Communicable Disease Nursing

Communicable Diseases
DENNIS N. MUÑOZ, RN, RM, MAN (candidate)
TERMINOLOGIES
Communicable Disease
 Disease caused by an infectious agent from an infected individual and transmitted to a susceptible host
either by:
Direct
Indirect contact
Through direct inoculation through a broken skin
Infectious Disease
Diseases of man or an animal resulting from infection
Contagious Disease
Diseases that can be easily transmitted from the source to another like direct contact
All communicable disease are infectious but not necessarily contagious
All contagious diseases are infectious but not all infectious diseases are contagious
NATURE OF INFECTIOUS PROCESS
Force of HUMAN Force of

Infection BODY Resistance
** Magkakaroon nang disease if there is increased force of infection and decreased force of resistance**
Immunity:
1. Natural Immunity
a. Passive Immunity – from mother to baby
b. Active Immunity – if I experience the disease, by having the disease, the disease itself develop a
lifelong immunity in me (ex. Chickenpox)
2. Artificial Immunity
a. Passive Immunity – from immunoglobulin, antitoxin
b. Active Immunity – provided by vaccines
Cycle:
It doesn’t mean na kung

exposed ka sa causative agent,
infected na ka
Reservoir:
Body of man or animal
MODE OF TRANSMISSION
Direct Contact
1
- actual physical contact with the infected person
- from one person to another
Indirect Contact
- contact of a susceptible person with a contaminated object
- from inanimate object to a person
- fomite (soiled clothes)
Break in the Skin Integrity

- infection from an open wound, abrasion, bite
Vertical Transmission
- from mother to child
Horizontal Transmission
- direct, indirect, break in skin integrity
BREAKING THE CHAIN OF INFECTION

- Weakest link is the mode of transmission
Contact
- in close association with an infected person or animal; exposed
- I was not able to harbor the organisms
Carrier
- without symptoms of disease who harbors the specific agent and may serve as a source of infection
- was able to harbor the organisms
Suspect
- medical history suggests development of infection
Patient
- shows signs and symptoms of the disease
STAGES OF INFECTION
1. Incubation
a. Entry of microorganism into the body to the onset of signs and symptoms
2. Prodromal
a. Onset of non-specific signs and symptoms to the appearance of specific signs and symptoms
b. The only stage of the disease… (Catarrhal)
3. Period of Illness/Acme
a. Peak of the disease
b. Specific signs and symptoms develop and become evident
4. Recovery, Convalescence or Decline
a. Signs and symptoms start to abate until the client returns to normal state of health
EPIDEMIOLOGY
- study of the spread of the disease in the community
Pattern of Disease Occurrence

1. Sporadic
a. Intermittent occurrence or on-and-off presence of a disease
2. Endemic
a. Continuous or constant occurrence of a disease in a certain area
2
3. Epidemic
a. Sudden increase in the number of cases in a short period of time in a certain area
b. outbreak
4. Pandemic
a. Worldwide epidemic or global outbreak
INFLAMMATORY PROCESS
1. Inflammant
a. Microorganisms
b. Physical
c. Mechanical
2. Would lead to Tissue Injury
a. Local Adaptation Syndrome – it will only localize the experience
b. General Adaptation Syndrome - systemic
3. Inflammation
4. Vasoconstriction - para naay local experience
a. Would lead to Hyperemia – cuz nacontain ang blood didto sa localized area
i. Redness/rubor (1st)
ii. Heat/Calor (2nd)
b. Would lead to Tissue Permeability
i. Fluid shifting
ii. Edema formation due to fluid shifting
iii. Swelling or Tumor (3rd)
iv. Pain or Dolor (4th) – due to compression of nerve endings
v. Loss of Function (5th)
GENERAL NURSING CARE

- number one role is to stop transmission (priority)
1. Preventive Aspect
a. Health Education – increasing the knowledge, skills and attitude
b. Immunization – PD 996 (compulsory immunization of all children below age 8 years old)
c. Environmental Sanitation – PD 856 Environmental Sanitation Code of the Philippines; PD 825 Garbage
Disposal Law; RA9003 Ecological Solid Waste Management Act; RA 8749 Clean Air Act; RA 9275 Clean
Water Act
i. Water Source
ii. Excreta Disposal
iii. Garbage Disposal
iv. Food Handling
- Four rights in food handling
a. Right source
b. Right preparation
c. Right cooking
d. Right storage
Vaccine Minimum Age Number Dose Minimum Route Site Reason

at 1st Dose of Interval
Doses Between
Doses
Bacillus Calmette- Birth or 1 0.05 -- Intradermal Right BCG given at
Guérin anytime after mL deltoid earliest possible
birth region age protects the
of the possibility of
arm infections in
3
which infants
are prone from
other family
members
Diptheria- 6 weeks 3 0.5 4 weeks Intramuscular Vastus An early start
Pertussis-Tetanus mL (6th week – lateralis with DPT
Vaccine 10th week – or reduces the
14th week) Upper chance of
outer severe
portion pertussis.
of the
thigh
Oral Polio Vaccine 6 weeks 3 2 4 weeks Oral Mouth The extent of
drops (6th week – protection
10th week – against polio is
14th week) increased the
earlier the OPV
is given.
Keeps the
Philippines
polio-free.
Hepatitis B At birth 3 0.5 6 weeks Intramuscular Vastus An early start of
Vaccine mL interval lateralis Hepatitis B
from or vaccine reduces
1st dose to Upper the chance of
2nd dose, outer being infected
8 weeks portion and becoming a
interval of the carrier.
from thigh Prevents liver
2nd dose to cirrhosis and
third dose. liver cancer
which are more
(At birth – likely to develop
6th week – if infected with
14th week) Hepatitis B early
in life.
About 9,000 die
of complications
of Hepatits B.
10% of Filipinos
have Hepatitis B
infection
Measles Vaccine 9 months 1 0.5 -- Subcutaneous Vastus At least 85% of
mL lateralis measles can be
(not MMR) Upper prevented by
outer immunization at
portion this age
of the
thigh
TT Deltoid
region
of the
upper
4
arm
Maximum Transport:
RHO (3 months) – PHO (3 months) – DHO (1 month)
Most sensitive to heat:
OPV, AMV (so ibutang sa freezer; temp=-15 to -25°C
Place sa body: BCG, Hepa, DPT
2. Levels of Prevention
a. Primary
i. Health promotion/specific protection
ii. Target: well clients (prepathogenic)
iii. Aspects: General health promotions (health education),
Specific Protection (Immunization),
Primordial Prevention (elimination of risk factors)
b. Secondary
i. Early diagnosis/Prompt Treatment
ii. Target: Early Sick (pwedeng hindi pa alam),
Pathogenic,
Asymptomatic (best way to treat kay early pa ang infection)
iii. Aspects: Early Detection (Screening, case finding, determining and identifying signs and
symptoms) and prompt treatment (to prevent complication)
c. Tertiary
i. Rehabilitation
ii. Target: Late Sick, symptomatic and pathogenic, at Convalescence Stage na
iii. Aspects: Rehabilitation,
Prevention of Further Disability,
Prevention of permanent damage
3. Control Aspect
a. Isolation
i. Separation from the period of communicability of infected persons from other persons who
are susceptible
ii. Best time to do isolation technique: During period of communicability
b. Quarantine
i. Complete Quarantine
- limitation of freedom of movement of person exposed to communicable diseases
during the longest incubation period
ii. Modified Quarantine
- selective partial limitation of freedom
c. Surveillance
i. Monitoring
ii. Close supervision of contacts without restriction of their movement
d. Disinfection
i. Killing a pathogenic agent by chemical or physical means
e. Fumigation
i. Killing of animal forms by gaseous agent
f. Medical Asepsis
i. Gloving, gowning and hand washing, eye shield, eye goggles
ii. Using barriers
4. Standard Precaution
a. Correlates with Universal Precaution
i. All patients are considered infectious
b. Focused on use of protective barriers
i. Interrupting transmission
c. Added Airborne, Contact and Droplet routes as categories of precautions
5. Hand Hygiene
5
a. Most effective means of preventing the spread of disease
b. Elements:
i. Friction
ii. Soap
iii. Water
c. Before and after contact
6. Barrier Protection
a. Gloves – protect hands from being exposed to blood and body secretions or when you are touching
an instrument exposed to blood or any secretion
b. Gown – protect the body from accidental splashing or splattering of blood
c. Eye wear – eye shields to protect the eyes
d. Face shield – especially if there is an outbreak; protect mouth, eyes, nose
e. Mask – protect nose and mouth; airborne and droplet precaution (within 3 feet from patient)
f. Isolation
7. Transmission Based Precaution
a. Airborne precaution – mask N95; less than 5 micron or smaller (ex TB)
b. Droplet Precaution – mask; larger than 5 micron particles (ex coughing, sneezing)
c. Contact Precaution – if there is direct and indirect
Strict – highly transmissible diseases by direct contact and airborne routes of transmission
Respiratory – droplet transmission
TB – suspected/active TB patients
Contact – infectious diseases or multiple resistant microorganisms that are spread by close or direct contact
Private Handwashing Gloving Gowning Mask

Room
Strict / / / / /
Respiratory / / / /
TB / / /
Contact / / / / /
Enteric / /
Drainage / /
Universal / / / /
CENTRAL NERVOUS SYSTEM
TETANUS / Lock-Jaw
1. Definition
a. An infectious disease which produces potent exotoxin with prominent neuromuscular efforts
2. Etiologic agent
a. Clostridium tetani
3. Incubation Period
a. 3 days to 3 weeks – adult
b. 3 to 30 days – neonate
4. Source of Infection
a. Feces, soil, dust, rusty materials
5. Mode of Transmission
a. Direct inoculation through punctured wound
6. Avenues for entrance of organisms
a. Rugged traumatic wound or burns
b. Umbilical stump
c. Unrecognized wound
d. Dental extraction, ear piercing, circumcision
7. Signs and Symptoms
6
a. Spasm and tightening of the jaw muscle
b. Trismus – prolonged spasm of the masseter
c. Risus sardonicus – spasm of the facial muscle
d. Opisthotonus – arching of the back; affecting muscles of the back holding the spine
e. Swallowing difficulty
f. Hand or foot spasm
g. Pain
h. Uncontrolled urination or defecation
8. Pathophysiology
a. Entry via open wound
b. Bacterial proliferation
c. Immune response (increased body temperature)
d. Bacteria is reached after successful proliferation
e. Secretion of toxins
f. Tetanolysin (destruction of rbc)
g. Spasms of muscles
i. Facial muscle – risus sardonicus
ii. Masseter – trismus
iii. Spine – opisthotonus
iv. Resp muscles – dyspnea, chest heaviness
v. GUT – urinary retention
vi. GIT – constipation
vii. Abdomen – abdominal rigidity
viii. Extremity – robot gait
9. Modalities of Treatment
a. Antitoxin
b. Penicillin G
c. Surgical exploration and cleaning of wound
d. Muscle relaxant
e. Oxygen inhalation
f. NGT feeding – to facilitate proper nutrition
g. Tracheostomy – pag severe na jud
10. Nursing Mgt
a. Bedrest with non-stimulating environment
b. Adequate airway
c. Elevate head
d. Efficient wound care
e. Avoid contractures, pressure sores, urinary retention
f. Optimum comfort measures
11. Prevention and Control
a. Active immunization with tetanus toxoid for adults
7
b. Tetanus toxoid – 5 doses
c. DPT immunization for babies and children
d. Early consultation and adequate wound care after an injury
Additional Notes:
Tetanospasm – muscle spasm
Clostridium tetani – anaerobic; gram-positive; drumstick appearance
Source of tetanus infection in a neonate – umbilical stump or cord
Vaccine Minimum Percent Duration of Protection

Age/Interval Protected
TT1 As early as -- primary dose; given as early in
possible pregnancy as possible; not given
during pregnancy at first trimester because it has a
teratogenic effect that would lead
to deformity; starting 5th or 6th
month of pregnancy
TT2 At least 4 weeks 80%  infants born to the mother
later will be protected from
neonatal tetanus
 gives 3 years protection
for the mother
TT3 At least 6 months 95%  infants born to the mother
neonatal tetanus
for the mother
***booster dose
TT4 At least 1 year 99%  infants born to the mother
neonatal tetanus
for the mother
***booster dose
TT5 At least 1 year 99%  gives lifetime protection
later for the mother
 all infants born to that
mother will be protected
***booster dose
MENINGITIS (AKA Cerebrospinal Fever)

1. Definition
a. Inflammation of the meninges of the brain and spinal cord
2. Etiologic agent
a. Neisseria meningitidis
a. 2 to 10 days
a. Respiratory droplets
b. Direct invasion
a. Severe headache
b. Stiff neck
c. Dislike of bright lights
8
d. Fever/vomiting (projectile)
e. Drowsy and less responsive/vacant (decrease level of consciousness)
f. Rashes (develops anywhere on the body)
g. Brudzinski’s Sign – automated reflex of the hips and knees when a patient's neck is flexed forward
while lying down
h. Kernig’s Sign – Severe stiffness and pain of the hamstrings causes an inability to straighten the leg
when the hip is flexed to 90 degrees
6. Pathophysiology
a. Entry of causative agent to the respiratory tract
b. S/Sx of Upper Respiratory Tract Infection
i. Cough, cold, fever, sore throat
c. Bloodstream, crossing blood brain barrier
d. Meninges: inflammatory response
i. Nuchal rigidity – neck stiffness
ii. Kernig’s sign
iii. Brudzinski’s sign
e. Decreased flow of CSF
f. Increased ICP
i. Mannitol – decrease ICP; osmotic diuretic
ii. There is severe headache
iii. Projectile vomiting
iv. Widening of pulse pressure
7. Diagnostic Exam
a. Lumbar Puncture with CSF glucose measurement and CSF cell count
b. Gram stain and culture of CSF
c. Head CT Scan
a. Antibiotic Therapy
b. Mannitol – nursing responsibility: monitor urine output/ I&O assessment
c. Anticonvulsants – priority: safety/seizure precaution, siderails up
d. Acetaminophen
9. Nursing Management
a. Respiratory isolation
b. Assess neurologic condition
c. Monitor fluid balance
d. Position patient carefully – elevate head
e. Keeping extraneous noise to minimum – to avoid seizures
f. Ensure patient’s comfort
ENCEPHALITIS (AKA Brain Fever)

1. Definition
a. Acute inflammatory condition of the brain
2. Etiologic agent
9
a. Arboviruses
a. 5 to 15 days
a. Transmitted to humans by bite of an infected mosquito
a. Flu-like Symptoms (prodromal)
i. Chills
ii. Headache
iii. Fever
iv. Nausea
v. Vomiting
b. Neurologic Manifestations
i. Confusion
ii. Drowsiness
iii. Stiff neck
iv. Seizures
v. Photophobia
6. Classification
a. Eastern Equine – horse and children below 4 years old
b. Japanese – 5 to 10 years old
c. Secondary Encephalitis
i. Post-infection encephalitis
ii. viral infection first occurs elsewhere in your body and then travels to your brain
7. Pathophysiology
a. Causative agent reaches brain
b. Activation of the inflammatory process
c. Lymphocytic infiltration of brain tissues
d. Cerebral edema
e. Degeneration of the brain ganglion cells
f. Diffused brain cell destruction
8. Diagnostic Exam
a. Lumbar puncture test
i. CSF fluid
ii. CSF test
iii. Fetal or shrimp position between L4 and L5
b. Serology tests
c. EEG
d. Brain MRI
e. CT scan of the head – to check for inflammation of the head
a. Symptomatic and supportive
b. Control of convulsions
c. TSB
d. Unless comatose, oral fluid should be encouraged
e. Observe for neurologic signs
MENINGOCOCCEMIA
1. Definition
a. Acute infection of the bloodstream and developing vasculitis
2. Etiologic agent
a. Neisseria meningitidis
a. 3 to 4 days
10
b. Kissing distance
c. Direct contact with discharges from the nose and throat which contain the bacteria
d. Secretions of the nose, mouth and throat propelled through coughing, sneezing and kissing
e. Through saliva (spit) when sharing items such as food or drinks, cups, utensils and drinking straws
5. Who is considered close contact?
a. Those who live in the same house
b. Those who have kissed the infected person
c. Those who share bed
d. Children in daycare center
e. Sharing drinks, cigarette, lipstick, etc
a. Fever
b. Vomiting
c. Cough and sore throat
d. Stiff neck
e. Convulsion
f. Delirium
g. Pinpoint rashes then become wider and appear like bruises starting on the legs and arms
h. Severe skin lesions may lead to gangrene
i. Acute vasculitis
i. Waterhouse-Friderichsen Syndrome
- combination of dermal manifestations and adrenal medullary hemorrhage
- development of petechial spots in association with shock
ii. Fulminant Type
- short course and usually fatal
7. Preventive Measures
a. Hand washing
b. Avoid close contact
c. Increase resistance by having healthy diet, regular exercise, healthy lifestyle
d. Maintain clean environment
e. Avoid sharing utensils, cups, etc
f. Avoiding crowded areas
g. Do not self medicate unless directed by doctors
Additional Notes:
- Most common among children 6 months to 5 years
- Most devastating form of meningococcemia is fulminant meningococcemia which consists of
hemorrhagic episodes
11
POLIOMYELITIS
1. Definition
a. Acute infectious disease characterized by the changes in the CNS which may result in pathologic
reflexes, muscle spasm, paresis or paralysis, more on the lower extremities
2. Etiologic agent
a. Legio debilitans
a. 7 to 14 days
4. Period of Communicability
a. 1st 3 days to 3 months of illness
a. Contact transmission
6. Clinical Features
a. Acute onset, flaccid paralysis
b. Fever present at onset
c. No progression after 2-3 days
d. Asymmetric
e. Legs affected most often
f. Mortality rate 5 to 10%
g. Permanent paralysis
7. Types
a. Abortive Type
i. Was exposed, able to harbor but di nagtuloy ang sakit
b. Pre-paralytic
i. To bloodstream
c. Paralytic
i. To CNS
a. Nasopharynx
i. tonsilitis
b. Mouth
i. Peyer’s patches
c. Cervical Lymph Nodes
i. Severe muscle pain
ii. Hayne’s sign – head drop
iii. Poker’s sign – opisthotonus with head retraction
iv. Flaccid paralysis – soft, flabby, limp
d. CNS
i. Paralysis
9. Diagnostic Exam
a. Virus isolation from throat washings or swab
b. Stool culture throughout the disease – kung nagtravel sa GI
c. Culture from CSF
10. Most commonly affected parts
a. Muscles that straighten or bend hip
b. Muscles that straighten knee
c. Shoulder muscles
d. Muscles behind the arms
e. Muscles that lift the food
a. Analgesics
b. Morphine – pain reliever
c. Moist heat application
12
d. Encourage bed rest
e. Rehabilitation – because of permanent paralysis

a. Enteric isolation
b. Watch out for signs and symptoms of paralysis
c. Check BP regularly
d. WOF signs of fecal impaction
e. Hot packs
f. Dispose excreta and vomitus properly
13. Untreated Polio Patient
a. Quadriplegic Patient
b. Severe Paralysis
c. Crawling
d. Patient Dragging Flail Lower Limbs
e. All Fours
f. Crouching Gait
14. Prevention
a. Immunization
b. Proper disposal of GIT secretions
c. Enteric isolation
d. Sanitation
e. Avoid overcrowding
RABIES (AKA Lyssa)

1. Definition
a. Acute viral infection communicated to man by the saliva of an infected animal
2. Etiologic agent
a. Rhabdovirus
a. 2 to 8 weeks – rabid animals
b. 10 to 21 days - man
a. 3 to 10 days before onset of symptoms
a. Bite of an infected animal
6. Clinical Manifestations
a. Animals
i. Withdrawn and quiet
ii. Manic behavior
iii. Dumb Stage: complete change in position
iv. Furious Stage: easily agitated, fierceful look, drooling of saliva
b. Humans
i. Invasive Stage
1. numbness of the bite site
2. flu-like symptoms
3. insomnia
4. restless, irritable, apprehensive
5. slight photosensitivity
ii. Excitement Stage
1. aerophobia, hydrophobia
2. manic behavior
iii. Paralytic Stage
1. spasms stop
13
2. paralysis starts from the toes
3. death within 24 to 72 hours
7. Pathophysiology
a. Rahbdo virus enters
i. Peripheral Nerves
ii. CNS (negri bodies) except cerebrum
b. Efferent Nerves
i. Salivary Gland (drooling of saliva)
8. Diagnostic Exam
a. Isolation of virus from patient’s saliva or throat
b. Fluorescent Rabies Antibody – provides the most definitive diagnosis
c. Presence of negri bodies in the dog’s brain
a. Isolation
b. Optimum comfort
c. Darken room and quiet environment
d. No running water
e. Concurrent and terminal disinfection
a. Vaccination of all dogs – at 3 months
b. Picking up of astray dogs
c. Confinement for 10 to 14 days of any dog that has bitten a person
d. Laboratory facilities
e. Public education
Additional Notes:
- Every 10 to 15 minutes somebody dies of rabies in the world
- In most instances dog
- Warm-blooded animals susceptible
- Brain biopsy is a diagnostic test
- Virus: Bullet-shaped filterable virus, has strong affinity to the CNS, sensitive to sunlight
14
RESPIRATORY SYSTEM
DIPHTHERIA
1. Definition
a. Acute infectious disease that can infect the throat and skin
2. Etiologic agent
a. Corynebacterium diphtheriae (Kleb-Loeffler bacillus)
a. 2 to 5 days
a. 2 to 4 weeks
a. Discharges from nose, pharynx, eyes or lesions
a. Contact
7. Types
a. Nasal
i. Bloody discharge from the nose
ii. Excoriated nares and upper lip
iii. Enlarged cervical and sub maxillary gland
b. Tonsilopharyngeal
i. Fever
ii. Sore throat
iii. Pseudomembrane:
- fibrinous, dirty gray and foul-smelling
iv. “Bull-neck” appearance
v. Death occurs from toxic myocarditis or bronchopneumonia
c. Laryngeal
i. Increasing hoarseness
ii. Croupy cough
iii. Aphonia
iv. Cyanosis
v. Diaphoresis
vi. Death due to suffocation
vii. Management: low tracheostomy to establish airway
d. Wound or Cutaneous Diphtheria
i. Yellow spots or sores in the skin
8. Complications:
a. Myocarditis
b. Bronchopneumonia
c. Airway obstruction
d. Nose bleeding
a. Pseudomembrane
15
b. “Bull Neck” appearance
10. Diagnostic Exam
a. Swab from nose and throat and other suspected lesions
b. Schick’s Test: determines susceptibility and immunity to diphtheria
c. Maloney’s Test: determine hypersensitivity to diphtheria anti-toxin
a. Penicillin – broad spectrum antibiotic
b. Anti-toxin
c. Erythromycin
d. Nutrition
e. Bed rest
f. Tracheostomy
g. Isolation for minimum of 14 days from onset of the disease until three cultures from nose and throat
are negative
Additional Notes:
- bacteria destroyed by heat
PERTUSSIS
1. Definition
a. A highly contagious disease characterized by repeated attacks of spasmodic coughing
2. Etiologic agent
a. Bordetella pertussis
a. 7 to 21 days
a. 1st 2 weeks of the disease
b. Up to 3 weeks
c. Catarrhal period of the disease
a. Secretions of nose and throat
a. Direct contact
b. Droplet
a. Catarrhal Stage
i. Most communicable
ii. Lasts for one to two weeks
iii. Coryza, sneezing, lacrimation
iv. Dry, bronchial cough
v. Cough becomes irritating, hacking, nocturnal and more severe
b. Paroxysmal Stage
i. Cough becomes spasmodic and recurrent
ii. With excessive explosive outburst in series
iii. Ends with loud, crowing inspiratory whoop
iv. Choking on mucus causes vomiting
v. Face becomes cyanotic
vi. Accompanied by profused sweating, involuntary urination and exhaustion
vii. Provoked by crying, eating, drinking or physical exertion
viii. Lasts 4 to 6 weeks
c. Convalescent Stage
i. Gradual decrease in paroxysms
ii. After six weeks, the attack subsides
8. Diagnostic Exam
a. Nasopharyngeal swabs
16
b. Sputum culture
c. CBC
a. Antibiotics
b. Fluid and electrolyte replacement
c. Nutrition
d. Oxygen therapy
e. Isolation
f. Bed rest
g. Warm baths
TUBERCULOSIS
1. Definition
a. Formation of tubercles in lung tissues which undergo caseation, necrosis and calcification
b. Koch’s Disease
2. Etiologic agent
a. Mycobacterium tuberculosis
b. Mycobacterium africanum – pag human type
c. Mycobacterium bovis – kung sa cattle
a. 2 to 10 weeks
a. Until capable of discharging the organism
a. Sputum, nasal discharge, saliva
a. Airborne method
b. Droplet
a. Cough
i. Early stage – dry
ii. Pag nagdevelop na - productive
b. Afternoon fever
c. Weight loss
d. Blood strained sputum
e. Night sweats
f. Chest pain
g. Hemoptysis
8. Diagnostic Exam
a. Chest X-ray
i. To determine extent or severity of lung affectation
b. Mantoux Test
i. PPD
1. ID
2. gagawa nang wheal
3. best time to interpret results: 48 to 72 hours
4. after 72 hours, titingnan ang induration and measure
5. positive kung 10mm, kung foreigner and also sa mga immunosuppressed na patient
5mm positive na
c. Sputum smear and culture examination
d. Bronchoscopy, lavage and tissue biopsy
e. Direct Sputum Smear Microscopy
i. 3 times for 3 consecutive days
ii. Early in the morning/upon awakening
17
iii. Di pwede mag toothbrush
iv. Dili pwede mag gargle nang mouthwash
v. Only plain water
vi. Who is only allowed to perform DSSM?
1. Medical technologist
2. in the absence of med tech: Barangay Health Worker only with proper training and
supervision
vii. dili pwede pag mag hemoptysis ang client, only pag wala nay episodes sa hemoptysis
a. Anti-TB chemotherapy
i. 3 to 4 drug regimen
10. TB Prevention
a. BCG
Additional Notes:
- Categorization
- Multi-Drug Therapy
1. 2 phases:
 Intensive
 Maintenance
2. RIPES
- Combination drug
- Rifampicin, Isoniazid, Pyrazinamide, Erythromycin, Sulfonamide
CATEGORY Description Intensive Maintenance Remarks

I (+) SS, (+) CXR RIPE RI If (+), add 1
(2 months) (4 months) month Rx
II Relapse RIPES RIE If (+), add 1
III (-) SS, (+) CXR RIPE RI If (+), add 1
IV Chronic Refer to any DOTS Center immediately.
Primary element of DOTS: Political Will/Political
Commitment
BIRD FLU
1. Definition
a. Flu infection in birds that affects humans
2. Etiologic agent
a. Avian influenza (AI) virus
a. 2 to 4 days
a. Handling infected bird
5. What is Bird Flu?
a. Contagious disease of birds
b. H5N1 virus – can also cause severe infections in humans
c. Bird flu can cause death to almost, if not all poultry infected by the H5N1 influenza virus
d. Virus can cause serious and fatal disease in humans
e. Bird flu can enter the country through smuggling of infected birds
f. Migratory birds may carry the virus to our country
6. How is Bird Flu Transmitted to Other Birds?
a. Direct contact with discharges of infected birds, especially feces and respiratory secretions
b. Contaminated feed, water, cages, equipment, vehicle, clothing
18
c. Sea and migratory birds may introduce the virus into flocks
d. Broken contaminated eggs may infect chicks in the incubator
7. How Transmitted to Humans?
a. Close contacts with infected birds
b. Through inhalation or contamination with infected discharges or feces of infected birds
c. The feces with the virus dries up, become pulverized and can be inhaled
d. Flapping of wings of sick bids can hasten transmission
e. One does not get bird flu from thoroughly cooked chicken meat
f. No evidence of transmission of the virus to humans from raw, chilled or frozen poultry
a. In Chickens
i. Weakness
ii. Fever, sneezing and cough
iii. Diarrhea
iv. Excessive thirst
v. Facial edema and swelling
vi. Crown and wattle turn purple
vii. Ruffled feathers
viii. Sudden death
ix. Drastic decline in egg production
b. Humans
i. Fever
ii. Cough
iii. Body weakness or muscle pain
iv. Sore throat
v. Difficulty of breathing (in severe cases)
vi. Sore eyes and diarrhea may be present
9. What to do with a person suspected to have bird flu?
a. Place patient in an area away from other persons, like in a separate room or a covered or shaded area
b. Place a face mask on the patient
c. Protect oneself by using face mask and eye goggles/glasses
d. Keep a distance of 1 meter from the patient – dapat more than 3 feet from patient
e. Transport the patient to a DOH referral hospital
10. Referral Hospitals
a. National Referal Center – Research Institute for Tropical Meidcine
b. Luzon – San Lazaro Hospital
a. Treatments are the same as for other influenza virus
b. Antiviral drugs, such as Osetalmivir (Tamiflu) halts of the illness is given within the first 2 days from
the onset of fever
c. Samples of H5N1 from human infections proved resistant to anti-viral medications amantadine and
rimantadine
12. DOH ACTIONS

a. OPLAN S4 VS BIRD FLU
i. Structure
1. re-activate Sars structure and system
2. close coordination with BAI at all levels
ii. Surveillance
1. issue guidance for enhanced surveillance
2. strengthen laboratory capacity
iii. Statements to the Public
19
1. disseminate fact sheets/website
2. joint statements from DOH and DA
3. press conferences
iv. Supplies
1. inventory of vaccines/antivirals
Additional Notes:
Hongkong in 1997 – place where the first AI virus infected a human
SARS
1. Definition
a. A new type of atypical pneumonia that infects the lungs
2. Etiologic agent
a. Corona virus – can survive sa surface for 4 hours
a. 2 to 13 days
a. Droplet
a. High grade fever (>38 degrees Celsius)
b. Muscle aches
c. Chills and shaking
d. Cough
e. Headache
f. Dizziness
g. Productive cough
h. Sore throat
i. Runny nose
6. Global Alert, Global Response
a. Guangdong, China – initial cases appear
b. Hongkong and Vietnam – outbreak as severe form of pneumonia were reported
7. Background
a. A significant number of cases have been in health care workers and household contacts
b. Affects all age groups, highest number of deaths have been among people with pre-existing chronic
conditions
8. Infectious Agent
a. A new member of the corona virus family
b. Able to survive inanimate objects for up to 4 hours
c. Can be killed by exposure to unltra-violet light
d. Mutate easily
e. Low infectivity – infectivity is the ability of a virus to jump from one person to another
f. High virulent – virulence is the property of the virus to cause damage to the patient’s organs
g. Transmitted through droplet spread to as far as one meter or roughly three feet away
9. Host
a. Civet cats
10. Pathophysiology
a. SARS virus enters the body
b. 5th or 6th day, chest x ray will show a whitening of the lung tissue
c. Over the next few days, inflammation spreads and the lung tissue swells. Millions of tiny air sacs in
the lungs fill with fluid, white blood cells and other debris.
d. Swollen tissue surrounding the alveoli collapses the fluid-filled sacs, impairing the CO2 and O2
exchange
e. By the 12th day, the patient becomes hypoxic, patient dies of lung failure
a. No treatment
20
b. Early detection to improve chances of recovery
c. No vaccines available
d. Can use steroids since there is inflammation
e. Generic anti-virals can be used
f. Antibacterial – to recover secondary bacterial infections, together with antiviral and anti-inflammants
g. Personal Protective Equipment – N95 mask, goggles, shoe cover, gloves, plastic apron
12. Prevention
a. Maintain good personal hygiene
b. Adopt a healthy lifestyle
c. Strict observance of preventive measures among health personnel
d. Do not spit
e. Wash hands always with soap frequently
f. Serve meals with serving spoon para walang transfer nang saliva
g. Avoid touching your mouth, nose, etc
h. Automatic consult doctor kung naa signs and symptoms
i. Ensure good ventilation (open windows at all times)
j. Avoid visiting crowded areas
k. When traveling on public transport, open windows whenever possible
l. Adequate rest
m. Reduce stress
n. A balanced diet
o. Avoid smoking or alcohol consumption
p. Intake of vitamins
Additional Notes:
March 12, 2003 – first WHO alert
PNEUMONIA IMCI
SIGNS CLASSIFICATION TREATMENT

*DANGER SIGN *VERY SEVERE DISEASE *First dose of ANTIBIOTIC
*Stridor >Clotrimoxazole
*CHEST INDRAWING *SEVERE PNEUMONIA
*VIT A
>100,000 IU
*Breast Milk/Sugar
*Urgent REFERRAL
*Cough *PNEUMONIA *ANTIBIOTIC 5 DAYS
*FAST BREATHING > 2 mos to <1 yo: 5ml
<2 mos: ≥ 60 >1 to <5yo: 10ml
2 mos – less than 1 yo: ≥50 For cough:
1 yo – 5 yo: ≥40 1. Breastfeeding
2. SLK
>sampalok
>luya
>kalamansi
21
*FOLLOW UP 2 DAYS
*Specific Treatment
*COUGH AND COLD *NO PNEUMONIA: Common Relieve cough with safe
cough or cold remedy
*COUGH >30 DAYS= REFER
*CONDITION NOT IMPROVE=
FOLLOW UP 5 DAYS
1. #1 problems among acute respiratory problems, which could lead to death among children
2. Major factor that leads to death of children having Pneumonia: Mother’s failure to recognize the signs and
symptoms of pneumonia
3. What should the nurse do when having contact with client having pneumonia: Ask, Look and Listen
(Assessment by asking)
4. AGE – important to ask sa child
5. Steps
a. Focused Assessment: (Integrated approach)
i. Danger signs
ii. Main symptoms
iii. Nutritional status
iv. Immunization status
v. Other problems
b. Classification
i. Urgent Referral (pink)
1. Pag may danger sign
2. Urgent referral sa hospital
3. indicates severe disease
ii. Specific treatment (Yellow)
1. May sakit ang bata, walang danger sign
2. Saan ginagawa? Health Center
iii. Home Management (green)
iv. Sa home
1. May sakit ang bata, walang danger
c. Treatment
i. identify treatment plan
d. Counsel and Follow-up
i. Counsel Caretaker
ii. Advise when to come back for follow up check up
6. Danger sign
a. Inability to feed or drink
b. Vomits everything
c. Convulsion
d. Sleeping abnormality
7. Lower lip – to stimulate sucking reflex
8. How to know if there is sleeping abnormality?
a. Pag clap nimo, walay reaction ang bata
9. Altered Level of Consciousness/Lethargic
a. Pag clap nimo, wala nakurat, walay reaction, wala namilok
10. Main Symptoms
a. Cough or difficulty breathing – indicates pneumonia
b. Diarrhea
c. Fever
d. Ear problems
22
11. ALL
a. Ask: If cough is more than 30 days, refer to hospital
b. Look: Dapat calm ang bata
i. RR – to establish whether there is fast breathing
ii. Stridor – adventitious sound, harsher than a wheeze, heard upon inspiration/when the client
breaths in
iii. Chest indrawing – if there is retraction or subcostal retraction
GASTROINTESTINAL TRACT
AMOEBIASIS
1. Definition
a. A protozoal infection of the bowel
2. Etiologic agent
a. Entamoeba histolytica
a. 3 to 4 weeks/21 to 28 weeks
a. For the whole duration of illness
a. Human excreta
a. Oro-fecal route or Fecal-Oral Route
b. Direct and indirect contact
a. Acute amoebic dysentery
i. Diarrhea alternated with constipation
ii. Tenesmus - is a feeling of incomplete defecation. It is experienced as an inability or difficulty
to empty the bowel at defecation. It is frequently painful and may be accompanied by
involuntary
straining and other gastrointestinal symptoms.
iii. Bloody mucoid stool
b. Chronic amoebic dysentery
i. Enlarged liver
ii. Large sloughs of intestinal tissues accompanied by hemorrhage
c. Hepatic forms
i. RUQ (Right upper quadrant) pain and jaundice (due to obstruction)
8. Pathophysiology
a. Bacteria enters
b. Multiplication in mucosa
c. Endotoxic production
d. Necrosis of mucosal layer
e. Ulceration
f. Gangrene
g. Toxemia
9. In untreated cases
a. Watery stools
b. Severe blood-mucoid stools
c. Hemorrhage
d. Intestinal perforation
e. Peritonitis
f. Death
10. Diagnostic Exam
23
a. Stool exam
i. If there is causative agent in stool
b. Blood Exam
i. Increased WBC
c. Sigmoidoscopy
i. To check for ulceration
11. Prevention
a. Health education
b. Sanitary disposal of feces
c. Protect, chlorinate and purify drinking water
d. Cleanliness in food preparation, handling and storage
e. Detection and treatment of carriers (enteric precaution)
f. Fly control
a. Metronidazole (Flagyl)
b. Tetracycline – for children
c. Chloramphenicol
Additional Notes:
Infective stage – during cysts stage
Extra-intestinal amoebiasis, it can spread to: liver, lungs, brain
BACILLARY DYSENTERY (AKA Shigellosis)

1. Definition
a. Acute infection of the lining of the small intestine
2. Etiologic agent
a. Shigella group
a. 1 to 3 days
a. During acute infection until feces is negative for the organism
a. Fecal-oral route
b. Or through contaminated food and water
a. Fever
b. Headache
c. Nausea and vomiting
d. Tenesmus – painful defecation, tidbits ang tae
e. Colicky or cramping abdominal pain
f. Diarrhea with bloody mucoid stool
g. Dehydration
h. Weight loss – pag more than 10%, suspect that there is dehydration
7. Diagnostic Exam
a. Fecalysis – to determine presence of organisms in stool
b. Isolation of microorganisms from rectal swab or culture
c. Peripheral blood examination
d. Blood culture
i. WBC more than 10,000 (bacterial)
ii. Less than 5000 (viral)
a. Antibiotics – Clotrimoxazole
b. Severe cases: Ampicillin, tetracycline, Cotrimoxazole
c. IV infusion of NSS
d. Low-residue diet
24
a. Fluid and electrolyte balance – 1&O Monitoring
b. Restrict food – especially if contraindicated sa sakit; oily food promote diarrhea; dili japun pwede ang
irritants
c. Concurrent and terminal disinfection
d. Personal hygiene
e. Proper disposal of excreta
Additional Notes:
Shigella dystenterai – pinaka infectious
Kung minsan within 24 hours, lumalabas na signs and symptoms.
BOTULISM
1. Definition
a. A paralytic illness caused by a potent exotoxin
2. Etiologic agent
a. Clostridium botulinum
a. 8 to 36 hours
a. Wounds – horizontal infection
b. Improperly canned or preserved food – if home made, dili sakto pagka preserve ang food
5. 3 Human Forms of Botulism
a. Food-Borne
i. Ingestion of inadequately cooked contaminated food
b. Wound
i. Formation of ulcers with sharply demarcated edges and a membranous base
c. Infant
i. Hypotonic infant syndrome
ii. Feeble cry, depressed gag reflex, inability to drink
6. Clinical Characteristics
a. Manifest within 12 to 36 hours
b. First 24 hours – critical
c. Intial S/Sx
i. Dry mouth
ii. Sore throat
iii. Weakness
iv. Vomiting
v. Diarrhea
d. Neurological symptoms
7. Management
a. Supportive care, especially respiratory and nutritional needs
b. Food-borne: emetics and gastric lavage
c. Wound: exploration and debridement
d. Infant: supportive care
e. Antibiotics and aminoglycosides
a. Health education on proper food preparation, especially home canning
b. Avoid tasting food from a bulging can or one with a peculiar odor
c. Sterilize utensils
d. Do not give honey or corn syrups to infants
Additional Notes:
Classical botulism – food-borne
CHOLERA (AKA Eltore)

25
1. Definition
a. Acute bacterial infection of the small intestine
b. Violent dysentera
2. Etiologic agent
a. Vibrio cholerae or eltore
a. Few hours to 5 days
a. During stool positive stage
a. Fecal-oral route
b. Ingestion of contaminated food or water
c. Flies, soiled hands and utensils
a. Acute, profuse, watery diarrhea with no tenesmus or intestinal cramping
b. Initial: stools brown with fecal materials
c. Latter: Pale gray, rice-water in appearance with inoffensive, slightly fishy odor
d. Vomiting
e. Poor tissue turgor – because of fluid loss leading to dehydration; skin pinch: slow ang return sa skin
f. Washer-woman’s-hand
g. Radial pulses imperceptible
h. Cyanosis
i. Hoarseness and aphonia
j. Rapid and deep breathing
k. Oliguria – because kino-conserve fluid
l. Shock – because of fluid loss, there is fluid volume deficit
7. Prevention
a. Protection of food and water supply from fecal contamination
b. Boiling or chlorination of water
c. Pasteurization of milk
d. Sanitary disposal of human excreta
e. Sanitary supervision of food handlers
f. Meticulous hand washing
a. Objective: Replacement of fluids and electrolytes lost
b. Intravenous infusion
c. Oral rehydration therapy – may use Oresol
d. Antibiotics
i. Tetracycline – drug of choice, especially for children
ii. Furazolidone
iii. Chloramphenicol
iv. Cotrimoxazole
a. Enteric isolation
b. Accurate recording of vital signs
c. Accurate measurement of I and O
d. Personal hygiene
e. Proper disposal of excreta
f. Proper preparation of food
g. Environmental sanitation
Additional Notes:
Posterior pituitary gland – mag signal nga mag drink na
First sign of dehydration – thirst
26
At least 25 meters ang distance sa
5 to 10 minutes after boiling point – to kill the contaminants
DIARRHEA FROM IMCI
1. Dehydration
2. Persistent or chronic diarrhea – 14 days or more
3. Blood in the Stool (dysentery)
FOR DEHYDRATION
1. Classification
a. Severe
i. 2 or more of the following:
1. Sleeping abnormality **
2. Inability to feed/drink or thirst
3. Sunken eyes (fluid deficit)
4. Poor skin turgor (skin pinch goes back so slow)
ii. Plan C – To treat severe dehydration quickly
1. Give Vitamin A 100,000 IU
2. IV Therapy
a. LR is the solution of choice;
b. PNSS kung walay LR;
c. 100ml/kg
d. 1st 30 minutes = 30 ml
e. Remaining minutes = 70ml
f. Infants: 6 hours duration
i. 1st hour = 30 ml
ii. Remaining 5 hours = 70ml
g. Children: 3 hours duration
h. To be started within 30 minutes
i. Kung hindi na start within 30 minutes, give Oresol per NGT
j. If wala na insert ang tube, give Oresol per orem
k. Gagawin sa health center until ma reach ang hospital for Urgent Referral
b. Some Dehydration
i. Manifestation:
1. Restless, Irritable
2. Sunken eyes
3. Poor skin turgor
ii. Plan B
1. Give oresol
a. 2 rehydration solution packs
b. Kung walay rehydration solution, make home made rehydration solution: (181)
available for 24 hours
i. 1 liter of boiled water
ii. 8 tsp sugar
iii. 1 tsp salt
c. 121
i. 1 liter of boiled water
ii. 2 pinch of sugar
iii. 1 pinch salt
2. Weight
a. Determine weight in kg X 75 = ml to be given to the child
b. To be given for 4 hours
c. Kung dili pwede ang weight, determine age of child
27
3. Age
a. < 4 mos = 200 to 400 ml
b. 4 mos to < 1 year old = 400 to 700 ml
c. 1 to < 2 yo = 700 to 900 ml
d. 2 yo to <5 yo = 900 to 1400ml
4. Teach mother how to give Oresol: through frequent sips from a cup
5. What if the child vomits: Stop and wait for 10 minutes and continue feeding
6. If child wants to breastfeed: Allow to do so
7. When to stop feeding:
a. Puffy eyelids or periorbital edema – signs of overhydration
8. After 4 hours, reassess the child
9. What to feed to the child:
a. If purely breastfed – oresol
b. If not purely breastfed – food based fluid
i. Soup
ii. Rice water
iii. Buko juice
c. No dehydration
i. Not in pink, not in yellow
ii. Nagtatae, no other signs and symptoms
iii. Plan A (Volume per volume fluid replacement))
1. Give extra fluids
a. If child is up to 2 years old = 50 to 100ml
b. 2 years up to 5 years old = 100 ml to 200 ml
2. Start feeding the child
a. Purely breastfed – oresol
b. Not purely breastfed – food based fluid
3. Pag nibalik ang danger signs, balik agad sa health center
d. Severe, Persistent diarrhea
i. Persistent diarrhea, 14 days or more
ii. Plus dehydration
iii. Treatment: Dehydration, Plan C
iv. Give Vitamin A 100,000 IU
v. Pink
e. Persistent Diarrhea
i. Manifestation:
1. Persistent diarrhea
2. without dehydration
ii. Treatment
1. advise feeding
2. give vitamin A
iii. Follow up in 5 days
iv. Yellow card
f. Dysentery
i. Manifestation
1. Blood in stool
ii. Treatment:
1. Antibiotic
a. Bacillary Shiggellosis
i. Cotrimoxazole
ii. Nalidixic Acid
b. Violent
i. Tetracycline
1. 250 mg/cap
28
2. 4x/day for 3 days
3. 4 months to < 1 year old = ½
4. >1 yo to 5 yo = 1 cap
ii. Cotrimoxazole
2. Give Vitamin A
iii. Yellow
INTEGUMENTARY SYSTEM
CHICKENPOX
1. Definition
a. Characterized by vesicular eruptions on skin and mucous membrane
b. Centrifugal (starts from trunk, palabas)
2. Etiologic agent
a. Varicella zoster virus
a. 2 to 3 weeks (3 to 17 days)
a. 1 day before eruption of first lesion and 6 days after appearance of first crop or 6 days after crusting
a. Airborne or droplet
b. Direct contact
c. Indirect contact
6. Complication
a. Secondary infection
b. Meningoencephalitis
c. Pneumonia
d. Sepsis
e. Hemorrhagic varicella
a. Pre-eruptive Stage (Prodromal Stage)
i. Fever
ii. Malaise
b. Eruptive Stage
i. Rashes starts from trunk
ii. Initial lesions: red papules
iii. Contents of lesions become milky and pus-like within 4 days, fluid-filled vesicles
iv. Pruritus
8. Pathophysiology
a. Macule
b. Papule
c. Fluid-Filled Vesicles
d. Crusting
a. Zovirax
b. Acyclovir
c. Oral antihistamine
d. Calamine lotion – or baking powder paste for pruritus
29
e. Antipyretic
a. Strict isolation
b. Prevention of secondary infection
c. Proper disposal of secretions and disinfection of linen
d. Cut fingernails short and hand washing
e. Diversionary activities (ex. Brick game, gameboy)
RUBELLA (AKA German Measles)

1. Definition
a. Mild viral illness
2. Etiologic agent
a. Rubella virus
a. 14 to 21 days or 2 to 3 weeks
a. 1 week before and four days after onset of rashes
a. Direct contact
b. Droplet method
6. Complication
a. Encephalitis
b. Neuritis
c. Arthritis
d. Arthralgias
e. Rubella syndrome – especially in infants or children
i. PDA
ii. Microcephaly
iii. Cataracts
a. Prodromal Period
i. Low grade fever
ii. Malaise
iii. Headache
iv. Mild coryza
v. Conjunctivitis
b. Eruptive Period
i. Forcheimer’s spots
ii. Exanthematous rash
30
a. Isolation
b. Bed rest until fever subsides
c. Darken room – kay sometimes affected ang eyes
d. Liquid diet
e. Eye irrigation – especially during prodromal stage nga naay conjunctivitis
f. Good ventilation
g. Prevent spread of infection
h. Prevent occurrence of complications
Additional Notes:
German measles – no desquamation
Measles – with desquamation
Neurologic defects secondary to congenital rubella syndrome:
- microcephaly, mental retardation, behavioral disturbances
MEASLES (Rubeola)
1. Definition
a. Acute exanthematous disease and symptoms referable to the upper respiratory tract
2. Etiologic agent
a. Filterable virus of paramyxoviridae
a. 10 (fever) to 14 (rashes) days
a. 4 days before and 5 days after the appearance of rashes (catarrhal stage)
a. Blood, secretion of the eyes, nose and throat
a. Direct and indirect contact
b. Droplet
7. Complication
a. Bronchopneumonia – most common
b. Otitis media
c. Nephritis
d. Encephalitis
e. Blindness
a. Pre-eruptive Stage (Prodromal)
i. Fever
ii. Catarrhal symptoms: Rhinitis, conjunctivitis, photophobia, coryza
iii. Respiratory symptoms
31
iv. Koplik’s spot – at buccal cavity
b. Eruptive Stage
i. Rash: 4th to 5th day
ii. Rash: cheeks, bridge of the nose, along the hairline temple or earlobe, but not on the nape
(cephalocaudal)
iii. Anorexia and irritability
iv. Pruritus
v. Lethargy
vi. Throat is red and swollen
c. Stage of Convalescnece
i. Rashes fade: face downwards
ii. Desquamation
iii. First in, first out nag pagwala sa rashes
a. Isolation
b. Fever control
c. Skin care
d. Oral and nasal hygiene
e. Care of the ears
f. Daily elimination
g. Nutrition
h. Penicillin – to prevent secondary infection, especially during desquamation or convalescence period
Additional Notes:
Darkened room – to prevent blindness
HERPES ZOSTER
1. Definition
a. Acute viral infection of the sensory nerve
b. Difference with chickenpox: Unilateral in terms of rashes and rashes are clustered
2. Etiologic agent
a. Varicella zoster virus
a. 13 to 17 days
a. A day before the appearance of 1st rash and 5-6 days after the last crust
a. Droplet and contact
6. Complication
a. Encephalitis
b. Blindness
c. Deafness
d. Facial paralysis
e. Loss of taste
f. Recurrence
32

a. Erythematous base
b. Cluster of vesicles
c. Pain, described as burning or stabbing
d. Pruritus
e. Fever, malaise, anorexia and headache
f. Lymphadenopathy
g. Ramsay Hunt Syndrome – an infection of your facial nerve that's accompanied by a painful rash and
facial muscle weakness; affected ang facial nerve
8. Diagnostic Exam
a. Characteristic skin rash
b. Tissue culture – to determine causative agent
c. Smear of vesicle fluid
d. Microscopy
a. Symptomatic
i. For pruritus, mga anti pruritic agent
b. Antiviral drugs
c. Analgesics
d. Anti-inflammatory drugs
a. Strict isolation
b. Cool, wet dressings
c. Prevent secondary infection
Additional Notes:
Ramsay-hunt syndrome – facial affectation, leading to facial paralysis
Aziclovir – drug of choice
ANTHRAX
1. Definition
a. Acute infectious disease usually affecting the skin
2. Etiologic agent
a. Bacillus anthracis
33
a. Few hours to 7 days
a. Animal bites
b. Airborne
c. Ingestion of contaminated meat
5. Types
a. Cutaneous (skin infection)
i. 1 to 2 days: macule
ii. 3rd to 4th day: ring of vesicles develop around the papule
iii. Vesicular fluid may exude
iv. Marked edema
v. 5th to 7th day: original papule ulcerates to form eschar
vi. High fever, toxemia and painful lymphadenopathy
vii. 20% of untreated cases result to death
b. Inhalation
i. Woolsorter’s disease
ii. Organisms directly deposited into alveolar ducts causing hemorrhagic necrosis
iii. Dyspnea
iv. Stridor
v. Hypoxia
vi. Hypotension
vii. Death within 24 hours
viii. 90% untreated cases lead to death
c. Gastrointestinal
i. Ingestion of inadequately cooked meat which is infected with the causative agent
ii. Fever
iii. Nausea and vomiting
iv. Abdominal pain
v. Bloody diarrhea
vi. Ascites
vii. 25 to 60% untreated cases lead to death
a. Penicillin, Doxycycline, and Ciprofloxacin
b. Erythromycin, Tetracycline (for gastrointestinal) or Chloramphenicol
c. Length of treatment: 60 days
d. Proper handling
Additional Notes:
Bacillus anthracis:
- Aerobic and spore forming
- Rod-shaped and encapsulated
- Can be destroyed by boiling for ten minutes
LEPROSY (AKA Hansen’s Disease)

1. Definition
34
a. A chronic systemic infection characterized by progressive cutaneous lesions
b. A chronic mild communicable disease caused by Mycobacterium leprae, a rod-shaped bacteria
c. Mainly affects the skin, peripheral nerves, eyes, mucosa of the upper respiratory tract
d. Early s/sx: skin lesions, ulcers that do not heal
2. Etiologic agent
a. Mycobacterium leprae
a. 5 ½ months to 8 years
a. Contact – prolonged skin to skin contact
b. Droplet – a very rare mode of transmission
a. Early signs and symptoms:
i. Anhdrosis
ii. Reddening of the eyes
iii. Light discoloration or reddish skin lesions/with definite loss of sensation
iv. Loss of sensation and weakness of the muscles of the hands, feet or face
v. Positive slit skin smears
vi. Neonyne Face
b. Late signs and symptoms:
i. Loss of eyelid reflex
ii. Gynecomastia in males
iii. Sunken nose bridge
iv. Madarosis – falling of the eyebrows
v. Clawing and contracture
vi. Chronic ulcers = sole, palm, fingers
vii. Lagophthalmos
6. Diagnostic Exam
a. Based on the clinical signs and symptoms
b. Positive slit skin smear
7. Medical Management
a. Multi drug therapy is the accepted standard treatment for Leprosy and is proven safe and effective
b. MDT must be started as soon as the diagnosis is made
c. It is the combination of two or more anti-leprosy drugs that renders the patient non-infectious within
1 week after starting treatment
a. Health education
b. BCG vaccination
c. Adequate nutrition
d. Good Personal hygiene
Classification
Classification Single Lesion Paucibacillary (PB) Multibacillary (MB)
Paucibacillary (SLPB)
Skin lesions include: Only one lesion 2 to 5 lesions, More than 5 lesions,
>Flat lesion unequally districuted, equally distributed,
>Raised lesion and definite loss of loss of sensation
nodule sensation
Nerve Damage: No nerve involvement None or one nerve Many nerves
Resulting in loss of
sensation and >tuberculoid >Luprematous or
weakness of muscles >non infectious borderline
supplies by the >infectious
35
effected nerve
Multidrug Therapy
Children Adult
PB Rif – 450 mg Rif – 600 mg 6 blister packs 9 months
Dap – 50 mg Dap – 100 mg
MB Rif – 450 mg Rif – 600 mg 12 blister packs 18 months
Dap – 50 mg Dap – 100 mg
Clo – 150 mg Clo – 300 mg
Rif – Rifampicin
Dap – Dapsone
Clo - Clofazimine
Side Effects:
 Gastric irritation
 Discoloration of the skin scaling due to Clofazimine
 Dermatitis due to Dapsone
 Weakness, joint and muscle pains for Rifampicin
 Psychosis due to Dapsone (rare case)
Contraindication:
 cases of severe liver and kidney disease
 known severe drug hypersensitivity to any of the MDT drugs
 severe anemia
 Ofloxacin and Minocycline are not recommended for use in pregnant women and children below 5
years
 Dapsone should not be given to people with sulfone sensitivity
**Management and Storage: Cool dry place to prevent coating
**TC – Treatment Completed
**Kung TB patient, dili na maghatag ug Rifampicin para dili mag overdose
**Relapse – reoccurrence of leprosy successful completion of treatment characterized by occurrence of new lesion,
but very rare and confirmed by laboratory
SCABIES
1. Definition
a. Infestation of the skin produced by the burrowing action of a parasite mite resulting in irritation and
the formation of vesicles or pustules
2. Etiologic agent
a. Sarcoptes scabiei
a. Within 24 hours
a. For the entire period the host is infected
a. Direct contact
b. Indirect contact
6. Usually infected sites:
a. Nipples
b. Armpits
c. Wrists
d. Fingers
e. Belly button
f. Pubic area
36
a. Itching, especially at night
b. Thin, pencil-mark lines on the skin
c. Rashes
d. Skin abrasions
a. Scabicide: Eurax Ointment (Crotamiton)
b. Pediculicide: Kwell lotion (Gamma Benzene Hexachloride) – contraindicated in young children and
pregnant women
c. Topical steroids
d. Hydrogen peroxide: cleanliness of wound
e. Lindane Lotion for itchiness
a. Apply cream at bedtime, from neck to toes
b. Instruct patient to avoid bathing for 8 to 12 hours
c. Dry-clean or boil bedclothes – boil 30 minutes before laundering
d. Report any skin irritation
e. Family members and close contact treatment
f. Good hand washing
g. Terminal disinfection through scabicides
Additional Notes:
Description of the causative agent:
Yellowish-white in color
Can barely be seen by the unaided eye
Female parasite burrows beneath the epidermis to lay their eggs
MUMPS (AKA Parotitis)

1. Definition
a. Manifested by swelling of one or both parotid glands
2. Etiologic agent
a. Paramyxovirus
a. 12 to 26 days
a. Before onset of parotid gland swelling until it remains
b. Direct contact
6. Complication
a. Orchitis
b. Oophoritis
c. Mastitis
d. Central nervous system involvement
e. Nuchal rigidity
f. Deafness
g. Sterility
a. Sudden earache
b. Face pain
c. Swelling of the parotid glands
d. Headache
e. Fever
f. Sore throat
g. Swelling of the temples or jaw
37
a. Relief of pain
b. Bed rest
c. Orchitis
i. Suspensory
ii. Sedatives
iii. 300 to 400 mg of Cortisone followed by 100 mg every 6 hours
iv. Nick in the membrane
d. Diet
i. Soft or liquid
ii. Sour food or fruit juices
iii. Hot and cold foods
a. Isolation
b. Concurrent and terminal disinfection
c. Oral care and personal hygiene
d. Eye care
e. Diet
f. Bed rest
g. Diversional activities – since there is pain
Additional Notes:
48-hour after onset of swelling – highest communicability
SEXUALLY TRANSMITTED INFECTIONS
AIDS
1. Definition
a. Final and most serious stage of HIV disease
2. Etiologic agent
a. Retrovirus-Human T-Cell Lymphotropic virus 3 (HTLV-3)
a. 1-3 months to 1-15 years
4. Most common method of transmission:
a. Unprotected sex with an infected partner
b. Sharing needles with infected person
5. Almost eliminated risk factors for HIV transmission are:
a. Infection from blood products
b. Transmission from mother to fetus
a. Sexual contact
b. Blood transfusion
c. Contaminated syringes, needles, nipper, razor blades
d. Direct contact of open wound/mucous membrane with contaminated blood, body fluids, semen and
vaginal discharge
7. Safer Sex Methods
a. One sexual partner
b. Condom
a. Loss of appetite
b. Weight loss
c. Fever
d. Malaise
e. Persistent diarrhea
9. Pathophysiology
38
a. HIV infection
b. Acute illness
i. Fever, rash, joint and muscle pain and sore throat
c. Chronic Illness
d. AIDS
i. Kaposis’s sarcoma
ii. Pneumocystis carinii pneumonia
iii. Cyrptococcal menigitis
10. Diagnostic Exam
a. ELISA
b. Western Blot Analysis – confirmatory test
c. Radio Immuno-precipitation assay (RIPA)
11. Prevention (Four C’s In The Management of Aids)
a. Compliance
b. Counseling/education
c. Contact tracing
d. Condoms
12. Prevention
a. Maintain monogamous relationship
b. Avoid promiscuous sexual contact
c. Sterilize needles, syringes and instruments used for cutting operations
d. Proper screening of blood donors
e. Rigid examination of blood donors
f. Rigid examination of blood and other products for transfusion
g. Avoid oral, anal contact and swallowing of semen
h. Use condom and other protective devices
a. Fatigue
i. Provide restful environment
ii. Assist with personal care
iii. Monitor tolerance for visitors
b. Pain
i. Give meds as appropriate
ii. Assess level of pain
c. Disease susceptibility
i. Implement infection control precautions
ii. Handwashing on entering and leaving room
iii. Monitor for oral infections and meningitis
iv. Give antibiotics as ordered
d. Respiratory distress
i. Monitor vital signs, chest sounds – especially RR
ii. Give bronchodilators and antibiotics as ordered
iii. Suction and maintain oxygen as ordered – hyper oxygenate before suctioning
iv. Monitor for symptoms of secondary infection
e. Anxiety, depression
i. Use tact, sensitivity in gathering personal in gathering data
ii. Encourage expression of feelings – encourage verbalization
iii. Respect client’s own limits in ability to discuss problems – sense of privacy
f. Anorexia, diarrhea
i. Monitor weight
ii. Encourage nutritional supplements
iii. Assess hydration
Additional Notes:
39
***Opportunistic infections such as pneumocystosis or malignancies such as Kaposi’s sarcoma can signal the final
stage of HIV infection, AIDS.
***Africa – HIV/AIDS first occur
CANDIDIASIS
1. Definition
a. Mild superficial fungal infection
2. Etiologic agent
a. Candida albicans
3. Candida Albicans
a. Normal flora of the GIT, mouth, vagina and skin
b. Rise in glucose (diabetes)
c. Lowered resistance (cancer)
d. Immunosuppression (aging, radiation therapy, HIV, drug)
e. Increase in estrogen (pregnancy)
f. Broad-spectrum antibiotics
4. Affected Body Parts
a. Nails (ONYCHOMYCOSIS)
b. Skin (Diaper Rash)
c. Oropharynx (oral thrush)
d. Vagina (Moniliasis)
a. Skin
i. Scaly, erythematous, popular rash
ii. Covered with exudates
iii. Appear below breasts, between fingers, axillae, groin and umbilicus
b. Nail
i. Red, swollen, darkened nailbeds
ii. Purulent discharge
iii. Separation of pruritic nails from nailbeds – indication of Onychomycosis
c. Thrush
i. Cream-colored or bluish-white patches on the tongue, mouth or pharynx
ii. Bloody engorgement when scraped
d. Moniliasis
i. White or yellow discharge
ii. Pruritis
iii. Local excoriation
iv. White or gray-raised patches on vaginal walls with local inflammation
a. Contact with secretions from mouth, vagina, skin and feces
a. Nystatin or Imidazole
b. Cotrimoxazole
c. Ketoconazole
d. Fluconazole
e. Nystatin solution
f. Cranberry juice or yogurt – rich in Vitamin C
CHLAMYDIA
1. Definition
a. Sexually transmitted disease caused by a bacteria
2. Etiologic agent
a. Chlamydia trachomatis
40
a. 2 to 3 weeks (males)
b. Asymptomatic (females)
a. Vaginal or rectal intercourse
b. Oral-genital contact with infected person
c. Children born to mothers
a. Males
i. Burning sensation during urination
ii. Discharge from the penis
iii. Testicular tenderness or pain
iv. Rectal discharge or pain
b. Females
i. Burning sensation during urination
ii. Vaginal discharge
iii. Painful sexual intercourse
iv. Rectal pain or discharge
6. Diagnostic Exam
a. Swab from site of infection
b. Culture of aspirated materials
c. ELISA
d. Direct fluorescent antibody test
7. Chlamydia Effects
a. Causes a build-up of scarring that can block the fallopian tube and prevent fertilization
b. Cause sterility
c. Ectopic pregnancy
a. Doxycycline given orally for 7 days
b. Azithromycin in single dose
c. Universal precaution
d. Submit for HIV testing
GONORRHEA (AKA Gleet, Drip, GC, Clap)

1. Definition
a. A sexually transmitted disease involving mucosal lining of the GUT, rectum and pharynx
2. Etiologic agent
a. Neisseria gonorrhea
a. 2 to 10 days
a. As long as organisms present in discharges
a. Sexual contact
b. Vaginal delivery
c. Contact with exudates
6. Complication
a. Females
i. Salphingitis
ii. Pelvic Inflammatory Disease
iii. Vulvovaginitis
iv. Sterility
v. Dyspareunia
41
b. Males
i. Periurethral abscess
ii. Urethral stricture
iii. Urination problems
a. Females
i. Burning and frequent urination
ii. Yellowish, purulent vaginal discharge
iii. Redness and swelling of the genitals
iv. Burning and itching of the vaginal area
v. Urinary frequency and pain on urination
b. Males
i. Dysuria with purulent discharge (gleet) from the urethra 2-7 days after exposure
ii. Rectal infection common among homosexuals
iii. Inflammation of urethra
iv. Pelvic pain
v. Fever
8. Modalities of Treatment (usually broad spectrum antibiotics)
a. Azithromycin 2 g by mouth, single dose
b. Cefixime 400 mg by mouth, single dose
c. Ceftriaxone 125 mg IM, single dose
d. Doxycycline 200 mg by mouth BID x7 days
e. For pregnant women:
i. Ceftriaxone 125-250 mg IM single dose
ii. Erythromycin 500 mg orally x7 days
f. Aqueous procaine penicillin 4 million units IM
a. All information about patient is considered confidential
b. Infants born to mothers positive of gonorrhea should be instilled with 1% silver nitrate or any
recommended ophthalmic prophylaxis into both eyes at the time of birth
Additional Notes:
Characteristics of Neisseria gonorrhea:
Gram-negative
Readily killed by drying, sunlight or ultraviolet
Fragile and does not survive long outside the body
HERPES SIMPLEX
1. Definition
a. A viral disease characterized by the appearance of sores and blisters on the skin
2. Etiologic agent
a. Herpes simplex virus (HSV)
a. 2 to 12 days
4. Types
a. Type 1 virus
i. Tiny, clear, fluid-filled blisters
ii. Commonly affect lips, mouth, nose, chin or cheeks
iii. Transmitted by kissing, sharing kitchen utensils or sharing towels
iv. Usually last for 7 to 10 days
b. Type 2 virus
i. Cause genital sores, affecting buttocks, penis, vagina or cervix
ii. Acquired by sexual contact
iii. Can also be spread by touching an unaffected part of the body after touching the herpes
lesion
42
iv. Manifestations: minor rash or itching, painful sores, fever, muscular pain, burning sensation
on urination
v. Small, painful sores or blisters
vi. Usually heal in 1 to 3 weeks
vii. Can come back weeks
SYPHILIS (AKA Lues venereal)

1. Definition
a. Infectious disease caused by a spirochete
2. Etiologic agent
a. Treponema pallidum
a. 10 to 90 days
a. Variable and indefinite
a. Discharges from skin lesions or mucous membrane
b. Semen, blood, tears and urine
a. Direct transmission
b. Indirect contact
c. Trans-placentally
7. Types
a. Primary Syphilis
i. CHANCRES: small, painless, pimple-like ulceration on the penis, labia majora and minora and
lips
ii. Disappear after 3 to 6 weeks even without treatment
iii. Enlarged lymph nodes
b. Secondary Syphilis
i. Extensive lymph node enlargement
ii. Skin rash
iii. Mucous patches
iv. CONDYLOMATA LATA: Coalescing papules which form a gray-white plaque frequently in folds
such as groin, genital areas, axilla and under the breasts
v. Hair loss
c. Tertiary Syphilis
i. Infiltrative destructive lesions of skin, bones or liver
ii. GUMMA: chronic, superficial nodule or deep, granulomatous lesion that is solitary,
asymmetric, painless, and indurated
iii. Cardiovascular syphilis
a. Encourage patient to undergo VDRL (Venereal Disease Research Laboratory) testing after 3, 6, 12 and
24 months
b. Early treatment: Penicillin G benzathine IM (2.4 million units)
c. More than 1 year: Penicillin G benzathine 2.4 m units x3 weeks
d. Nonpregnant patients: Tetracycline or Doxycycline (15 days – early; 30 days – late)
a. Importance of completing treatment
b. Partners should be tested and treated
c. Universal precaution
d. Secondary syphilis: keep lesions dry; dispose contaminated materials properly
e. Cardiovascular: check for signs of decreased cardiac output
f. Neurosyphilis: WOF decreasing LOC
g. Report all cases to local health authorities for early detection and prompt treatment
43
BLOOD–BORNE DISEASES
DENGUE
1. Definition
a. Dengue fever
b. Dengue hemorrhagic fever
c. A mosquito-borne viral disease
d. Transmitted by the bite of an infected female Aedes mosquito
e. Caused by 4 serotypes: Den-1, Den-2, Den-3 and Den-4
f. Dengue by characterized by:
i. Fever
ii. Rash
iii. Muscle and joint pains
iv. Bleeding
g. Common during rainy seasons
h. Where is Dengue found?
i. Reported from over 100 countries
ii. First outbreak in 1952
i. Who is most affected by dengue?
i. Anybody can get sick regardless of age, sex, health and social status
ii. However infants and school children are mostly affected
iii. Generally 0 to 9 year old age group are vulnerable
j. Only through the bite of an infected female
k. Virus will reproduce inside the body then illness follows after 5 to days
l. The vector mosquito becomes infected when it bites people with DF/DHF following 8 to 10 days after
the bite. The infected mosquito then transmits the disease through its bite to other people.
m. Characteristics of Dengue Mosquito
i. Small, black and white insects
1. with stripes on its legs, body and back
2. measures about 5mm in size
ii. feeding
1. female - blood meal
2. male feeds on plant juices and nectars
iii. generally day biters
1. prefers to bite just after sunrise and before sunset
iv. can fly from 50 to 300 meters only to look for blood meal or breeding site
v. 1 female lays about 60 to 100 eggs per batch; lays about 3-4 batches of eggs in its lifetime
vi. Prefers dark color for oviposition; breeds in artificial or natural containers
vii. Ae. Aegypti prefers to rest cool shaded places, dark corners, closets and drawer, clear
stagnant waters
2. Etiologic agent
a. Dengue virus
b. Arboviruses
c. Flavivirus
a. Uncertain (up to 1 week) or 6 to 7 days
4. Stages
a. Dengue Hemorrhagic Fever
i. 1st 4 days: Febrile or Invasive Stage
ii. 4th to 7th day: Toxic or Hemorrhagic Stage
iii. 7th to 10th day: Convalescent or Recovery Stage
5. What should be done?
44
a. all dengue suspects should be brought to the nearest health facility, do not self medicate
b. don’t give aspirin – it may lead to bleeding and or gastric irritation
c. start oral rehydration int eh early stages of fever
d. if symptoms persists for 3 or more days or if danger signs appear, refer the patient immediately to
the hospital
e. pag more than 3 days na ang fever, mag tourniquet test
a. High continuous fever lasting 2 to 7 days
b. Loss of appetite
c. Nausea and vomiting
d. Muscle and joint pain
e. Abdominal pain
f. Body weakness
g. Bleeding tendencies – if there are signs of bleeding, rehydration daun
h. Presence of small reddish spots, or skin flushing
i. Rashes
7. Danger Signs
a. Spontaneous bleeding
b. Sudden onset of abdominal pain
c. Persistent vomiting
d. Listlessness
e. Changes in mental status/restlessness
f. Weak, rapid pulse
g. Cold, clammy skin – indicative of shock due to hemorrhage
h. Difficulty of breathing
8. Diagnostic Exam
a. Tourniquet test (Rumpels Lead Test) – using bp cuff; 1 square inch, positive if 20 or more
b. Plately count
i. Normal 150 to 450k
c. Hemoconcentration
d. Occult blood
9. Prevention
a. Best way: search and destroy
b. Destroy breeding sites
i. Cover all water containers
ii. Change water of flower vases and scrub side of containers once a week
iii. Dispose of garbage properly and remove rubbish around premises that can collect rain water
iv. Inspect and clean roof gutters
v. Properly arrange discarded tires under the shade or stock pile and place a cover on top
c. Preventing mosquito bites
i. Install screens on windows and doors
ii. Se protective clothing or repellants
iii. Use mosquito nets for infants or adults while sleeping at daytime
iv. Isolate the person sick with dengue in a screened room or by using a mosquito net
a. Paracetamol
b. Blood transfusion
c. Oxygen therapy
d. Sedatives
e. Intravenous fluids
Additional Notes:
45
Arbovirus:
West nile virus
O’nyong ‘nyong virus
Chikungunya virus
FILARIASIS
1. Definition
a. A parasitic disease caused by an African eye worm
2. Etiologic agent
a. Wuchereria bancrofti, Brugia malayi and Brugia timori
a. 8 to 16 months
a. Person-to-person by mosquito bites
5. Stages
a. Acute Stage
i. Lymphadenitis – inflammation of lymph nodes
ii. Lymphangitis – inflammation of lymph vessels
iii. Male genitalia affected leading to funiculitis, epididymitis and orchitis (redness, painful and
tender scrotum)
b. Chronic Stage
i. Develop 10 to 15 years from onset of first attack
ii. Hydrocele (swelling of the scrotum)
iii. Lymphedema (temporary swelling of the upper and lower extremities)
iv. Elephantiasis (enlargement and thickening of the skin of the upper and lower extremities,
scrotum and breast)
6. Diagnostic Exam
a. Nocturnal blood examination (NBE) – taken at patients residence or hospital after 8 pm
b. Immunochromatographic test (ICT) – rapid assessment method; an antigen test done at daytime
a. Diethylcarbamazine Citrate (DEC) or HETRAZAN – an individual treatment kills almost all microfilaria
and a good proportion of adult worms
8. Mass Treatment
a. Distribution to all population
b. Endemic and infected or not infected with filariasis in established endemic areas
c. The dosage is 6 mg/kg of body weight taken as a single dose per year
9. Surgical Treatment
a. Mild lymphedema: lymphovenous anastamosis distal to the site of the lymphatic destruction
b. Hydrocele managed by inversion or resection of tunica vaginalis
c. Chyluria is operated on by ligation and stripping of the lymphatics of the pedicle of the affected
kidney
a. Measures aimed to control vectors
b. Environmental sanitation such as proper drainage and cleanliness of surroundings
c. Spraying with insecticides
d. Measures aimed to protect individuals and families:
i. Use of mosquito nets
ii. Use of long sleeves, long pants and socks
iii. Application of insect repellant
iv. Screening of houses
v. Health education
Additional Notes:
Marinduque, Saranggani – provinces which are considered endemic for filariasis
46
LEPTOSPIRORIS (AKA Mud fever, Weil’s Disease, Flood Fever)

1. Definition
a. A zoonotic infectious bacterial disease carried by animals
2. Etiologic agent
a. Leptospira interrogans
a. 7 to 19 days; average 10 days
a. 10 to 20 days after onset
a. Contaminated food and water
a. Ingestion or contact with skin and mucous membrane with infected urine
a. Septic/Leptospiremic Stage
i. Febrile, lasting for 4 to 7 days
ii. Remittent fever
iii. Headache
iv. Myalgia
v. Nausea
vi. Vomiting
vii. Cough
viii. Chest pain
b. Immune or Toxic Stage
i. Lasts for 4 to 30 days
ii. Iritis, headache, meningeal manifestations
iii. Oliguria and anuria with progressive renal failure
iv. Shock, coma and congestive heart failure
v. Death may occur between the 9th and 16th day
a. Education on how to control leptospirosis specially during rainy season
b. Protective clothing
c. Stringent community-wide rat eradication program
d. Report all cases
a. Penicillin at 2m units q6hours IM/IV
b. Tetracycline/Doxycycline 100 mg q12 hours per orem
c. Erythromycin 500 mg q12hours per orem in patient allergic to penicillin
d. Urine must be properly disposed – using gloves
Additional Notes:
Reservoir hosts: rat, rabbits, cattles
MALARIA
1. Definition
a. Primary vector breeds in clear slow flowing streams, vector in coastal areas
2. Etiologic agent
a. Plasmodium falciparum – 70%
b. Plasmodium vivax – 30%
c. P. malariae – 1% very rare
d. P. ovale – not found in philippines
47
a. From an infected mosquito
a. Recurrent chills
b. Fever
c. Profuse sweating
d. Anemia – destruction of rbc
e. malaise
f. hepatomegaly
g. splenomegaly
5. Pathophysiology
a. 1st vector
b. Initial human host
c. Liver infection
d. Blood infection
e. 2nd vector
f. Next human host
6. Top 10 provinces:
a. Palawan
7. Affected:
a. At high risk: pregnant women (sulfadoxine pyrimethamine) and children
b. High-risk groups: indigenous cultural communities, non-immune travelers to endemic areas, soldiers,
forest product gatherers
8. Diagnosti c Exam
a. Clinical diagnosis – but have 50% accuracy
b. Blood smear – at the peak of the fever
c. Microscopic Diagnosis (Gold Standard) – definite diagnosis
d. Rapid Diagnostic Test (RDT) – to detect plasmodium-specific antigens; takes about 7 to 15 minutes,
very senstivite, accurate 90%, fast to detect
9. Control Program
a. Vision: malaria-free by year 2020
b. Chemoprophylaxis – for pregnant women
c. Use of mosquito repellants
a. Early diagnosis and treatment
Additional Notes:
Chloroquine – first line drugs
HELMINTHS
ASCARIASIS
1. Definition
a. An infection caused by a parasitic roundworm
2. Etiologic agent
a. Ascaris lumbricoides
a. 4 to 8 weeks
a. Fecal-oral route
5. Complication
a. Biliary tract obstruction
b. Hepatic abscess
c. Intestinal obstruction
d. Peritonitis
48
e. Malnutrition
a. Passing worms in stool
b. Vomiting up worms
c. Worms exiting through nose or mouth
d. Low grade fever
e. Bloody sputum
f. Wheezing
g. Shortness of breath
h. Stomach pain
a. Drug of choice: Albendazole or Mebendazole 15cc as single dose
b. Piperazine citrate 75 mg/kg, daily x2 doses orally
c. Pyrantel pamoate 1 mg/kg as a single dose orally
d. Niyog-niyogan – herbal remedy
a. No isolation needed
b. Preventive measures
c. Handwashing
d. Proper sewage disposal
e. Personal hygiene
Additional Notes:
1 year old – safest time to start deworming
Unfertilized egg – will not undergo biological development
Palmar pallor/malaki ang tiyan/muscle wasting/sagging of gluteal folds (signs of malnutrition) – mag deworm.
If more than 1 year old wala pa nag deworm, pwede magdeworm.
HOOKWORM
1. Definition
a. Roundworm infestation affecting small intestines and lungs
2. Etiologic agent
a. Necator americanus
b. Ancylostoma duodenale
a. 2 to 8 weeks
a. Contaminated drinking water or food
b. Direct skin contact
a. Itchy rash
b. Cough
c. Fever
d. Bloody sputum
e. Loss of appetite
f. Nausea, vomiting
g. Diarrhea
h. Abdominal discomfort
6. Infected Children
a. Underdeveloped mentally and physically
b. Protruding abdomen
c. Lethargic
d. Malnourished
e. Lazy and have no energy
f. Pupils dilated
49
g. Perverted appetite
7. Pathophysiology
a. Direct entry of causative agent (ex. Walking barefooted)
b. Eggs in feces
c. Egg become larva
d. Filariform larva
e. Filariform penetrates skin
f. And penetrates intestines
8. Management:
a. Pyrantel pamoate (Quantrel)
b. Diet – rich in iron
c. Personal hygiene
d. Proper disposal of excreta
e. Avoid going barefoot
f. Use purified or boiled water for drinking
g. Vegetables should not be eaten raw
PINWORM
1. Definition
a. An intestinal infection due to small intestinal worm
2. Etiologic agent
a. Enterobius vermicularis
a. 1 to 2 weeks
a. As long as the person harbors the organism
a. Direct and indirect contact
a. Intense itching around the anus
b. Difficulty sleeping
c. Irritability
d. Vaginal irritation
e. Loss of appetite
7. Diagnostic Exam
a. Scotch tape test
a. Piperazine hexahydrate
b. Family treatment
c. Toilet seats must be washed
d. Sleep alone
e. Handwashing
50

Communicable Disease Nursing

Uploaded by

Copyright:

Available Formats

You might also like

Communicable Disease Nursing

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Communicable Disease Nursing

Uploaded by

Copyright:

Available Formats

Communicable Diseases

DENNIS N. MUÑOZ, RN, RM, MAN (candidate)

NATURE OF INFECTIOUS PROCESS

Force of HUMAN Force of

It doesn’t mean na kung

Break in the Skin Integrity

BREAKING THE CHAIN OF INFECTION

Pattern of Disease Occurrence

GENERAL NURSING CARE

Vaccine Minimum Age Number Dose Minimum Route Site Reason

Private Handwashing Gloving Gowning Mask

CENTRAL NERVOUS SYSTEM

Vaccine Minimum Percent Duration of Protection

MENINGITIS (AKA Cerebrospinal Fever)

ENCEPHALITIS (AKA Brain Fever)

12. Nursing Management

RABIES (AKA Lyssa)

CATEGORY Description Intensive Maintenance Remarks

12. DOH ACTIONS

SIGNS CLASSIFICATION TREATMENT

BACILLARY DYSENTERY (AKA Shigellosis)

CHOLERA (AKA Eltore)

DIARRHEA FROM IMCI

RUBELLA (AKA German Measles)

7. Signs and Symptoms

LEPROSY (AKA Hansen’s Disease)

MUMPS (AKA Parotitis)

SEXUALLY TRANSMITTED INFECTIONS

GONORRHEA (AKA Gleet, Drip, GC, Clap)

SYPHILIS (AKA Lues venereal)

LEPTOSPIRORIS (AKA Mud fever, Weil’s Disease, Flood Fever)

You might also like