Whooping cough, a communicable, Potentially deadly illness characterized by Fits of coughing followed by a noisy, Whooping indrawn breath.

It is caused by The bacteria Bordetella pertussis. The illness Is most likely to affect young children, but Sometimes appears in teenagers and adults, Even those who have been previously Immunized. Immunization with DPT (diphtheria-pertusis-tetanus) vaccine

may wear off with age. When teenagers and adults get pertusis, it appears first as coughing lasting up to eight weeks.

Treatment is by supportive therapy, and Young infants need hospitalization if the Coughing becomes severe. See DPT Immunization, DTaP immunization

Bordetella pertussis, a gram-negative Cocobacillus

Occurs through direct contact with Discharges from respiratory mucous Membranes of infected person

The incubation period is typically given to ten days in infants or young children, after which there are usually mild respiratory symptoms, mild coughing, sneezing, or runny nose. This is known as the catarrhal. After one to two weeks, the coughing classically develops into uncontrollable fits, each with five to ten forceful coughs, followed by a high-pitched whoop sound in younger children, as the patient struggles to breathe in afterwards (paroxysmal stage).

Fits can occur on their own or can be triggered by yawning, stretching, laughing, eating or yelling: they usually occur in groups, with multiple episodes every hour around the clock. This stage usually last two to eight weeks. This stage is marked by a decrease in paroxysms of coughing, both in frequency and severity, and a cessation of vomiting

The classic symptoms of pertusis are a paroxysmal cough, inspiratory whoop, and vomiting after coughing. The cough from pertusis has been documented to cause subconjunctival hemorrhages, rib fractures, urinary incontinence, hernias, post-cough fainting, and vertebral artery dissection. If there is vomiting after a coughing spell or an inspiratory whooping sound on coughing, the likelihood that that the illness is pertusis is nearly doubled. On the other hand, the absence of a paroxysmal cough or posttussive emesis make it almost half as likely.

Culture: Historically, culture has been the gold standard for pertussis testing because of its high specificity: however, the sensitivity of culture is low and the time needed to obtain results may be long (days to as long as 2 weeks.) The efficacy of culture in detecting B. pertussis is greatest during the first 14 days following cough onset. Receipt of antibiotics effective against pertussis decreases the likelihood of isolating B. pertussis

In Culture. PCR: polymerase chain reaction (PCR) is a valuable tool for the detection of B. pertussis because the test is substantially more sensitive than culture and results are available more rapidly. PCR is most reliable within the first 21 days after onset of cough before initiation of appropriate antibiotic treatment. However, a positive PCR test. Result is not dependent upon the presence of living organisms: thus, the impact of antibiotic treatment on the result is less with PCR than culture.

Antibiotics are necessary in treating pertussis cases. The drug of choice is usually a form of erythromycin that is also given to all household and other close contacts of the patient to minimize transmission, regardless of age and vaccination status

The childhood vaccine is called DTaP. The whooping cough booster vaccine for adolescents and adults is called Tdap. Both protect against whooping cough, tetanus, and diphtheria.

Get vaccinated! The best way to protect yourself and your family from getting sick is to get vaccinated because the vaccine wears off with time, everyone needs booster shots Everyone should get the whooping cough vaccine. This is especially important if you are around babies or pregnant women The vaccine used in children younger than age of 7 is called DTap (diphtheria, tetanus, and acellular pertussis vaccine)

The vaccine used in people age 7 and older is called Tdap (tetanus, diphtheria , and acellular pertussis vaccine). Pregnant women should get the whooping cough vaccine (Tdap) either during pregnancy or immediately after birth. Tdap is considered safe during pregnancy The best place to be vaccinated is at your own doctors office. The new immunization law requires all students entering into 7th- 12th grades to show proof of a pertussis (whooping) booster shot, known as Tdap before the start of the school fall of 2011 children who cannot prove vaccination or exemption status will not be allowed school entry.

Please contact your doctor now to get your child up-to-date on the pertussis booster shot, known as Tdap. Additional immunizations are recommended for your pre-teen and teen. Please talk with your doctor about getting your child upto-date on meningococcal, varicella (chicken pox), human papillomavirus (HPV), and flu shots

isolation during catarrhal stage bed rest, mental rest provide restful environment and reduce factors that provide paroxysm (dust, smoking) encourage fluid, small frequent feeding increase humidity observe for signs of air way obstruction small amount of sedatives may be necessary to quiet the child protect the child from secondary infections, antibiotics may be given to treat secondary infection pertussis immune antiserum may be given\

Pertussis is usually based on upon a characteristics history and physical examination. However, laboratory test may be useful in young infants, atypical cases, and cases modified by vaccine; an elevated white blood cell count with a lymphocytosis is usually present in classical disease. The absolute lymphocyte count often reaches 20,000 or greater. However, there may be no lymphocytosis in infants and children or in mild or modified cases of pertussis

Cholera is an acute bacterial enteric disease of the GIT which is characterized by profuse diarrhea, vomiting, massive loss of fluid, and electrolytes that could result to hypovolemic shock, acidosis, and death.

Vibrio Cholerae/ Vibrio Coma

shaped), gram negative (-)

Organisms are slightly curved rods (coma

and motile with a with a single polar flagellum

The organisms survive well at ordinary

In temperature ranging from 22- 40 degrees centigrade

They survive longer in refrigerated foods

temperature and can grow well

Fecal transmission passes via oral route from contaminated water Milk, and other foods The organisms are transmitted through ingestion of food or water Contaminated with stool or vomitus of patient Flies, soiled hands, and utensils also serve to transmit the infection

 Acute profuse, watery diarrhea with no tetanus

or intestinal cramping the stool becomes pale gray, rice-water in appearance with an inoffensive, slightly fish odor vomiting occurs after diarrhea has establish Dehydration. Dry tongue withered skin on the hands, face, and feet, hoarseness. The lips are bluish in color and the becomes cold and damp Muscular cramps. About 75% of all cholera patients also suffer severe muscular cramps, usually confined to the extremities. These result from the rapid loss of salts

 Breathing is rapid and deep. Patients develops oliguria and may even

develop anuria Despite marked diminished peripheral circulation consciousness is patient temperature becomes subnormal in later stage especially if the patient is in shock

Rice water stool

Rectal swab Darkfield or phase microscopy Stool exam

Antibiotics Adults: Tetracycline 500mg every 6 hours Furazolidone 100mg Chloramphenicol may also be given 500mg

Children: Tetracycline 125mg/kg weight every 6 hours for 72 hours Furazolidone 125mg/kg might be given every 6 hours for 72 hours Chloramphenicol 18mg/kg every 6 hours for 72 hours Contrimoxaxole can be also administered 8mg/kg for 72 hours

Cholera vaccine Is a suspension of two strains of killed cholera bacteria in saline solution in which phenol is added as a preservative 50% effective in preventing disease and its protection can last from 3-6 months Course the primary immunization series consists of two doses of vaccine given one week to one month apart.

A booster vaccine is required after two years for adults and children over 6 and after 6 months and fro children aged two to six years old Side effects: Mild symptoms such as tummy pain or cramps, fever listlessness, headache, generalized aches and pains, diarrhea and feeling sick are observed after having the vaccine. Not indicated to : pregnant women, persons with any acute respiratory disease, infants under six months of age, and person receiving immunosuppressive therapy such as cancer chemotherapy should not take the vaccine

Food and water supply must be protected from fecal contamination. Water should be boiled 5-15 mins. Sanitary disposal of human excreta is a must Sanitary supervision is important.

Medical aseptic protective care must be provided Enteric isolation must be observed. Vital signs must be recorded accurately A through careful personal hygiene must be provided Excreta must be properly disposed off food must be properly prepared environmental sanitation must be observed Appropriate diet is given according to the stage of recovery.

It is an inflammation of the lungs caused by infections agent in which air sacs are filled with pus or exudate so that air is excluded and the lungs become solid Is an acute infections disease caused by pneumococcus associated by general toxemia and a consolidation of one or more lobes of either one or both

Is a pneumonia that develops while the client is in the hospital. Such as pneumonia reflects the kind of nursing care given to the client Occurs 48 hrs after admission is inhaled into the lungs, most commonly when a gastric content enter the lungs after vomit

A pneumonia acquired in the course of ones daily in life at work, at school or at the gym A person is diagnosed with CAP if the hospitalized px develop pneumonia in 48hrs The most common bacterial caused of CAP is Stretococcus pneumoniae ( pneumococcus) some others are Hemophillus influenzae and Legionella

Strikes people with compromised immune system. Organisms that are not harmful for healthy people can be extremely dangerous for those with HIV/AIDS. Sickle cell disease and other conditions that impair the immune system

Consolidation of the entire lobe Manifested by chills, chest pain on breathing and cough with bloodstreaked sputum (prune juice or rusty) As the disease progresses, the heart weakens and death occurs due to heart failure. Edema of the lungs or severe exhaustion

Streptococcus pneumoniae Staphylococcus Aureus Hemophilus Influenzae Klebsiella Pneumoniae ( Friedlanders Bacilli)

The disease is transmitted though droplet infection The disease can also be transmitted through indirect contact

2 3 days with sudden onset of shaking, chills, rapidly rising fever and stabbing chest pains aggravated by coughing and respiration

Sudden onset of chills with rising fever (38.5c -40.5 c ) Pleuritic chest pain aggravated by deep breathing and coughing Rapid bounding pulse Dyspnea Body malaise Productive cough with rusty brown or blood streaked purulent sputum Tachypnea Diaphoresis

GREENISH RUSTY SPUTUM

Chest x-ray WBC Sputum Culture Bronchoscopy ABG

Assist patient in assuming a comfortable position (semi fowlers position) to promote lung expansion, rest and breathing Assist patient in change positions to enhance secretion clearance and ventilation prefussion lungs

Provide fluids with electrolytes( commercially available drinks such as Gatorade) Other enriched drinks or shakes may also be helpful IV fluids