Communicable Diseases

Rho Vince C. Malagueño, RM, RN

Communicable Disease

 A disease caused by an infective

agent acquired from an infected
individual and is transmitted to a
susceptible host either by direct or
indirect contact.
Types of Communicable
Disease

 Infectious Disease - A disease

transmitted only by a specific kind of
contact but require a direct inoculation
through a break in previously intact skin
or mucus membrane.
 Contagious Disease - - Any disease easily
transmitted from person to person;
acquired
Epidemiology
 branch
of medicine that deals with the
study of the causes, distribution,
and control of disease in
populations

 servesas the foundation and logic of

interventions made in the interest of
public health and preventive medicine.
Patterns of Diseases Occurrence
 Sporadic – Intermittent occurrence of
a disease.
 Endemic – Continuous or constant
occurrence of a disease in a certain
geographical area.
 Epidemic – Sudden increase in the
number of expected cases of a disease
in a short period of time within a given
population.
 Pandemic – Worldwide epidemic.
Triad of Disease Causation
 Agent – The causative organism of a
specific disease (e.g. bacteria, virus, fungi
etc.)
 Environment – Medium for survival,
culture and transmission of causative
organism.
 Host – A resistant or susceptible
organism that harbors or nourishes
another organism.
 Review Terms:
 Infectivity – ability of pathogenic organism
to enter and move in the body

 Pathogenicity – ability to cause a disease

 Virulence – potency/strength of the

pathogenic organism that will cause the
disease
 Review Terms:

 Antigenicity – ability of pathogenic

organism to stimulate an antibody
response

 Infectivity Dose – number of

sufficient pathogenic organism present
to cause a disease
 INFECTIOUS PROCESS

AGENT

Host RESERVOIR

Portal of Entry Portal of Exit

ROUTE of Transmission
 INFECTIOUS PROCESS
 Causative agent – microorganisms that caused
the disease
◦ Bacteria, Fungus,Viruses, Parasites
◦ FACTORS:
 VIRULENCE – ability of the pathogen to cause
a disease
 SUSCEPTIBILITY – affinity to the host

 Portal of entry– where the causative agent enters

the body.
◦ Respiratory
◦ G.I.
◦ G.U.
INFECTIOUS PROCESS

Reservoir – caters the

survival of microorganism
- source
*carrier-
◦Animal
◦Humans
Mode of Transmission
 1. DIRECT TRANSMISSON
-person to person
*Immediate and direct transfer
- touching, biting, kissing, sex
2. INDIRECT TRANSMISSION
A. VEHICLE-BORNE TRANSMISSION
-transport of IA through a VEHICLE
into a susceptible host thru a suitable portal
of entry.
e.g. Fomites, water, food, blood, serum,
plasma
B.VECTOR-BORNE TRANSMISSION
-thru vector
e.g. Mosquito, ticks, snails, rats
DROPLET TRANSMISSION
•Occurs when the mucous membrane of
the nose, mouth or conjunctiva are exposed
to secretions of an infected person within a
distance of three feet

AIRBORNE TRANSMISSION
•Occurs when fine particles are suspended
in the air for a long time or when dust
particles contain pathogens
SUSCEPTIBLE HOST
 A person at risk for infection, whose
defense mechanisms are unable to
withstand invasion of pathogens
 CARRIER – an individual who harbors the
organism and is capable of transmitting it
without showing manifestations of the
disease
 CASE – a person who is infected and
manifesting the signs and symptoms of the
disease

 SUSPECT – a person whose medical
history and signs and symptoms suggest
that such person is suffering from that
particular disease
 CONTACT – any person who had been
in close association with an infected
person
Stages of a Disease
 Incubation Period - the period between
infection and the appearance of the first
signs and symptoms of the disease.

 Prodromal Period – from the

appearance of the first signs and symptoms
to the appearance of the characteristic of
sign and symptoms of disease.
 Stages of a Disease

 Illness – from the appearance of the

characteristic of sign and symptoms of
disease up to appearance of signs and
symptoms observe by others.

 Convalescence - gradual return to health

and strength after an illness, recovery
period.
Three Lines of
Defense
First Line

 Mechanical Barriers – skin, mucus

membranes

 Chemical Barriers – body secretions

 Body’s Own Microorganism – normal

flora
Second Line: Inflammatory
Response
 brings pathogocytic cells to
inflamed area to destroy
invading microbes.

4 Cardinal Signs
Third Line: Immune Response

Immunization –
process of rendering
individual resistance
or immunity to a
specific disease.
Types of Immunity
PREVENTION AND
CONTROL OF
COMMUNICABLE DISEASE
Prevention
 Health Education
 Specific Protection
 Environmental Sanitation
Control
 Notification
 EpidemiologicalInvestigation
 Case Finding and Treatment
 Isolation and Quarantine
 Quarantine - restriction of
freedom of movement
 Isolation - the separation of
infected individuals from those
uninfected for
the communicable period.
 Types of Isolation Technique
 Strict Isolation – for highly contagious
 Protective or Reverse Isolation – for
immunocompromised
 Enteric Isolation – prevent contamination from
stool/feces
 Respiratory Isolation – Prevents transmission
through droplet infection
 Wound and Skin Precaution – for diseases, e.g.
boil, scabies
 Blood and body fluids – for diseases e.g. HIV
Disinfection and disinfestations
 Disinfection – to destroy
microorganism excluding the
spores
 Sterilization – to destroy
microorganism including the
spores
 Disinfestation- insects, rodents
and pests are destroyed
 CONCURRENT
- Done immediately after the discharge of
infectious materials / secretions
 TERMINAL
- Applied when the patient is no longer the
source of infection
 BACTERICIDAL
- A chemical that kills microorganisms
 BACTERIOSTATIC
- An agent that prevents bacterial
multiplication but does not kill
microorganisms
 Asepsis
 The state of being free of pathogenic
microorganisms or the process of removing
pathogenic microorganisms or protecting
against infection by such organisms.
 MEDICAL ASEPSIS-Practices designed to
reduce the number and transfer of
pathogens
 Clean technique
 SURGICAL ASEPSIS- Practices that
render and keep objects and areas free
from microorganisms
 Sterile technique
SPECIAL MASKS USED
 PARTICULATE FILTER MASK- P95 & N95
- 95% efficient
 HEPA Filter Mask- 99.9%
 WAYS TO CONTROL SPREAD OF
INFECTION
 A. HANDWASHING
 B. DISINFECTION-CONCURRENT
TERMINAL
 C. PPE’s- gloves, masks, goggles, gowns
 D. BARRIER CARDS/PLACARDING- used of
card that indicate the disease of the pt.

 DISEASES AFFECTING
INTEGUMENTARY SYSTEM
(RUBEOLA/ MORBILLI/7
days measles)
MEASLES
ETIOLOGIC AGENT: filterable virus of measles
(paramyxovirus)

MODE OF TRANSMISSION:
 Droplet spread or direct contact with infected
persons
 Airborne
INCUBATION PERIOD:
 10 days from exposure to apprearance of fever. And
about 14days until rash appears.

PERIOD OF COMMUNICABILITY:
 During the period of coryza or catarrhal symptoms –
9 days, (from 4 days before and 5 days after rash
appears).
MEASLES: S & Sx
CLINICAL MANIFESTATIONS:
 PREERUPTIVE STAGE/ PRODROMAL
Fever
Catarrhal Sx (rhinitis/ colds, conjuntivitis, coryza,
photophobia)
Respiratory symptoms (colds & persistent coughing)
Stimson’s sign
KOPLIK SPOT’s

 ERUPTIVE STAGE
Rash appears (4th day)
MACULOPAPULAR RASH appears first in the cheeks,
bridge of the nose, hairline, earlobe (
CEPHALOCAUDAL & EXPOSED AREAS 1st)

 Stage of CONVALESCENCE
Desquamation & appetite returns
 MEASLES
PATHOGNOMONIC SIGN:
 Koplik Spots
--inflammatory lesions in the buccal mucous gland with superficial necrosis
--appears 1-2 days before measles rash
--located on the mucosa of the inner cheek
MEASLES
MEASLES
 MEASLES
DIAGNOSTICS: COMPLICATIONS:
No specific test.  Bronchopneumonia
 Otitis media
 Pneumonia
 Nephritis
 encephalitis
 MEASLES
NURSING MANAGEMENT:
 Isolation (quiet, well ventilated, darken room)
 Warm or TSB for high fever
 Skin care (cleansing bed bath)
 Eye care
 Care of the ears
 Change position every 2 hours
 Promote elimination
 Fruit juice, water, & milk during febrile stage
 Vitamin A
 Increase fluid, antipyretics
METHODS OS PREVENTION AND
CONTROL:

 Avoid exposing children to any person with

fever
 Isolation of cases from diagnosis until about
5-7 days after the onset of rash
 Disinfection
 Encouragement of health department and
by private physician
 Live attenuated and inactivated measles
virus vaccines
 Anti measles (9 months), MMR (15 mos-1st
dose, 2nd dose-11 to 12 years old)
 Don’t give measles vaccine to PREGNANT
WOMEN, active tuberculosis,
lymphoma, leukemia, depressed
immune system
 GERMAN MEASLES
(Rubella/ 3-day Measles)
A mild viral illness caused by rubella
virus that causes mild fever & has
teratogenic effect to the fetus
 GERMAN MEASLES
ETIOLOGIC AGENT: CLINICAL MANIFESTATIONS:
 Rubella virus (genus  Prodromal
Rubivirus)  Low grade fever
 Togavirus  Headache
 Malaise, coryza, conjunctivitis
PERIOD OF  lymadenopathy
COMMUNICABIITY:  Eruptive
 1 week befor and at least 5 days  Pinkish rash on soft palate
after onset of rash (Forcheimer’s spot)=
EXANTHEM rash starting on
the face (EXPOSED areas) up
to the trunk
MODE OF TRANSMISSION:
 No pigmentation or
 Direct desquamation
 Droplet  Testicular pain in young adults
 Transplacental  Transient polyarthralgia &
polyarthritis
 Indirect

Incubation: 2-3 weeks

GERMAN MEASLES
COMPLICATIONS: NURSING MANAGEMENT:
 Isolation
 Darken room
 Encephalitis  Mild liquid diet but
 Neuritis nourishing
 Irrigate eyes with NSS
 Arthritis  Care of the Ears
 Arthralgia  Good ventilation
 Rubella syndrome  Prevent spread of infection
(microcephaly,  Prevent occurrence of
complications
cataract, heart
disease, mental PREVENTION:
retardation,  MMR
deafness-mutism)  Pregnant women AVOID
 Congenital rubella  Immune serum globulin 1
week after exposure to rubella
Conjunctivitis
German Measles
German Measles
Acute & highly contagious disease of viral
etiology characterized by
MACULOVESICUPAPULAR eruptions on
the skin & mucous membrane with mild
constitutional symptoms
CHICKEN POX
ETIOLOGIC AGENT:
 Human (alpha) herpes virus 3 (varicella-zoster
virus), a member of the Herpes virus group.

SOURCE OF INFECTION:
 Secretion of respiratory tract of infected persons.
Lesions of skin are of little consequence. Scabs
themselves are not infective.

MODE OF TRANSMISSION:
 Direct/indirect contact or airborne spread
 Most contagious during catarrhal stage

INCUBATION PERIOD:
 10-14 days
CHICKEN POX

PERIOD OF COMMUNICABILITY:
 Until all lesions have crusted
SIGNS & SYMPTOMS:
 PREERUPTIVE
 Mild fever & malaise, cold-like symptoms

 ERUPTIVE
 Rash start FROM THE TRUNK (UNEXPOSED
AREA)
 Lesions progresses from macule, papule, vesicle,
pustule, then crust
 EXANTHEM- vesiculopustuar (centrifugal)
CHICKEN POX

DIAGNOSTICS:
 Complement Fixation test
 Electroscopic Examination of Vesicular
fluid

COMPLICATIONS:
 Secondary infections
 Meningoencephalitis
 Pneumonia
 sepsis
CHICKENPOX
 CHICKENPOX

METHODS OS
PREVENTION
AND
CONTROL:
 Exclusion from
school for 1
week
 Avoid MOT
 Varivax
Immunization
NURSING INTERVENTIONS:
Strict isolation
Prevent secondary infection
(cut fingernails short, wear
mittens)
Eliminate itching: calamine
lotions, warm baths,
baking soda paste
Encourage not going to
school; usually 7 days
Disinfection of clothes and
linen with nasopharyngeal
discharges by sunlight or
boiling
 HERPES ZOSTER
(SHINGLES/ Acute
Posterior Ganglionitis)
Acute viral infection of the PNS
due to reactivation of VZV
 HERPES ZOSTER
CAUSATTIVE AGENT:
TREATMENT:
 VZ virus
 Acyclovir
MODE OF TRANSMISSION:  Potassium Permanganate compress
 droplet  Analgesics
 Airborne; direct skin
contact/indirect
NURSING INTERVENTIONS:
INCUBATION PERIOD: SPEED
 Months to years after varicella
infection COMPLICATIONS:
 Encephalitis
PERIOD OF COMMUNICABILITY:  Paralytic ileus
 A day before the appearance of the
rash or 5-6 days after the last crust  Blindness
 Post herpetic neuralgia
CLINICAL MANIFESTATIONS:  Ramsay hunt syndrome
 Vesiculopustular
 Gasserin ganglionitis
 Follows a dermatome (belt like)
 Very painful
 Pruritic
 unilateral
SHINGLES
SHINGLES
SHINGLES
 Measles German Chickenpox Herpes
Measles zoster
Synonym rubeola rubella varicella shingles

Causative agent paramyxovirus togavirus Varicella- Dormant

zoster virus VZV/ HZV

MOT airborne Droplet/ airborne droplet

transplacenta
l
Age of childhood childhood childhood childhood
susceptibility

Period of 4 days before Entire course Once all All lesion

communicabilit & 5 days after lesions have have
y the crusted crusted
appearance of
rash
 Measles German Chickenpox Herpes
Measles zoster

Enanthem Koplik’s spot Forscheimer’s none none

spot
Exanthem Maculupapular Maculupapular Vesiculopustular Vesiculopu
(itchy, reddish (pinkisfh skin, (itchy, stular
skin, dry) moist to touch) generalized)
(painful)
Direction of cephalocaudal cephalocauda centrifugal Follows the
spread l nerve.
 Measles German Chickenpox Herpes
Measles zoster

Signs and Pre-eruptive: Eruptive: Low-grade painful

symptoms fever,
fever, Rash
Stimson’s sign -pinkish Cold-like
Koplik’s pot maculupapular symptoms,
Stomatitis -Begins on the Vesiculopustu
face ar (most
Catarrhal s/sx
-no contagious on
Eruptive: pigmentation catarrhal
rashes+previou or dsquamation stage)
s s/sx Posterior
Convalescence: auricular and
suboccipital
Desquamation
lymphadenopat
Drying hy
Brownish
staining, peels
off
SCABIES
An age-old skin infection caused by
an itch mite which bore beneath the
surface of the skin forming burrows
ETIOLOGIC AGENT:
CLINICAL MANIFESTATIONS:
 Sarcoptes scabei
 Severe itching at night
 Secondary lesions include
INCUBATION PERIOD: vesicles, papules, pustules,
 Within 24 hours of an original excoriations, crusts on affected
contact (length of time it site
requires for the itch mite to  Bacterial super infection
burrow)
 Linear burrows (on warm,
moist areas of the body)
PERIOD OF  Common sites: inter digital
COMMUNICABILITY: areas, flexor surface of wrist
 For the entire period the host is & palms, nipple, umbilicus,
infected axillary folds, groin or
gluteal folds, penis, scrotum
MODE OF TRANSMISSION:
 Direct skin contact DIAGNOSTICS:
 Indirect contact thru linen &  Microscopic Examination of the
clothing scraped tissue
 Skin biopsy
 SCABIES
Medical Management:

 Take warm, soapy bath or shower & dry thoroughly

 Scabicide such as Lindane (Kwell),
 Crotamiton (Eurax),
 Permithrin :
 thin layer applied when wet or after a bath, meds left for
12-24 hours, wash with cold water thoroughly
(NEUROTOXIC), repeat treatment after 1 WEEK CI: young
children, nursing & pregnant mothers
 Antihistamines
NURSING MANAGEMENT:

 Family members & contacts treated simultaneously

 Wear clean clothing & sleep between freshly laundered bed
linens
 Beddings & clothing be washed in hot water & dried on the hot
water cycle (mites survive up tp 36 hours)
SCABIES
S
PEDICULOSIS/Phthiriasis
ETIOLOGIC AGENT:
 Pediculusis humanos var.
corporis (body lice)

SIGNS & SYMPTOMS:

 Initial lesions-minute red
spots
 Swelling
 Macular rash
 Excoriation
 Crusts

MANAGEMENT:
 Laundering (dry clean) or
boiling clothing & bedding
 Good body hygiene
ETIOLOGIC AGENT:
 Pedicels var. pubis (crab lice)

SIGNS & SYMPTOMS:

 Unusual persistent itching
 Grayish pigmented spots

MANAGEMENT:
 Kwell or Gamene (lindane)
 Crotamiton (eurax)
 Second application repeated
after 1 week
 Sexual contacts treated
simultaneously
 Remove remaining nits
mechanically
ETIOLOGIC AGENT:
 Pediculus humanos var. capitis
(head lice)

SIGNS & SYMPTOMS:

 Earliest- ITCHING
 Irritation, excoriation, crust,
foul smelling mass consisting of
matted hair, nits, ova, pus, crust
PEDICULI ( PLICA
POLONICA)
 More common in females &
children

MANAGEMENT:
 Dusting scalp with 1%
malathion powder
 Gamma benzene hexachloride
shampoo for four minutes then
rinse
Anthrax (Woolsorter Disease,
Ragpicker Disease)
- An infectious, usually fatal
disease of warm-blooded animals,
especially of cattle and sheep
ANTHRAX
 Etiologic Agent: Bacillus
Anthracis
 Mode of Transmission:
 1. Ingestion
 2. Inhalation
 3. Cutaneous
ANTHRAX
Diagnosis: Nursing Care:
 Culture of secretion Symptomatic
 Chest x-ray
 Sputum exam Prevention:
 Stool exam  Immunization -
Anthrax Vaccine
Adsorbed “Bio Thrax”
Treatment:
 Sterilization
 Chloramphenicol,
 Protective Barriers
Penicillin, Erthromycin,
Tetraclcline
 DISEASES AFFECTING THE
CENTRAL NERVOUS SYSTEM
 Rabies
(hydrophobia/lyssa, Le
Rage)
A specific, acute viral infection
communicated to man by saliva of
an infected animal
Rhabdovirus
Source of Infection: Rabid animals
CAUSATIVE AGENT:
 Rhabdovirus
 PERIOD OF
SOURCES OF INFECTION: COMMUNICABIL
 Saliva of rabid animals
ITY:
INCUBATION PERIOD:
 1 week to 7 1/2 months in
 3-5 days before the
dogs onset of symptoms
 10days to 15 years in human
until the entire
Depends on:
 Distance of the bite to the
course of illness
brain
 Extensiveness of bite
 Specie of animal
 Nearness to blood supply
 Resistance of the host
CLINICAL MANIFESTATIONS:

Prodromal/ Invasive Phase

 Fever, anorexia, salivation, lacrimation, perspiration.
Restlessness, drowsy, marked insomnia, melancholia
 Photophobia, numbness

Excitement/ Neurological/ ManiacAL

 Marked excitation, apprehension, terror
 Nuchal rigidity, involuntary twitching
 Generalized convulsions
 Maniacal behavior, eyes fixed & glossy, cold clammy
skin
 Severe & painful spasm of them uscles of the omuth,
pharynx, larnyx
 Aerophobia
 Profuse drooling of saliva

Terminal/ Paralytic Phase

 Quiet, unconscious, bowel & urinary incontinence,
paralysis, irregular RR &PR
Rabies Transmission
Rabies Patient
Patient displaying Hydrophobia
Rabies Patient

DIAGNOSTICS:
 Viral isolation from throat
 Fluorescent rabies antibody
(FRA)- most definitive
 Presence of negri bodies in
the dogs brain
TREATMENT:
 Wash bite wounds & scratches
with soap & running water
 Check immunization status
 Antirabies vaccine
NURSING CARE:
 Isolate
 Darken room, quiet environment
 Should not be bathed & no running
water in the room or within hearing
distance
 Secure IV fluid needle & solution must
be wrapped
 Concurrent & terminal disinfection
PREVENTION & CONTROL:
 Vaccination of all dogs
 Law enforcement
 Confinement for 10-14 days of any dog
that has bitten a person
 Laboratory facilities for diagnosis and
observation
 Poliomyelitis
(Infantile Paralysis/
Heine-Medin Disease
Legio Debilitans
ETIOLOGIC AGENT: PREDISPOSING FACTORS:
 Legio debilitans (Brunhilde,
Lansing, Leon)
 Age=<10 y/0
INCUBATION PERIOD:  Sex= males>female
 7-21 days for paralytic cases  not hereditary
 Average 3 -35 days  Environmental & hygienic
condition ( excessive work,
PERIOD OF strian, marked overexertion)
COMMUNICABILITY:
 1st 3 days to 3 months of illness TYPES:
 Abortive
MOT:
 Nonparalytic
 Direct contact with
oropharyngeal secretions  Paralytic ( spinal/bulbar)
 Person to person
 Indirect-contaminated articles
& flies
 Contaminated food, utensils
 ABORTIVE Nonparalytic Paralytic

Doesn’t invade CNS All above signs All above signshy

Headache & sore Spasms of the (+) Hoyne’s sign
throat hamstring Paralysis
Slight or moderate  changes in deep & Less tendon reflexes
fever superficial reflexes (+) Kernigs &
Occasional vomiting Pain in neck, back, Babinski
Low lumbar pain arms, legs, abdomen Muscle weakness
Resolves with 3 days Inability to place
Hyperesthesia
hand in b/w knees
Urinary retention,
(+) Pandys test
constipation,
(+) Poker sign abdominal distension
Last x 1wk, with
meningeal irritation
Polio Affectations
Polio Patient
Polio Patient
Polio Patient
Polio Patient
Polio Victim
COMPLICATIONS: TREATMENT:
 Respiratory failure  Analgesics
 Circulatory collapse  Moist heat appication
 Eletrolyte imbalance  Bed rest
 Bacterial infection  Rehabilitation using physical
 Urinary retention therapy, braces, orthopedic
 Abdominal distention surgery

DIAGNOSTICS:
 Isolation of virus from throat
washings or swab
 Stool culture
 Culture from CSF
NURSING CARE: PREVENTION & CONTROL:
 Enteric isolation  OPV vaccine
 Observe for Sx of paralysis &  Proper disposal of GIT
other neurologic damage secretions
 Neuro assessmnet once a day  Isolation
 Avoid vigorous muscular  Implementation of standard
activity precaution
 Check BP  Environmental sanitation
 Watch out for signs of fecal
impaction
 Prevent pressure sores
 Handwashing
 Hot packs tp affected limb
 Dispose excreta& vomitus
properly
 Good personal hygiene
TETANUS
 SIGNS & SYMPTOMS:
CAUSATIVE AGENT:  Neonatees- malaise, difficulty in
 Clostridium tetani sucking, excessive crying, stiffness
of the jaw
MOT:  Risus sardonicus
Break in the skin & mucous  Trismus
membranes (umbilical cord,
 Opisthotonus
dental carries, septic abortion,
puncture wound)  Muscular spasm

TREATMENT:
INCUBATION PERIOD:
 ATS/TAT
 3-14days
 TIG
 Release of tetanospasmin:  IVF
spasm
 Pen G
 Release of tetanolysin: lysis of
 Diazepam
RBC, WBC
Supprotive;
DIAGNOSTICS:
 O2 inhalation
 History of wound  Tracheostomy
 S & Sx  Suction secretions
NURSING CARE:
PREVENTION:
 Quiet room
 Proper wound care
 Avoid unnecessary handling
 immunization
 Padded tongue depressor
 NPO if cant pen mouth
 Liquid to soft diet
 SAP
 Suction secretions
 Observe frquency, duration
of muscular spasm
 Assess respiration during
spasm
 Put bedrails
 Do not restrain
Bacterial Meningitis
Newborns- E.coli
Older infants & young
children –
H.influenzae
Young adults -
Neisseria meningitidis
Older adults -
Streptococcus
pneumoniae
 Meningitis
 Mode of Transmission: Droplet
 Incubation Period: 2-10 days
 Clinical Manifestations:
 Kernig’s sign – pain is elicited when knees are extended
Brudzinski’s sign - forward flexion of the neck may
cause involuntary knee and hip
flexion.
 Nuchal rigidity
Head ache
Poker spine
 Photophobia – inability to tolerate bright light
. Phonophobia – inability to tolerate loud sounds
 Signs of Meningeal Irritation

K- Kernig’s Sign (Knee)

N- Nuchal Rigidity (Neck Stiffness)

O- Opisthotonos (Overexaggerated
Arching of the Bck)

B – Brudzinski (“Batok” & “Baba”)

BRUDZINSKI’S SIGN
Present if the client’s hips and knees flex when he is
lying supine with his head lifted towards his chest.
KERNIG’S SIGN
Present if lower leg cannot extend due to pain and spasm
when client is lying supine with one leg bent over his
abdomen.
 MENINGITIS

Tests:
Lumbar puncture
Blood tests
Meningitis
Treatment: Nursing Care:
 Osmotic diuretic – Symptomatic
mannitol 20%
 Anti-inflamatory – Prevention:
Dexamethasone  Amoid MOT
(decadron)
 Anti-microbial
 Anti-convulsant –
Phenetoin (Dilantin)
 CNS Stimulant –
Pyritinol
Is an ancient disease and is a leading
cause of permanent physical disability
among the communicable diseases. It is
a chronic mildly communicable disease
that mainly affects the skin, the
peripheral nerves, the eyes, and
mucvoas of the upper respiratory
tract.
Leprosy is still a public health
problem in 8 cities (Laoag, Candon,
Vigan, San Jose, Cagayan de Oro,
Oroquieta, Iligan, and Isabela) and 5
provinces (Ilocos Norte, Ilocos Sur,
basilan, Sulu, and Tawi-tawi).
 Leprosy: SIGN AND SYMPTOMS
EARLY SIGN AND SYMPTOMS LATESIGN AND SYMPTOMS

 Change in skin color- either  Loss of eyebrow-

reddish or white.
 Loss of sensation on the skin
madarosis
lesion  Inability to close eyelid-
 Decrease/loss of sweating lagophthalmos
and hair hair growth over the  Clawing of fingers and
lesion
toes
 Thickened and or painful
nerves  Contractures
 Muscle weakness or paralysis  Sinking of the mosebridge
of extremeties
 Enlargement of the breast
 Pain and redness of the eyes
in males or gynecomastia
 Nasal obstruction or
bleeding  Chronic ulcers
 Ulcers that do not heal
INFECTIOUS PREVENTION:
AGENT:  Aoidance of prolonged
 Mycobacterium skin-to-skin contact
leprae an acid fast, especially with a
rod- shaped lepromatous case
bacillus which can  Children should avoid
be detected by Slit close contact with
Skin Smear (SSS) active, untreated
leprosy case
METHOD OF
 BCG vaccination
TRANSMISSION
 Good personal hygiene
 Airborne
 Adequate nutrition
 Prolonged skin-to-
 Health education
skin contact
MANAGEMENT/TREATMENT
 Ambulatory chemotherapy - Multi-drug therapy
 Domiciliary treatment -R.A. 4073 which
advocates home treatment.
MULTI-DRUG THERAPY:
 Paucibacillary (tuberculoid and indeterminate)
◦ Non-infectious types
◦ Duration of treatment 6-9 months
 Multibacillary (Lepromatous and borderline)
◦ Infectious types
◦ Duration of treatment 24-30 months
FOR PAUCIBACILLARY (PB)
LEPROSY CASES
DRUGS/DURATION ADULT CHILD (10-14years)

Rifampicin 600 mg once a month 450 mg once a month

Dapsone 100 mg daily 50 mg daily

Duration of treatment 6 blisters packs to be 6 blisters packs to be

taken monthly within a taken monthly within a
maximum period of 9 maximum period of 9
months.*1 months.*2
For MultiBaciliary LEPROSY CASE
Drugs/duration Adult Child (10-14 years)
Rifampicin 600 mg once a month 450 mg once a month

Clofazimine 300 mg once a month 150 mg once a month,

and 50 mg daily and 50 mg every other
day
Dapsone 100 mg daily 50 mg daily
Duration of 12 blister packs to be 12 blister packs to be
treament taken within a taken monthly within
maximum period of 18 a maximum period of
months.*3 18 months.*4
Rifampicin SIDE EFFECTS

 Discoloration of body fluids

 Rashes
 Muscle soreness
 Anuria (nephrotoxicity)
 Thrombocytopenia
 Jaundice
DAPSONE & LAMPRENE

Dapsone Lamprene
 Increase  Skin
discoloration
number of
 Dryness and
lesion flakeness of
the skin – hot
soak
Mycobacterium Leprae
Madarosis
Lagophthalmos
Gynecomastia
Lepra Patient
Leprosy patient
Leprosy patient
Leprosy patient
Leprosy patient
Leprosy patient
Hands of Leprosy Patient
Hands of Leprosy Patient
Leprosy patient
Diseases Affecting
Circulatory System
A disease of the poor both in rural &
urban areas which is extremely
debilitating & stigmatizing disease
caused by parasitic worms
INFECTIOUS
AGENTS;
INCUBATION PERIOD:
 Human Lymphatic
 8-16 months
Filariasis
◦ Asymptomatic stage
Wuchereria bacroffi,
◦ Acute stage
Brugia malayi and/or
◦ Chronic stage
Brugia timori.
MOT:
 Aedes poecilius that
bites at night.
Clinical Manifestations:
Filariasis
 Acute
- Fever
- Malaise
- Chills
 B. Chronic
- Lymphadenitis
- Elephantiasis
- Hydrocele
Wuchereria Bancofti
Aedes Poecilus
Brugia Malayi
Brugia Timori
Culex Quinquefasciatus
Anopheles Minimus Flavirostris

CHRONIC SIGN AND
SYMPTOMS:
 Hydrocoele (swelling of the
scrotum)
 Lymphedema (temporary
swellibng of the upper and
lower extremities)
 Elephantiasis (enlargement
and thickening of hte skin of
the ;lower and/or upper
extremities, scrotum, breast)
DIAGNOSIS:
 Physical exam
 History taking
 Observation of the minor
and major sign and
symptoms
LABORATORY EXAMINATIONS;
 Nocturnal Blood Exam (NBE)
 Immunochromatographic test (ICT)
TREATMENT:
 Diathylcarbamazine Citrate (DEC)
or Hetrazan
MASS TREAMENT:
 Distribution to all population
 Endemic and infected or not
infected with filariasis in
established endemic areas
 The dosage is 6 mg/kg body weight
taken as a single dose per year
SURGICAL TREATMENT:
 Lymphovenous anastomosis
 Chyluria
 PREVENTIONAND CONTROL:

A.Aimed to control the vector

B. Aimed to protect the individual and

families in endemic areas
◦ Sleep under mosquito net
◦ Mosquito repellant
◦ Take yearly dose of medicine
Filariasis Victim
Filariasis Victim
Filariasis Victim
Filariasis Victim
Scrotal Elephantiasis
Scrotal and Penile Elephantiasis
Elephantiasis on Legs
Filariasis Victim
Elephantiasis on Legs
Scrotal Elephantiasis
Breast Elephantiasis
Labial Elephantiasis
Penile Elephantiasis
Elephantiasis
Scrotal Elephantiasis
MALARIA (AGUE)
An acute and chronic parasitic disease
transmitted by the bite of infected
mosquitoes & is confined mainly to tropical
& subtropical areas

Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale
MALARIA (AGUE
 Cold Stage – severe chills
(10-15 min)
Hot stage – fever (4-6 hours)
 wet stage – profuse sweating
INFECTIOUS AGENTS: SIGN AND SYMPTOMS:
 Plasmodium falciparum, P.  Recurrent chills
Vivax, P. Ovale and P. Malariae  Fever
INCUBATION PERIOD:  Profuse sweating
 12 days for p.falciparum  Anemia
 14 days for p. vivax,ovale  Malise

 30 days for malariae  Hepatomegaly

PERIOD OF  Spleenomegaly
COMMUNICABILITY:
 1-3 years CHEMOPROPHYLAXIS:
 CHLOROQUINE weekly
MODE of Transmission:
intervals, starting from 1-2
 Mosquito bite weeks before entering the
 Parenteral (BT) endemic area. Pregnant
women, it is given
 Shared contaminated needles
throughout the duration of
 transplacental
pregnancy.
DIAGNOSTICS: PREVENTIVE AND
 Malarial smear VECTOR
 Rapid diagnostic test CONTROL
(RDT) MEASURES:

MANAGEMENT:  Insecticide
 Chloroquine
 House spraying
 Quinine
 On stream seeding
 Sulfadoxine
 On stream clearing
 Primaquine
 Proper screening of
 Erythrocyte exchange
transfusion blood donors
LIFE CYCLE: MALARIA
MALARIA
 RECOMMENDED ANTI-MALARIA DRUGS:
BLOOD
SCHIZONTICIDES OTHER PREVENTIVE
 Chloroquine phosphate MEASURES:
250 mg ( 150mg
base/tablet)  Wearing of clothings that
 Sulfadoxine (or Sulfalene) covers arms anf legs in
50 mg – pyrimethamine
25mg/tablet the evening
 Quidine sulphate 300 mg  Avoiding outdoor night
tablet
 Tetracycline hydrochloride
activities
250 mg/capsule  Using mosquito
 Quinidine sulphate 200
mg/durules
repellents
 Quinidine gluconate 80  Planting of Neem tree or
mg (50 mg base) ml, 1 ml herbal plants
vial
 Zooprophylaxis
Palsmodium Vivax
Plasmodium Ovale
Plasmodium Malariae
Plasmodium Falcifarum
Female Anopheles
Female Anopheles
Female Anopheles
Dengue cases usually peaks in the months of July
to November and lowest during the month of
February to April.
breakbone fever, dandy fever, infectious
thrombocytopenic purpura
ETIOLOGIC AGENT:
 Dengue Virus Types 1,2,3,& 4
and Chikungunya virus
SOURCE OF INFECTION:
 Immediate source is a vector
mosquito, the Aedes Aegypti
or the common household
mosquito. TDLSU
 The infected person
MODE OF TRANSMISSION:
Mosquito bite (Aedes Aegypti)
INCUBATION PERIOD:
uncertain, probably 6 days to
one week.
PERIOD OF
COMMUNICABILITY:
Unknown. Presumed to be on
the 1st week of illness when
virus is still present in the
blood.
SIGN ANS SYMPTOMS:
THREE STAGES:
A. First 4 days – febrile or invasive
stage
◦ abrupt high fever, abdominal pain
and headache, later flushing which
may be accompanied by vomiting,
conjunctival infection
◦ epistaxis
◦ HERMAN’s SIGN
B. 4th – 7th days – toxic or
hemorrhagic stage
◦ Falling temperature (cool, clammy)
◦ Cyanosis, bleeding, profound
thrombocytopenia
C. 7th – 10th day – convalescent or
recovery stage
generalized flushing with interventing
areas of blanching appetite regained
and blood pressure already stable.
 DENGUE HEMORRHAGIC
FEVER
 Grade I: (+) tourniquet test
 Fever
Abdominal pain
Herman’s sign
 Grade II: Grade 1 plus bleeding
 Petechiae
Epistaxis
Melena
Gingival bleeding
Coffee ground vomitus
 Grade III: Grade 2 plus circulatory collapse
Hypotension
Cold clammy skin
Weak thready pulse
 Grade IV: Grade 3 plus shock
 Dengue Fever
Classification According to Severity (Halstead & Nimmanitya)

Grade 1 Fever & (+) Tourniquet test,

non specfic symptoms
Grade 2 Grade 1 + spontaneous
bleeding from nose, gums,
GIT
Grade 3 Presence of circulatory
failure

Grade 4 Profound shock,

undetectable BP & pulse
DIAGNOSTIC TEST: METHODS OF PREVENTION
 Tourniquet Test (Rumpel AND CONTROL:
Leads Test)  Early Recognition &
 Platelet count treatment of the disease
 Hemoconcentration  Isolation of patient
 Occult blood  Epidemiological investigation
 Hemoglobin determination  Case finding and reporting
 Health education
MANAGEMENT:
 For fever, give paracetamol. For CONTROL MEASURES:
headache give analgesic.  eliminate vector by changing
DON’T give ASPIRIN. water, scrubbing lower sides if
 Rapid replacement of body base q week, containers covered
fluids  avoid too many hanging clothes
 Intensive monitoring and inside the house.
follow-up  residual spraying with
 Give ORESOL to replace fluid insecticides
 Dengue FEVER

COMPLICATIONS: PUBLIC HEALTH

 Epistaxis NURSING
RESPONSIBILITIES:
 GIT bleeding
 report immediately to the
 GIT ulcer
municipal health office
 Metabolic acidosis
 refer immediately to the
 Hyperkalemia nearest hospital
 Tissue anoxia  health education program
 Myocarditis  assist in the diagnosis of
 enchepalopathy suspect based on the sign
and symptoms
 conduct epidemiologic
investigations
Chikungunya Virus
Aedes Aegypti
Aedes Aegypti
Petechial Rash
Dengue Victim
Dengue Patient
 DISEASES
OF THE
RESPIRATORTY TRACT
Tuberculosis ranks sixth in the leading
cause of morbidity (2002) and
mortality (2002)
INFECTIOUS AGENTS:
SIGNS AND SYMPTOMS:
 Mycobacterium
 Cough of two weeks or more
tuberculosis, M.
Africanum and M. Bovis  Fever
 Chest or backpains not
referable to any musculo-
MODE OF skeletal disorders
TRANSMISSION:  Hemoptysis or recurrent
 Airborne droplet blood-streaked sputum
 Direct invasion through
 Significant weight loss
mucous membranes or
breaks in the skin  Other sign and symptoms
 Ingestion of such as sweating, fatigue,
unpasteurized milk or body malaise and shorthness
dairy products. of breath.
PERIOD OF
COMMUNICABILITY:
 As long as viable tubercle
bacilli are being
discharged in the sputum
SUSCEPTIBILITY AND
RESISTANCE:
 First 6-12 months after
injection.
SOURCES OF INFECTION:
 Sputum from hemoptysis,
nasal discharge, saliva
DIAGNOSTIC PROCEDURES:
 Sputum AFB
 Chest X-ray
 Mantoux test
 Tine test
 Heaf test
TREATMENT:
 DOTS ( Directly Observed
Treatment Short Course
 Anti- TB drugs: RIPES
(Rifampicin, INH, PZA,
Ethambutol, Streptomycin)
DOTS
 Sustain political commitment
 Access to quality-assured sputum microscopy
 Standardized short-course chemotherapy for all
cases of TB under proper case management
conditions, including direct observation of treatment
Uninterrupted supply of quality assured drugs
Recording and reporting system enabling outcome
assessment of all patients and assessment of
overall program performance.
Category I

 new pulmonary tb patients whose sputum

is positive
 seriously ill with severe forms
a. 2 months (intensive) RIPE
b. 4 months (maintenance)
- Rifampicin, Isoniazid
Category II
Relapses
 Failures

a. 2 months (intensive) RIPES

b. 1 month (intensive) RIPE
c. 5 months (maintenance) RIE
Category III

 New pulmonary tb pts. Whose sputum is

negative for 3 times and x-ray result of
PTB minimal
 Extra Pulmonary (not serious)
. 2 months (intensive)
- RIP
- RI
Category IV

 Chronic TB
 TUBERCULOSIS
 METHODS OF CONTROL:
 Prompt diagnosis and treatment
 BCG vaccination
 Educate the public
 Improve social conditions
 Make available medical, laboratory and x-ray facilities for
examinations of patients, contacts, and suspects, and
facilities for earlt treatment of cases and persons at risk of
infection and beds for those needing hospitalization.
 Provide public health nursing and outreach services for
home supervision of patients to supervise therapy directly
and to arrange for examination and preventive treatments
of contacts.
Mycobacterium Tuberculosis
TB
TB patient
TB patient
 An acute infectious disease of the lungs
usually caused by the pneumoccocus
resulting in the consolidation of one or more
lobes of either one or both lungs.
ETIOLOGY:
 Streptococcus pneumoniae
 Hemophilus influenzae
 Staphylococcus aureus
 Klebsiella pneumoniae
(Friedlander’s bacilli)
PREDISPOSING CAUSES:
 Fatigue
 Overexposure to inclement
weather (extreme heat or
cold)
 Exposure to polluted air
 Malnutrition
INCUBATION PERIOD: 2-3
days
MODE OF TRANMISSION:
 Droplet; indirect contact
SIGN AND SYMPTOMS:
 Rhinitis/common cold
 Chest indrawing
 Rusty sputum
 Productive cough
 Fast respiration
 High fever
 Vomiting at times
 Convulsions may occur
 Flushed face
 Dilated pupils
 Severe chill, in young children
 Pain over affected lung
 Highly colored urine with
reduced chlorides and
increase urates
STAGES OF INFLAMMATION

1. ENGORGEMENT

2. RED HEPATIZATION

3. GRAY HEPATIZATION

4. RESOLUTION
SPUTUM COLORS

RUSTY

GREENISH

YELLOWISH

CURRANT JELLY

CLEAR
 PNEUMONIAS
TYPES:
 Hospital Acquired Pneumonia (Nosocomial)
Develops while the patient is in the hospital
 Community Acquired Pneumonia
Less than 36 hours hospital stay from admission
 Aspiration Pneumonia
Foreign material is inhaled (aspirated into the lungs)
 Pneumonia caused by Opportunistic
Organisms
Immunocompromised patients
Unharmful organisms become virulent
DIAGNOSIS:
 Based on history and clinical
sign and symptoms
 Dull percussion note on
affected side (lung)
 X-ray
COMPLICATIONS:
 Emphysema or pleural effusion
 Pneumococcal meningitis
 Endocarditis or pericarditis
with effusion
 Otitis media in children
 Hypostatic edema and
hypeemia of unaffected lung in
the elderly
 Jaundice
 Abortion
MANAGEMENT:
 Bedrest
 Adequate salt, fluid, calorie and
vitamin intake
 Tepid sponge for fever
 Frequent turning from side to
side
 Antibiotics based on care of
acute respiratory infection
CARI of the department of
health
PREVENTION & CONTROL:
 prevent common colds,
influenza & other URTI
 Immuinzation
 Limit alcohol, avoid pollution &
excessive fatigue
Acute febrile infection of the tonsil, throat,
nose, larynx or a wound marked by a
patch or patches of grayish membrane
from which the diphtheria bacillus is
readily cultured.
Corynebacterium diphtheriae
ETIOLOGIC AGENT:
Corynebacterium diphtheria
(Klebs-Loeffler bacillus)
SOURCE OF INFECTION:
discharges and secretions
MODE OF TRANSMISSION:
 Contact with person or carrier
or with articles soiled with
discharges o infected persons.
Milk has served as a vehicle.
INCUBATION PERIOD: 2-5
days
PERIOD OF
COMMUNICABILITY:
usually 2 weeks and seldom
more than 4 weeks
SUSCEPTIBILITY,
RESISTANCE and
OCCURRENCE:
 infants born of mothers
who had diphtheria
 recovery from an attack of
diphtheria is usually but not
necessary followed by
persistent immunity
 immunity is often acquired
throughunrecognized
infection
 two – thirds or more of
the urban cases are in
children under 10 years of
age.
 DIPTHERIA
3 TYPES OF DIPTHERIA: NURSING CARE:
 Nasal  follow prescribed dosage
 Pharyngeal  comport of the patient
 Laryngeal should always be in
 Cutaneous
mind
DIAGNOSTICS:
 visiting bag set up
 Nose & throat culture
should be outside the
 Schick’s test
room of the patient
 Moloney’s test  other nursing care
should be based on the
MEDICATIONS: prescribed treatment of
 Pen G the physician
 Erythromycin
 DIPTHERIA

METHODS OF PREVENTION AND

CONTROL:
 active immunization of all infants
 pasteurization of milk
 educating of parents
 reporting of the case to the health officer for proper medical
care.
 Isolate until 2-3 cultures are negative taken @ leat 24 hrs apart
 Small frequent feedings
 CBR
 Ice collar for sore throat
 Soft diet
ETIOLOGIC AGENT:
Hemophilus Pretussis or
Bordet Gengou Bacillus or
Bordetella pertussis or
pretusssis bacillus
SOURCE OF INFECTON:
 Discharges from laryngeal and
bronchial mucous membrane
of infected persons.
MODE OF TRANSMISSION:
 Direct spread through
respiratory and salivary
contacts.
INCUBATION PERIOD: 7-10
but not exceeding 21 days.
PERIOD OF
COMMUNICABILITY:
 In early catarrhal stage,
paroyxmal cough confirms
provisional clinical diagnosis 7
days after exposure to 3 weeks
after onset of typical
paroxysms.
METHODS OF
PREVENTION AND
CONTROL:
 DPT immunization of all infants
 Booster dose is to be given at
the age of 2 years and again at
4-5 years of age
 Patient should be segregated
until after 3 weeks from the
appearance of paroxysmal
cough.
Bordetella Pertussis
 PERTUSSIS
CLINICAL MANIFESTATIONS:

 Catarrhal Stage
 Coryza, sneezing, dry bronchial cough
 Most communicable/ last for 1 week
 Paroxysmal Stage
 7th to 14th day
 Spasmodic & recurrent cough with EXCESSIVE OUTBURST in a
series of 5-10 rapid coughs in one exhalation ending with a loud
crowning inspiratory whoop
 Convalescent Stage
 Gradual decrease in coughing
 Attack subsides after attack
Pertussis Patient
Pertussis in Neonate
 PERTUSSIS
DIAGNOSTIC COMPLICATIONS:
PROCEDURE:  Pneumonia
 Atelectasis
 Convulsions
 Nasopharyngeal swab
 Umbilical hernia
 Sputum culture
 Otitis media
 CBC (Leukocytosis)
 bronchopneumonia- most
dangerous
 Severe malnutrition &
starvation
 PERTUSSIS
MEDICAL MANAGEMENT:
 Fluid & electrolyte replacement
 Adequate nutrition
 Oxygen therapy
 Antibiotics: Streptomycin & Ampicillin
 Gamma globulin

NURSING CARE:
 Patient should not be left alone, suction equipment at
bedside
 Sunshine & fresh air, avoid draft
 Kept child as quiet as possible
 Provide warm baths, keep bed dry & free from soiled lines
 I & O monitored
 MUMPS/ INFECTIOUS
PAROTITIS/EPIDEMIC PAROTITIS

An acute contagious disease, the characteristics

feture of which is the swelling of one or both of the
paratid glands, usually occurring in epidemic form

ETIOLOGIC AGENT:
 Mumps virus, a member of
the family
Paramyxomviridae, genus
Paramyxovirus, is
antigenetically related to the
parainfluenza viruses.
SOURCE OF INFECTION:
secretion of the mouth and
nose
MODE OF TRANSMISSION:
direct contact
Droplet
indirect
INCUBATION PERIOD:
 12-26 days, usually 18 days.
PERIOD OF COMMUNICABILITY:
 6 days before & 9 days after onset of
parotid gland swelling
SIGN AND SYMPTOMS:
 Painful swelling in front of ear,
angle of jaws and down the neck
 Fever
 Malaise
 Loss of appetite
 Swelling of one or both testicles
(orchitis) in some boys
TREATMENT:
 prophylactic
 active treatment
 after the age of puberty
 diet should be soft or liquid as
tolerated
NURSING CARE:
 encourage control of scratching to prevent local infections and scars
 Masks for susceptibles, hand washing
 Oral care & personal hygiene
 Bed rest
 No restriction of food
 Soft & semi solid foods is easily managed
 Acid foods such as fruit juices may increase discomfort
 Hydration
 Warm/cool compress
 Excluded from school or work 9 days from the onset

PREVENTION & CONTROL:

 MMR
 Reporting of cases
 Isolation of patient
 INFLUENZA/ LA GRIPPE

Acute highly communicable disease

characterized by abrupt onset with fever which
last 1-6 days, chilly sensation or chills, aches or
pains in the back and limbs with proatrations.
Respiratory symptoms include coryza, sore throat
and cough.
ETIOLOGIC AGENT: Influenza virus
A,B,C CLINICAL
SOURCE OF INFECTON: discharges MANIFESTATIONS:
from the mouth and nose of infected
persons  Chilly sensation,
MOT: hyperpyrexia
 Direct contact
 Malaise, sore throat
 Droplet
 Articles freshly soiled discharge of  Coryza, rhinorrhea, myalgia
nose and throat of infected person
 Airborne  Headache
INCUBATION PERIOD: short, usually
24-72 hours
DIAGNOSTICS:
PERIOD OF COMMUNICABILITY:
probably limited to 5 days from  Compliment fixation test
clinical onset.
 Heme agglutination test
 Neutralization test
 Viral culture
 Blood examination
 METHODS OF PREVENTION AND CONTROL:
 Education of the public
 Avoid use of common towels, glases, and eating utensils
 Active immunization with influenza vaccine provided prevailing strain of
virus matches antigenic component of vaccine

 NURSING CARE:
 Keep patient warm and free from drafts in bed.
 Keep patient away from persons suffering from respiratory tract
infections to prevent pneumonia.
 Tepid sponge
 Teach and demonstrate proper sneezing and cough technique
 Teach the burning method or disposal of contaminated tissues and
newspaper
 Clothing soiled with throat and nose discharges should be boiled for 30
minutes before laundering
 Plenty of water
 Limit strenuous activity
 (Bilhariasis or snail fever)
CAUSATIVE AGENTS:
blood fluke, schistosoma Japonicum,mansoni, hematobium that is
transmitted by a tiny snail oncomelania quadrasi.
AREAS AFFECTED:
Bicol
Samar
Leyte
Davao
INFECTIOUS AGENTS:
 Schistosoma mansoni. S.
Haematobium and 51:
japonicum are the major species
causing human disease.
MOT:
 Skin comes in contact with
contaminated fresh water.
INCUBATION PERIOD: 2 weeks
after skin preparation
SIGN AND SYMPTOMS:
 earliest= Swimmer's ITCH
 Diarrhea
 Bloody stools
 Enlargement of abdomen
 Splenomegaly
 Weakness
 Anemia
 Inflamed liver
DIAGNOSTICS: Stool Exam (kato
Technics)
TREATMENT:
 Praziquantel (Biltricide) is the drug
of choice against all species.
 Alternative drugs are Oxamniquine
for S. Mansoni and metrifonate for
haematobium
METHOD OF CONTROL:
 Preventive measures
 Control of patients, contacts and the
immediate environment
 Investigationof contacts and sourceof
infection: examine contacts for
infection from a common source.
 Dispose feces & urine
 Prevent exposure to contaminated
water (rubber boots)
 Proper irrigation of all stagnant bodies
of water
aa worldwide
worldwide zoonotic
zoonotic disease
disease caused
caused byby bacteria
bacteria called
called leptospires, Leptospira interrogans.
leptospires, Leptospira interrogans.

“ canicola fever, swineherd’s fever, hemorrhagic

jaundice”
Causative agent: Clinical Manifestations:
Leptospira interrogans
Incubation Period: SEPTICIMIC Stage
 High remittent fever
Varies from 6-15 days
 Myalgia, calf pain, abdominal
pain
Period of Communicability:
 Found in urine between 10- ANICTERIC Stage
20 days after onset  Conjunctival effusion (
orange/red eye)
Sources of Infection:  Abrupt high grade fever
 disorientation
 Contaminated food, water &
rodents (dogs, mice, rats)
ICTERIC Stage
 Acute Renal failure
Mode of Transmission:
 Jaundice
 Ingestion or skin contact
 Myocarditis
with infected urine or
carcasses of infected animals  Hemorrhage
 Mucuos membrane of the
eye, nose & mouth; break in COMPLICATIONS: RENAL Failure
the skin
 LEPTOSPIROSIS
DIAGNOSTICS: NURSING CARE:
 Blood culture  Isolate patient’s urine
 Close monitoring
 Leptospira
 Clean dirty places, pools, &
Agglutination stagnant water
test(LAT)  Eradicate rats & rodents

TREATMENT: PREVENTION & CONTROL:

 Penicillin G  Environmental sanitation
 Proper drainage system &
 Tetracylcline control of rodents
 Peritoneal dialysis  Vaccination of animals
 Fluid & electolytes,  Treatment of infected
blood transfusion human & pets
 Effective IEC
Leptospira Interrogans
Leptospirosis Patient
DISEASES AFFECTING
GASTROINTESTINAL
SYSTEM
 CHOLERA BACILLARY AMOEBIASIS
DYSENTERY

Synonym
Causative
Agent
MOT
Incubation
Explosive vomiting and Fvere, colicky abd. Pain, Severe cramping, o and
S/Sx
diarrhea; diarrhea with tenesmus off diarrhea
_______________, (____________________
Dehydration (washer _
(woman’s hands) _______), greenish,
bubbly, foul odored stool,
frequent flatulence

Dx
An acute serious illness characterized by sudden
onset of acute and profuse colorless diarrhea,
vomiting, severe dehydration, mucular cramps,
cyanosis and in severe cases collapse
Vibrio coma
TYPHOID FEVER/ ENTERIC FEVER

A systemic infection characterized by continued fever,

malaria, anorexia, slow pulse, involvement of
lymphoid tissues, especially ulceration of Peyer’s
patches, enlargement of spleen, rose spots on trunk
and diarrhea.
ETIOLOGIC AGENT: Salmonella
typhosa, typhoid bacillus
CLINICAL
SOURCES OF INFECTION: MANIFESTATIONS:
 Feces and urine of infected Prodromal Stage
persons, contaminated milk,  h/a, fever, anorexia, lethargy,
shellfish
constipation or diarrhea,
vomiting, abdominal pain
MOT:
 Direct or indirect contact with
Fastigial Stage
patient or carrier.  LADDER LIKE FEVER,
 Fecal-oral ROSE SPOTS, splenomegaly,
 5 F’s typhoid state

INCUBATIONPERIOD; variable; Defervescence Stage

2 weeks
PERIOD OF  Fever subsides, hemorrhage,
COMMUNICABILITY: peritonitis
 As long as typhoid bacilli
appear in excreta; usually from
appearance of prodromal Lysis/ Convalescence Stage
symptoms from first week  S&Sx gradually disappears
throughout convalescence.
DIAGNOSTICS: NURSING CARE:
 Hemoculture
 Fluid & electrolyte
 Widal’s test/ typhidot
 Stool exam
balance
 Rectal swab  VS monitoring
 Protect from fall
TREATMENT:  Good personal hygiene &
CHLORAMPHENICOL doc
mouth care
COMPLICATIONS:  Cooling measures
 Hemorrhage/ perforation (most  Watch out for intestinal
dreaded) bleeding
 Peritonitis
 Bronchitis/ pneumonia
 Thromboembolism DIET:
 Heart failure  Low fiber plenty of fluids,
 TYPHOID SPINE or Neuitis easily digestible foods
 An acute bacterial infection of the intestine
characterized by diarrhea, fever, tenesmus and in
severe cases bloody and mucoid stools.

“ BLOODY FLUX”
Shigella (dysentery bacillus).
ETIOLOGIC AGENT:
 Twenty seven zero- types of germs
Shigella (dysentery bacillus). There
are four main groups: Shflesneri;
Shboy-dii; Sn-connei; Sh-
dysenterae
PERIOD OF
COMMUNICABILITY:
 During acute infection until
negative for the organism

SOURCES OF INFECTION: CLINICAL MANIFESTATIONS:

 Feces of infected person
 Fever

MOT:  Tenesmus, nausea & vomiting,

 Eating contaminated foods, or h/a
drinking contaminated water or  Colicky/ Crampy abdominal
milk and by hand to mouth
transfer of contaminated materials; pain
by files, by objects soiled with feces
of a patient or carrier.  BLOODY MUCOID STOOL
 Fecal-oral  Dehydration
 Weight loss
INCUBATIONPERIOD; 7 hours- 7
days average: 3-5 days7
COMPLICATIONS: METHODS OF PREVENTION
 Rectal prolapse AND CONTROL:
 Cough & pneumonia
 Arthritis  Sanitary disposal of human feces
 Sanitary supervision of
DIAGNOSTICS: processing, preparation and
 Fecalysis serving of food particularly those
eaten raw.
 Rectal swab or culture
 Peripheral blood examination
 Adequate provision for safe
washing facilities
 Blood culture
 Fly control
TREATMENT:  Protection of purified water
supplies and construction of safe
 Cotrimoxazole, privy
Choramphenicol
 IV: NSS  Control of infected individual
contacts and environment
 Low residue diet
 No to anti-diarrheal drugs  Reporting to local health officer
(delay defecation prolonging  Isolation
fever)  Rigid personal precautions by
attendants
 Avoid 5F’s
 AMOEBIASIS/ AMOEBIC
DYSENTERY

Protozoan infection initially involving the colon but

may spread to soft tissues by contiguity 0r
hematogenous or lymphatic dissemination most
commonly to the liver or lungs
CAUSATIVE AGENT:
 Entamoeba histolytica
SOURCES OF INFECTION:
 Human excreta
INCUBATION PERIOD:
 3 days in severe infection; several
months in subacute & chronic
infection; average: 3-4 days
PERIOD OF COMMUNICABILITY:
 Entire duration of illness
MODE OF TRANSMISSION:
 Fecal-oral
 Direct contact (sexual contact by
orogenital, oroanal sexual act)
 Digestion of uncooked leafy veges
 Contaminated fecal materials
 Contaminated food or drinks
CLINICAL MANIFESTATIONS:
 On & off Diarrhea accompanied
by tenesmus (greenish stool)
 Colic & gaseous distention of
the lower abdomen
 Nausea
 Flatulence
 Anorexia, weight loss, weakness
 Enlarged liver
 GRADUAL onset, BLOODY
MUCOID STOOLS
DIAGNOSTICS:
 Stool exam
 Blood exam (leukocytosis)
 Protoscopy/ sigmoidoscopy
TREATMENT:
 Metronidazole or Flagyl
 IV infusion
 AMOEBIASIS
NURSING MANAGEMENT:
 Enteric isolation
 Boil water/ purified water
 Avoid washing from open
drum
 Cover left over foods
 Wash hands after defecation
or before eating
 Avoid ground vegetables (
lettuce, carrots)
PREVENTION & CONTROL:
 Health education
 Sanitary disposal of feces
 Protect, chlorinate, purify
drinking water
 Cleanliness in food
preparation & handling
 Detection & treatment of
carriers
 Fly control
 ASCARIASIS/ ROUNDWORM
INFECTION
An infection caused by a parasitic
roundworm Ascaris lumbricoides
CAUSATIVE AGENT:
 Ascaris lumbricoides
MODE of TRANSMISSION:
 Fecal-oral
 Contaminated fingers put in
the mouth
 Ingestion of contaminated food
& drinks
SOURCE OF INFECTION:
 Contaminated soil (no sanitary
toilets)
DIAGNOSTICS:
 Fecalysis, Kato Katz
 Abdominal X-ray ( dot sign)
 Routine CBC- eosinophilia
TREATMENT:
 Albendazole or mebendazole 100mg
BID x 3 days
 Piperazine citrate 75 mg/kg x 2 doses
daily
 Pyrantel pamoate 1 mg/kg single dose
NURSING INTERVENTIONS:
 No isolation needed
 Handwashing
 Proper food handling & preparation
 Insepction of toilet facilities
 Personal hygiene
PREVENTION:
 Improved sanitation & hygienic
practices
 Improved nutrition
 deworming
ENTEROBIASIS/ OXYURIASIS
Causative Agent:
 Enterobius vermicularis/
SIGNS & SYMPTOMS;
human pinworm or seatworm  Perianal ithching
Mode of Transmission:  Disturbed sleep
 Ingestion or inhalation of eggs  Nervousness
 Irritability
Incubation Period:
 4 to 6 hours
TREATMENT:
 Mebendazole 100mg single dose
Diagnostics:
repeated onnce at 2nd week for
 Scotch tape test (perianal effectivity
region) done in the morning
prior to bath
PREVENTION & CONTROL:
SOURCES OF INFECTION:  Personal hygiene
 Overcrowding  Handwashing
 Water supply inadequate for  Keep fingernails short
personal hygiene
 Eggs- fingernail cuttings  Sterilization of contaminated
linens, clothing
ANCYLOSTOSOMIASIS
CAUSATIVE AGENT:
 Necator americanus
(Philippine) DIAGNOSTICS:
 Ancylostoma duodenale (blood  Fecalysis
sucking roundworms of the  FECT ( direct fecal smear)
intestine

SOURCES OF INFECTION: TREATMENT:

 Soil
MODE OF TRANSMISSION:
 Direct contact (skin)
SYMPTOMS:
 Ground/dew itch dermatitis
 Pulmonary symptoms
(coughing, sneezing, wheezing)
 Abdominal pain, anemia
 Mebendazole 100mg BID x
3days
 Iron supplementation
 Diet
 Health education
 Use of footwear
Hookworm
Hookworm foot
PARAGONOMIASIS
ETIOLOGY:
 LUNG FLUKE SPECIES IN THE PHILIPPINES
 Paragonimus westermani (subspecie: philippinensis/filipinus) is the most important causative
agent in asia.
 Paragonimus siamense

KNOWN INTERMEDIATE HOSTS IN THE PHIL.:

 ANTEMELANIA ASPERETA (Brotia asprreta, form dactylus)
 Ccrabs, S1
 Varona litterata
 Crayfish

MOT:
 Ingestionof rwa or insufficiently cooked crabs
 Contamination of food or utensils
 Consumption of inadequately cooke meat of animal reservoirs
 Using meat or juice of infected animals for certain means
 Accidental transfer of excysted meta-cercariae to the moth during food preparation.
 Drinking contaminated water.
RESEVOIR OF HOST: TREATMENT:
 CATS  Praziquantel (Biltrizide) is the
 DOGS treatment of choice
 RATS  Bithionol (BITIN) is the
 PIGS alternative drug.
 Other wild and domestic animals  Surgical removal – for
heterotopic cases
SIGN AND SYMPTOMS:
 Cough of long duration PREVENTION AND
 Hemoptysis CONTROL:
 Chest/backpain  Treatment of infected person
 PTB- like signs and symptoms not  Disinfection/sanitary disposal
responding to anti-TB medications of excreta
 Anti-mollusk campaigns
DIAGNOSIS:  Education of the population
 Sputum exam  Avoid eating infected foods
 Immunology
 Avoid bathing I infected water
 Cerebral paragonimiasis
A form of acute hepatitis occurring either sporadically
or in epidemics and caused by viruses introduced by
fecally contaminated water or food.
PREDISPOSING FACTORS:
 Poor sanitation
MANAGEMENT AND
 Contaminated water supplies TREATMENT:
 Unsanitary method of preparing  Prophylaxis
and serving of food
 Malnutrition  CBR
 Disaster an wartime conditions  Low fat diet but high in sugar

INCUBATIONPERIOD; 15-50 days,

dpending on dose; average 2830
days PREVENTION AND CONTROL:
 Ensure safe water for drinking
SIGN AND SYMPTOMS:
 Sanitary method in preparing
 Influenza
 Malaise and easy fatigability handling and serving food
 Anorexia and abdominal  Proper disposal of urine and
discomfort/pain
 Nausea and vomiting
feces
 Fever  Washing hands very well
 Lymphadenopathy
 Separate and proper cleaning of
 Jaundice accompanied by pruritus
and urticaria articles used by patient
 Bilirubinemia with clay-colored
stools
 HEPATITIS
Infection of the liver caused by
bacteria or virus A, B, C, D,E, G
or substances toxic to the liver
Hepatitis B Virus
 DIAGNOSTICS:
SIGNS & SYMPTOMS:
 SGPT (ALT; SGOT (AST, bilirubin,
PRE-ICTERIC Stage: alkaline phosphatase
 Flu like symptoms  UTZ of liver
 Sligh RUQ pain  Liver agglutination test
 Liver biopsy
 N/V, fatigue, constipation or
diarrhea  HbsAg- Hepa B

 Weight loss
TREATMENT: no specific treatment
 Hepatomegaly, splenomegaly
 Essential phospholipids (Jelapor)
 Lymphadenopathy  Sylimarine- helps liver regenerate
ICTERIC stage:
 Light colored stools (acholic stool) CHRONIC HEPA B
 Jaundice-sclera  Lamivudine (Zelfix) 100mg tab OD x 1yr
(inhibit reproduction of Hepa B virus)
 Tea colored urine
 White people alpha interferon
 Continued hepatomegaly with
tenderness NURSING CARE:
POST-ICTERIC Stage  Bedrest
 Fatigue bu increased sense of well  Increase cHON, CHO, low fat diet
being  Oral care
 Hepatomegaly  Psychological support
 Sx gradually subsides  Monitor/ relieve oruritus- cool moist
compress, emollient lotion
 HEPATITIS A HEPATITIS B HEPATITIS C
Synony Infectious Catarrhal Serum/inoculation/transfusion Post-transfusion/
jaundice; epidemic hepatitis non-A, non-B
m
hepatitis hepatitis

Causative
Agent

MOT Person-person, percutaneous,

parenteral, placental

Source Food, water, feces Blood, semen, vaginal secretion

Incubation 2-6 weeks 6wks-6months 6-8mons

Period

At risk Lack of hygiene, Health worker, blood recipients, drug

travelers, unsafe water addict, promiscuous.
supply, food handlers

Carrier none
state
Preventi Hygiene, immunization Immunization, blood screening, use of Same w/ HBV
sterile needle, monogamous except no vaccine
on
relationship
 A syndrome of characteristics symptoms
predominantly neurologic which occur within minutes
or several hours after ingestion of poisonous shellfish
MOT: MANAGEMENT AND
 Ingestion of raw or CONTROL
inadequately cooked MEASURES:
seafood usually bi-valve  No definite medication
shellfish or molluscs indicated
during red tide season.  Induce vomiting
 Drink pure coconut milk
INCUBATION  Shellfish affected by the
PERIOD; red tide should not be
 Varies from about 30 cooked with vinegar.
minutes to several hours  Educate to avoid bi-valve
after ingestion of the mollusks when the red
toxic shellfish have a tide warning has
greater chance of beenissued by the proper
survival. authorities.
SEXUALLY TRANSMITTED
DISEASES
 GONORRHEA

o causative agent is Neisseria gonorrhea.

o During delivery - opthalmia neonatorium,
 Signs and Symptoms

Women: Greenish Vaginal Discharge

 Painful Urination (dysuria)
 Painful Intercourse
Men: Painful Urination
 Pelvic pain and fever
 Purulent discharge
 Urethritis
 Management
1. Medications
a. Tetracycline 500
b. Ceftriaxone
c. Tetracycline ophthalmic ointment or 1% silver nitrate for the is
routinely given to all newborns.
2. Health teachings
◦ Avoid sexual intercourse until cure of infection or use condom to prevent
transmitting the infection.
◦ Examinations and treatment of sexual partner to prevent reinfection is
necessary.
◦ Return to clinic for check-up in 4 to 7 days after completion of treatment.
Complications
1. Preterm delivery
2. Chorioamnionitis
3. Opthalmia neonatorum in newborn.
4. Sterility and pelvic inflammatory disease
(PLD) in women.
5. Sterility, infertility, epididymitis and
postgonococcal urethras in men.
 SYPHILIS

 causative agent is spirochete, Treponema

pallidum.
 A woman who has untreated syphilis can
pass the infection to the after 10 weeks of
pregnancy.
 Stages
1. Incubation Period- The first 10 to 90.
no signs and symptoms appears.
2. Primary Stage- most infectious stage
This period is characterized with
chancre
3. Tertiary Stage- The destructive stage. –
extends to the different systems of the
body: cardiovascular, nervous and
skeletal system.
4. Latency- Lasts from 5 to 20 years during
-no signs and symptoms appear
Diagnosis

1. Fluorescent treponemal antibody

test- specific test for syphilis
2. Kahn and Wasserman Test
3. Venereal Disease Reference
Laboratory Slide Test (VDRL)
 Management

DOC:
After completion of treatment, the women is treated
monthly and the sexual partner at 3 months, 6 months
and 12 months.
. Fetus will not be affected if the mother is treated before the
fifth month, emphasize the importance of screening for
syphilis during the first prenatal visit for early detection
and treatment.
 Complications

1. Congenital syphilis in newborn if untreated

in late pregnancy.
2. Late abortion
3. Stillbirth
ACQUIRED IMMUNODEFICIENCY
SYNDROME

 first recognized in 1981.it is caused by a virus, the

immunodeficiency virus, that attacked the
immune system of the body
 virus multiply within white blood cells and attack
different organs of the body thereby causing wide
variety of signs and symptoms.
Causative agent:

Source of infection: Blood, semen, cervical discharges,

breastmilk, CSF, Body fluids except tears
Incubation period: 6 months-5 years or more

TARGET CELL:
FX: Identifies pathogenic memory; mobilizes other
elements of immune system; ___________________
 Mode of Transmission
 exchange of body fluids, blood and semen
 not spread by casual contact such as
holding hands, kissing, hugging and
sharing of eating utensils
 sexual contact, sharing of contaminated
needles and syringes and transfusion of
infected blood products
infected mother can pass the virus to the
fetus during pregnancy and childbirth or
via the breast milk.
 Persons at Risk

1. Hemophilliacs- because of their need for blood

transfusion.
2. Intravenous Drug Abusers- Sharing of
contaminated needles and syringes during pot
sessions.
2. Homosexual and bisexual men with multiple sex
partners.
Diagnosis

 Enzymes Linked Immunosorbent Assay or

ELISA- the first test conducted.
 Immunofluorescent Assay or IFA- confirms
ELISA results
 Signs and Symptoms

Clinical Staging
 1. Window Phase- initial esposure; no diagnostic
procedure can detect this stages

 2. Acute Primary HIV infection – flu-like symptoms;

screening should be done
 3. Asymptomatic HIV Infxn- 1-20 years depends on:
immune system status at the time of exposure,
lifestyle, treatment regimen to delay the progress of
HIV infection
 4. ARC- composed of s/sx that indicate
immunosuppression
 CD4 is 200-800
 10% body weight loss
 Night sweats
 Repeated , chronic diarrhea
 Lymphadenopathy (armpit, inguinal)
 Flu-like symptoms
5. AIDS
Opportunistic Infections
 ORAL: candidiasis, oral hairy leukoplakia
 NERVOUS- Encephalitis, meningitis, AIDS dementia,
toxoplasmosis, Cryptococcus neoformans
 RESP-TB, pneumocystis carinii pneumonia,
coccydiomycosis
 GIT- Diarrhea, hepatitis, Isospora belli
 SKIN-scabies, herpes zoster
 SENSES-blindness, deafness
 Effects of the infant
1. Encephalopathy
2. Microcephaly
3. Central nervous system lymphomas
4. Cerebrovascular accidents
5. Respiratory failure
6. Lymphadenophaty
7. Developmental Anomalies
Preventing AIDS: SECT
Screening:blood donor, organ donor
Education: know the disease process,
sex education
Counselling: High-risk behaviour
Training: members of the healthcare
team
 Management
1. For AIDS infected person:
a. Medication to restore the immune system:
 Interferon
 Interlukin 11
 Azidothymidine (AZT)
b. Specific drugs and treatment for opportunistic diseases
c. Health teachings.
 avoid infections
 use latex condoms to protect partner during sexual
intercourse
 do not donate blood, sperm organs or other body
tissue.
 do not share items with other persons that may be
contaminated with bloods and other body fluids.
 do not breastfeed infants
2. Noninfected persons:
a. Stick to one partner, practice monogamous relationship
b. Use condoms
c. Avoid oral and anal sex
d. Practice good personal hygiene
e. Practice healthful living: exercise, nutritional diet, safe
sex
 weight loss of greater than 10% of the body
 chronic diarrhea, more than 1 month
 prolonged fever, lasting more than 1 month
 AIDS cannot be transmitted by sharing foods,
eating utensils, toilet swimming pools, water
 Abstinence is the best method of preventiont
3. Precautionary workers for health workers:
a. Handle all sharp instruments with care, use disposable
needles and do not reuse as much as possible.
b. Protect yourself, increase resistance to infections by proper
diet, exercise, rest and sleep.
c. Avoiding body fluids-label blood and other specimen of a
person known or suspected with AIDS properly, clean
blood spills with disinfectants.
d. Practice strict aseptic technique- hand washing, wear
gloves, clean, disinfectant and sterilize
e. Wear protective clothing when necessary-gloves, arms,
mask, goggles
 CANDIDIASIS

 caused by a yeast-liked fungus, Candida

albicans
 increase vaginal secretion with high glycogen
content during pregnancy favors the growth
and multiplications of Candida albicans.
 identified in about 25% of women near the end
of pregnancy.
 Predisposing Factors
1. Diabetes mellitus
2. Obesity
3. Antibiotic therapy
4. Tight Clothing
5. AIDS
5. frequent douching
6. Corticoids therapy
 Signs and Symptoms

1. White Cheese-like vaginal discharge

2. Patches of curdlike, cheesy material that
adhere to the vaginal wall
3. Pruritus of the perineum
4. Painful Intercourse (dspareunia)
5. Redness of the perineum
TRICHOMONiASis

 Trichomonas is a vaginal infection caused by

single cell protozoan, Trichomonal vaginalis.
 Signs and Symptoms

1. Yellow green frothy vaginal discharge

2. Vaginal irritation and inflammation
3. Dyspareunia
4. Dysuria
5. Vulvar itching
 Management
1. Medications
a. Metronidazole (flagyl) 250 mg 3 times a day for
a week
- this drug is contraindicated during the first
trimester of pregnancy
2. Home Remedies:
Acidic Vaginal douche- 1 tablespoon vinegar
mixed with 1 liter water to counteract the alkaline
environment of the vagina that favors the growth
of Trichomoniasis vaginalis.