St.

Paul University Dumaguete

(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

HEALTH TEACHING PLAN

Topic: Animal Bite and Rabies Exposure

Participants: Out-Patient Department (OPD)

Goal: After 2 hours of health education and nursing interventions, the patient will be able to have sufficient knowledge, raise awareness to family
and others; apply the proper hand hygiene, sanitation, management, aid in medication and vaccines until proper treatment is given.

Learning Objectives Content Outline Method of Time frame Instructional Methods of

Instruction (in minutes) Resources Evaluation

Following the 2 hours Opening Prayer Visual Aids 3 mins. Laptop, WiFi Observation
of nursing Extension,
interventions, the The student nurse will PowerPoint, The student nurse will
patient will be able to: have the prayer Video, Animation observe if the patient
through a video with / without
animation. significant other is
praying as we play
the video.

Energizer (Family Visual Aids 7 mins Laptop, WiFi Observation

Zumba Dance) Extension,
The student nurse will PowerPoint, The student nurse will
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

give a simple Video, Animation observe if the patient,

energizer to the with or without
patient as it is being significant other is
displayed and lead doing the virtual
upon the student energizer as
nurse. it follows and dances
the music on the
animated video.

Get to know Each Visual Aids

other Activity 5 mins Any recycled paper Observation
The student nurse uses and bowl
different papers placed Question and Answer
in a bowl. The patient
would write any The student nurse will
information or ask questions to verify
question he / she has and observe the
for the student nurse patient / significant
to find the queries, other as simply,
concerns and build asking, (what are they
rapport. feeling right now, or
how are they, concerns
or queries) and the
communication within
the activity.

Cognitive Domain: I. Animal Bites and Lecture Discussion Laptop, WiFi Question and Answer
5 mins
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

1. Define of Animal Rabies Exposure (The student nurse Extension, The student nurse will
Bites and Rabies will discuss about the PowerPoint, ask the learners what
Exposure A. Definition definition, Video, Animation, they know about
B. Transmission transmission and Pamphlet animal bites and rabies
C. Clinical clinical manifestations exposure in order to
Manifestation of animal bites and know to what extent
rabies exposure with the learners currently
visual aids.) know about the topic.

Let the learners raise

their hand freely and
ask their opinion.

II. Categories of Lecture Discussion Laptop, WiFi Question and Answer

2. Describe and show Rabies Exposure and Visual aids 10 mins Extension,
the categories of (animations, videos) PowerPoint, The student nurse
rabies exposure Video, Animation, should interact to the
A. Categories The student nurse Pamphlet learners and ask some
will elaborate how the easy questions to
rabies exposure assess the learning
transcends with the they have obtained.
help of visual The questions are
aids and provided related to (pamphlet)
pamphlet. the rabies exposure
transcends.

3. Identify the III. Identify the Lecture Discussion, Laptop Question and Answer
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

medication and treatment and Visual Aids, with 10 mins Extension

treatment medication images of the WiFi Game
medication and WiFi Extension
A. Medication treatment displayed. PowerPoint The student nurse may
Pamphlet ask the patient and
B. Treatment Videos significant others
Animations some
questions to assess if
they are attentively
listening and what
they have learn
through a visual game
(knowing about the
medication and
treatment).
Affective Domain: IV. Awareness: Do's Lecture-Discussion, Laptop Question and Answer
and Don't for Animal Visual Aids and 10 mins Extension
4. Gain the bites and Rabies Computer based WiFi Game
awareness and Exposure method game WiFi Extension
importance of the PowerPoint The student nurse may
Do's and Don't for A. Do’s and Dont’s The student nurse will Pamphlet ask the patient and
Animal bites and enumerate the do’s Videos significant other some
Rabies Exposure and don't s for animal Animations questions to assess if
bites and rabies they have gained
exposure knowledge within the
with visual aids Do’s and Don’t.
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

and provide hand out.

5.Aid the self, each

family members and
others

Psychomotor Domain: V. Proper Sanitation Lecture Discussion 1 hour (60 mins) Laptop Question and Answer
Extension
6. Demonstrate proper A. Hand washing / Audio and visual aids WiFi Return Demonstration
sanitation and hygiene Hand hygiene (animation and WiFi Extension
videos) PowerPoint The student nurse may
Pamphlet ask the patient and
The student nurse will Videos significant others
demonstrate the Animations some questions to
proper hygiene and assess
sanitation with a video what they have
presentation. learned
throughout the
discussion as
evaluated with the
guidance of the
student nurse.
Finalization Visual Aids 5 mins Laptop Question and Answer
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

The student nurse will Extension The student nurse will

use a video animation WiFi ask and know on what
where the topic will WiFi Extension the patient and
be summarized and to PowerPoint significant other have
check on the patient Pamphlet learn, may
and significant other. Videos ask questions,
Animations clarifications,
verification and the
like.
Closing Prayer Visual Aids 5 mins Laptop, WiFi Observation
Extension,
(The student nurse PowerPoint, The student nurse will
will have the prayer Video, Animation observe if the patient
through a video and significant other
animation.) are praying as we play
the video.

HEALTH TEACHING PLAN CONTENT

 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

I. Animal Bites and Rabies Exposure

A. Definition

Animal bites pose a first-rate public fitness hassle in kids and adults worldwide. The fitness influences of animal bites are depending on
the sort and fitness of the animal species, the dimensions and fitness of the bitten person, and accessibility to suitable fitness care. Numerous
animal species have the capability to chunk humans; but the maximum crucial are the ones springing up from snakes, dogs, cats and monkeys.
Animal bites and scratches, even when they are minor, can become infected and spread bacteria to other parts of the body. Whether the bite is
from a family pet or an animal in the wild, scratches and bites can carry disease. Cat scratches, even from a kitten, can carry "cat scratch
disease," a bacterial infection. Other animals can transmit rabies and tetanus (John Hopkins Hospital, 2022).
Bites that break the skin are even more likely to become infected.Most states require that animal bites be reported. Therefore, the person
bitten will be asked to fill out a form with information about the bite or asked specific questions for reporting purposes when medical care is
sought. Aside from simple data collection, this can be important in cases of rabies cases to help officials track location(s) and monitor a possible
spread of the disease. Rabies is a preventable viral disease most often transmitted through the bite of a rabid animal. The rabies virus infects the
central nervous system of mammals, ultimately causing disease in the brain and death. The vast majority of rabies cases reported to the Centers
for Disease Control and Prevention (CDC) each year occur in wild animals like bats, raccoons, skunks, and foxes, although any mammal can get
rabies where the person is exposed to (CDC, 2023).
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

B. Transmission

People usually get rabies from the bite of a rabid animal. People with rabies can also get rabies from contact with non-bite bites, but this
can include scratches, abrasions, or open wounds from contact with saliva or potentially dangerous materials. other infections from animals
infected with rabies. Other forms of exposure, such as petting an animal with rabies or contact with the blood, urine, or feces of a rabid animal,
are not associated with an increased risk of infection and are not considered significant exposures. concerned with rabies. Other forms of
transmission, other than bites and scratches, are rare. Inhalation of aerosol rabies virus is a potential non-bite route of exposure, but with the
exception of laboratory workers, most people will not encounter aerosol rabies virus. Rabies transmission through corneal and solid organ
transplantation has been reported, but is also very rare. Since 2008, only two solid organ donors with rabies are known. Many organ procurement
organizations have added a rabies exposure screening question to their screening process to assess individual donor suitability (CDC, 2023).
Bites and bites of infected people could theoretically transmit rabies, but no such cases have been recorded. Casual contact, such as
touching a person with rabies or contact with non-infectious fluids or tissues (urine, blood, feces), is not associated with an increased risk of
infection. Contact with a person vaccinated against rabies does not constitute rabies exposure, does not pose a risk of transmission, and does not
require post-exposure prophylaxis.The rabies virus becomes non-infectious as it dries and when exposed to sunlight. Different environmental
conditions affect the rate at which a virus becomes inactivated, but in general, if virus-containing material dries, the virus can be considered non-
infectious (Mayo Clinic, 2023).

C. Clinical Manifestation
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

Rabies virus causes an acute encephalitis in all warm-blooded hosts and the outcome is almost always fatal. The first symptoms of rabies
may be nonspecific and include lethargy, fever, vomiting, and anorexia. Signs progress within days to cerebral dysfunction, cranial nerve
dysfunction, ataxia, weakness, paralysis, seizures, difficulty breathing, difficulty swallowing, excessive salivation, abnormal behavior,
aggression, and/or self-mutilation. People usually get rabies from the bite of a rabid animal. It is also possible, but rare, for people to get rabies
from non-bite exposures, which can include scratches, abrasions, or open wounds that are exposed to saliva or other potentially infectious
material from a rabid animal. Other types of contact, such as petting a rabid animal or contact with the blood, urine or feces of a rabid animal,
are not associated with risk for infection and are not considered to be exposures of concern for rabies.
The first symptoms of rabies are similar to those of the flu: fever, headache, and general malaise. As the disease progresses, the person
may experience delirium, abnormal behavior, and hallucinations, as well as the well-known hydrophobia and foaming at the mouth (related to
paralysis of the swallowing muscle). However, it's important to note that rabies symptoms can vary widely, meaning not everyone will
experience all (or even many) of the typical symptoms (CDC, 2023).

What are the symptoms of rabies in humans?

May have no symptoms of rabies for several weeks after it enters your body. When rabies makes it to your central nervous system
(prodromal phase), you experience flu-like symptoms. In the final stages, you have neurological (brain) symptoms

Prodromal symptoms of rabies

 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

 Fever.
 Tiredness (fatigue).
 Bite wound burning, itching, tingling, pain or numbness.
 Cough.
 Sore throat.
 Muscle pain.
 Nausea and vomiting.
 Diarrhea.

Acute neurologic symptoms of rabies

Neurological symptoms of rabies are either furious or paralytic. Furious rabies symptoms may come and go with periods of calm in between
(furious episodes).

Furious rabies symptoms

 Agitation and aggression.

 Restlessness.
 Seizures.
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

 Hallucinations.
 Muscle twitching (fasciculations).
 Fever.
 Racing heart (tachycardia).
 Fast breathing (hyperventilation).
 Excessive salivation.
 Two different-sized pupils (anisocoria).
 Facial paralysis (facial palsy).
 Fear of water/drinking (hydrophobia).
 Fear of air being blown in your face/drafts (aerophobia).
 Delirium.

Paralytic rabies symptoms

 Fever.
 Headache.
 Neck stiffness.
 Weakness, especially starting from the body part that was bitten and progressing to other body parts.
 Tingling, “pins and needles” or other strange sensations.
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

 Paralysis.
 Coma.

Signs of rabies in animals

Signs of rabies in animals are similar, with behavioral changes (aggressive or wild animals becoming tame and calm, or calm animals
becoming aggressive aggressive), paralysis or partial paralysis in many cases, speech abnormalities (dog barking strangely), animals attacking
inanimate objects (such as biting rocks or trees), hydrophobia and foaming edge, among other things. However, rabies in animals is even more
difficult to diagnose without laboratory tests, as the signs can vary widely from case to case. One thing is for sure, all cases of rabies will
eventually lead to death in the presence of the above symptoms.

II. Categories of Rabies Exposure

A. Categories

Category I Contact with animal, or licks on intact skin No exposure

Nibbles on exposed skin

Category II Minor exposure
Minor bite(s) or scratch(es) without bleeding
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

Transdermal bite(s) or scratch(es)

Licks on broken skin
Category III Contamination of mucous membranes by animal’s Severe exposure
saliva (licks)
Direct contact with bats.

Post-exposure prophylaxis is carried out for Category II and III exposures.

Bite
Any penetration of the skin by teeth constitutes a bite exposure. All bites, regardless of body site, represent a potential risk of rabies
transmission, but that risk varies with the species of biting animal, the anatomic site of the bite, and the severity of the wound. Bites by some
animals, such as bats, can inflict minor injury and thus be difficult to detect.

Nonbite
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

The contamination of open wounds, abrasions, mucous membranes, or theoretically, scratches (potentially contaminated with infectious
material from a rabid animal) constitutes a nonbite exposure. Nonbite exposures from terrestrial animals rarely cause rabies. However,
occasional reports of rabies transmission by nonbite exposures suggest that such exposures should be evaluated for possible postexposure
prophylaxis administration. Other contact by itself, such as petting a rabid animal and contact with blood, urine, or feces of a rabid animal, does
not constitute an exposure and is not an indication for postexposure vaccination (Web MD, 2023).

III. Identify the treatment and medication

A. Medication

There is no approved treatment for rabies when you have symptoms. If you have been exposed to rabies (if you were bitten or exposed to
an infected animal), contact a health care provider as soon as possible. Clean the wound gently but thoroughly with soap and water. Ask your
provider for further instructions on how to clean the wound. The doctor will give you a series of shots (vaccines) to prevent the virus that causes
rabies. They will also give you antibody treatment directly on the wound if you have never been vaccinated before. If you have been bitten or
scratched by a wild animal, you can take steps to prevent rabies. Medicines to prevent infection from spreading to your brain if you have been
exposed to rabies (post-exposure prophylaxis/PEP). These drugs are usually combined: Rabies vaccine. The healthcare provider will give you
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

four shots in 14 days. If you were vaccinated before exposure, you will only need two shots. The vaccine teaches your body to destroy the rabies
virus before it enters your brain. Human Rabies Immune Globulin (HRIG). Your provider will inject you around the wound. HRIG gives you
antibodies (infection-fighting molecules) that will kill the virus near the wound until your body picks it up. You should not receive HRIG if you
were vaccinated prior to exposure.

Side effects of rabies treatment:

 May have mild side effects from rabies vaccine
 Pain, itching, or swelling where you were given the shot.
 Nausea.
 Headache.
 Muscle pain.
 Dizziness.

B. Treatment

Once a rabies infection is established, there's no effective treatment. Though a small number of people have survived rabies, the disease
usually causes death. For that reason, if you think you've been exposed to rabies, you must get a series of shots to prevent the infection from
taking hold. If you've been bitten by an animal that is known to have rabies, you'll receive a series of shots to prevent the rabies virus from
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

infecting you. If the animal that bit you can't be found, it may be safest to assume that the animal has rabies. But this will depend on several
factors, such as the type of animal and the situation in which the bite occurred.

Rabies shots include:

 A fast-acting shot (rabies immune globulin) to prevent the virus from infecting you. This is given if you haven't had the rabies vaccine. This
injection is given near the area where the animal bit you if possible, as soon as possible after the bite.
 A series of rabies vaccinations to help your body learn to identify and fight the rabies virus. Rabies vaccinations are given as injections in
your arm. If you haven't previously had the rabies vaccines, you'll receive four injections over 14 days. If you have had the rabies vaccine,
you'll have two injections over the first three days (CDC, 2022).

IV. Awareness: Do's and Don't for Animal bites and Rabies Exposure

A. Do’s and Dont’s

What can be done to prevent rabies?

 Vaccinate pets against rabies

 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

 Avoid contact with potentially rabid animals

 Avoid contact with all stray dogs and stray cats, as well as wild animals.
 Do not handle, feed or attract wild animals by leaving trashcans uncovered. Never “adopt” a wild animal.
 Avoid contact with any animal that is acting abnormally and displaying signs of rabies such as the following:
 Pets acting withdrawn
 Wildlife acting unusually friendly or calm
 Animals acting unusually aggressive, potentially snapping or lunging at anything in their path
 Animals active in the daytime that normally only appear at night
 Animals demonstrating difficulty swallowing and excessive salivation (drooling)
 Animals that are fearful of water or light
 Animals searching for an isolated place to die

What to Do?
Call 911 if:
The person is seriously injured in an animal attack.
1. Stop Bleeding
Apply sustained pressure for several minutes.
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

2. Clean Wound
Wash with clean water and gentle soap for 15 minutes.

3. Gather Information About Animal

Notify the local health department or animal control about the animal's possible whereabouts.
If the animal is a pet, get owner's contact information.

4. See a Healthcare Provider Immediately

Do not wait for symptoms to appear.
If possible, bring information about the animal.
If the person was in an enclosed area with a bat, see a healthcare provider whether or not there is a bite wound. The person may have been bitten
and not know it.

5. Follow Up
If there is any risk of rabies infection, the healthcare provider will recommend anti-rabies treatment. This may include a series of shots.
The person may require a tetanus shot, depending on the date of the last shot.

What you shouldn’t do are?

 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

 Rabies is incurable: If you allow a rabies infection to become established, there is no effective treatment and rabies is always life-
threatening when left untreated. But there is a slim chance of survival after a rabies infection, and the key is getting immediate treatment
with a series of shots that prevent the infection from taking hold.

 Washing a dog bite wound won’t work: According to the World Health Organization, one of the best things to do after a dog bite is to
wash the wound immediately and thoroughly to limit your chances of getting rabies. But washing alone isn’t enough to treat rabies. Seek
urgent medical care, including post-exposure vaccinations (WHO, 2023).

V. Proper Sanitation / Hygiene

A. Hand washing / Hand hygiene

Washing hands can also help reduce the risk of falling ill through food poisoning, which can be contracted if food prepared has not been
properly handled.
Our hands are the part of the body that most come into contact with surfaces that could be covered in bacteria, such as kitchen sides, bathroom
sinks and door handles. Often, we then touch our eyes, noses and mouths which is how bacteria and viruses gain access to our bodies to make us
ill (Cleanipedia, 2023).
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

What is the proper hand washing procedure?

By following these proper hand washing steps whenever our hands are dirty, we can keep ourselves and our families happier and healthier.

 Use soap and water. The proper way of handwashing involves using soap and water together to kill any bacteria. Studies have found that
while water alone only kills around 77% of bacteria, soap and water combined can kill up to 92% of those nasty germs. If you don’t have
easy access to clean water, don’t worry. Alcohol-based hand sanitizer and ‘tippy taps’ are starting to be introduced in the Philippines, which
can make it much easier for you to wash effectively.
 Develop a great hand washing technique. Is there a ‘right’ way to wash your hands? Oh yes! Remember, germs could be hiding anywhere,
so follow these proper hand washing steps to make sure you get rid of as many nasties as possible:
 Rub the soap around your thumbs, covering them completely.
 Rub your hands together palm to palm and palm to back of the hand to cover the main surfaces of your hands.
 Rub soap in between your fingers.
 Use soap and a nail brush to clean underneath the nails.
 Wash your hands for at least 20 seconds.
 Think before you touch. Whilst knowing how to wash hands properly is important, sometimes prevention is better than cure. If you’re out
and about when nature calls, be careful what you touch after washing your hands – remember, that door handle has probably been touched
 St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023

by people that skipped the sink after doing their business. If tissues or paper towels are available, grab one to open the door with, then
dispose of it as soon as you can. You don’t want to undo those 20 seconds of good work.
 October 15th may well be Global Handwashing Day, but that doesn’t mean we can’t practice good hygiene every other day of the year. Stay
clean. Stay healthy.

References:
St. Paul University Dumaguete
(St. Paul University System)
Second Semester
COLLEGE OF NURSING
AY: 2022-2023