MODULE: INFECTIOUS DISORDERS OF ADULTS

MODULE DESCRIPTION:

This module deals with concepts, principles, theories and techniques of

nursing care management of at risk and sick adult clients in any setting
with alterations/problems in infectious. The learners are expected to
provide nursing care to at risk and sick adult clients utilizing the nursing
process.
COURSE LEARNING OUTCOME:

Assess with the at risk and sick adult clients one’s health
status/competence
Formulate with the client a plan of care to address the needs or
problems, and based on priorities.
Implement safe and quality interventions with the client to address the identified
needs/problems.
Provide health education using selected planning models to sick adult client.

PRETEST:

1. Discuss the chain of infection.

TOPIC CONTENT:

PULMONARY TUBERCULOSIS

Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may
spread to other organs.

CAUSES:

 Mycobacterium tuberculosis (M tuberculosis).

RISK FACTOR:
 Older adults

 Infants

 People with weakened immune systems, for example due to HIV/AIDS, chemotherapy,

diabetes, or medicines that weaken the immune system
 Are around people who have TB

 Live in crowded or unclean living conditions

 Have poor nutrition

The following factors can increase the rate of TB infection in a population:

 Increase in HIV infections

 Increase in number of homeless people (poor environment and nutrition)

 Presence of drug-resistant strains of TB

PHATHOPHYSIOLOGY

 Mycobacterium tuberculosis is an acid-fast, gram-positive bacillus with transmission via

airborne droplets
 Infection usually results from frequent close contact with infected individual
 Inhaled bacilli inhabit the respiratory bronchioles and alveoli
 Bacilli travel through the lymph circulation and may spread throughout the body before cell-
mediated immunity can contain its movement
 Eventual activation of cell-mediated immunity produces a granuloma
 Liquified necrotic material from Ghon tubercle portion of the granuloma lesion results in passage
of infectious particles into the major airways where they can be exhaled into the air

ASSESSMENT:

A. CLINICAL MANIFESTATION
 Frequent cough with copious frothy pink sputum; nonproductive cough develops first as
early symptoms
 Night sweats
 Anorexia
 Weight loss
 History may indicate recent exposure to infected individual(s)

B. LABORATORY AND DIAGNOSTIC TEST FINDINGS

  Positive tuberculin skin test (indicated exposure)
 Appearance of characteristic Ghon tubercle on chest x-ray
 Positive acid-fast bacillus sputum cultures (provides definitive diagnosis of infection)

C. PRIORITY NURSING DIAGNOSIS

 Ineffective breathing pattern

 Ineffective health maintenance
 Imbalance nutrition: less than body requirements
 Hyperthermia
 Pain
 Activity intolerance

D. PLANNING AND IMPLEMENTATION

1. Monitor respiratory and oxygen status

2. Provide nutrition and hydration

3. Institute standard precaution and airborne precaution

 Use room with negative air pressure

 Wear fitted mask ( N95 respirator) whenever entering to client’s room
 Provide client with surgical mask

4. Administer antimicrobial as needed

5. Provide supplemental oxygen as needed

6. Obtain periodic sputum cultures following onset of antimicrobial therapy

E. MEDICATION THERAPY

1. Antibiotic prophylaxis for individuals exposed to client with active disease

2. Isoniazid (INH) drug of choice for 6 months if no clinical evidence of the disease

3. INH drug of choice for 12 months if abnormal chest x-ray or high risk population such as HIV
or drug induced immunosuppression

4. Active disease: treatment options prescribed by Center for Disease Control (CDC)

a. Option 1: INH, rifampin (Rifadin), pyrazinamide (Tebrazid) and Ethambutol (Myambutol) or

streptomycin given daily or 2 to 3 times weekly.
 If cultures report sensitivity to rifampin or isoniazid ethambutol or streptomycin can be
stopped; minimal 6 months drug therapy; drug therapy continues for at least 3 months
after first negative sputum culture obtained.
b.

Option 2: INH, rifampin, pyrazinamide and ethambutol or streptomycin given daily for 2 weeks
then 2 times weekly for 6 months then 2 times weekly isoniazid and rifampin for 16 weeks

c. Option 3: INH, rifampin, pyrazinamide and ethambutol or streptomycin 3 times a week for 6
months

d. Option 4: active TB with HIV; option 1,2 or 3 for minimum of 9 months and to continue for at
least 6 months after first negative sputum culture.

NURSING RESPONSIBILITY

1. Infection control measures, including handwashing, coughing into tissues and disposing of
them in a closed bag.

2. Teach client/family/close contact about mechanism of transmission and antimicrobial therapy.

3. Teach client about adverse effects of medication, including but not limited to the following:

 INH: hepatotoxicity that requires assessment of onset of jaundice, periodic monitoring of

liver function test, peripheral neuritis (numbness and tingling), hematologic effects
( anemia, agranulocytosis, bleeding), or hypersensitivity
 Rifampin: relatively low toxicity but monitor CBC, liver function test and renal status,
medication causes orange discoloration of the body fluids.
 Pyrazinamide: primary causes hepatotoxicity and elevates uric acid level, periodic
monitoring of blood levels is indicated and assessment of jaundice and symptoms of gout.
 Ethambutol: causes optic neuritis, obtain baseline vision screening and periodic eye
exams (changes can include loss of visual acuity and red/green color discrimination.
 Streptomycin: primarily causes ototoxicity ( similar to other aminoglycoside
antibiotics) ;monitoring hearing ability and renal function, maintain fluid intake of 2.5 to
3 liter of fluid per day.

4. Maintain good nutrition and provide adequate rest periods for healing and to minimize
fatigue.
Activity 1: What therapies are used as tuberculosis prophylaxis for individuals who have been exposed to
an individual with active disease?

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PNEUMONIA

- is an acute inflammation of lung parenchyma ( alveoli and respiratory bronchioles)

- classified as viral versus bacterial, community acquired versus hospital acquired, atypical or
pneumocystis

A. ETIOLOGY AND PATHOPHYSIOLOGY

 Causative agent can be infectious (bacteria, Viruses, fungi and other microbes) or non
infectious (aspirated or inhaled substances)
 Most common organism for both community acquired and hospital acquired is the
Gram- positive bacteria, streptococcus pneumonia
 Other common organism for both community- acquired pneumonia include Klebsiella
pneumonia, Pseudomonas aeruginosa, Escherichia coli, haemophilus influenza and
other influenza virus.
 Spread of microbes in alveoli activates inflammation and immune response
 Antigen- antibody response damages mucous membranes of bronchioles and alveoli
resulting in edema
 Microbe cellular debris and exudate fill alveoli and can impair gas exchange

B. ASSESSMENT

1. Viral

 Fever: low-grade
 Cough: non-productive
 WBC count: normal to low elevation
 Chest X-ray: minimal changes evident
 Clinical course: less severe than pneumonia of bacterial origin
2. Bacterial

 Fever: high
 Cough: productive
 WBC count: high elevation
 Chest X-ray: obvious infiltrates
 Clinical course: more severe than pneumonia of viral origin

C. PRIORITY NURSING DIAGNOSIS

 Impaired gas exchange

 Ineffective airway clearance
 Ineffective breathing pattern
 Imbalanced nutrition: less than body requirements
 Activity intolerance
 Anxiety
 Pain
 Hyperthermia

D. PLANNING AND IMPLEMENTATION

1. Maintain patent airway

2. Monitor respiratory and oxygenation status

3. Provide supplemental oxygen as indicated

4. Be prepared to initiate mechanical ventilatory support

5. Administer antimicrobial as prescribed

6. Provide pain management

7. Provide nutritional support and fluids via appropriate route

8. Provide adequate opportunities for physical rest

9. For all hospitalized clients, take measures to prevent pneumonia

 Identify clients at risk for pneumonia

 Maintain adequate nutrition
 Activate aspiration precaution
 Encourage activity and mobility as soon as feasible
E. THERAPEUTIC AND MEDICAL MANAGEMENT

1. Antibiotic therapy as indicated ( ex. Azithromycin, clarithromycin)

2. Analgesics

3. Antipyretics

4. Oxygen therapy to treat hypoxemia

F. NURSING RESPONSIBILITY

1. Immunization against influenza and pneumococcal pneumonia

2. Activity limitations and importance of rest

3. Effects and dosages of medications

4. Avoid pollutants and irritants such as smoke

5. Symptoms to report to health care provider ( return of fever, worsening respiratory status)

ACTIVITY 2: How do assessment findings differ among clients with viral versus bacterial origin of
pneumonia?

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EBOLA VIRUS DISEASE

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal
illness affecting humans and other primates.
The virus is transmitted to people from wild animals (such as fruit bats, porcupines and non-
human primates) and then spreads in the human population through direct contact with the blood,
secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g.
bedding, clothing) contaminated with these fluids.

A. CAUSES

 Ebola virus (species Zaire ebolavirus)

 Sudan virus (species Sudan ebolavirus)
 Taï Forest virus (species Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus)
 Bundibugyo virus (species Bundibugyo ebolavirus)
 Reston virus (species Reston ebolavirus)
 Bombali virus (species Bombali ebolavirus)

B. MODE OF TRANSMISSION

The virus spreads through direct contact (such as through broken skin or mucous membranes in
the eyes, nose, or mouth) with:

 Blood or body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen) of a
person who is sick with or has died from Ebola virus disease (EVD).
 Objects (such as clothes, bedding, needles, and medical equipment) contaminated with
body fluids from a person who is sick with or has died from EVD.
 Infected fruit bats or nonhuman primates (such as apes and monkeys).
 Semen from a man who recovered from EVD (through oral, vaginal, or anal sex). The
virus can remain in certain body fluids (including semen) of a patient who has recovered
from EVD, even if they no longer have symptoms of severe illness..
C. RISK FACTOR

 Health workers who do not use proper infection control while caring for Ebola patients,
and family and friends in close contact with Ebola patients, are at the highest risk of
getting sick. Ebola can spread when people come into contact with infected blood or
body fluids.

PATHOPHYSIOLOGY
D. SIGNS AND SYMPTOMS

1. The incubation period is 2 to 21 days before symptoms appear.

2. The average time for S/S to appear is 8 to 10 days.
1. 95% will have a sign and symptoms during the first 14 days.
3. Humans are not infectious until they develop symptoms.
4. There is a sudden onset of:
1. Fever.
1. There is malaise, fatigue, myalgia, and arthralgia.
2. Muscle pain, headache, and sore throat.
3. After 3 to 5 days:
1. This is followed by vomiting, diarrhea.
2. Rash.
3. There are symptoms of impaired kidney and liver function.
4. In some cases, both internal and external bleeding (e.g. oozing from the
gums, blood in the stools).
4. Nausea and vomiting worsen, cannot tolerate oral intake.
1. Diarrhea becomes a large volume and patients may lose 5 or more liters of
the fluid per day.
5. Disease progresses and patient may develop neurological symptoms.
1. Encephalitis is accompanied by confusion, agitation, and occasional
seizures.
6. The patient may go into shock.
7. Hemorrhagic manifestations are seen in only 1 to 5% of the cases.
8. A complication of the Ebola virus:
1. There is a hypovolemic shock.
2. There may be a multiorgan failure.

E. DIAGNOSIS
Laboratory findings include:

1. Blood sample:
1. Low white blood cell and platelet counts.
2. Abnormal Liver function tests.
3. Increased serum creatinine level.
2. ELISA (antibody-capture enzyme-linked immunosorbent assay).
1. IgM antibodies appear after 10 days of the infection.
2. After 2 weeks IgG antibodies appear.
3. Serum neutralization test.
3. Antigen-capture detection tests.
4. PCR – RT (Reverse transcriptase-polymerase chain reaction assay), can diagnose in the
first three days of illness
1. If negative and, the patient has still signs and symptoms then repeat this test.
5. Electron microscopy
6. Virus isolation by cell culture.
 F. TREATMENT

1. This is mainly supportive.

2. Rehydrate the patient and that may reduce the mortality.
3. Antiviral drugs may be tried.
4. People sometimes give antimalarial and broad-spectrum antibiotics.

G. NURSING RESPONSIBILITY IN HANDLING PATIENT WITH EVD

1. EVD patients should be isolated in a private room with standard, contact, and droplet
precautions in place.

2.The CDC has specific recommendations related to infection prevention and control, including
the use of the following personal protective equipment (PPE):

o Double gloves
o Waterproof boot covers that go to at least mid-calf or waterproof leg covers
o Single use fluid resistant or imperable gown that extends to at least mid-calf  or
coverall without intergraded hood.
o Respirators, including either N95 respirators or powered air purifying respirator
(PAPR)
o Single-use, full-face shield that is disposable
o Surgical hoods to ensure complete coverage of the head and neck
o Apron that is waterproof and covers the torso to the level of the mid-calf should
be used if Ebola patients have vomiting or diarrhea

3. Visitors should be restricted. Exceptions may be considered on an individual basis, and then
visitors should be trained and a logbook kept of all who enter the room

ACTIVITY 3: What are the antimalarial and broad-spectrum antibiotic for Ebola
virus disease?
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HEPATITIS A VIRUS (HAV)

-a viral infection of the liver causing diffuse inflammation of hepatic tissue; self limiting
 A. ETIOLOGY AND PATHOPHYSIOLOGY

 Transmitted by fecal-oral route particularly in overcrowded and unsanitary conditions

 Also transmitted by intimate contact with a person infected with a virus or through
blood transfusion
 Virus can be isolated from feces, bile, and serum of infected individuals
 Many adults have HAV antibodies in their blood without knowledge of having the
disease
 Incubation period is 4 to 6 weeks
 The client is most contagious 10 to 14 days prior to the onset of symptoms when fecal
shedding of the virus is greatest
 Antibodies (anti-HAV) from 4 weeks post infection; during the acute phase (2 to 3
months post infection) IgM anti-HAV is elevated followed by elevation of IgG anti-
HAV that persists for several years post infection and creates immunity to the disease
 Can cause hepatic cell necrosis and swelling; inflammation, degradation. And
regeneration of the liver cells occur simultaneously
 In acute phase, swelling of the hepatic cells causes obstruction of the flow of bile
within the bile canaliculi causing jaundice

B. ASSESSMENT

1. General assessment (Physical assessment)

 Signs of dehydration secondary to nausea, vomiting and anorexia

 Jaundice
 Abdominal pain
 Review of laboratory studies for evaluation of progression or regression of disease

2. CLINICAL MANIFESTATION

a. A range of symptoms occurs, including anorexia, vomiting, malaise, fever, jaundice and
abdominal pain secondary to liver swelling.

b. Course of acute viral hepatitis is divided into 3 phases

1.Prodromal (preicteric) phase

 Most contagious, occurs before jaundice appears

 About 2 weeks after exposure to the virus
 Flu like symptoms- general malaise, gastrointestinal complaints, nausea,
vomiting, diarrhea and anorexia
 Headache, fatigue, myalgia, joint pain and low grade fever

2. Icteric phase
  Marked by the onset of jaundice
 Occurs 2 weeks after the prodromal phase and last 2 to 6 weeks
 Dark colored urine and clay colored stool prior to the appearance of jaundice and
pruritis
 Liver remains enlarged and may be tender to touch

3. Recovery (posticteric) phase

 Begins with the resolution of jaundice and lasts several weeks

 Symptoms improve, energy levels increase and serum enzymes normalize

C. DIAGNOSTIC AND LABORATORY FINDINGS

 Anti-HAV is the antibody to HAV and is present from the onset of symptoms and
persists for a lifetime
 IgM anti HAV is the serum immunoglobulin M HAV antibody: it is found in clients with
recent infection and persists for up to 6 months post infection
 IgG anti HAV is the serum immunoglobulin G HAV antibody: is present during recovery
phase and remains elevated for years post infection: contributes to immunity to the
disease
 Alkaline phosphatase (ALP): nonspecific test to evaluate liver or bone dysfunction; can
be elevated with hepatitis
 Gamma-glutamyl transferase (GGT) :acutely elevated with alcohol consumption and
hepatotoxic drus
 Transaminases: ALT and AST: elevated to varying degrees with hepatitis caused by
hepatic injury
 Bilirubin: both direct and indirect levels can be elevated secondary to liver cell injury
 Prothrombin time (PT): prolonged if the liver is injured to the point that it can no longer
produce the proteins necessary for blood coagulation

D. THERAPEUTIC MANAGEMENT

 This include both pre and post exposure prophylaxis as well as symptom management

1. Transmission is prevented through proper handwashing and the use of gloves for disposal of
contaminated items

2. Contact precautions should be instituted if there is fecal incontinence

3. HAV vaccine: given prior to exposure or during the early incubation period

4. Most clients with HAV infection are managed as outpatients and rarely are admitted to the
hospitals.

E. PRIORITY NURSING DIAGNOSIS

  Risk for transmission of infection
 Imbalance nutrition: less than body requirements related to nausea, vomiting, anorexia,
diarrhea
 Activity intolerance
 Altered comfort related to pain, arthralgia, abdominal pain, pruritis, headache

F. PLANNING AND IMPLEMENTATION and NURSING RESPONSIBILITY

1. Use of universal precaution such as proper handwashing etc.

2. Clients should have a private bathroom

3. Proper handling and disposal of contaminated items

4. Provide anti-emetic medications as ordered and encourage a high carbohydrates and low fat
diet

5. Abstinence from alcohol intake

6. If liver function is compromised, protein and salt should be restricted

7. Encourage to take good breakfast ; clients tend to become more nauseous later in the day

8. Initiate IVF as ordered

9. Assess signs of dehydration and monitor electrolyte status

10. Encourage gradual increase of activity as tolerated

11. Plan for nursing activities to allow for adequate rest

12. Inform client that they may never donate blood

13. Observe for blood in stool or urine, multiple ecchymosis or petechiae or oozing of blood
from gums or minor cuts which may indicate a complication

14. Educate client about safe sex practice as general health measure

G. MEDICATION THERAPY

 Symptomatic management
 IVF if the client is unable to tolerate oral fluids
 Prophylaxis may be considered if known HAV exposure has occurred and it is early
within the incubation period
 Vitamin K is indicated if prothrombin time is prolonged
 Antihistamine can be given for pruritis
HEPATITIS B (HBV)

-DNA hepadenovirus

-another form of viral hepatitis

-can progress to a chronic form of disease

A. ETIOLOGY AND PATHOPHYSIOLOGY

 Transmitted parenterally and through sexual contact with infected individuals

 Transmitted through contaminated blood or blood products or sharing of needles with
infected individuals; clients who require hemodialysis are also at risk
 The incubation period is 30 to 160 days
 Onset is insidious and associated with wide spectrum of liver involvement ranging from
subclinical carrier state to fulminant hepatitis
 Can be severe to chronic
 The pathophysiological changes are the same with all types of viral hepatitis

B. ASSESSMENT

1. Clinical manifestations for all forms of viral hepatitis are similar and may vary only in degrees

2. Specific assessments

 Weight loss
 Jaundice, pruritis, signs of bleeding, petechiae or ecchymotic areas,dehydration and
scleral icterus
 Lymphadenopathy
 Abdominal pain, hepatomegaly, swelling of the abdomen ( may indicate ascites)
 Edema
 Anorexia, nausea, vomiting and diarrhea
 Fatigue
 Risk factors: IV drug use, homo/bisexual lifestyle, unprotected sexual contact, blood
transfusion, tattoos

C. DIAGNOSTIC AND LABORATORY TEST

1. HBsAg: hepatitis surface antigen, present during active disease

 First test to become abnormal; rises prior to the onset of symptoms

  Peaks during the first week of symptoms and normalizes prior to the resolution of
jaundice
 If remain elevated for prolonged period of time, the client is considered to be a carrier

2. HBsAb; appears about 4 weeks after disappearance of HBsAg

 Signifies the end of acute phase of infection as well as immunity to subsequent infection
 In its concentrated form, it is given as HBV vaccine

3. HBc Ag; hepatitis core antigen

4. HBcAb; hepatitis core antibody; appears about 1 month after infection

 Remains in the serum of clients with chronic hepatitis

 Remains elevated during the time when HBsAg disappears and HBsAb appears
 This is called the “core window”
 HBcAb is the only detectable marker of recent infection

5. HBeAg; hepatitis B e-antigen; not usually use as a diagnostic test

 Marker use to determine client’s index of infectivity

 Its presence in a client with acute HBV infection indicates early and active disease with
high infectivity
 Used to predict the development of chronic HBV infection

6. HBeAb; this antibody indicates that the acute HBV infection is over or nearly over

 Infectivity is low

7. Anti-HBs-antibody is the IgG immunoglobulin that creates immunity and is present for a
lifetime

8. Anti-HBe-antibody to HBeAG

9. Anti-HBc-antibody to hepatitis B core antigen, present for a lifetime

10. Alkaline phosphatase

11. Gamma-glutamyl tranferase

12. Transaminases: ALT and AST

13. Bilirubin

14. Prothrombin

D. THEAPEUTIC MANAGEMENT
  The goal of management is to prevent transmission support the liver’s ability to heal itself

E. NURSING DIAGNOSIS

 Same as HAV

F. MEDICATION THERAPY

1. Vaccination

 Given as a series of 3 IM injection to adults

 Children and infants: the 2nd and 3rd injection are given at 1 and 6 months after the initial
injection
 Efficiency of the vaccination approaches 95%

2.Pre exposed vaccination is recommended for individuals in high risk occupation

3.Post exposure vaccination is recommended for individuals who come in close contact with
infected blood or body fluids, who have sex contact with infected individual, and infants exposed
to caregiver with known HBV infection or born to a mother with known HBsAg

4. HBIG is given to newborns exposed prenatally and to unvaccinated individuals who have been
exposed (percutaneously or mucosally) to infected blood or body fluids.

5. If a person with prior vaccination has had percutaneous or mucosal exposure to infected blood
or body fluids, the blood should be tested for anti-HBs and the client should be given HBIG as
well as a booster dose of HBV vaccine.

G. NURSING RESPONSIBILITY

 Instruct the client about the possibility of developing chronic active hepatitis and the
importance of follow up
 Reinforce the use of safe sex practices and vaccination

HEPATITIS C (HCV)

 previously known as non- A and non- B hepatitis

 is the cause of post transfusion hepatitis
 up to 80% of individuals develop chronic hepatitis which is a risk factor for liver failure
and hepatocellular carcinoma

A.ETIOLOGY AND PATHOPHYSIOLOGY

 incubation period is between 2 to 20 weeks post exposure

 transmission occurs parenterally and possibly sexually since virus has been isolated from
feces and semen
 most cases of HCV have no known risk factors
  the pathophysiology is the same for all forms of hepatitis

B.ASSESSMENT

1. Clinical manifestations

 acute infection is generally asymptomatic

 25 to 35% develop malaise, weakness and anorexia
 Symptoms in chronic hepatitis generally only occur when liver disease is advanced;
fatigue and malaise most commonly occur

2.Diagnostic and laboratory test

 Anti-HCV; antibody to hepatitis C virus; most accurate in detecting chronic hepatitis C

 There is HCV viral titer; HCV IgG indicates prior infection
 Liver biopsy to determine the extent of liver damage and response to treatment

C.THERAPEUTIC MANAGEMENT

1. The hallmark of treatment now is medication therapy to prevent chronic hepatitis development

2. A goal is to prevent transmission of the virus

D. MEDICATION THERAPY

 Combination therapy is used for 12 to 18 weeks or as long as 48 weeks

 The combination of interferon alfa-2b and ribavirin therapy produces a more sustained
response than when interferon is used alone
 Cost of therapy is high in both price and adverse effects ( fever, chills, fatigue, myalgia,
headache, arthralgia, leukopenia, neutropenia, thrombocytopenia, anemia, anorexia,
nausea, dizziness, confusion, paresthesia, numbness, depression, hypotension, chest pain
and heart failure)

HEPATITIS D VIRUS (HDV)

-defective RNA virus

-also known as “delta hepatitis” and occurs only to individuals with HBV because it depends
upon the HBV virus to replicate

A.ETIOLOGY AND PATHOPHYSIOLOGY

 Incubation period is 4 to 24 weeks

 Transmitted parenterally; there is a question of whether it can be transmitted via the
fecal-oral route or sexually
B.ASSESSMENT

1. Clinical manifestation

 Similar to all viral hepatitis infection

2.Diagnostics and laboratory test

 HDV antigen can be detected by immunoassay within few days of infection

 IgM HDV; present during early infection
 Persistent elevations of antibodies indicates a chronic/carrier state

C. THERAPEUTIC MANAGEMENT

 Because HDV requires the presence of HBV; vaccination of individuals not infected with
HBV is recommended

GUILLAIN BARRE SYNDROME

-an acute, rapidly-progressive inflammation of peripheral motor and sensory nerves

characterized by motor weakness and paralysis that ascends from lower extremities in a
majority of cases

-outcome is generally excellent if care is appropriate

A. ETIOLOGY AND PATHOPHYSILOGY

 Occurs most frequently between ages 30 to 50 years

 Etiology is unknown, but autoimmune reaction is suspected
 It often develops after viral infection, immunization, fever, injury and sometimes surgery
 Antibody (IgM) formation targets peripheral nerve myelin
 Which damages myelin sheath and disrupts nerve conduction
 The nerve myelinizes in the opposite direction of the demyelination

B. ASSESSMENT

1. Clinical manifestation
  Weakness/paresis or partial paralysis progressing upward from lower extremities
(paralysis in Guillain Barre is ground to brain) and then total paralysis requiring
ventilator support
 Paresthesia (numbness and tingling) and pain
 Muscle ache, cramping and nighttime pain
 Respiratory compromise and/ or failure (dyspnea, diminished vital capacity and breath
sounds), decreasing oxygen saturation, abnormal ABGs
 Difficulty with extraocular eye movement, dysphagia, diplopia, difficulty speaking
 Autonomic dysfunction (orthostatic hypotension), changes in heart rate, bowel and
bladder dysfunction, flushing and diaphoresis

2.Diagnostic and laboratory test

 Nerve conduction test results are diminished

 CSF examination shows elevated protein

C. THERAPEUTIC MANAGEMENT

1. Supportive care to maintain functions of all body system, including respiratory, cardiac, GI,
renal, skin

2. Plasmapheresis:

 plasma is removed and separated from whole blood

 blood cells are then returned without the plasma to remove antibodies that cause disorder
 complications of this therapy includes bleeding from loss of clotting factors and fluids
and electrolyte imbalance

D. PRIORITY NURSING DIAGNOSIS

 Risk for disuse syndrome

 Altered protection
 Ineffective breathing pattern
 Risk for impaired gas exchange
 Imbalance nutrition: less than body requirements

E. PLANNING AND IMPLEMENTATION

1. Monitor respiratory status: rate, depth, breath sounds, vital capacity, note secretions, and
check gag, cough and swallowing reflexes
2. Monitor cardiac status: heart rate, BP, dysrhythmias

3. Administer chest physiotherapy and pulmonary hygiene measures

4. Maintain adequate nutrition as appropriate:

 Administer enteral or parenteral nutrition as needed

 If client can swallow assist with small frequent feeding of soft foods
 Weigh client weekly
 Check electrolyte status
 Provide mouth care every 2 hours

5.Monitor bowel and bladder function

 Assess bowel sounds and frequency; offer bed pan

 Check for distention and residuals in client who cannot void spontaneously; perform
intermittent catheterization as needed
 Encourage fluid intake to 3500 ml/day

6.Prevent complications of immobility

 Encourage weak extremities as able

 Provide assistance with ROM and exercises prescribed by PT
 Protect immobile extremities with use of air mattress or special bed, and elbow and heel
protectors
 Turn and reposition every 2 hours
 Elevate extremities to prevent dependent edema
 Use antiembolism compression devices/ stockings

7.Provide eye care for the client with inability to close eyelids completely

 Instill artificial tears

 Use eye shields
 Tape eye close if needed

8.Provide comfort and analgesics as needed

9.Promote communication with client and family

 Use alternative means of communication if the client is on ventilator or is unable to speak

because of weak speech muscles

10.Initiate discharge planning at time of admission

D. MEDICATION THERAPY

1.IV immunoglobulin
  May result in low grade fever, muscle aches, or (rarely) renal failure or retinal necrosis

2.Adrenocorticotropic hormone (ACTH), and corticosteroids or inti-inflammatory drugs

3. Supportive medications that includes stool softeners, antacids or H2 receptor antagonist and
analgesics.

E. NURSING RESPONSIBILITY

 Explain all care with rationales and provide information about the progression of the
disease
 Encourage client and family to express feelings and participate in care as much as
possible.

POSTTEST:

1. MAKE A CONCEPT MAP on COVID 19 OR MERS CoV

FOLLOWING THIS OUTLINE:

 Overview of the disesase

 Risk factors/ causes
 Pathophysiology
 Signs and sympyoms
 Diagnostic exams
 Nursing diagnosis
 Treatment and management
 Complications
 Preventions
 Prognosis