin care.