Republic of the Philippines

ISABELA STATE UNIVERSITY

City of Ilagan Campus

POLIOMYELITIS
Poliomyelitis is caused by a virus called poliovirus that belongs to the enterovirus species and causes the inflammation of the spinal cord. The virus enters the body
through the mouth or nose, getting into the digestive and respiratory (breathing) systems. It multiplies in the throat and intestines. From there, it can enter the
bloodstream. It can also attack the nervous system, the nerve network that helps the brain communicate with the rest of the body.

POLIOVIRUS
Poliovirus is an enteric virus under the picornavirus family. It is a non-enveloped, single-stranded positive RNA with a icosahedral symmetry.

PATHOPHYSIOLOGY
PREDISPOSING FACTORS

 Children below the age of 5 years

 Those living in unhygienic settings with poor sanitary conditions, and those who are not immunized against Polio have the greatest risk
 Travelers, who visit areas that have had recent Polio outbreaks
 Healthcare individuals - those who handle lab specimens containing the virus
 Living with someone who has the disease
 Recent or previous tonsillectomy. Removing the immunological -active tonsils exposes nerve ending to the virus
 Histocompatibility antigens HLA-3 and HLA-7 maybe associated with an increased risk paralysis
 People who indulge in vigorous physical activities, even though unaware that they are exposed to the poliovirus

PRECIPITATING FACTORS
 Previous neurologic diseases
 Ingestion of food and water contaminated with feces containing virus.
 Contact with nasal secretions or mouth droplets from untreated patients.
ALIMENTARY PHASE

Ingestion. The virus enters the body via fecal-oral transmission. This is when food, water or hands that are contaminated with feces (poo) enters the mouth of an
uninfected person.

After gaining access to the body through primary replication takes place in the intestinal and the oropharyngeal mucosa. In here, the Polio virus infects the
epithelial cell/s by binding to a receptor (CD 15). The virus enters the cell and begins uncoating releasing the genetic material. The viral RNA undergoes translation
to make its proteins. The genome is duplicated by an RNA dependent RNA polymerase creating new and thousands more of the same virus.

LMPHATIC PHASE

Now that translation, replication and duplication is done new viral particles assembles which the lyse or kill the infected cell. During lysis of the infected cell, large
amounts of numbers of virus are present. And these viral particles are released. Some may go into the feces and the other remains at the interstitium
(fluid-filled area) of the cell. These fluid-infected materials are swept into the lymphatic vessels and passes through the lymph nodes (cervical and
mesenteric nodes).

During this stage the virus is present and continuously sheds through the feces but the person infected is asymptomatic, meaning there are no presence of
symptoms. (SUBCLINICAL)

VIREMIC PHASE

From the lymph nodes, the virus is dumped or transported into the bloodstream where it gets carried by the blood to various internal organs and regional lymph
nodes. This is called viremia (presence of virus in the blood).

At this phase symptoms are present and is flu-like. Clinical manifestations are as follow:

 Fever - One of the most common symptoms related to polio is fever, which is the body's natural way of killing disease or fighting a virus. To do so, the body
heats up.
 Fatigue - As the body fights a disease or an infection, its energy levels tend to decrease as a result of the body's natural mechanisms. It takes lots of energy
to heal the body, which results in fatigue completely.
 Vomiting - When our bodies become sick - and especially our stomach (where polio virus mainly replicates) - one of the body's natural reactions is vomiting,
which eliminates food or other substances from the stomach.
 Sore Throat - If you become infected with polio, one of the most likely symptoms you'll experience is a sore throat (also a site of replication for polio virus).
Even though the throat isn't directly affected by the virus, the many lymph nodes of the throat can become inflamed and stiff, causing pain to be felt. You
may also experience discomfort in the tonsils, which may cause a burning or irritating pain. 
 Headache - You are likely to experience a headache when dealing with a viral infection, such as polio. Most patients report this symptom, which tends to
appear alongside chills and other related symptoms, such as vomiting. When fighting a viral infection, the body's natural reaction is to increase body
 temperature. This can also cause symptoms in the head, including pain. You may experience different types of pain, including a stabbing pain. In the case of
polio, the brain is directly affected, so pain is naturally present.

Symptoms during the viremic phase can be treated and prevented if diagnosed. Since clinical manifestations can be aborted this is also termed as “ABORTIVE
POLIO”

NEURAL PHASE

Now that the virus circulates the body it can travel into the spinal cord and can cross the blood-brain barrier by transcapillary diffusion.

At the spinal cord, located is the anterior horn. This is where the cell body or motor neurons (transmits signals for movement of muscles and glands) reside. The
virus infiltrates the anterior horn infecting the motor neuron which causes severe damages such as loss of reflex, sever spasms and muscle pain, deformed limbs,
Acute Asymmetric Flaccid Paralysis and/or permanent paralysis. Paralysis involving the spinal cord is referred to as “SPINAL POLIO”.

The virus can also infect the brain stem that can affect the cranial nerves; 9 – responsible for swallowing, 10 – responsible for muscles in the throat and of the heart,
11 – responsible for muscle movement of shoulders, and 12 – movement of tongue. Organs such as the diaphragm and the heart are made up of muscles, which
means that its motor neurons are no exemption for the invasion of polio virus. When these organs are to be invaded its function would decrease movement and is
weakened causing symptoms such as, respiratory depressions, difficulty breathing, problems in swallowing, and even death. This Infection of the brain stem can be
paralytic and is termed as “BULBAR POLIO”. There are also non-paralytic manifestations of poliomyelitis. Muscle stiffness in the neck, leg and arm, and Meningitis;
Inflammation of the fluid and membranes (meninges) surrounding the brain and spinal cord.

If both the spinal cord and brain is infected at the same time this is called “BULBO-SPINAL POLIO” that manifest both symptoms of Spinal and Bulbar Polio.
 NURSING CARE PLAN

NCP 1
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Subjective Impaired physical Short term: Monitor Vital Signs To note changes and for baseline Short term:
Data: mobility related to After 8 hours of comparison. After 8 hours of
“Parang decreased strength nursing nursing
lantang gulay and endurance intervention the Determine the diagnosis that These conditions can cause intervention the
ang kanang secondary to patient will contributes to immobility. physiological and psychological patient is able to
binti ng anak neuromuscular demonstrate problems that can seriously impact demonstrate
ko. Di niya impairment as increased strength physical, social, and economic well- increased strength
maigalaw ng evidenced by and function of being. and function of
maayos at inability to affected body part. affected body part.
parang purposively move Note factors affecting current Identifies potential impairments and
nanghihina.” and lower leg Long term: situation and potential time determines types of interventions Long term:
As verbalized paralysis. After 1 month of involved. needed to provide for client’s safety. After 1 month of
by the patient’s nursing nursing
mother. intervention the Evaluate for presence and degree To determine if pain management can intervention the
patient will be able of pain, listening to client’s improve mobility. patient is able to:
Objective to: description about manner in  Maintain position
Data:  Maintain position which pain limits mobility of function as
Age: 3 y/o of function as evidenced by
Gender: evidenced by Continually assess motor function Evaluates status of individual absence of foot
Female absence of foot by requesting patient to perform situation, affecting type and choice of drop.
Height: 95.3 drop. certain actions like shrugging interventions.  Perform physical
cm  Perform physical shoulders, spreading fingers. activity
Weight: 29 lbs. activity independently or
independently or Assess the strength to perform This assessment provides data on within limits of
 Ascending within limits of ROM to all joints. extent of any physical problems and disease.
Paralysis disease. guide therapy. Testing by a physical  Increase strength
 The patient  Increase strength therapist may be needed. of
is weak of unaffected/comp
 Have limited unaffected/comp Ascertain client’s perception of Helps to determine client’s ensatory body
ROM activity ensatory body activity and exercise needs and expectation and beliefs related to parts.
 Minimized parts. impact of current situation. activity and potential long-term effect  Demonstrate
movement  Demonstrate Identify cultural beliefs and of current immobility. Also, identifies techniques/behav
 Level of techniques/behav expectations affecting recovery or barriers that may be addressed. iors that enable
functional iors that enable response to long-term limitations. resumption of
mobility – 2; resumption of activity.
Requires activity. Ascertain nutritional status and Deficiencies in nutrients and water,
assistance client’s report or energy level. electrolytes, and minerals can
when negatively affect activity tolerance.
walking.
Determine degree of immobility in Identifies strengths and deficits and
RR: 26 relation to 0 to 4 scale, noting may provide information regarding
PR: 110 muscle strength and tone, joint potential for recovery.
BP: 90/60 mobility, cardiovascular status,
TEMP: 36.6 balance, and endurance.

Discuss discrepancies in May be necessary when the client is

movement noted when client is using avoidance or controlling
unaware of observations and behavior or is not aware of his or her
address methods for dealing with own abilities due to anxiety or fear.
identified problems.

Note emotional/behavioral Feelings of frustration or

responses to problems of powerlessness may impede
immobility. attainment of goal.

Determine presence of Effects of immobility are rarely

complications related to confined to one body system and can
immobility. include muscle wasting, contractures,
pressure sores, constipation,
aspiration pneumonia, thrombotic
phenomena, and weakened immune
system functioning.

Assist with the treatment of To maximize the potential for mobility

underlying condition causing pain and function.
and/or dysfunction.
Assist or have client reposition self To reduce pressure on sensitive areas
on a regular schedule as dictated and to prevent development of
by individual situation. problems with skin integrity.

Perform and encourage regular Reduces tissue pressure and aids in

skin examination and care maximizing cellular perfusion to
prevent dermal injury.

Provide or recommend pressure- Promotes well-being and maximizes

reducing mattress, such as egg energy production.
crate, or pressure-relieving
mattress, such as alternating air
pressure, or water.

Encourage adequate intake of To permit maximal effort and

fluids and nutritious foods. involvement in activity.

Administer medications prior to Antispasmodic medications may

activity as needed for pain relief. reduce muscle spasms or spasticity
that interferes with mobility;
analgesics may reduce pain that
impedes movement

Give medications as appropriate. To develop individual exercise and

mobility program, to identify
appropriate mobility devices, and to
limit or reduce effects and
complications of immobility.

Collaborate with physical Enhancer commit to plan, optimizing

medicine specialist and outcomes.
occupational or physical therapists
in providing range-of-motion
exercise (active or passive),
isotonic muscle contractions,
assistive devices, and activities.
Encourage client’s/SO’s
involvement in decision-making as
much as possible.
Involve client and SO in care,
assisting them to learn ways of
managing problems of immobility.
May need referral for support and
community services to provide care,
supervision, companionship, respite
services, nutritional and ADL
assistance, adaptive devices or
changes to living environment,
financial assistance, etc.
 NCP 2
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Subjective: Ineffective After 8 hours of Monitor Vital Signs To note changes and for baseline After 8 hours of
“Mainit lang thermoregulation nursing comparison. nursing
ang katawan related to infection intervention the intervention the
niya. Parang process as patient will Note chronological and Infants, young children, and elderly patient has
nanghihina.” evidenced by maintain core developmental age of client. persons are most susceptible to maintained core
As stated by increased body temperature within damaging hyperthermia. temperature within
the patient’s temperature and normal range as Environmental factors and relatively normal range as
mother. white blood cells evidenced by minor infections can produce a much evidenced by
(WBC) normal body higher temperature in infants and normal body
Objective: temperature and young children than in older children temperature and
Age: 6 y/o value of white and adults. Infants, children or value of white
Gender: Male blood cells. impaired individuals are not able to blood cells.
Height: 127 cm protect themselves and cannot
Weight: 43.7 recognize and/or act on symptoms of
lbs. hyperthermia.

 Skin is warm Monitor core temperature by Rectal and tympanic temperatures

to touch appropriate route. Note the most closely approximate core
 Weakness presence of temperature temperature.
observed elevation or fever.

RR: 33 Asses neurological responses, Hyperventilation may initially be

PR: 118 noting level of consciousness and present, but ventilatory effort may
BP: 110/70 orientation, reaction to stimuli, eventually be impaired by seizures or
TEMP: 38.6 reaction of pupils, and presence of hypermetabolic state.
posturing seizures.
RBC: 4.40
Hgb: 12.30 Monitor respirations. Oliguria and/or renal failure may occur
WBC: 17.2 due to hypotension, dehydration,
Lymph: 4,700 shock, and tissue necrosis.

Monitor and record all sources of Can potentiate fluid and electrolyte
fluid loss such as urine; losses.
Vomiting and diarrhea, wounds,
fistulas, and insensible losses.

Administer antipyretics, orally or

rectally, as ordered. Refrain from
using aspirin products in children
or individuals with clotting
disorders.

Promote surface cooling by means Alcohol sponge baths are

of: contraindicated because they increase
peripheral vascular constriction and
CNS depression; cold water sponges or
immersion can increase shivering,
producing heat.

 Undressing; Heat loss by radiation or conduction.

 Cool environment and/or fans; Heat loss by convection

 Cool, tepid sponge baths; or Heat loss by evaporation and

conduction.
 Local ice packs, especially in
groin and axillae Areas of high blood flow.

Monitor the use of hyperthermia

blanket and wrap extremities with To minimize shivering.
bath towels.

Administer medications (e.g.,

chlorpromazine or diazepam), as To control shivering and seizures.
ordered.

Provide supplemental oxygen. To offset increased oxygen demands

 and consumption.

Administer medications, as To treat underlying cause, such as

indicated. antibiotics (for infection), dantrolene
(for malignant hyperthermia), or beta-
adrenergic blockers (for thyroid
storm).

Administer replacement fluids and To support circulating volume and

electrolytes tissue perfusion.

Instruct the parents on how to Fever may be treated at home to

measure the child’s temperature, relieve the general discomfort and
at what body temperature to give lethargy associated with fever.
antipyretic medications, and what
symptoms to report to the
physician.

Review specific risk factor or

cause, such as (1) underlying
conditions, (2) use of certain
medications, (3) environmental
factors (4) reaction to anesthesia
or (5) other risk factors.
Review signs/symptoms of This indicates a need for prompt
hyperthermia (e.g., flushed skin, intervention.
increased body temperature,
increased respiratory and heart
rate, fainting, loss of
consciousness, seizures).
 DRUG STUDY
DRUG STUDY #1
Drug Name Action Dosage/Route Indication/Uses Contraindication Adverse Reaction Nursing
Management
Infanrix Hexa Description: DTP- IM Primary & booster  Hypersensitivity.  Appetite loss Postpone
HIB-HBV-POL Dosage: immunization  Encephalopathy of unknown  Irritability vaccination in
vaccine, a Primary against DPT, etiology occurring within 7  Abnormal crying patients with acute
combination of Immunization: hepatitis B, days following previous  Restlessness severe febrile
diphtheria and Children ages 6 poliomyelitis & HIB vaccination with pertussis  Injection site illness. If any of the
tetanus toxoids, weeks to 6 years in infants. containing vaccine. reactions such following occur, the
acellular pertussis, (prior to 7th  Postpone vaccination in as pain, decision to give
Haemophilus birthday):0.5 mL IM subsequent dose of
patients w/ acute severe redness, local
influenzae type B 4 to 8 weeks apart vaccine should be
febrile illness. If any of the swelling (≤50
conjugate, for three doses (6 carefully
following occur, the decision mm)
recombinant to 8 weeks for considered.
hepatitis B and Daptacel) and a to give subsequent dose of  Fever ≥38°C
inactivated fourth dose at least vaccine should be carefully  Fatigue. BT of ≥40°C w/in 48
poliovirus vaccines, 6 months after the considered  Nervousness hours of
Promotes third dose.  Temp of ≥40℃ w/in 48 hr of  Vomiting unidentifiable
immunity against unidentifiable cause  Diarrhea cause.
diphtheria, Booster  Collapse or shock-like state  Pruritus
tetanus, pertussis, immunization: (hypotonic-hyporesponsive  Local swelling at
Haemophilus Children ages 6 episode) w/in 48 hr of the injection
influenza type B or weeks to 7 years: vaccination site (>50 mm)
hepatitis infection Daptacel may be  Persistent, inconsolable  Fever >39.5°C
and poliomyelitis. given to complete crying lasting ≥3 hr w/in 48  Injection site
the immunization hr of vaccination. reactions
series in children  Convulsion w/ or w/o fever including
who have received w/in 3 days of vaccination. induration.
at least one dose of
 Progressive neurological
whole-cell DTP
disorders including infantile
vaccine.
spasms, uncontrolled
Infanrix is indicated
as a fifth dose in epilepsy or progressive
encephalopathy.
children ages 4 to 6  Thrombocytopenia or
before entering bleeding disorders.
school in those who  Do not administer
received at least intravascularly/intradermally.
one dose of whole-  Hypersensitivity to neomycin
cell DTP vaccine, & polymyxin.
unless the fourth  History of febrile convulsions
dose was given
or sudden infant death
after the fourth
syndrome.
birthday.
 Syncope can occur.
 Consider risk of apnea & resp
Adults and children
ages 10 to monitoring for 48-72 hr in
64(Adacel): very premature infants (≤28
0.5mL IM as a wk of gestation) & those w/
single dose at least history of resp immaturity.
5 years after the  False +ve urine tests for HIB
last DTa infection w/in 1-2 wk after
vaccination. vaccination.
 Pregnancy & lactation.
Adults and children
age 10 and older
(Boostrix): 0.5 mL
IM as a single dose
at least 5 years
after the last DTaP
vaccination.
 DRUG STUDY #2
Drug Name Action Dosage/Route Indication/Uses Contraindication Adverse Reaction Nursing
Management
Tetanus toxoid and Description: DTP- IM  Primary Hypersensitivity.  Hypersensitivity Do not administer by
reduced diphtheria HIB-HBV-POL Dosage: immunization Acute neurologic  Pain at intravascular,
toxoid and acellular vaccine, a Primary (Daptacel, disorders. injection site. intradermal, or SC;
pertussis vaccine combination of Immunization: Infanrix)  Tiredness in IM in patient with
adsorbed (Tdap) diphtheria and Children ages 6  Booster child any bleeding
tetanus toxoids, weeks to 6 years Immunization  Headache in disorders (e.g.,
Adacel, Boostrix acellular pertussis, (prior to 7th  Active adolescents & hemophilia or
Haemophilus birthday):0.5 mL IM immunization adults 18-64. thrombocytopenia or
Pharmacologic Class: influenzae type B 4 to 8 weeks apart against  Myalgia in persons on
Vaccine/Toxoids conjugate, for three doses (6 to diphtheria,  Fever anticoagulant
recombinant 8 weeks for tetanus, therapy; individuals
hepatitis B and Daptacel) and a pertussis, with progressive or
inactivated fourth dose at least 6 poliomyelitis, unstable neurological
poliovirus vaccines, months after the hepatitis B and disorders,
Promotes immunity third dose. Haemophilus uncontrolled epilepsy
against diphtheria, influenza type B. or progressive
tetanus, pertussis, Booster encephalopathy.)
Haemophilus immunization:
influenza type B or Children ages 6 Postpone
hepatitis infection weeks to 7 years: vaccination in cases
and poliomyelitis. Daptacel may be of an acute or febrile
given to complete disease. Pregnancy
the immunization
series in children
who have received
at least one dose of
whole-cell DTP
vaccine.
Infanrix is indicated
as a fifth dose in
children ages 4 to 6
before entering
school in those who
received at least one
dose of whole-cell
DTP vaccine, unless
the fourth dose was
given after the
fourth birthday.

Adults and children

ages 10 to
64(Adacel):
0.5mL IM as a single
dose at least 5 years
after the last DTa
vaccination.

Adults and children

age 10 and older
(Boostrix): 0.5 mL IM
as a single dose at
least 5 years after
the last DTaP
vaccination.