• BOTULISM :

= Acute flaccid paralysis caused by potent

neurotoxin
Agent : Clostridium botulinum
Botulinal toxin is a very potent toxin
Spore can withstand boiling for several hours
Natural habitat is soil
Gram + sporeforming- anaerobe
• Types of Botulism :
Food Borne Botulism: Inadequately cooked
food

• Wound botulism
Infant Botulism : 3 weeks to 5 months.
Hypotonic
Depressed gag reflex,
inability to suck
feeble cry.
• Pathogenesis :
Toxins block the acetylcholine causing impaired
voluntary and neuromuscular transmission.
S and Sx:
flaccid paralysis
Generalized weakness
Diplopia,blurred vision,drooping eyelids
Slurred speech,swallowin difficulty
Food borne: 18 to 36 hours after
contaminating food.
• Treatment:
Supportive respiratory and nutritional needs
Exploration ad debribement(wound botulism)
Emetics and gastric lavage (food born)
Nursing Diagnosis:
Impaired physical mobility
Altrration in bowel elimination
Pain and dicomfort
Potential impairment of skin integrity
Altered nutrition
Prevention and control
Don’t give honey to infants
Proper preparation of food specially
home canning
 POLIOVIRUS INFECTIONS:
POLIOMYELITIS (INFANTILE
PARALYSIS)
• Causative agent: Poliovirus
• Incubation period: 7 – 14 days
• Period of communicability: Greatest shortly before and after
onset of symptoms, when virus is present in the throat
and feces (1 – 6 weeks)
• Mode of transmission: Direct and indirect contact
• Assessment:
– Fever, headache, nausea, vomiting, or abdominal pain
– Moderate pain of the neck, back, and legs
– ↑ protein & lymphocytes in the CSF fluid
– (+) tripod sign
• Management:
– Bed rest with analgesia
– Moist hot packs
– Long-term ventilation

• Complications:
– Progressive muscle atropy
– Severe arthritis
 RABIES
• Causative agent: Rabies virus
• Incubation period: 2 – 6 weeks, possibly as long as 12
months
• Period of communicability: 3 – 5 days before the onset
of sypmtoms through the course of the disease
• Mode of transmission: bite of rabid animals
• Assessment:
– Prodromal signs: malaise, fever, anorexia, nausea, sore throat,
drowsiness, irritability & restlessness
– (+) hydrophobia
– Comatose with possible total body paralysis
• Treatment:
– Prevention
– History taking BRAIN Presence of NEGRI
BODIES
 TETANUS
• LOCK JAW
Agent : Clostridium Tetani
Potent exotoxin
Tetanospasmin >> Muscle spasm
Tetanolysin >>> RBC destruction
Anaerobic gram (+)

Sources :
Animal and human Feces
Soil and dust
Pins,Rusty materials
Transmission :
Punctured wound
Traumatic wounds and burns
Umbilical stump
Dental extraction , circumcision , ear
piercing

• Pathogenesis :Entry
–Local infection
–Extensive tissue destruction
–Release of toxin > Blood >> Brain
–Hyper excitability
Manifestation :
Pedia : Feeding and sucking difficulty
Spasm and cyanosis
Stiff jaw ( unable to suck)
Rigid muscular contractions
spasms and convulsions
Cyanosis ,Pallor
Flaccidity , exhaustion and Death
• Adult:
Hyper active reflexes
Painful involuntary contraction
Fever
TRISMUS ; Neck and facial muscle
rigidity
Risus sardonicus :Grinning expression
Opisthotonus
Tonic convulsions >> Cyanosis >>
DEATH
Laryngospasm >> Accumulation of
secretion, Fracture of vertebra
• Management :
Tet Toxoid : ATS : TIG
Pen G
Muscle relaxant

Nursing management :
Maintain airway
Wound care Avoid stimulation
Maintain IV line
Avoid contractures and pressure sores
• Nursing diagnosis :
Impaired physical mobility
Altered nutrition
Sensory perceptual alteration
Hyper-excitability

Preventive control :
Tatanus Toxoid
DPT for babies and children
 MENINGITIS
• VIRAL MENINGITIS
(Enterovirus,coxsackie,entero,mumps virus)
Common,self limited with meningeal irritation
Signs and Symptoms :
Nuchal spinal rigidity
Headache, nausea and vomiting
Fever, rashes , irritabilty
Labs : Specimen : CSF
Increased protein, Normal sugar
(+) polymorphonuclears,mono nuclears
• BACTERIAL MENINGITIS
• Meningococcal Meningitis
Acute, contagious, sporadic,epidemics
Inflammation of the meninges
Agent : Neisseria Meningitidis
Reservoir : MAN
Transmission : Droplets
Direct contact
Incubation P ; 2 to 20 days
As long as the meningococci is present in nose
and mouth the patient is infectious
S & Sx : Fever, headache,
vomiting, Stiff neck
nuchal rigidity,coma
Hyperthesia, delirium
Opisthotonus
Petechial rash with pink macules

meningitis :
Resistance to neck flexion
BRUDZINSKI’S Sign
(When the patients neck is flexed on the chest,
flexion on the knees and hips are produced.
• KERNIG’S Sign :
When lying with the thigh flexed on the abdomen,
patient cannot completely extend his legs.
• Labs :
Lumbar puncture : spinal fluid
Findings : Cloudy
Elevated protein
decreased sugar
(+) Diplococci

• Prophylaxis : Rifampicin
• Treatment : Penicillin, 3rd generation Cephalosporins
Ampicillin, Chloramphenicol
Diazepam > seizures
• Haemophilus Meningitis
• Signs & Symptoms :
fever,vomiting,lethargy
Bulging fontanelle
stupor,coma
Transmission :
Discharge from nose and throat
Droplet infection
Prevention: Vacination
prophylaxis : Rifampicin
Treatment ;
Ampicillin,chloramphenicol,Rifampicin
• Nursing management for all types of meningitis:

Maintain isolation
positioning : side lying (opisthotonus)
Flat on bed (nuchal rigidity)
Darken the environment,rest,silence
Non constipating diet, XXX Valsalva maneuver
Check ICP ,VS,I&O, Signs of shock,ABG
Changes in LOC
Maintain clear airway
Proper Hydration