MERSCOV - Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by Middle

East respiratory syndrome coronavirus (MERS-CoV) that was first identified in Saudi Arabia in 2012. It is
also known as severe acute respiratory syndrome coronavirus. MERS- CoV is a virus transferred
to humans from infected dromedary camels.

INCUBATION PERIOD - The median incubation period for secondary cases associated with limited
human-to-human transmission is approximately 5 days (range 2-14 days).

SIGNS AND SYMPTOMS - Some people can be asymptomatic that can lead to severe respiratory illness
leading to death.

RESERVOIR
- Zoonotic transmission
- Current scientific evidence suggests that dromedary camels are a major reservoir host for MERS-CoV
and an animal source of MERS infection in humans. The virus likely originated in a bat and transferred to
camels. Genetic sequencing to date has determined the virus is most closely related to coronaviruses
detected in bats.

MODES OF TRANSMISSION -

DIAGNOSTIC EXAM - In general, these lab tests fall into two categories:
Molecular tests, which look for evidence of active
infection; and Serology tests, which look for previous infection by
detecting antibodies to MERS-CoV. Serology tests are
for surveillance or investigational purposes and not
for diagnostic purposes.
NURSING DIAGNOSIS –
• Infection related to failure to avoid pathogen secondary to exposure to MERS-CoV.
• Deficient knowledge related to unfamiliarity with disease transmission information.
• Hyperthermia related to increase in metabolic rate.
• Ineffective airway clearance related to excessive production of pulmonary secretions.
• Anxiety related to unknown etiology of the disease.

NURSING RESPONSIBILITY
•Monitor vital signs
•Educate the patient and folks
•Minimize Chance for Exposures
•Ensure Adherence to Standard, Contact and Airborne Precautions
•Manage Visitor Access and Movement Within the Facility

PREVENTION

Tubercolosis
Tuberculosis (TB) also known as phthisis, tabes, schachepheth, the white plague, and consumption. It is
contagious bacterial infection and is spread when a person with active TB exhales the bacteria into air
via taking, sneezing, coughing, yelling, or laughing and another.
CAUSATIVE AGENT
Mycobacterium tuberculosis
is a species of pathogenic bacteria in the family Mycobacteriaceae and a causative agent of tuberculosis.

INCUBATION PERIOD
The period from infection to development of the primary lesion or significant tuberculin reaction is
about 3–9 weeks.

SIGNS AND SYMPTOMS

Coughing out blood
Chills and fatigue
Coughing for more than 3 weeks
Loss of appetite and unintentional weight loss
Chest pain or pain with breathing or coughing
Fever and night sweats

PATHOGONOMIC SYMPTOMS
cerebrospinal fluid high in lymphocytes with very high albumin (0.6-2 g) and low glucose (0.4-0.2 g/l).

RESERVOIRS
Humans are the only known reservoir for Mycobacterium tuberculosis. Diseased animals rarely act as
reservoirs. The organism is spread primarily as an airborne aerosol from an individual who is in the
infectious stage of TB (although transdermal and GI transmission have been reported). In certain
instances, such as extremes of age or defects in cell-mediated immune or (CMI) response TB may
develop.

PORTAL OF ENTRY AND EXIT

TB's portal of entry is also its portal of exit – THE HUMAN RESPIRATORY SYSTEM.

MODE OF TRANSMISSION
COUGHING AND SNEEZING
DROPLET NUCLEI OF TB BACTERIA

DIAGNOSTIC EXAM
TB SKIN TEST
TB BLOOD TEST

NURSING DIAGNOSIS
• Risk for infection related to inadequate primary defenses and lowered resistance.
• Ineffective airway clearance related to thick, viscous, or bloody secretions.
• Risk for impaired gas exchange related to decrease in effective lung surface.
• Activity intolerance related to imbalance between oxygen supply and demand.
• Imbalanced nutrition: less than body requirements related to inability to ingest adequate nutrients.

NURSING RESPONSIBILITY
Ensure That Patients Are Given the Correct Medication No Interruptions Occur In Treatment Identify
serious side-effects from the treatment
Monitor Improvement
PREVENTION

EBOLA
Definition
It is a fatal disease, a type of hemorrhagic fever, caused by the Ebola virus and marked by high fever,
severe gastrointestinal distress, and bleeding.

Causative Agents
Ebola virus disease (EVD; formerly known as Ebola hemorrhagic fever) is caused by infection with Ebola
virus which belongs to the family Filoviridae.

IncubationPeriod
2 TO 21 DAYS

Signs and Symptoms

● Fever
● Aches and pains
● Weakness and fatigue
● Sore throat
● Loss of appetite
● Abdominal pain, diarrhea, and vomiting
● Unexplained hemorrhaging, bleeding or bruising
● Red eyes, skin rash, and hiccups (late-stage).

Portal of Entry/Exit
Non intact skin, eyes, nose or mouth of an unprotected person
Blood and bodily fluid of the infected person carry the virus that may potentially escape from the body
with the mucous membranes of broken skin.

MOT
Direct contact with blood or bodily fluid of infected person
Contact with contaminated object.

Diagnostic Exam
• Antibody-capture enzyme-linked immunosorbent assay (ELISA)
• Antigen-capture detection tests
• Serum neutralization test
• Reverse transcriptase polymerase chain reaction (RT-PCR) assay
• Electron microscopy
• Virus isolation by cell culture.
Nursing Responsibilities
•Prevention of bleeding.
•Restoration of normal fluid and electrolyte balance.
•Prevention of shock.
•Relief from pain.
•Restoration of normal body fluid volume.

Medical Intervention
Ebola Zaire vaccine (Ervebo). Recombinant vesicular stomatitis virus-Zaire ebolavirus (rVSV-ZEBOV;
V920) is a replication-competent vaccine; it is genetically engineered to express a glycoprotein from
Zaire ebolavirus to provoke a neutralizing immune response to the Ebola virus; it is indicated for
prevention of disease caused by Zaire ebolavirus

Prevention
* A regular wash of hands with soap and water
* Avoid contact with blood and body fluids of people who are sick.
* Avoid contact with semen from a man who has recovered from EVD, until testing shows that the virus
is gone from his semen.
*Avoid contact with items that may have come in contact with an infected person’s blood or body fluids.
*Avoid funeral or burial practices that involve touching the body of someone who died from EVD or
suspect EVD.
*Avoid contact with bats, forest antelopes, and nonhuman primates’ blood, fluids, or raw meat
prepared from these or unknown animals.

Guillain-Barre Syndrome
Guillain-Barre Syndrome is an acute, rapidly progressive demyellination of peripheral nervous system
(preipheral nerves and some cranial nerves, producting ascending weakness of paralysis.

Nursing Assessment
• Ineffective breathing pattern and impaired gas
exchange related to rapidly progressive weakness and
impending respiratory failure
• Impaired bed and physical mobility related to paralysis
• Imbalanced nutrition, less than body requirements,
related to inability to swallow
• Impaired verbal communication related to cranial nerve
dysfunction
• Fear and anxiety related to loss of control and paralysis

Nursing Diagnosis
• Ineffective Breathing pattern
• Acute Pain
• Impaired Physical Mobility
• Impaired Urinary Elimination
• Anxiety
Diagnostic Exam
1. Health History
2. Musculoskeletal Examination
3. Nerve Test
4. Lumbar Puncture

Planning/Outcome Identification
• Client will maintain effective breathing pattern
• The patient rates pain as less tan 5 using Wong-Bakers pain
scale.
• Patient will have an improved strength and function of the
affected extremity.
• Patient will demonstrate the use of adaptive devices to
increase mobility.
• Client will establish routine urinary elimination patterns
• Family and the patient verbalize decreased feelings of anxiety.

Nursing Interventions
 Assess frequency, symmetry, and depth of breathing. Observed for increased work of breathing
and evaluate skin color, temperature, capillary refill.
 Observe for signs of respiratory fatigue such as shortness of breath, decreased attention span,
and impaired cough.
 Auscultate lung sounds for any changes and notifies the physician immediately.
 Assess oxygen saturation and review client’s arterial blood gases results.
 Keep the head of bed elevated at around 35-45°
 Perform chest physiotherapy which includes postural drainage, chest percussion, chest
vibration, turning, deep breathing and coughing exercises.
 Anticipate the need for mechanical ventilation as ordered.
 Suction secretions as appropriate, especially if the client is intubated or undergone a
tracheostomy.

Nursing Interventions
 Assess level of pain and ability to engage in activities.
 Identify the child’s perception of the word “pain” and inquire family members what word the
child uses at home; Utilize pain scale appropriate for the child’s age and developmental level.
 Administer analgesics based on pain assessment and respiratory status; Monitor side effect after
administration.
 Provide support to extremities and maintain clean, comfortable bed using egg-crate mattress
and padding to bony prominences as needed; Reposition client every 2 hours, use good postural
alignment, assist with passive ROM.
 Apply a moist warm compress to painful areas as needed.
 Reassure parents and child that pain diminishes as motor function slowly improve or resolved.
 Identify pain preventive measures around the clock; observe for behavioral and physiological
signs of pain.
 Assess motor strength or functional level of mobility.
 Monitor nutritional needs as they associate with immobility.
 Place the client in a position of comfort. Provide frequent position changes as tolerated.
  Administer heparin as ordered.
 Provide padding to bony prominences such as elbow and heels.
 Perform active, passive and isotonic range of motion exercises as appropriate.
 Evaluate the need for assistive devices and provide a safe environment e.g., bed in low position
and side rails up.
 Provide rest periods in between activities. Consider energy-saving techniques.
 Assist client and their families to establish goals in participation with activities, exercise and
position changes.
 Consider the need for home assistance (e.g., physical therapy and occupational therapy).

Medical Management
1. Intravenous immunoglobulin (IVIG)
 The most commonly used treatment for Guillain-Barré syndrome is intravenous
immunoglobulin (IVIG).
 When you have Guillain-Barré syndrome, the immune
 system (the body's natural defences) produces harmful antibodies that attack the
nerves.
 IVIG is a treatment made from donated blood that contains healthy antibodies. These
are given to help stop the harmful antibodies damaging your nerves.
 IVIG is given directly into a vein.
2. Plasma exchange (plasmapheresis)
 A plasma exchange, also called plasmapheresis, is sometimes used instead of IVIG.
 This involves being attached to a machine that removes blood from a vein and filters out
the harmful antibodies that are attacking your nerves before returning the blood to your
body.
 Most people need treatment over the course of around 5 days.

H1N1
H1N1 Influenza is a subtype of influenza A virus which causes upper, and potentially, lower respiratory
tract infections. Initially, H1N1 swine influenza is more common infection in pigs, thus called swine flu. In
2009, the virus emerged to infect humans and causing a global flu pandemic.

Causative Agents
Influenza A Virus subtype H1N1

INCUBATION
1 to 4 days on average

COMMUNICABILITY
1 day before symptoms develop and 5 to 7 days after symptoms

TRANSMISSION
person-to-person and in some cases pigs-to-humans
SYMPTOMS OF THE DISEASE
HEADACHE FEVER
BODY ACHE
CHILLS
COUGH
SORE THROAT
DIARRHEA
VOMITING

rRT-PCR Test

NURSING DIAGNOSIS
Ineffective airway clearance
Ineffective breathing pattern
Hyperthermia related to infection
Acute pain
Deficient knowledge

MEDCIAL ASSESSMENT
Advise patient to take lots of rest, oral hydration and manage symptoms with medication
NSAIDS for body pain
Antipyretics for fever
Antihistamine for nasal congestion
ANTIVIRAL DRUGS
Zanamivir
Oseltamivir
Peramivir

NURSING MANAGEMENT
Isolate the patient
Wear appropriate protective equipment
Encourage hand washing
Provide oxygenation
Administer antiviral medications
Prevent fluid loss
Monitor breathing pattern and chest movement
Assess for respiratory distress

PREVENTION
Surveillance
watch out for people with flu symptoms and assess its cause
Prevent spread
limit contact, cover mouth and nose, wash hands, take the flu shot
Swine Farming
follow health protocols and ensure that your pigs have their vaccinations
Vaccines
routine annual influenza vaccination for all persons aged 6 months or older
MULTIPLE SCLEROSIS
• Immune-mediated disease resulting in demyelination of the nerves of the CNS.
Causative Agent: unknown

Signs and Symptoms

Motor abnormalities:
Muscle weakness
*Spasticity
*Hyperreflexia
*Disrupted fine motor skills
*Positive Babinski sign
*Absent abdominal reflex

Sensory disturbances:
Dysesthesia
Hypoesthesia
Loss or impaired vibration
sense
Neuralgia
Lhermitte’s sign

Constitutional
symptoms:
fatigue
Headache

Ocular abnormalities:
* Optic or retrobulbar neuritis
* Internuclear ophthalmoplegia
* Hazy vision
*Central scotoma
*Painless loss of vision for hours or days
*Double vision
*Monocular vision

Motor abnormalities:
*Muscle weakness
*Spasticity
*Hyperreflexia
*Disrupted fine motor skills
*Positive Babinski sign
*Absent abdominal reflex

Brain stem/cerebellar
symptoms:
*Vertigo/dizziness
*Ataxia/impaired walking
*Loss of balance or coordination *Dysarthria
CARRIER/RESERVOIR
Anyone may develop MS but there are some patterns.

POTAL OF ENTRY/EXIT
MS occurs when the immune system attacks nerve fibers and myelin sheathing (a fatty substance which
surrounds/insulates healthy nerve fibers) in the brain and spinal cord. This attack causes inflammation,
which destroys nerve cell processes and myelin – altering electrical messages in the brain.

MODE OF TRANSMISSION
MS is not contagious or directly inherited.

DIAGNOSTIC EXAM
■ MRI scan
■ Optical coherence tomography (OCT).
■ Spinal tap (lumbar puncture)
■ Blood tests.
■ Visual evoked potentials (VEP) test

NSG RESPONSIBILITIES
To assist in creating an accurate diagnosis and monitor effectiveness of treatment and therapy. Assist
the patient during exercise and when performing activities of daily living.

MED-INTERACTION AND DRUG OF CHOICE

Ocrelizumab (Ocrevus)
• This humanized monoclonal antibody medication is the only DMT approved by the FDA to treat both
the relapse-remitting and primary-progressive forms of MS. Clinical trials showed that is reduced relapse
rate in relapsing disease and slowed worsening of disability in both forms of the disease.

PREVENTIONS
It can be totally prevented, as there are some risk factors for the condition that you cannot change, such
as your age and genetics. However, making some changes to your lifestyle can help reduce your risk of
developing MS.

DIABETES MELLITUS
Insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes mellitus, is a chronic autoimmune
condition where your pancreas produces little or no insulin, the crucial hormone that helps convert the
glucose in your bloodstream into fuel.

Insulin works like a key for the glucose, unlocking the cells so that the glucose can enter. Without insulin,
our cells can’t function, because the glucose remains locked out.

Signs and Symptoms

• Extreme thirst •Fatigue
• Increased hunger •Blurry vision
• Dry mouth •Heavy, labored breathing
• Upset stomach and vomiting
•Frequent infections of your skin, urinary tract, or vagina
• Frequent urination •Crankiness or mood changes
•Unexplained weight loss, even though you’re eating and feel hungry
•Bedwetting in a child who’s been dry at night

Signs of an emergency with type 1

diabetes include:
•Shaking and confusion
•Rapid breathing
•Fruity smell to your breath
•Belly pain
•Loss of consciousness

High blood sugar can harm the eyes, nerves, and kidneys.

Diabetic dermopathy: Pathognomonic of diabetes mellitus

Diabetic dermopathy is a condition of multiple hyperpigmented depressed, sometimes linear macules
characteristically presenting on the shins of diabetic patients.

TYPE 1 DIABETES RISK FACTORS

VIRAL INFECTIONS
Researchers have found that certain viruses may trigger the development of type 1 diabetes by causing
the immune system to turn against the body—instead of helping it fight infection and sickness. Viruses
that are believed to trigger type 1 include: German measles, coxsackie, and mumps.
FAMILY HISTORY
As with many health conditions, having a family history of type 1 diabetes may increase the risk of
developing type 1 diabetes. People who have a parent or diabetes may be at an increased risk.
GEOGRAPHY
The number of people who have type 1 diabetes tends to be higher as you travel away from the
equator. Very rarely, type 1 diabetes can be triggered by an injury or trauma to the pancreas.
INJURY TO OR REMOVAL OF THE PANCREAS.
Whenever the pancreas is surgically removed, the body also loses the ability to produce insulin, which
then causes type 1 diabetes.

DIAGNOSTIC EXAM

Glycated Hemoglobin (A1C) Test.

This test, also called HbA1C or glycated hemoglobin test, provides your average blood glucose level over
the past two to three months. This test measures the amount of glucose attached to hemoglobin, the
protein in your red blood cells that carries oxygen. You don’t need to fast before this test.
Random Blood Sugar Test.
A blood sample will be taken at a random time and may be confirmed by additional tests.
Fasting Blood Sugar Test
This test is best done in the morning after an eight hour fast (nothing to eat or drink except sips of
water).
NURSING RESPONSIBILITIES
-Educate patient about diabetes
-Educate patient on foot protection
-Examine feet and skin and teach patient foot care
-Monitor blood sugar and use a sliding scale to treat high levels of glucose
-Monitor vitals -Teach patient about insulin self-injections and how to perform fingerstick
-Encourage annual visits to the dentist, ophthalmologist, cardiologist, and neurologist -Teach the patient
about hypoglycemia and how to manage it.
-Teach patient about nutrition and importance of exercise.
-Urge the patient not to smoke and to abstain from alcohol

MEDICAL MANAGEMENT
A. INSULIN THERAPY
Insulin therapy is an essential part of the treatment of diabetes; The goal of taking insulin is to keep your
blood sugar level in a normal range as much as possible. Keeping blood sugar in check helps you stay
healthy.

Insulin and other Medications

There are many types of insulin, including:
• Short-acting insulin.
• Rapid-acting insulin.
• Intermediate-acting insulin.
• Long- and ultra-long-acting insulin.

B. DIET
Current dietary management of diabetes emphasizes a healthy, balanced diet that is high in
carbohydrates and fiber and low in fat.

C. ACTIVITY
Type 1 diabetes mellitus requires no restrictions on activity; exercise has real benefits for a child with
diabetes; current guidelines are increasingly sophisticated and allow children to compete at the highest
levels in sports.

D. CONTINUOUS GLUCOSE MONITORING

The American Diabetes Association’s Standards of Medical Care in Diabetes-2018 recommend
consideration of continuous glucose monitoring for children and adolescents with type 1 diabetes,
whether they are using injections or continuous subcutaneous insulin infusion, to aid in glycemic
control.

DIABETES PREVENTION: 5 TIPS FOR TAKING CONTROL

Type 1 diabetes can't be prevented. But the healthy lifestyle choices that help treat prediabetes, type 2
diabetes and gestational diabetes can also help prevent them:
A. Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits,
vegetables and whole grains. Eat a variety to keep from feeling bored.
B. Get more physical activity. Try to get about 30 minutes of moderate aerobic activity on most
days of the week. Or aim to get at least 150 minutes of moderate aerobic activity a week. For
example, take a brisk daily walk. If you can't fit in a long workout, break it up into smaller
sessions throughout the day.
 C. Lose excess pounds. If you're overweight, losing even 7% of your body weight can lower the risk
of diabetes.

What is a Crohn’s Disease?

Crohn’s disease is an subacute and chronic inflammation of the GI tract wall that extends through all
layers (i.e., transmural lesion). Although its characteristic histopathologic changes can occur anywhere in
the GI tract, it most commonly occurs in the distal ileum and, to a lesser degree, the ascending colon. It
is characterized by periods of remission and exacerbation.

CAUSATIVE AGENT
There's no evidence that any contagious diseases or pathogens cause Crohn's disease, or that Crohn's
disease itself is contagious. You can't catch it from another person or an animal. Crohn's disease has a
complex set of causes that can trigger its development.

INCUBATION PERIOD
There's no evidence that any contagious diseases or pathogens cause Crohn's disease and studies are
still ongoing to know more about disease.

SIGNS AND SYMPTOMS

Signs and symptoms of Crohn's disease can range from mild to severe. They usually develop gradually,
but sometimes will come on suddenly, without warning. You may also have periods of time when you
have no signs or symptoms (remission).
When the disease is active, symptoms typically include:
• Diarrhea
• Fever
• Fatigue
• Abdominal pain and cramping
• Blood in your stool
• Mouth sores
• Reduced appetite and weight loss
• Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula)

PORTAL OF ENTRY/EXIT
It was already stated that this disease still has unknown cause, thus, the portal of entry and exit is
unclear.

MODE OF TRANSMISSION
There’s no known cause of Crohn’s disease. Certain factors may increase your risk of developing the
condition, including:
• Autoimmune disease: Bacteria in the digestive tract may cause the body’s immune system to attack
your healthy cells.
• Genes: Inflammatory bowel disease (IBD) often runs in families. If you have a parent, sibling or other
family member with Crohn’s, you may be at an increased risk of also having it. There are several specific
mutations (changes) to your genes that can predispose people to developing Crohn’s disease.
• Smoking: Cigarette smoking could as much as double your risk of Crohn’s disease.
DIAGNOSTIC EXAM
o BLOOD TESTS. Your doctor may suggest blood tests to check for anemia — a condition in which there
aren't enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of
infection.
o STOOL STUDIES. You may need to provide a stool sample so that your doctor can test for hidden
(occult) blood or organisms, such as parasites, in your stool.
o COLONOSCOPY. This test allows your doctor to view your entire colon and the very end of your ileum
(terminal ileum) using a thin, flexible, lighted tube with a camera at the end. During the procedure, your
doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help to make a
diagnosis. Granulomas, if present, help essentially confirm the diagnosis of Crohn’s.
o COMPUTERIZED TOMOGRAPHY (CT). You may have a CT scan — a special X-ray technique that
provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues
outside the bowel. CT enterography is a special CT scan that provides better images of the small bowel.
This test has replaced barium X-rays in many medical centers.
o MAGNETIC RESONANCE IMAGING (MRI). An MRI scanner uses a magnetic field and radio waves to
create detailed images of organs and tissues. MRI is particularly useful for evaluating a fistula around the
anal area (pelvic MRI) or the small intestine (MR enterography).

NURSING DIAGNOSES
✔Diarrhea
✔ Acute pain
✔ Deficient fluid volume
✔ Imbalanced nutrition, less than body requirements
✔ Activity intolerance
✔ Anxiety
✔ Ineffective individual coping
✔ Risk for impaired skin integrity
✔ Risk for ineffective management of therapeutic regimen

NURSING RESPONSIBILITY
❑ Maintaining Normal Elimination Patterns
❑ Relieving Pain
❑ Maintaining Fluid Intake
❑ Maintaining Optimal Nutrition
❑ Promoting Rest
❑ Reducing Anxiety
❑ Enhancing Coping Measures
❑ Preventing Skin Breakdown
❑ Monitoring and Managing Potential Complications

MEDICAL MANAGEMENT
Medical treatment for both Crohn’s disease and ulcerative colitis is aimed at reducing inflammation,
suppressing inappropriate immune responses, providing rest for a diseased bowel so that healing may
take place, improving quality of life, and preventing or minimizing complications.
PREVENTION
 If your family has a history of Crohn’s Disease, check and study the concept and all aboutness of
the disease.
 Know your partner and family history/genomics
 Self-care

WHAT IS APPENDICITIS?
Inflammation of your appendix, a finger-like pouch attached to your large intestine.

INCUBATION PERIOD
❑ Usually within the first 24 hours. Signs can appear anywhere from four to 48 hours after a problem
occurs.

DIAGNOSTIC EXAM:
1. Physical exam
2. Blood test
3. Urine test
4. Imaging test

CLINICAL MANIFESTATIONS
•Sudden pain that begins on the right side of the lower abdomen
•Sudden pain that begins around your navel and often shifts to your lower right abdomen
•Pain that worsens if you cough, walk or make other jarring movements
•Nausea and vomiting
•Loss of appetite
•Low-grade fever that may worsen as the illness progresses
•Constipation or diarrhea
•Abdominal bloating
•Flatulence

NURSING DIAGNOSES
• Pain
• Anxiety
• Infection
• Fluid volume deficit

MEDICAL MANAGEMENT
• Surgery (conventional or laparoscopic) is indicated if appendicitis is diagnosed and should be
performed as soon as possible to decrease risk of perforation.
• Administer fluids until surgery is performed.
• Analgesic agents can be given after diagnosis is made
NURSING MANAGEMENT

Nursing goals include relieving pain, preventing fluid volume deficit, reducing anxiety, eliminating
infection due tothe potential or actual disruption of the GI tract, maintaining skin integrity, and attaining
optimal nutrition

Do not administer an enema or laxative (could cause perforation).

Postoperatively, place patient in high Fowler’s position, give narcotic analgesic as ordered, administer
oral fluids when tolerated, give food as desired on day of surgery (if tolerated). If dehydrated before
surgery, administer IV fluid

If a drain is left in place at the area of the incision, monitor carefully for signs of intestinal obstruction,
secondary hemorrhage, or secondary abscesses (eg, fever, tachycardia, and increased leukocyte count)

Peritonitis
In peritonitis, the peritoneum, a serous sac lining the abdominal cavity, becomes inflamed. Peritonitis
may be caused by perforation of a peptic ulcer, the bowel, or the appendix; abdominal trauma, such as
gunshot or knife wounds; IBD; ruptured ectopic pregnancy; or infection introduced during peritoneal
dialysis, a procedure used to treat kidney failure.

Causative Agents and Incubation Period

Escherichia coli - 3-4 days after the exposure, but may be as short as 1 day or as long as 10 days.
Klebsiella - 1-3 weeks
Proteus - 1-3 days
Pseudomonas -Usually 24-72 hours

Signs and Symptoms

• Symptoms include severe abdominal pain, distention, tenderness, nausea, and vomiting.
• Fever
• Abdominal pain
• The abdomen feels rigid and board like as it distends with gas and intestinal contents.
• Bowel sounds typically are absent.
• Severe weakness, hypotension, and a drop in body temperature.

Portal of Entry/Exit
Escherichia coli - Urinary Tract
Klebsiella - Respiratory Tract
Proteus - Enters the body through wounds
Pseudomonas - Urinary Tract

Escherichia coli - • Urethral meatus • Urinary Diversion ostomies

Klebsiella - • Nose and mouth sneezing, coughing, beathing or talking • Endotracheal tubes, tracheostomies
Pseudomonas - • Urethral meatus • Urinary Diversion ostomies
Mode of Transmission
Escherichia coli - Urine
Klebsiella - Airborne droplets from sneezing or coughing
Proteus - Catheterization
Pseudomonas - Urine

Diagnostic Exam
The results of a WBC count show marked leukocytosis. Abdominal radiographs reveal free air and fluid in
the peritoneum. A CT scan or ultrasonography identifies structural changes in abdominal organs.
Cultures of peritoneal fluid and blood usually reveal bacteria such as Escherichia coli, Klebsiella, Proteus,
and Pseudomonas. If untreated, clients develop sepsis and septic shock, which, if untreated, can lead to
death.

Nursing Diagnoses
• Acute pain related to increased peristalsis and GI inflammation
• Activity intolerance related to generalized weakness
• Anxiety related impending surgery
• Deficient knowledge concerning the process and management of the disease

Nursing Responsibility
The nurse monitors the acutely ill client while completing preparations for diagnostic tests or surgery.
He or she administers analgesics and infuses IV fluids with secondary administrations of antibiotics. If
ordered, a nurse passes a nasogastric tube and connects it to suction. The client may need a urinary
retention catheter. The nurse assesses the circulatory status by taking vital signs frequently and
monitoring central venous and pulmonary artery pressures.

For the client who has had surgery, the nurse assesses the client’s vital signs, fluid balance, incision,
dressing, and drains. Assessing the client’s pain level is important, as is medicating according to the
medical orders. For clients who have prolonged recovery time, TPN may be initiated.

For the client who has had surgery, the nurse assesses the client’s vital signs, fluid balance, incision,
dressing, and drains. Assessing the client’s pain level is important, as is medicating according to the
medical orders. For clients who have prolonged recovery time, TPN may be initiated.

Clients are fearful of the emergent nature of the peritonitis and subsequent surgery. The nurse provides
frequent explanations and emotional support. Clients also need monitoring for continued abdominal
infection. If the client experiences abdominal distention, fever, changes in level of consciousness, or
deviations in vital signs, the nurse must notify the physician quickly.

Medical Management
A nasogastric tube is used to relieve abdominal distention by suctioning the accumulated gas and
stagnant upper GI fluids. IV fluids and electrolytes replace substances relocated in the peritoneal cavity
and lost through vomiting and drainage from gastric intubation. Large doses of antibiotics are prescribed
to combat infection. Analgesics such as meperidine (Demerol) or IV morphine sulfate are ordered to
relieve pain and promote rest. Antiemetics are prescribed for nausea and vomiting. The perforation is
surgically closed so that intestinal contents can no longer escape.
Prevention
• Wash hands including the areas between fingers and under fingernails, before touching the catheter.
• Wear a mouth/nose mask during exchanges.
• Observe the proper sterile exchange technique.
• Clean the skin around the catheter daily.

Prevention
• Other considerations:
❑ Seeking help for alcohol use disorder
❑ Using condoms or other barrier methods
❑ Limiting use of nonsteroidal anti-inflammatory drugs (NSAIDs)
❑ Getting prompt treatment if symptoms of appendicitis is
present.

INFLAMMATORY BOWEL DISEASE

it is defined as a chronic intestinal inflammation that results from host microbial interactions in a
genetically susceptible individual. IBDs are a group of autoimmune diseases that are characterized by
inflammation of both the small and large intestine, in which elements of the digestive system are
attacked by the body's own immune system.

ULCERATIVE COLITIS
Ulcerative colitis is a recurrent ulcerative and inflammatory disease of the mucosal and submucosal
layers of the colon and rectum. It is a serious disease, accompanied by systemic complications and a
high mortality rate; approximately 5% of patients with ulcerative colitis develop colon cancer. It is
characterized by multiple ulcerations, diffuse inflammations, and desquamation or shedding of the
colonic epithelium, with alternating periods of exacerbation and remission.

SYNONYMS OF ULCERATIVE COLITIS

 Chronic Non-Specific Ulcerative Colitis
 Colitis Gravis
 Idiopathic Non-Specific Ulcerative Colitis
 Inflammatory Bowel Disease (IBD), Ulcerative Colitis Type
 Proctocolitis, Idiopathic

CAUSATIVE AGENT
The exact cause of ulcerative colitis remains unknown.
Possible causes are:
1. Immune System Malfunction
2. Heredity
3. Environmental Triggers

Incubation Period
Symptoms most often start between the ages of 15 and 30. The second most common period for onset
is between the ages of 50 and 70.
SIGNS AND SYMPTOMS

Portal of Entry/Exit
The inflammation in ulcerative colitis usually starts in the rectum, which is close to the anus (where
poop leaves your body). The inflammation can spread and affect a portion of, or the entire colon. When
the inflammation occurs in the rectum and lower part of the colon it is called ulcerative proctitis. If the
entire large intestine is affected it is called pancolitis. If only the left side of the colon is affected it is
called limited or distal colitis.

Mode of Transmission
Ulcerative colitis is not contagious. Some causes of colitis or inflammation in the colon can be
contagious, though. That includes inflammation caused by bacteria and viruses. However, ulcerative
colitis is not caused by anything that can be transmitted to another person.

DIAGNOSTIC EXAM
Sigmoidoscopy
A diagnosis of ulcerative colitis can be confirmed by examining the level and extent of bowel
inflammation.
Colonoscopy
One method that doctors use to diagnose Ulcerative Colitis. This test looks at the full length of your
large intestine.
Stool sample test.
Some stool tests check for any abnormal bacteria in your digestive tract that may cause diarrhea and
other problems. To do this, a small stool sample is taken and sent to a lab.
Upper endoscopy.
This is also called EGD or esophagogastroduodenoscopy. This test looks at the inside or lining of your
food pipe (esophagus), stomach, and the top part of your small intestine (duodenum). They can also
take a small tissue sample (biopsy) if needed.

Lower GI (gastrointestinal) series.

This is also called a barium enema. This is an X-ray exam of your rectum, the large intestine, and the
lower part of your small intestine (the ileum).

Blood tests.
No blood test can diagnose or rule out ulcerative colitis. But some blood tests can help to monitor the
disease. It can show if you have anemia or inflammation.

NURSING DIAGNOSES
 Diarrhea related to inflammatory process
 Acute pain related to increased peristalsis and gastrointestinal inflammation
 Deficient fluid volume related to anorexia, nausea, and diarrhea
 Imbalanced nutrition, less than body requirements, related to dietary restrictions, nausea, and
malabsorption
 Activity intolerance related to generalized weakness
 Anxiety related to impending surgery
 Ineffective individual coping related to repeated episodes of diarrhea
 Risk for impaired skin integrity related to malnutrition and diarrhea
 Risk for ineffective management of therapeutic regimen related to insufficient knowledge
concerning process and management of disease

NURSING RESPONSIBILITIES
Relieve Pain
 Treat, pain, if in hospital, or provide the individual with the appropriate methods to deal with
pain - some foods are good at avoiding aggravation of inflammation
 Provide patient with the appropriate pharmacological pain management options depending on
the stage of disease, and treatment being done
 Provide the patient with various non-pharmacological methods of pain management

Care Coordination
 Assist with the coordination of care, or obtaining resources for medication coverage, as some
medications are quite expensive
 Coordinate patient with various groups within the community that provide support for patients
with ulcerative colitis
 Put patient in contact with the appropriate dietitian to assist with detailed nutritional
counselling

Provide Emotional Support

 Promote patient to express thoughts and feelings about diagnosis and current therapeutic
regimen
 Discuss ways to decrease stressors in life
 Teach the patient about the disease process, and various treatment options
MEDICAL INTERVENTION
Aminosalicylate - often effective for mild or moderate inflammation and are used to prevent or reduce
recurrences in long-term maintenance regimens.
 Sulfasalazine (Azulfidine)
Antibiotics – used for secondary infections, particularly for purulent complications such as abscesses,
perforation, and peritonitis.
 Metronidazole
Newer sulfa-free aminosalicylates - have been developed and shown effective in preventing and
treating recurrence of inflammation
 Mesalamine [Asacol, Pentasal]
Oral Corticosteroids – can be administered orally in outpatient treatment or parentally in hospitalized
patients.
 Prednisone
Topical Cortecosteroids – widely used in the treatment of distal colon disease.

Immunomodulators – used to alter the immune response.

 Azathioprene
 6-mercaptopurine
 Methotrexate
 Cyclosporin

PREVENTION
 NOT DRINKING CARBONATED DRINKS
 NOT EATING HIGH-FIBER FOODS SUCH AS POPCORN, VEGETABLE SKINS, AND NUTS WHILE YOU
HAVE SYMPTOMS
 EATING MORE FREQUENT, SMALLER MEALS
 DRINKING MORE LIQUIDS
 KEEPING A FOOD DIARY THAT IDENTIFIES FOODS THAT CAUSE SYMPTOMS