Mark Michael J.

Cuevas, SN ‘08
Diphtheria

• Acute febrile infection of the tonsil, throat,

nose, larynx or a wound
• Patch or patches of grayish membrane
• Source are discharges and secretions from
nose and nasopharynx
Diphtheria
Causative Agent:
Cornybacterium diphtheriae
(Klebs-Loeffler bacilllus)

Portal of Entry: Nose and Throat

Mode of Transmission: Person to

person through close physical
and respiratory contact
(coughing and sneezing)
Diphtheria
Incubation Period: 2-5 days,
occasionally longer

Susceptibility, Resistance and

Occurrence:
First Born: relatively immune
until 6th month when the mother
had a diphtheria infection
Diphtheria
Classification:
1. Nasal – (+) serosanguinous
secretion
- foul odor
- one sided nasal discharge
- nasal excoriation
- fever
Diphtheria
2. Pharyngeal – (+)
complaints from sore throat and
dysphagia
- (+) pseudomembrane
appearance
- bull-neck appearance
- fever
Diphtheria
3. Laryngeal – (+) hoarseness of
voice
- loss of voice
- dyspnea
- chest retraction
- barking cough
- laryngeal edema
- fever
 Complications:
Diphtheria 1. Early Stage – abnormal
heartbeats which can
result to heart failure
2. Inflammation of the
heart muscles and
valves, leading to
chronic heart disease
and heart failure
3. Severe – respiratory
obstruction followed
by…
Diphtheria
Diagnostic Examination: Schick’s Test and
Throat Culture

Treatment:
1. Diphtheria antitoxin and antibiotics
2. Isolation

Prevention: Active Immunization of Diphtheria

Vaccine (DPT)
Diphtheria
Timing of Administration: infants –
6 weeks old

Total # of Doses of DPT: 3 Doses

administered at 4-6 weeks
interval and then booster
doses following year after the
last dose of primary series
and another dose on the 4th or
5th year of age
Diphtheria
Site of Administration:
Outer mid-thigh in
infants / outer upper arm
if older

Injection Type:
Intramuscular

Dosage: 0.5ml
Diphtheria

Side Effects of Vaccine:

1. Fever
2. Soreness
3. Pain (in 1% of
infants)
Diphtheria

Nursing Care:
1. CBR and comfort
2. Patent Airway
3. Adequate Nutrition
4. Personal Hygiene
5. Health Education
 Pertussis (Whooping Cough)
• Acute infection of the respiratory tract
• Begins as an ordinary cold, becomes
increasingly severe
• The coughing can make it hard to breathe
• A deep "whooping" sound is often heard when
the patient tries to take a breath
Pertussis (Whooping Cough)
Causative Agent: Haemophilus Pertussis or
Bordet Gengou Bacillus or Bordetella
Pertussis or Pertussis Bacillus

Portal of Entry: Respiratory Tract

Mode of Transmission: Droplet

Pertussis (Whooping Cough)
Stages:
1. Catarrhal / Invasive Stage (highly
contagious)
- colds
- dry hacking nocturnal cough
- low-grade fever
- fatigue
-anorexia
-sneezing / runny nose
 Pertussis (Whooping Cough)
2. Spasmodic / Paroxysmal Stage
- characteristic cough with inspiratory whoop
- teary red eyes
- congested tongue
- vomiting (posttussive vomiting)
- exhaustion
- abdominal hernia
 Pertussis (Whooping Cough)
3. Convalescence Stage
- less paroxysmal coughing
- recovery is gradual

Diagnostic Exam:
- Nasopharyngeal Swab
- Clinical history
- Sputum Culture
(Bordet Gengou Agar Plate)
Pertussis (Whooping Cough)
Complications:
1. Secondary Bacterial Pneumonia
2. Seizures and Encephalopathy
3. Reactive Airway Disease (Asthma)
4. Malnutrition
Pertussis (Whooping Cough)
Treatment:
1. Antibiotics
2. Oxygen with high
humidity
3. Intravenous Fluids
4. Do not give cough
mixtures and
expectorants

Prevention: DPT Vaccine

 Pertussis (Whooping Cough)
Nursing Care:
1. CBR
2. Prevent Aspiration
3. Patent Airway
4. Health Education
5. Abdominal Support
 Tetanus
Acute disease induced by toxin of tetanus
bacillus growing anaerobically in wounds
and at site of umbilicus among infants

Causative Agent: Clostridium tetani

Portal of Entry: Cut, puncture wound,

laceration or other wound
 Tetanus
Mode of Transmission:
- Contamination of
unhealed stump of the
umbilical cord
- Animal Bites

Incubation Period: Varies from

3 days to 1 month or more,
falling between 7 and 14 days
in high proportion of cases
 Tetanus
Clinical Manifestations:
1. Lockjaw (trismus)
2. Sardonic Smile (risus
sardonicus)
3. Opisthotonus
4. Rigidity / stiffness of
abdomen
5. Dyspnea, chest
heaviness
 Tetanus
Diagnostic Exam:
- Wound Culture
- Physical Exam

Treatment:
1. Tetanus Immune Globulin
2. Antibiotics
3. Tetanus Vaccine
 Tetanus
4. Sedative Drugs (Diazepam) and Muscle
Relaxants
5. Temporary – Ventilator

Prevention:
1. Keep the wound clean
2. Consider the source of cut / wound
3. Change wound dressing
4. Active Immunization (DPT)
 Tetanus
Nursing Care:
1. Provision of a quiet environment
2. Minimal gentle handling
3. Never leave the patient alone
4. Padded tongue depressor at bedside
5. Start with liquid food then small
frequent feedings
6. No overfeeding
7. Health Education
Poliomyelitis (Infantile Paralysis)
• Caused by a virus that infects the nerves
• May cause temporary paralysis or
permanent and eventually leading to
death

Causative Agent: Legio debilitans

Portal of Entry: Nasopharynx and multiplies

in the throat and intestinal tract
Poliomyelitis (Infantile Paralysis)

Mode of Transmission:
- Droplet Infection (Early stage)
- Fecal-oral (Late stage)

Incubation Period: 5-35 days, 7-14 days on

average
 Poliomyelitis (Infantile Paralysis)

Clinical Manifestations:
1. Subclinical Infection
- slight fever
- headache
- sore / red throat
- vomiting
- general discomfort
Poliomyelitis (Infantile Paralysis)

2. Abortive Poliomyelitis
- severe muscle pain
- stiffness of the hamstring
muscles
Poliomyelitis (Infantile Paralysis)
3. Major Poliomyelitis
a. Non-paralytic
- moderate fever
- vomiting
- diarrhea
- Muscle tenderness and spasm in any area
of the body
- Pain or stiffness of the back, arms, legs,
abdomen
 Poliomyelitis (Infantile Paralysis)

3. Major Poliomyelitis
b. Paralytic
- Muscle weakness
- Constipation
- Swallowing difficulty, drooling
- Breathing difficulty
- (+) Babinski Reflex, Hoyne’s Sign
Poliomyelitis (Infantile Paralysis)
Types of Paralysis:
1. Bulbar
2. Spinal – most common
3. Bulbo-spinal
Poliomyelitis (Infantile Paralysis)

Diagnostic Exam:
- Lumbar Puncture
- Cultures of throat, secretions and feces
- Muscle testing, EMG
Poliomyelitis (Infantile Paralysis)
Treatment:
• Analgesics
• Bedrest
• Moist heat application
• Mechanical Ventilator – Bulbar Paralysis
• Physical Rehabilitation

Prevention: Oral Polio Vaccine (given at 6

weeks of age)
Poliomyelitis (Infantile Paralysis)

Nursing Care:
1. Check blood pressure
2. Adequate nutrition
3. Handwashing
 Measles
An acute, highly communicable
infection characterized by fever,
rashes and symptoms referable
to upper respiratory tract

Causative Agent: Filterable

virus, family Paramyxoviridae

Portals of Entry: Nose and

throat
 Measles

Mode of Transmission: Droplet spread or

direct contact with infected persons, or
indirectly through articles freshly soiled with
secretions of nose and throat. In some
instances, airborne

Incubation Period: 8-12 days

 Measles
Clinical Manifestations:
1. fever
2. dry cough
3. runny nose
4. conjunctivitis
5. Koplik’s spots
6. morbiliform rash appears on the 3rd
or 4th day affecting face, body and
extremities ending in branny desquamation
 Measles
Diagnostic Exam:
1. Based on clinical picture
2. Blood samples

Complications:
1. Ear infection
2. Encephalitis (1 in 1,000)
3. Pneumonia
4. Pregnancy problem
 Treatment:
Measles • Antipyretics
• Antibiotics – for bacterial
infection
• Isolation

Prevention: Measles
Vaccine (0.5ml,
Subcutaneous route,
given at 9 months of age
or if there is an outbreak
of measles in the area)
 Measles
Nursing Care:
1. Protect eyes from glare of strong light
2. Adequately ventilated room but
prevent chilling to avoid pulmonary
complications
3. Sponge bath
 Hepatitis
• Acute inflammatory disorder of the liver
• Caused by viruses, bacteria or toxic
injury to the liver
 Hepatitis A
Infectious Hepatitis, Epidemic Hepatitis,
Catarrhal Jaundice

Causative Agent: Hepatitis A Virus

Mode of Transmission: Fecal-oral route

Incubation Period: 15-50 days, average is

28-30 days
 Hepatitis A
Predisposing Factors:
1. Poor sanitation
2. Contaminated water
supply
3. Malnutrition
4. Disaster and wartime
conditions
 Hepatitis A
Clinical Manifestations:
1. Influenza-like such as headache
2. Malaise and easy fatigability
3. Anorexia and abdominal pain
(RUQ)
4. Nausea and vomiting
5. Fever
6. Lymphadenopathy
7. Jaundice with pruritus and
urticaria
8. Bilirubinemia with clay-colored
stools
 Hepatitis A
Diagnostic Exam: Enzyme levels

Treatment:
1. Gamma globulin –
prophylaxis
2. CBR
3. Adequate nutrition

Prevention: Hepatitis A Vaccine

(Havrix and Vaqta )
 Hepatitis B
Serum Hepatitis

Causative Agent: Hepatitis B Virus

Modes of Transmission:
- permucosal exposure to
infectious blood, blood
products or other body fluids
- contaminated needles
- sexual contact
 Hepatitis B
Incubation Period: 45-160 days, average 60-
120 days

Clinical Manifestations:
1. Anorexia
2. Nausea and vomiting
3. Fatigue and weakness
4. Abdominal Pain
5. Jaundice
 Hepatitis B
Diagnostic Exam:
- Presence of Hepa-B Surface Antigen
and Antibodies to Hepa-B Surface
Antigen
- Liver Enzyme levels

Treatment:
1. Immune globulin
2. Antivirals
 Hepatitis B
Prevention: Hepatitis B Vaccine (may be
given at birth)
Hepatitis C
Non A Non B Hepatitis

Causative Agent: Hepatitis C

Virus

Mode of Transmission:
Contact with
contaminated blood

Incubation Period: 14-150

days, average 50 days
 Hepatitis C
Clinical Manifestations:
1. Anorexia
2. Fatigue
3. Jaundice
4. Low-grade fever

Diagnostic Exam: Blood Tests and

Liver Biopsy
 Hepatitis C
Treatment:
1. Interferon
2. Liver Transplant

Prevention: No effective vaccine

1. Avoid illegal drug use
2. Avoid piercing and tattooing
3. Avoid risky sexual behavior
 Hepatitis D
Occurs with chronic
Hepatitis B infection

Causative Agent: Hepatitis

D Virus

Mode of Transmission: By
means of needle stick and
sharing of household items
like razor or toothbrush
 Hepatitis E
Causes acute hepatitis, but does not lead to
chronic hepatitis

Causative Agent: Hepatitis E Virus

Mode of Transmission: Contaminated food

and water

Incubation Period: 15- to 60-day

 Pulmonary Tuberculosis
• Highly infectious chronic disease often
occurs in children of underdeveloped
and developing countries in the form of
primary complex
• Ranks 6th in the leading cause of
morbidity and mortality (2002)

Causative Agent: Mycobacterium

Tuberculosis and Africanum (humans)
M. Bovis (from cattle)
 Pulmonary Tuberculosis
Mode of Transmission:
- Airborne droplet
- Direct invasion through mucous membranes
or breaks in the skin

Periods of Communicability:
- As long as bacillus is still contained in the
sputum
- Primary Complex is generally not contagious
- Good compliance to treatment regimen
renders the person not contagious 2-4 weeks
after initiation of treatment
 Pulmonary Tuberculosis
Incubation Period: 3-8 weeks

Clinical Manifestations:
1. Fatigue
2. Weight loss
3. Persistent low-grade afternoon fever
4. Night sweats and chills
5. Hemoptysis
6. Productive Cough
7. Chest Pain
 Pulmonary Tuberculosis
TB Classification:
1. Class 0 – no exposure
2. Class I – TB exposure
3. Class II – TB infection
4. Class III – TB disease
5. Class IV – TB inactive
 Pulmonary Tuberculosis
Diagnostic Exam:
1. Chest X-Ray
2. Mantoux Test (Tuberculin Test)
3. Sputum smear and culture
 Pulmonary Tuberculosis
Sputum Collection:
1. Oral hygiene
2. Breathe deeply 2x then exhale using
pursed lip breathing
3. After inhaling deeply on the 3rd time, at
the height of inspiration, cough strongly
and spit the sputum in the container (3-
5ml)
 Pulmonary Tuberculosis
Interpretation of Sputum Microscopy Result:
Smear (+) – 2 out of 3 or 3 out of 3 (+)
sputum microscopy
Doubtful – only 1 out of 3 (+) sputum
microscopy
Smear (-) – 3 out of 3 (-) sputum
microscopy
 National Tuberculosis
Program
Goal: to reduce prevalence and mortality
from TB by half by the year 2015

Targets:
1. Cure at least 85% of the sputum
smear (+) TB patient discovered
2. Detect at least 70% of the estimated
new sputum smear (+) TB cases
 Directly Observed Treatment
Short-course

A strategy which according to the

WHO, is the key to stopping TB
epidemic. Treatment partners must
watch their patients swallow their
medicines
 5 Elements in DOTS
1. Sustained political commitment
2. Access to quality-assured sputum
microscopy
3. Standardized short-course
chemotherapy for all cases of TB
under proper case management
conditions, including direct
observation of treatment
 5 Elements in DOTS

4. Uninterrupted, quality-assured drugs

5. Recording and reporting system
enabling outcome assessment of all
patients and assessment of overall
program performance
 Treatment Regimen
Category 1: Intensive Phase Maintenance Phase
New PTB
Seriously Ill 2HRZE 4HR
Category 2:
Relapse 2HRZES / 1HRZE 5HRE
Failure Cases
Category 3:
New PTB (smear (-) 2HRZE 4HR
for 3x, (+) x-ray)
Category 4:
Chronic Refer to specialized facility or DOTS Plus
Center
Mark Michael J. Cuevas, SN ‘08