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Nurse Licensure Examination Review Handouts

THE COMMUNITY HEALTH NURSING


AND
COMMUNICABLE DISEASES

Community Health Nursing


COMMUNITY HEALTH NURSING

I - Definition of Terms Community- derived from a latin word “comunicas” which means a group of
people. · a group of people with common characteristics or interests living together within a territory or
geographical boundary · place where people under usual conditions are found
Health - is the OLOF (Optimum Level of Functioning)
Community Health - part of paramedical and medical intervention/approach which is concerned on the
health of the whole population
Aims: 1. health promotion 2. disease prevention 3. management of factors affecting health
Nursing - both profession & a vocation. Assisting sick individuals to become healthy and healthy
individuals achieve optimum wellness

II - Community Health Nursing


• The utilization of the nursing process in the different levels of clientele-individuals, families,
population groups and communities, concerned with the promotion of health, prevention of
disease and disability and rehabilitation.
Goal: “To raise the level of citizenry by helping communities and families to cope with the discontinuities
in and threats to health in such a way as to maximize their potential for high-level wellness”

MISSION OF CHN
· Health Promotion – activities related to enhancement of health
· Health Protection – activities designed to protect the people
· Health Balance – activities designed to maintain well being
· Disease prevention – activities relate to avoid complication
· Social Justice – activities related to practice equity among clients

PHILOSOPHY OF CHN ACCORDING TO DR. MARGARET SHETLAND


• The philosophy of CHN is based on the worth and dignity on the worth and dignity of man.

Principles of Community Health:


1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele:
individual, family, population group (those who share common characteristics, developmental stages and
common exposure to health problems – e.g. children, elderly), and the community.

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2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in society, in
general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.

Role of CH Nurse:
· Clinician - who is a health care provider, taking care of the sick people at home or in the RHU
· Health Advocator – speaks on behalf of the client
· Advocator – act on behalf of the client
· Supervisor - who monitors and supervises the performance of midwives
· Facilitator - who establishes multi-sectoral linkages by referral system
· Collaborator – working with other health team member

COMMON PROCEDURE IN CHN:


· HOME VISIT
· BAG TECHNIQUE
· STERILIZATION
· SPECIMEN COLLECTION
- URINE – sterile bottle; midstream collection
- FECES - clean container; small amount of feces only
- SPUTUM - NPO midnight 1st collection early AM then submit at the health center immediately
then 2nd collection following day early in the Am then submit at the health center then collect the
3rd sputum; instruct patient to take a deep breath 4 times then cough out

Levels of Client in CHN:


1. Application of Nursing Process to:

1.a Family
1.a.1 Family Coping Index
· Physical Independence - ability of the family to move in & out of bed & performed activities of daily living

· Therapeutic Independence - ability of the family to comply with the therapeutic regimen (diet, medication
& usage of appliances)
· Knowledge of Health Condition- wisdom of the family to understand the disease process
· Application of General &Personal Hygiene- ability of the family to perform hygiene & maintain
environment conducive for living
· Emotional Competence – ability of the family to make decision maturely & appropriately (facing the
reality of life)
· Family Living Pattern- the relationship of the family towards each other with love, respect & trust
· Utilization of Community Resources – ability of the family to know the function & existence of resources
within the vicinity
· Health Care Attitude – relationship of the family with the health care provider
· Physical Environment – ability of the family to maintain environment conducive for living

1.a.2 Family Life Cycle


· Stage I – Beginning Family (newly wed couples)
TASK: compliance with the PD 965 & acceptance of the new member of the family
· Stage II – Early Child Bearing Family(0-30 months old)

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TASK: emphasize the importance of pregnancy & immunization & learn the concept of parenting
· Stage III –Family with Pre- school Children (3-6yrs old)
TASK: learn the concept of responsible parenthood
· Stage IV – Family with School age Children (6-12yrs old)
TASK: Reinforce the concept of responsible parenthood
· Stage V - Family with Teen Agers (13-25yrs old)
TASK: Parents to learn the concept of “let go system” and understands the “generation gap”
· Stage VI – Launching Center (1st child will get married up to the last child)
TASK: compliance with the PD 965 & acceptance of the new member of the family
· Stage VII -Family with Middle Adult parents (36-60yrs old)
TASK: provide a healthy environment, adjust with a new lifestyle and adjust with the financial aspect
· Stage VIII – Aging Family (61yrs old up to death)
TASK: learn the concept of death positively

1.b Community
COMMUNITY ASSESSMENT: · Status – information about morbidity, mortality & life expectancy ·
Structure – information about age, gender and socio economic · Process – information about how the
community function

TYPES OF COMMUNITY ASSESSMENT:

1. COMMUNITY DIAGNOSIS
A process by which the nurse collects data about the community in order to identify factors which may
influence the deaths and illnesses of the population, to formulate a community health nursing diagnosis
and develop and implement community health nursing interventions and strategies.

2 Types:
Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis
- aims to obtain general information about - type of assessment responds to a particular
the community need

STEPS: ·
Preparatory Phase
1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data collection
6. finalize sampling design and methods
7. make a timetable
· Implementation Phase
1. data utilization
2. data collection
3. data organization/collation
4. data presentation
5. data analysis
· Evaluation Phase

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2. BIOSTATISTICS

2.1 DEMOGRAPHY - study of population size, composition and spatial distribution as affected by births,
deaths and migration.
Sources : Census – complete enumeration of the population
2 Ways of Assigning People:
1. De Jure - People were assigned to the place where assigned to the place they usually live regardless
of where they are at the time of census. 2.De Facto - People were assigned to the place where they are
physically present at are at the time of census regardless, of their usual place of residence.

Components:
1. Population size
2. Population composition * Age Distribution * Sex Ratio * Population Pyramid * Median age - age below
which 50% of the population fall and above which 50% of the population fall. The lower the median age,
the younger the population (high fertility, high death rates). * Age – Dependency Ratio - used as an index
of age-induced economic drain on human resources * Other characteristics: - occupational groups -
economic groups - educational attainment - ethnic group
3. Population Distribution * Urban-Rural - shows the proportion of people living in urban compared to the
rural areas * Crowding Index - indicates the ease by which a communicable disease can be transmitted
from 1 host to another susceptible host. * Population Density - determines congestion of the place

3. VITAL STATISTICS
• the application of statistical measures to vital events (births, deaths and common illnesses) that is
utilized to gauge the levels of health, illness and health services of a community.

TYPES:
A. Fertility Rate

A. CRUDE BIRTH RATE


total # of livebirths in a given calendar year X 1000
estimated population as of July 1 of the same given year

B. GENERAL FERTILITY RATE


total # of livebirths in a given calendar year X 1000
Total number of reproductive age

B. Mortality Rate

A. CRUDE DEATH RATE


Total # of death in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year

B. INFANT MORTALITY RATE


Total # of death below 1 yr in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year

C. MATERNAL MORTALITY RATE


Total # of death among all maternal cases in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year

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C. Morbidity Rate

A. PREVALENCE RATE
Total # of new & old cases in a given calendar year X 100
Total # of persons examined at same given time
B. INCIDENCE RATE
Total # of new cases in a given calendar year X 100
Estimated population as of July 1 of the same year
C. ATTACK RATE
Total # of person who are exposed to the disease X 100
# of persons exposed to the same disease in same given year

III - Epidemiology

· the study of distribution of disease or physiologic condition among human population s and the factors
affecting such distribution
· the study of the occurrence and distribution of health conditions such as disease, death, deformities or
disabilities on human populations

A. Patterns of disease occurrence:


Epidemic - a situation when there is a high incidence of new cases of a specific disease in excess of the
expected.
- when the proportion of the susceptibles are high compared to the proportion of the immunes
Endemic - habitual presence of a disease in a given geographic location accounting for the low number
of both immunes and susceptibles e.g. Malaria is a disease endemic at Palawan.
- the causative factor of the disease is constantly available or present to the area.
Sporadic - disease occurs every now and then affecting only a small number of people relative to the
total population
- intermittent
Pandemic - global occurrence of a disease
Steps in EPIDEMIOLOGICAL IVESTIGATION:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained
B. Role of the Nurse
· Case Finding
· Health Teaching
· Counseling
· Follow up visit

IV. Health Situation of the Philippines

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Philippine Scenario:
· In the past 20 years some infectious degenerative diseases are on the rise.
· Many Filipinos are still living in remote and hard to reach areas where it is difficult to deliver the
health services they need
· The scarcity of doctors, nurses and midwives add to the poor health delivery system to the poor

VITAL HEALTH STATISTICS 2005

• PROJECTED POPULATION :
MALE - 42,874,766
FEMALE - 42,362,147
BOTH SEXES - 85,236,913
• LIFE EXPECTANCY
FEMALE - 70 yrs. old
MALE - 64 yrs. Old

LEADING CAUSES OF MORBIDITY


· Most of the top ten leading causes of morbidity are communicable disease
· These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and varicella
· Leading non CD are heart problem, HPN, accidents and malignant neoplasms
LEADING CAUSES OF MORTALITY
· The top 10 leading causes of mortality are due to non CD
· Diseases of the heart and vascular system are the 2 most common causes of deaths.
· Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading causes of deaths.

V. Health Care Delivery System · the totality of all policies, facilities, equipments, products, human
resources and services which address the health needs, problems and concerns of the people. It is large,
complex, multi-level and multi-disciplinary.

HEALTH SECTORS
· GOVERNMENT SECTORS
Department of Health Vision: Health for all by year 2000 ands Health in the Hands of the People by
2020
Mission: In partnership with the people, provide equity, quality and access to health care esp. the
marginalized

5 Major Functions:

1. Ensure equal access to basic health services


2. Ensure formulation of national policies for proper division of labor and proper coordination of
operations among the government agency jurisdictions
3. Ensure a minimum level of implementation nationwide of services regarded as public health goods
4. Plan and establish arrangements for the public health systems to achieve economies of scale
5. maintain a medium of regulations and standards to protect consumers and guide providers

· NON GOVERNMENT SECTORS – provides manpower in the execution of the program

· PRIVATE SECTORS – provides financial aspect in the execution of programs

PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS

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· Support for health goal


· Assurance of health care
· Increasing investment for PHC
· Development of National Standard

MILESTONE IN HEALTH CARE DELIVRY SYSTEM

· RA 1082 - RHU Act


· RA 1891 - Strengthen Health Services
· PD 568 - Restructuring HCDS
· RA 7160 - LGU Code

VI – National Health Plan

· National Health Plan is a long-term directional plan for health; the blueprint defining the country’s health
– PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS

GOAL : · to enable the Filipino population to achieve a level of health which will allow Filipino to lead a
socially and economically-productive life, with longer life expectancy, low infant mortality, low maternal
mortality and less disability through measures that will guarantee access of everyone to essential health
care

OBJECTIVES: · promote equity in health status among all segments of society · address specific health
problems of the population · upgrade the status and transform the HCDS into a responsive, dynamic and
highly efficient, and effective one in the provision of solutions to changing the health needs of the
population · promote active and sustained people’s participation in health care

“ MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR
2020”

A. MAJOR HEALTH PLAN


· 23 IN 93
· Health for more in 94
· Think health…… Health Link
· 5 in 95

B. PRIORITY PROGRAM IN YEAR 2000


· Plan 50 (Pharmaceutical Plan)
· Plan 500 ( Phil Health Insurance Plan)
· Women’s health
· Children’s health
· Healthy Lifestyle
· Prevention & Control of Infectious Disease

C. PRIORITY PROGRAM IN THE YEAR 2005


· Ligtas Buntis Campaign
· Mag healthy Lifestlye tayo
· TB Network

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· Blood Donation Program (RA 7719)


· DTOMIS
· Ligtas Tigdas Campaign
· Murang Gamot
· Anti Tobacco Signature Campaign
· Doctors to the Barrios Program
· Food Fortification Program
· Sentrong Sigla Movement

D. NATIONAL HEALTH EVENTS FOR 2006

JANUARY
· National Cancer Consciousness Week - (16-22)

FEBRUARY
· Heart Month
· Dental Health Month
· Responsible Parenthood Campaign National Health Insurance Program

MARCH
· Women's Health Month
· Rabies Awareness Month
· Burn Injury Prevention Month
· Responsible Parenthood Campaign
· Colon and Rectal Cancer Awareness Month
· World TB Day - (24)

APRIL
· Cancer in Children Awareness Month
· World Health Day - (7)
· Bright Child Week Phase I -
· Garantisadong Pambata (11-17)

MAY
· Natural Family Planning Month
· Cervical Cancer Awareness Month
· AIDS Candlelight Memorial Day - (21)
· World No Tobacco Day - (31)

JUNE
· Dengue Awareness Month
· No Smoking Month
· National Kidney Month
· Prostate Cancer Awareness Month

JULY
· Nutrition Month
· National Blood Donation Month
· National Disaster Consciousness Month

AUGUST

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· National Lung Month


· National Tuberculosis Awareness Month
· Sight-Saving Month
· Family Planning Month
· Lung Cancer Awareness Month

SEPTEMBER
· Generics Awareness Month
· Liver Cancer Awareness Month

OCTOBER
· National Children's Month
· Breast Cancer Awareness Month
· National Newborn Screening Week (3-9)
· Bright Child Week Phase II Garantisadong Pambata (10-16)

NOVEMBER
· Filariasis Awareness Month
· Cancer Pain Management Awareness Month
· Traditional and Alternative Health Care Month
· Campaign on Violence Against Women and Children

DECEMBER
· Firecracker Injury Prevention Campaign:
· “OPLAN IWAS PAPUTOK”

VII - INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

· IMCI is an integrated approach to child health that focuses on the well-being of the whole child.
· IMCI strategy is the main intervention proposed to achieve a significant reduction in the number
of deaths from communicable diseases in children under five

Goal:
· By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal
of reducing it by two thirds by 2015.

AIM:
· to reduce death, illness and disability, and to promote improved growth and development among
children under 5 years of age.
· IMCI includes both preventive and curative elements that are implemented by families and
communities as well as by health facilities.

IMCI OBJECTIVES:
· To reduce significantly global mortality and morbidity associated with the major causes of
disease in children
· To contribute to the healthy growth & development of children

IMCI COMPONENTS OF STRATEGY:


· Improving case management skills of health workers

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· Improving the health systems to deliver IMCI


· Improving family and community practices
**For many sick children a single diagnosis may not be apparent or appropriate

Presenting complaint:
· Cough and/or fast breathing
· Lethargy/Unconsciousness
· Measles rash
· “Very sick” young infant

Possible course/ associated condition:


· Pneumonia, Severe anemia, P. falciparum malaria
· Cerebral malaria, meningitis, severe dehydration
· Pneumonia, Diarrhea, Ear infection
· Pneumonia, Meningitis, Sepsis

Five Disease Focus of IMCI:


· Acute Respiratory Infection
· Diarrhea
· Fever
· Malaria
· Measles
· Dengue Fever
· Ear Infection
· Malnutrition
THE IMCI CASE MANAGEMENT PROCESS
· Assess and classify
· Identify appropriate treatment
· Treat/refer
· Counsel
· Follow-up

THE INTEGRATED CASE MANAGEMENT PROCESS

Check for General Danger Signs:


· A general danger sign is present if:
- the child is not able to drink or breastfeed
- the child vomits everything
- the child has had convulsions
- the child is lethargic or unconscious
ASSESS MAIN SYMPTOMS
· Cough/DOB
· Diarrhea
· Fever
· Ear problems
IMCI COLOR CODING

YELLOW (Treatment at GREEN (Home


PINK (URGENT REFERRAL)
outpatient health facility) management)
OUTPATIENT HEALTH OUTPATIENT HEALTH HOME Caretaker is
FACILITY •Pre-referral FACILITY •Treat local counseled on: •Home

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infection •Give oral drugs treatment/s •Feeding and


treatments •Advise parents
•Advise and teach caretaker fluids •When to return
•Refer child
Follow-up immediately Follow-up
Caretaker is counseled on:
REFERRAL FACILITY • Treat oral infection
• Home treatments
•Emergency Triage and • Give oral drugs
• Feeding & fluids
Treatment ( ETAT) • Advise & teach
• When to return
•Diagnosis, Treatment caretaker
immediately
•Monitoring, follow-up • Follow up
• Follow up
ASSESS AND CLASSIFY COUGH OR DIFFICULTY OF BREATHING

- Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx,
trachea, air passages or lungs. Assess and classify PNEUMONIA
· cough or difficult breathing
· an infection of the lungs
· Both bacteria and viruses can cause pneumonia
· Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis
(generalized infection).
** A child with cough or difficult breathing is assessed for:
· How long the child has had cough or difficult breathing
· Fast breathing – increase in RR
· Chest indrawing – Visible mark of ICS upon inhalation
· Stridor in a calm child – adventitious sounds heard even without the aid of stethoscope.
REMEMBER:
** If the child is 0 months up to 2 months the child has fast breathing if you count 60 breaths per
minute or more
** If the child is 2 months up to 1 year old the child has fast breathing if you count 50 breaths per
minute or more.
** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths per
minute or more.
PNEUMONIA – TREATMENT SCHEME
•Give first dose of an
appropriate antobiotic •Give
Vitamin A •Treat the child to
•Any general danger sign or
SEVERE PNEUMONIA OR prevent low blood sugar
•Chest indrawing or •Stridor in
VERY SEVERE DISEASE •Refer urgently to the hospital
calm child
•Give paracetamol for fever >
38.5oC

•Give an appropriate antibiotic


for 5 days •Soothe the throat
and relieve cough with a safe
remedy •Advise mother when
• Fast breathing PNEUMONIA
to return immediately •Follow
up in 2 days •Give
Paracetamol for fever >
38.5oC
•No signs of pneumonia or NO PNEUMONIA : COUGH •If coughing more than more
very severe disease OR COLD than 30 days, refer for
assessment •Soothe the
throat and relieve the cough

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with a safe remedy •Advise


mother when to return
immediately Follow up in 5
days if not improving

Assess and classify DIARRHEA

A child with diarrhea is assessed for:


· how long the child has had diarrhea
· blood in the stool to determine if the child has dysentery
· signs of dehydration.
Classify DYSENTERY
· child with diarrhea and blood in the stool

•If child has no other severe


classification: - Give fluid for
severe dehydration ( Plan C ) OR
• If child has another severe
Two of the following signs ? •
classification : - Refer
Abnormally sleepy or difficult to
SEVERE URGENTLY to hospital with
awaken • Sunken eyes • Not able
DEHYDRATION mother giving frequent sips of
to drink or drinking poorly Skin
ORS on the way - Advise the
pinch goes back very slowly
mother to continue breastfeeding
• If child is 2 years or older and
there is cholera in your area, give
antibiotic for cholera
•Give fluid and food for some
dehydration ( Plan B ) • If child
also has a severe classification : -
Two of the following signs : •
Refer URGENTLY to hospital with
Restless, irritable • Sunken eyes •
SOME DEHYDRATION mother giving frequent sips of
Drinks eagerly, thirsty Skin pinch
ORS on the way - Advise mother
goes back slowly
when to return immediately •
Follow up in 5 days if not
improving
•Home Care • Give fluid and food
to treat diarrhea at home ( Plan
•Not enough signs to classify as
NO DEHYDRATION A ) •Advise mother when to return
some or severe dehydration
immediately •Follow up in 5 days
if not improving
Types of Diarrhea
•Treat dehydration before referral
SEVERE PERSISTENT unless the child has another
Dehydration present
DIARRHEA severe classification • Give
Vitamin a • Refer to hospital
•Advise the mother on feeding a
PERSISTENT child who has persistent diarrhea
No dehydration
DIARRHEA • Give Vitamin A • Follow up in 5
days

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•Treat for 5 days with an oral


antibiotic recommended for
Blood in the stool DYSENTERY Shigella in your area • Follow up
in 2 days Give also referral
treatment
Does the child have fever? **Decide : - Malaria Risk - No Malaria Risk - Measles - Dengue Malaria
Risk
•Give first dose of quinine
( under medical supervision or
if a hospital is not accessible
within 4hrs ) • Give first dose
of an appropriate antibiotic •
•Any general danger sign or • VERY SEVERE FEBRILE Treat the child to prevent low
Stiff neck DISEASE / MALARIA blood sugar • Give one dose
of paracetamol in health
center for high fever (38.5oC)
or above • Send a blood
smear with the patient • Refer
URGENTLY to hospital
•Treat the child with an oral
antimalarial • Give one dose
of paracetamol in health
•Blood smear ( + ) If blood center for high fever (38.5oC)
smear not done: • NO runny or above • Advise mother
MALARIA
nose, and • NO measles, and when to return immediately •
NO other causes of fever Follow up in 2 days if fever
persists • If fever is present
everyday for more than 7
days, refer for assessment
•Give one dose of
paracetamol in health center
for high fever (38.5oC) or
•Blood smear ( - ), or • Runny above • Advise mother when
FEVER : MALARIA
nose, or • Measles, or Other to return immediately • Follow
UNLIKELY
causes of fever up in 2 days if fever persists •
If fever is present everyday
for more than 7 days, refer for
assessment
No Malaria Risk
•Give first dose of an appropriate
antibiotic • Treat the child to prevent
•Any general danger sign or • VERY SEVERE low blood sugar • Give one dose of
Stiff neck FEBRILE DISEASE paracetamol in health center for
high fever (38.5oC) or above •
Refer URGENTLY to hospital
•No signs of very severe FEVER : NO MALARIA •Give one dose of paracetamol in
febrile disease health center for high fever
(38.5oC) or above • Advise mother
when to return immediately • Follow
up in 2 days if fever persists • If
fever is present everyday for more

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than 7 days, refer for assessment


Measles
•Give Vitamin A • Give first
dose of an appropriate
antibiotic • If clouding of the
•Clouding of cornea or • Deep SEVERE COMPLICATED
cornea or pus draining from
or extensive mouth ulcers MEASLES
the eye, apply tetracycline
eye ointment • Refer
URGENTLY to hospital
•Give Vitamin A • If pus
draining from the eye, apply
•Pus draining from the eye or MEASLES WITH EYE OR tetracycline eye ointment If
• Mouth ulcers MOUTH COMPLICATIONS mouth ulcers, teach the
mother to treat with gentian
violet
•Measles now or within the
MEASLES •Give Vitamin A
last 3 months
Dengue Fever
•Bleeding from nose or gums •If skin petechiae or
or • Bleeding in stools or Tourniquet test,are the only
vomitus or • Black stools or positive signs give ORS • If
vomitus or • Skin petechiae or any other signs are positive,
SEVERE DENGUE
• Cold clammy extremities or • give fluids rapidly as in Plan C
HEMORRHAGIC FEVER
Capillary refill more than 3 • Treat the child to prevent low
seconds or • Abdominal pain blood sugar • DO NOT GIVE
or • Vomiting • Tourniquet test ASPIRIN • Refer all children
(+) Urgently to hospital
•DO NOT GIVE ASPIRIN •
Give one dose of paracetamol
in health center for high fever
No signs of severe dengue FEVER: DENGUE (38.5oC) or above • Follow up
hemorrhagic fever HEMORRHAGIC UNLIKELY in 2 days if fever persists or
child shows signs of bleeding
• Advise mother when to
return immediately
Does the child have an ear problem?
•Give first dose of appropriate
•Tender swelling behind the
MASTOIDITIS antibiotic • Give paracetamol
ear
for pain • Refer URGENTLY
•Pus seen draining from the •Give antibiotic for 5 days •
ear and discharge is reported Give paracetamol for pain •
ACUTE EAR INFECTION
for less than 14 days or • Ear Dry the ear by wicking •
pain Follow up in 5 days
•Pus seen draining from the
•Dry the ear by wicking •
ear and discharge is reported CHRONIC EAR INFECTION
Follow up in 5 days
for less than 14 days
•No ear pain and no pus seen
NO EAR INFECTION •No additional treatment
draining from the ear

Check for Malnutrition and Anemia


Give an Appropriate Antibiotic: A. For Pneumonia, Acute ear infection or Very Severe disease

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COTRIMOXAZOLE AMOXYCILLIN

BID FOR 5 DAYS BID FOR 5 DAYS


Age or Weight Adult tablet Syrup Tablet Syrup
2 months up to 12
1/2 5 ml 1/2 5 ml
months ( 4 - < 9 kg )
12 months up to 5
1 7.5 ml 1 10 ml
years ( 10 – 19kg )
B. For Dysentery
COTRIMOXAZOLE BID FOR 5 DAYS AMOXYCILLIN BID FOR 5 DAYS
AGE OR WEIGHT TABLET SYRUP SYRUP 250MG/5ML
2 – 4 months ( 4 -
½ 5 ml 1.25 ml ( ¼ tsp )
< 6kg )
4 – 12 months ( 6 -
½ 5 ml 2.5 ml ( ½ tsp )
< 10 kg )
1 – 5 years old
1 7.5 ml ( 1 tsp )
( 10 – 19 kg )
C. For Cholera
TETRACYCLINE QID
COTRIMOXAZOLE BID FOR 3 DAYS
FOR 3 DAYS
AGE OR WEIGHT Capsule 250mg Tablet Syrup
2 – 4 months ( 4 - < 6kg ) ¼ 1/2 5ml
4 – 12 months ( 6 - < 10 kg ) ½ 1/2 5 ml
1 – 5 years old ( 10 – 19 kg 1 1 7.5ml
Give an Oral Antimalarial
Primaquine Give
Primaquine Give Sulfadoxine +
CHOLOROQUINE single dose in
daily for 14 days for Pyrimethamine Give
Give for 3 days health center for
P. Vivax single dose
P. Falciparum
AGE TABLET ( 150MG ) TABLET ( 15MG) TABLET ( 15MG) TABLET ( 15MG)
DAY1 DAY2 DAY3
2months –
½ ½ ½ ¼
5months
5 months – 12
½ ½ ½ 1/2
months
12months – 3
1 1 ½ ½ ¼ ¾
years old
3 years old - 5
1½ 1½ 1 3/4 1/2 1
years old

GIVE VITAMIN A
AGE VITAMIN A CAPSULES 200,000 IU
6 months – 12 months 1//2 ( 100,000 IU) red capsules
12 months – 5 years old 1 ( 200,000 IU) blue capsules
GIVE IRON
Iron/Folate Tablet FeSo4 200mg + Iron Syrup FeSo4 150 mg/5ml
AGE or WEIGHT
250mcg Folate (60mg elemental iron) ( 6mg elemental iron per ml )
2months-4months ( 4 - <6kg ) 2.5 ml
4months – 12months ( 6 - <10kg ) 4 ml
12months – 3 years ( 10 - <14kg ) 1/2 5 ml
3years – 5 years ( 14 – 19kg ) 1/2 7.5 ml

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GIVE PARACETAMOL FOR HIGH FEVER ( 38.5oC OR MORE ) OR EAR PAIN


TABLET
AGE OR WEIGHT SYRUP ( 120MG / 5ML )
( 500MG )
2 months – 3 years ( 4 - <14kg ) ¼ 5 ml
3 years up to 5 years ( 14 – 19 kg ) 1/2 10 ml

GIVE MEBENDAZOLE · Give 500mg Mebendazole as a single dose in health center if : > hookworm /
whipworm are a problem in children in your area, and > the child is 2 years of age or older, and > the
child has not had a dose in the previous 6 months

VIII - DOH PROGRAMS DENTAL HEALTH PROGRAM


• To improve the quality of life of the people through the attainment of the highest possible oral
health.
• Objective: To prevent and control dental diseases and conditions like dental caries and
periodontal diseases thus reducing their prevalence.

OSTEOPOROSIS PROGRAM
• It is characterized by a decrease in bone mass and density that progresses without a symptom
or pain until a fracture occurs generally in the hip, spine or wrist.
• Objectives:
• To increase awareness on the prevention and control of osteoporosis as a chronic debilitating
condition;
• To increase awareness by physicians and other health professionals on the screening, treatment
and rehabilitation of osteoporosis;
• To empower people with knowledge and skills to adopt healthy lifestyle in preventing the
occurrence of osteoporosis.

HEALTH EDUCATION & CO


· Accepted activity at all levels of public health used as a means of improving the health of the
people through techniques which may influence peoples thought motivation, judgment and
action.
Three aspects of health education: · Information · Communication · Education Sequence of steps in
health education: · Creating awareness · Creating motivation · Decision making action

REPRODUCTIVE HEALTH
1. Family Planning
2. MCH & Nutrition
3. Prevention / treatment of Reproductive Tract Infection & STD
4. Prevention of abortion & its complication
5. Education & counseling on sexuality & sexual health
6. Adolescent sexual reproductive health
7. Violence against women
8. Men’s reproductive health ( Male sexual disorder )
9. Breast CA & other gyne problem
10. Prevention / treatment of infertility

OLDER PERSONS HEALTH SERVICES

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· Participation in the celebration of Healthy National Elderly Week ( Oct 1-7)


- Lecture on healthy lifestyle for the elderly
· Provision of drugs for the elderly( 20% discount)

GUIDELINES FOR GOOD NUTRITION


· Nutritional Guidelines are primary recommendations to promote good health through proper
nutrition.
ACTIVITIES:
1.Malnutrition Rehabilitation Program
• Targeted Food Task Force Assistance Program (TFAP)
• Nutrition Rehabilitation Ward
• Akbayan sa Kalusugan sa Kabataan (ASK Project)
2.Micronutrient Supplementation Program
· “23 in ‘93”
· Fortified Vitamin Rice
· “Health for More in ‘94”
· “Buwan ng Kabataan, Pag-asa ng Bayan”
· National Focus: National Micronutrient Day or “Araw ng Sangkap Pinoy”

PROTEIN ENERGY MALNUTRITION 1. Marasmus – looks like an old worried man - less subcutaneous
fats 2. Kwashiorkor - a moon face child - with flag sign (hair changes) VITAMIN A DEFICIENCY
Early symptoms: Xeropthalmia (Nigtblindess)

Bitot’s spot (silvery foamy spot located @ lateral sclera)

Corneal Xerosis (eye lesion)

Conjunctival Xerosis(scar in the eyes)

Keratomalacia ( whitish to grayish sclera)

BLINDNESS

RESPIRATORY INFECTION CONTROL


• Provision of medicines
• Consultative meetings with CARI coordinators
• Monitoring of health facilities on the implementation of the program

ALTERNATIVE MEDICINE
· RA 8423
· 23 IN 93

A. The 10 Herbal Medicine(LUBBY SANTA)

Herbal Medicine USES

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Skin diseases Headache,


Lagundi ( Vitex Negundo) SHARED Asthma,fever,cough&colds
Rheumatism Eczema Dysentery
Ulasimang Bato (Peperonia Lowers uric acid Rheumatism
Pellucida) RA Arthritis
Bawang ( Allium Sativum) HAT Headache and Tootache
Bayabas ( Psidium Guajava) Anti septic, Anti-diarrheal
Swollen gums, Pain, Insect bites,
Yerba Buena (Mentha Cordifolia) Toothache, Menstrual & gas pain,
SPITMAND Arthritis & rheumatism, Nausea &
vomiting & Diarrhea
Sambong (Blumea Balsamifera) Anti - edema, Diuretics, Anti uro-
ADA lithiasis
Akapulko Fungal infection, skin diseases
Niog Niogan (Quisqualis Indica) Anti-helminthic
Tsaang Gubat (Carmona
Stomachache & Diarrhea
Retusa)SAD
Ampalaya (Momordica Charantia) DM

MATERNAL- CHILD CARE


I - Maternal Care

A. FAMILY PLANNING
I. Spacing / Artificial Method
A. Hormonal
B. Mechanical & Barrier
C. Biologic
D. Natural
II. Permanent (surgical/irreversible)
A. Tubal Ligation
B. Vasectomy
III. Behavioral Method
B. BREASTFEEDING

II - CHILD CARE

A. UNDER FIVE CARE PROGRAM


· A package of child health-related services focused to the 0-59 months old children to assure
their wellness and survival
Growth Monitoring Chart (GMC)
· A standard tool used in health centers to record vital information related to child growth and
development, to assess signs of malnutrition.
B. EXPANDED PROGRAM ON IMMUNIZATION
· LEGAL BASIS
· PD #996 – Compulsory basic
· PP #147 – National Immunization Day
· PP #773 – Knock out Polio Days
· PP # 1064 – polio eradication campaign

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· PP #4 - Ligtas Tigdas month

MENTAL HEALTH · a state of well-being where a person can realize his or her own abilities, to cope with
the normal stresses of life and work productively

Components of Mental Health Program · Stress Management and Crisis Intervention · Drugs and
Alcohol Abuse Rehabilitation · Treatment and Rehabilitation of Mentally-Ill Patients · Special Project for
Vulnerable Groups

SENTRONG SIGLA MOVEMENT AIM: to promote availability of quality health services


4 pillars: · Quality assurance · Grants & technical assistance · Health promotion · Award

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH

Community Organizing
· a continuous and sustained process of
· EDUCATING THE PEOPLE,
· CRITICAL AWARENESS
· MOBILIZING

Participatory Action Research


· A combination of education, research and action.
· The purpose is the EMPOWERMENT of people

4 Phases:
· Pre entry
· Entry
· Organizational Building
· Sustenance and Strengthening

Laws Affecting CHN Implementation:


RA 8749 - Clean Air Act (2000)
RA 6425 – Dangerous Drug Act: sale, administration and distribution of prohibited drugs is punishable by
law
RA 9173 – Philippine Nursing act of 2002
RA 2382 – Philippines Medical Act: define the practice of medicine in the Philippines
RA 1082 – Rural Health Act: employment of more physicians, nurses, midwives who will live in the rural
areas to help raise the health condition.
RA 3573 - Reporting of Communicable Disease
RA 6675 – Generic Act: promotes, requires and ensures the production of an adequate supply,
distribution, use of drugs identified by their generic names.
RA 6365
RA 6758
RA 4703 Advocates Home Treatment for all Leprae Patient
RA 7305 – Magna Carta for Public Health Workers (approved by Pres. Corazon C. Aquino): aims to
promote and improve the social and economic well being of health workers, their living and conditions.
RA 7160 – Local Government Code: responsibility for the delivery of basic services of the national
government

IX - CHRONIC COMMUNICABLE DISEASES

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I - TUBERCULOSIS · TB is a highly infectious chronic disease that usually affects the lungs.
Causative Agent: Mycobacterium Tuberculosis
S/S: · cough · afternoon fever · weight loss · night sweat · blood stain sputum
Prevalence/Incidence: · ranks sixth in the leading causes of morbidity (with 114,221 cases) in the
Philippines · sixth leading cause of mortality (with 28507 cases) in the Philippines.
Nursing and Medical Management · Ventilation systems · Ultraviolet lighting · Vaccines, such as the
bacillus Calmette Guerin (BCG) vaccine · drug therapy
Preventing Tuberculosis · BCG vaccination · Adequate rest · Balanced diet · Fresh air · Adequate
exercise · Good personal Hygiene
DOTS (Direct Observed Treatment Short Course)
Regimen Type of TB Patient
New pulmonary smear (+) cases · New
seriously ill pulmonary smear (-) cases w/
Regimen I 2RIPE / 4RI
extensive lung lesions · New severely ill extra-
pulmo TB
· New pulmonary smear (+) case · New
seriously ill pulmonary smear (-) cases w/
Regimen II 2RIPES/ 1RIPE / 5RIE
extensive lung lesions · New severely ill extra-
pulmo TB
· New smear(-) but with minimal pulmonary TB
Regimen III 2RIP / 4RI on radiography as confirmed by a medical
officer · New extra-pulmo TB (not serious)

II - LEPROSY · Sometimes known as Hansen's disease


· is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium
· Gerhard Armauer Hansen - discovered the microbes
· Historically, leprosy was an incurable and disfiguring disease
· Today, leprosy is easily curable by multi-drug antibiotic therapy

Signs & Symptoms


Early stage(CLUMP)
Change in skin color
Loss in sensation
Ulcers that do not heal
Muscle weakness
Painful nerves
Late Stage(GMISC)
Gynocomastia
Madarosis(loss of eyebrows)
Inability to close eyelids (Lagopthalmos)
Sinking nosebridge
Clawing/contractures of fingers & nose

Prevalence Rate · Metro Manila, the prevalence rate ranged from 0.40 – 3.01 per one thousand
population.

MANAGEMENT: · Dapsone, Lamprene · clofazimine and rifampin · Multi-Drug-Therapy (MDT) · six


month course of tablets for the milder form of leprosy and two years for the more severe form

X - Vector Borne Communicable Disease

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I – LEPTOSPIROSIS · an infectious disease that affects humans and animals, is considered the most
common zoonosis in the world
Causative Agent: Leptospira interrogans
S/S: -high fever -severe headache -chills -muscle aches -vomiting -may include jaundice (yellow skin and
eyes) -red eyes -abdominal pain -diarrhea
TREATMENT: PET - > Penicillins , Erythromycin, Tetracycline

II - MALARIA · Malaria (from Medieval Italian: mala aria - "bad air"; formerly called ague or marsh fever)
is an infectious disease that is widespread in many tropical and subtropical regions.
Causative Agent: Anopheles female mosquito
Signs & Symptoms: Chills to convulsion Hepatomegaly Anemia Sweats profusely Elevated temperature
Treatment: Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2 weeks before
entering the endemic area.
Preventive Measures: (CLEAN)
Chemically treated mosquito nets
Larvae eating fish
Environmental clean up
Anti mosquito soap/lotion
Neem trees/eucalyptus tree

III - FILIARIASIS · name for a group of tropical diseases caused by various thread-like parasitic round
worms (nematodes) and their larvae
· larvae transmit the disease to humans through a mosquito bite
· can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis
S/S:

Asymptomatic Stage
· Characterized by the presence of microfilariae in the peripheral blood
· No clinical signs and symptoms of the disease
· Some remain asymptomatic for years and in some instances for life

Acute Stage
· Lymphadenitis (inflammation of lymph nodes)
· Lymphangitis (inflammation of lymph vessels)
· In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum)

Chronic Stage
· Hydrocoele (swelling of the scrotum)
· Lyphedema (temporary swelling of the upper and lower extremities
· Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum,
breast)

MANAGEMENT: · Diethylcarbamazine · Ivermectin, · Albendazolethe


· No treatment can reverse elephantiasis

VI – SCHISTOSOMIASIS · parasitic disease caused by a larvae

Causative Agent: Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni


Signs & Symptoms: (BALLIPS)
Bulging abdomen

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Abdominal pain
Loose bowel movement
Low grade fever
Inflammation of liver & spleen
Pallor
Seizure

Treatment: Diethylcarbamazepine citrate (DEC) or Hetrazan (drug of choice)

VII – DENGUE · DENGUE is a mosquito-borne infection which in recent years has become a major
international public health concern..
· It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban
areas.
S/S: (VLINOSPARD)
· Vomiting
· Low platelet
Increase Platelet count
· Nausea
· Onset of fever
· Severe headache
· Pain of the muscle and joint
· Abdominal pain
· Rashes
· Diarhhea

TREATMENT:
· The mainstay of treatment is supportive therapy.
- intravenous fluids
- A platelet transfusion
- No aspirin

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Communicable Disease
Module on Communicable Diseases
Community Health Nursing is faced with problems regarding communicable diseases. It is
important therefore that the nurse poses basic knowledge on how to deal with related problems
and more so prevent its occurrence, since this is like wise the focus of community health
nursing.

INTRODUCTION

This module focuses on the basic communicable diseases affecting the patterns of mortality and
morbidity in the Philippine community. It will give you the basic information regarding the
description, etiology, mode of transmission, incubation period, signs and symptoms, diagnostic
procedures and management of these diseases. As an added bonus each topic is carefully
selected to prepare you both in the practical application in the community setting and the board
exam most especially. Due to this you are advised to be familiarized with the following phrases:

ON THE BOARD refers to common question that comes out in the board exam.

CLINICAL FOCUS refers to the important reminders that are crucial in the actual practice.

GROUP ALERT refers to age group variation that also demand different approaches. A post test
is prepared for your satisfaction so that you will be able to measure your knowledge. It is
recommended that you supplement your studies with text books which focus on the said topic.
This is just a guide and although careful review has been made the author waive any
responsibility that may negatively occur due to application of the concepts learned here in.

OBJECTIVE GENERAL To study the different communicable diseases affecting man and the
family as a component of the community

SPECIFIC By the end of the module in 7 days you should be able to;
1. Understand the basic concepts of CD
2. Familiarize with the basic control and method of prevention to the said diseases.
3. be able to apply to practice the concepts learned by effectively giving health education all
these is expected to be attained by you none the less, by passing at least 65% of the final
assessment questions.

What is infection? Infection is the successful entry and multiplication of micro-organism in the
human body. Usually their entrance results in the appearance of the disease. But it doesn’t
always follow the same. Some organism may enter the body but no obvious illness is apparent.

What are the types of infection? There are two types of infection it could be nosocomial or
opportunistic. Nosocomial – refers to hospital acquired infection with sets in within the premises
of the hospital during confinement. Remember an infection is considered nosocomial if it sets in

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after 72 hours upon admission. Most of the time the responsible organism are hospital
pathogens such as pseudomonas, klebsiella etc. Opportunistic – refers to the type infection
acquired due to the failure of the immune defenses. Usually this is caused by the normal
microflora.

What are communicable diseases and contagious diseases? Communicable diseases are
any disease that are caused by microorganism and can be transferred from one body to another,
hence it is communicable. Contagious diseases are any communicable infection that are easily
transmissible. ON THE BOARD! Keep in mind that every contagious disease is communicable
and all communicable diseases are infection but never the other way around.

What is pathogenicity? It is the over all ability of the organism to cause pathogenic changes in
the body. Which is further described by the following terms:

Mode of action – manner by which organism damages the host. Example clostridium tetani
releases toxin while plasmodium falciparum kills the RBC.
Virulence – it is the over all strength of the microorganism
Dose – the number of the organism required to cause infection for example as little as 4 tubercle
bacilli inhaled is sufficient to cause Tuberculosis among high risk patient. Invasiveness – the
ability of the organism to penetrate an intact barrier
Toxigenicity – the ability of the organism to produce toxins
Specificity – is the ability of the organism to attach on specific cellular surface receptors. Viability
– the ability to sustain life outside the body of the host
Antigenicity – the ability of the organism to stimulate and or resist antibody response

THE 3 LEVELS OF PREVENTION

PRIMARY – focuses on health promotion and disease prevention


Promotive – there is no risk of having the disease. Activity is directed in promoting healthy
lifestyle, proper nutrition, adequate exercise and environmental sanitation.
Preventive – risk of having the disease is already existing and activity is directed in avoiding the
risk ergo the disease it self. Example are EPI, Pap smear, BSE and STE.
SECONDARY – focuses on the Curative aspect of care.
Curative – effort is directed for early treatment. Move is also undertaken to avoid possible
complications
TERTIARY – focuses on the rehabilitative aspect
Rehabilitative – effort of helping the patient adjust with the limitations and disability brought
about by the previous disease.

ELEMENTS OF DISEASE CAUSATION Refers to the relationship of the Agent


(microorganism), Host (Human) and the Environment (reservoir). If balance between the three is
present disease is absent but if one of the three gain advantage over the other it may
compromise one element and cause disease.

STAGES OF INFECTION
a) Exposure – the stage of contact with the infectious agent

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b) Incubation or latent – the organism successfully entered the body. No apparent illness is
present. The organism is still multiplying so as to manifest an actual illness.
c) Prodromal – the manifestation of vague signs and symptoms start to appear. Example fever,
cough, pain etc.
d) Acute disease – an acute disruption in the physiologic mechanism. Disease due to the
infecting organism is already present.
e) Convalescence – the stage of resolution. The body is able to maintain homeostasis. The
infectious organism is under control
f) Relapse – a stage of reactivation of a previous infection which may be due to re-exposure or
waning immunity.

CHAIN OF INFECTION The series of events that takes place in order for infection to occur.
The following subtopics describe each component of the chain.

ON THE BOARD! Remember infection will never occur unless the six chain are completed.

a) Causative agent – refers to the microorganism such as fungi, protozoa, parasite, viruses,
bacteria etc.
b) Reservoir – the medium or body which the microorganism thrive and survive.
c) Portal of Entry – opening in the body where in the microorganism could use as passageway to
reach the internal physiological structures. For example mouth, nose, wound etc.
d) Portal of exit – any opening to which the organism uses to exit from the body. Example are
anus, nose, vagina, penis, etc.
e) Mode of transmission – the method on how the organism travels from one infected host to
another.
i. Direct – requires physical contact from the point source of infection. Such as kissing and
unprotected sexual intercourse.
ii. Indirect – transmitted through fomites and other non living organism. Contaminated surgical
instruments.
iii. Vector borne – relies greatly on the presence of the secondary host to cause infection. e.g.
mosquitos, flies and rats
iv. Droplet – organism travels through droplet nuclei that comes out during coughing, sneezing
etc.
v. Airborne – the organism can uniquely suspend in the air and carried on air current and the like
method.
f) Susceptible host – any person whose immune defenses are weak or those who are healthy
but do not posses adequate specific immunity

ON THE BOARD! Remember that the mode of transmission is the chain that is easiest to break!

THE DEFENSE MECHANISM OF THE BODY The defensive mode is divided into three,
namely:
i. 1st line of defense
ii. 2nd line of defense
iii. 3rd line of defense
1st LINE OF DEFENSE Non specific defense mechanism this is the first to come in contact with

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harmful organism. E.g. skin, saliva,. Tears, stomach acids, urine etc. 2ND LINE OF DEFENSE
Non specific phagocytic response. E.g. phagocytosis by neutrophils.
3RD LINE OF DEFENSE Specific immune response dependent upon the presence of specific
anti bodies. E.g. immunity against chickenpox

IMMUNITY Ability of the body to effectively mount an immune response to prevent infection. it is
usually dependent on the presence of antibodies.
a. Natural active – contact with infectious organism and the immunity that follows after that.
b. Natural passive – immunity received from the mother through the placenta
c. Artificial active – immunity gained after the administration of vaccines
d. Artificial passive – immunity gained after receiving immune serum or immune globulin.

EPIDEMIOLOGY Refers to study of the pattern and distribution of diseases among the identified
population.
a. Endemic – the disease is always present in a community the rise and fall remains steadily
predictable.
b. Epidemic – there is a sharp increase in the number of disease as it affects the population over
a period of time and specific locality.
c. Pandemic – nations are affected by a disease. It is commonly referred to as international
epidemic.
d. Sporadic – patches in appearance. The disease does not manifest it self as a dominant entity.
Most often the disease affects only a small portion of the community.
e. Out break – the disease has affected the population but the number of the people afflicted is
above the endemic proportion but lower than epidemic levels. An outbreak is an indicator of
impending epidemic.

GENERAL MEASURES TO CONTROL COMMUNICABLE DISEASES


Hand washing – the most basic of infection control practices. It is the use of soap and water to
remove contaminant from our hands.

Disinfection – the use of chemicals like alcohol or other physical means to destroy disease
causing organism outside the body.
a. Terminal disinfection – disinfecting the surroundings of the patient
b. Concurrent disinfection – disinfection of substances and materials discharged from the body.

Sterilization – all forms of microbial life are eliminated.

Isolation – the act of separating an infected patient to prevent cross infection. The following are
the types of isolation precaution.
i. First Tier – Standard precaution ; applied to all patient regardless of their clinical diagnosis. It is
desired that the application of this tie will protect the nurse and the patient from body fluids
including blood as well as wounds or any break in the skin and mucous membrane. Use of
gloves.
ii. Second Tier – Transmission based precaution refers to any patient who require more stringent
control that necessitates deeper method than those identified above. These includes contact,
airborne and droplet precaution.

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a. Contact precaution – to protect against direct and indirect transmission. Mask and gown are
added.
b. Airborne precaution – the use of air filters to prevent infection due to organism suspended in
the air.
c. Droplet precaution – maintaining a distance of 3 feet from the point source of infection to
avoid droplet nuclei. The use of high particulate mask and goggles are added.

Quarantine – the act of limiting the movement and freedom of travel of any patient who have
been exposed from an infectious organism. The length of time is dependent to the maximum
incubation period of the suspected disease. Surveillance - monitoring of patients, high risk
groups or families to predict, identify and control infection.

CHEMICAL DISINFECTANTS THAT ARE COMMONLY USED


Germicide – also known as disinfectant this can kill disease causing organism.
Bactericidal – refers to its ability to kill bacteria only.
Bacteriostatic – the ability of a chemical agent to halt bacterial reproduction
Antiseptic – chemicals that can kill or control the growth of microorganism. This are usually
applied on the skin to prevent wound infection. Soaps and detergents – effective against
bacteria found in clothes.
Phenols (Lysol) – effective against gram negative bacteria.
Alcohol – ideally isopropyl alcohol in 70% solution. Effective in killing broad range of microbes.
Chlorine – one of the most effective water disinfectants Iodine – equally effective with chlorine in
antimicrobial activity. This is also used in skin disinfection (Betadine) Hydrogen Peroxide –
wound cleanser and disinfectant for surgical devices.

COMMUNICABLE DISEASES NEUROLOGICAL SYSTEM

TETANUS ALSO KNOWN AS LOCK JAW


Description: An acute infection associated with painful muscular spasm
Etiology: Caused by Clostridium tetani which are found on soils and human feces
Mode of
Contamination of wound
transmission:
Incubation period: 5 – 10 days
Fever, lock jaw, the most important sign is trismus and risus sardonicus.
Signs and symptoms
While laryngospasm is the most life threatening condition.
Diagnostic None. History of wound and possible contamination are usually enough
procedure to arouse suspicion and take necessary management.
Wash wound, apply wound antiseptic. Assess for history of
immunization Give tetanus toxoid for negative history of immunization
Administer Antitoxin after negative skin test Penicillin is the drug of
Management
choice Prepare for intubation. NGT feeding may become necessary.
Avoid over stimulation to prevent painful muscle contraction. Diazepam
is the drug of choice for muscle spasm

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MENINGITIS
Description: An acute inflammation of the meninges
Caused by Nesseria meningitides this is usually a normal inhabitant of
Etiology:
the nasopharynx.
Mode of
Droplet infection
transmission:
Incubation period: 2 – 10 days
The organism enters the bloodstream after invading the respiratory
tissues. Reaches the spinal cord and of course the meninges. It
stimulates chemotaxis that leads to leukocyte infiltration of the
Pathophysiology: meninges. As a result inflammation follows. This build up pressure, pus
and compresses sensitive nervous tissues, that may decrease the level
of consciousness and in more severe cases pus could impede blood
flow and brain infarct my ensue.
The most significant finding indicating meningeal irritation: brudzinski
Signs and symptoms and kernigs sign. Other sign observable are headache, opisthotonus,
fever and petechiae
Diagnostic
Lumbar puncture (CSF analysis)
procedure
Institute droplet precaution Rifampicin or Ciprofloxacin for prophylaxis
Ampicillin is the drug of choice Ceftriaxone for systemic and CNS
infection given in combination with Ampicillin to combat resistant
organism. Mass prophylaxis is not needed provided that all children in
Management day care centers who have been exposed are exempted hence they need
prophylaxis, this also includes all other children who are close to the
infected patient such as when they share eating utensils. Nurses and
Doctors are not at risk of having the disease except when close contact
occurred like in mouth to mouth resuscitation.

ENCEPHALITIS
Description: Inflammation of the tissues of the Brain
Mosquito borne – Japanese enceph, West Nile enceph etc Viral borne –
Etiology: Complication of chicken pox or measles Amebic – Acanthamoeba
hystolytica
Mosquito borne – bite of the infected mosquito Viral – may be droplet or
Mode of
airborne Amebic – accidental entry in the naso - pharynx due to
transmission:
swimming in infested waters.
Incubation period: Mosquito borne – varied Viral – 5 – 15 days Amebic – 3 – 7 days

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The infectious organism regardless of the type penetrate the brain and
causes inflammation of the brain tissues it self. the inflammatory
Pathophysiology:
response compresses the brain structure which explains the rapid
deterioration of the LOC. Encephalitis is more severe than meningitis.
Marked decrease in LOC. Brudzinski and kernigs may also be present if
Signs and symptoms meningeal irritation result. The most significant though is the
appearance of decorticate and decerebate rigidity.
Diagnostic
Lumbar Tap (CSF analysis) EEG
procedure
Primarily supportive. The body can neutralize the organism thru the
presence of antibody. Amebic encephalitis may benefit from
Management
metronidazole. Anti inflammatory may be given Mannitol could decrease
ICP

POLIOMYELITIS
Description: An acute paralytic infection that destroys the affected nerves.
Etiology: Caused by polio virus 1 (Brunhilde), 2 (Lansing), 3 (Leon)
Mode of Fecal – oral route. Particularly rampant among those in the squatters
transmission: area who have no access to sanitary toilet facilities
Incubation period: 7 – 14 days
The virus enters the oral cavity and reproduces in the intestines which
later penetrate the intestinal wall causing viremia and reaching the motor
Pathophysiology:
nerves and the spinal cord. The virus reproduces inside the nerve and as
they are released, the infected cell die, hence paralysis results.
Pokers sign, Haynes sign, tonsillitis, abdominal pain and flaccid
Signs and symptoms
paralysis
Diagnostic
Stool exam, pandys test, EMG
procedure
Prevention OPV No anti viral therapy. Toilet hygiene must be reinforced
Watch out for respiratory paralysis Assist in rehabilitation (physical
Management
therapy and comfort measures OPV is preferred over IPV because the
latter can only provide

RABIES
Description: Another acute viral infection which have a zoonotic origin
Primarily carried by mammals specially land and aerial mammals. In the
Etiology: Philippines Dogs and Cats are among the most important reservoir. The
causative organism is Rhabdo Virus
Mode of Bite of infected animal. Scratch wound from cats can also cause
transmission: infection since cats usually lick their paws.
Incubation period: 10 days for man 14 days for animals
Pathophysiology: The virus replicates at sight of infection which later proceeds to infect

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Nurse Licensure Examination Review Handouts

the nearby axons and then reaches the nerve it self. From that point
onwards the virus travels along the nerve pathway to reach the brain. In
the brain the virus insights inflammatory reaction that give rise to the
appearance of encephalitis like symptoms later the organism descends
from the brain and exit to affect other nerves in he body. The affectation
of trigeminal nerve causes throat spasms which gives rise to its classic
finding “hydrophobia”
Hydrophobia, aerophobia, laryngeal, Pharyngeal spasm excessive
Signs and symptoms
salivation.
Diagnostic Fluorescent antibody Staining, Negri bodies found in brain biopsy of the
procedure infected animal
Human Diploid Cell Vaccine, Rabies Immunoglobulin, Rabies Anti serum.
tetanus anti serum is also given if with negative or inadequate
immunization history Wash wound with soap and water, may apply
wound antiseptic Once sign and symptoms are present passive
Management immunization is already useless. Supportive therapy comes next. Protect
from glare and sunlight, protect from water and air current. Cover IV
bottle and tubing with carbon paper or any other else that can effectively
hide the iv fluids. Secure consent and restrain the patient. Observed
contact and droplet precaution.

LEPROSY
A chronic infection that usually affects the peripheral nerves and leads
Description:
to paresthesias
A possible zoonotic infection which is rarely cultured in laboratory but
Etiology: seen to be growing freely among armadillo. Causative organism is
Mycobacterium leprae
Mode of Droplet infection is the most important transmission. Skin contact may
transmission: cause infection only if there is an open lesion with prolonged contact.
Incubation period: 6 months to 8 years
The organism enters the body via droplet infection. It is ingested by
macrophages but can’t be killed, as this circulating macrophage reaches
the skin the bacteria penetrate the nerves. Later due to immune
Pathophysiology: recognition WBC attacks the infected cell which results to the
destruction of the affected cell hence the appearance of paresthesias
and consumption of the involved extremity becomes apparent due to
immune response it self.
Painless wound, paresthesias, ulcer that does not heal, leonine
Signs and symptoms appearance, maderosis. Nerve involvement with acid fast bacilli is the
pathognomic sign of leprosy
Diagnostic
Scraped incision method.
procedure
Management Institute concurrent disinfection specially of nasal discharge. Prevention

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Nurse Licensure Examination Review Handouts

is achieved by BCG immunization Rifampin, Dapsone and lampreme are


effective treatment against this infection
CIRCULATORY SYSTEM

DENGUE HEMORRHAGIC SHOCK


SYNDROME
Description: An acute arthropod borne infection which causes massive bleeding.
Causative organism is Dengue virus 1, 2, 3 and 4 the primary vector
is Aedes egypti other wise known as tiger mosquito because of the
Etiology:
black stripes present at the dorsal legs of the insect. The mosquito
prefers to thrive on clean stagnant water.
Mode of
Bite of the infected vector mosquito
transmission:
Incubation
6 – 7 days
period:
The virus is carried by the infected mosquito and transferred
through bites in the victim. Once the proboscis pierced the
capillaries it also leaves the viral organism. The virus mixes in the
bloodstream survive and reproduce causing viremia which explains
Pathophysiology: the appearance of generalized flushing. The virus will then
successfully enters the bone marrow and arrest the maturation of
megakaryocyte. Since the precursor of platelets can not take full
course it will result to massive drop in the patient’s platelet count
which significantly raises the risk for hemorrhage.
Signs and
Petechiae, bleeding, epitaxis, Herman’s sign and fever
symptoms
Diagnostic
Tourniquet test, platelet count.
procedure
Watch out for bleeding. Minimize injections and other parenteral
procedures if possible. Apply pressure for 10 minutes on injection
site. Avoid aspirin use acetaminophen provide TSB as an adjunct to
Management anti pyretics. Monitor platelet closely. Prepare for platelet
concentrate or fresh whole blood as the need may call for it. Hydrate
with PNSS Preventive measure focuses on 4 o clock habit Use DEET
as an effective mosquito repellant Use mosquito nets

MALARIA
Another type of mosquito borne infection most common in the
Description:
tropics
The causative organisms are Plasmodium Vivax, Falciparum, Ovale,
Etiology:
and Malariae. The primary vectors are anopheles mosquitoes.

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Nurse Licensure Examination Review Handouts

Mode of
Bite of the infected mosquito
transmission:
Incubation For Falciparum 12 days, for Vivax and Ovale 14 days and for
period: Malariae 30 days
From the bite of the infected mosquito the organism enters the body
via bloodstream and immediately proceed to the liver in the form of
sporozoites. Inside the hepatocytes reproduction continues until the
Pathophysiology: host burst releasing the parasite in the form trophozoites that enters
the RBC, inside it the organism divides and form schizont. This will
later produce merozoites that enters RBC the process causes drop
in the number of circulating RBC leading to anemia and cachexia.
A cycle of hot stage (high fever) followed by diaphoretic stage
Signs and
(sweating) and then cold stage (chilling). The cycle repeats leading
symptoms
to malarial cachexia
Diagnostic
Malarial smear or peripheral blood smear
procedure
Chloroquine is the drug of choice. Primaquine must be given to
Management prevent relapse. Prevent by using mosquito repellant and mosquito
net Chloroquine is the drug of choice for prophylaxis.

FILIRIASIS
Description: A chronic lymphatic disorder that is related to elephantiasis
Etiology: Causative organism is Wuchereria bancrofti primary vector Culex spp.
Mode of
Bite of the infected mosquito
transmission:
Incubation period: 6 – 12 months
The organism enters the body after the vectors’ bite, it then matures and
migrate on the lymphatic vessels but it usually affects those in the lower
extremity. The protozoal parasite crowds and destroy the filtering ability
Pathophysiology:
of the lymph nodes which then leads to the accumulation of lymph or
body fluids causing edema and at worst cases gross deformity hence it
could lead to elephantiasis.
Recurrent low grade fever, lymphangitis, nocturnal asthma and in worst
Signs and symptoms
cases elephantiasis
Diagnostic
Microscopic examination of peripheral blood.
procedure
Use of mosquito repellant and nets Hetrazan is effective against Filiriasis
Management adverse reaction though are seen in a number of patients, if such may be
present may use Ivermectin

RESPIRATORY SYSTEM

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Nurse Licensure Examination Review Handouts

DIPHTHERIA
An acute infection of the upper respiratory system whose complication
Description:
may include the lower respiratory tract.
Etiology: The organism, Corynebacterium diphtheriae is ubiquitous.
Mode of
Droplet infection is the means of spread
transmission:
Incubation period: 1 – 7 days
The organism infects the oral cavity which later due to its ability of
releasing toxins causes the death of the involved tissues. This gives rise
to the appearance of psudomembarne which may be dislodge and block
Pathophysiology:
the airway. As toxins are secreted the heart, kidney and the nerves
absorb it, this toxins halt protein synthesis of the infected cell which
later on causes its death.
Pathognomonic Sign is pseudo membrane. Tonsillitis may also be
Signs and symptoms present. Fever and malaise. If complication arises paralysis, endocarditis
and kidney failure may be seen.
Diagnostic
Throat swab
procedure
Gather specimen for culture Prepare for epinephrine and possible
Management intubation Be ready for antitoxin therapy after checking for allergy
Administer penicillin or erythromycin

PERTUSIS
A widespread organism that threaten any one who have no immunity
Description:
against it.
Etiology: Causative organism is Bordetella pertussis
Mode of
Droplet infection
transmission:
Incubation period: 7 – 21 days
Pathophysiology: The organism enters the upper respiratory tract attaches to the
respiratory epithelium and causes an increased production of cyclic
amino phosphate that essentially leads to hyperactivity of the mucous
secreting cells. Thick tenacious secretions blocks the airway. The
organism also halts the mucociliary escalator leaving coughing reflex
the last effective protective mechanism of expelling sputum. Due to its
relative tenaciousness the body experiences difficulty in coughing out

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phlegm thus we observe patient to manifest violent cough.


Pathognomonic of this infection is violent cough w/out intervening
inhalation followed by an inspiratory whoop. Vomiting may be present,
Signs and symptoms
Increased in ICP and IOP are also seen. Hernia is also a high risk
incident.
Diagnostic
Throat swab
procedure
Penicillin, Erythromycin ; Mucolytic may be ordered. Nebulization may
Management also be indicated; Provide small feedings Apply abdominal binder ;
Avoid dust and drafts

TUBERCULOSIS
Description: A chronic lung infection that leads to consumption of alveolar tissues
Etiology: Causative organism is acid fast bacillus mycobacterium tuberculosis.
Mode of
Droplet infection as well as airborne
transmission:
Incubation period: 2 – 4 weeks
The bacilli is inhaled and taken in the alveoli where macrophage will
ingest but fail to kill the organism. As these macrophages migrate to
nearby lymph nodes it will die and leave the capsulated bacteria
Pathophysiology: undigested. Once the body’s immune system dropped, the bacteria will
be activated and stimulate immune response which likewise damage the
alveolar tissues leading to casseation necrosis and could eventually
consume the entire lungs if the process is repeated frequently
Signs and symptoms Afternoon fever, night sweats, cough for 2 weeks, anorexia weight loss.
Diagnostic
Sputum microscopy, CXR, Mantoux test
procedure
Institute DOTS Give as ordered; Pyrazinamide, Izoniazid, Rifampicin,
Ethambutol and Streptomycin. Check for sensitivity to any of the drug
Management mentioned Provide B6 if receiving Izoniazid Watch out for visual problem
if receiving Ethambutol Ethambutol is contra indicated for children who
cant verbalize visual problems yet.

PNEUMONIA
Description: an acute usually bacterial in nature
the most common causative organism is strptococcus pneumoniae
ubiquitous, orgainsm and may be transferred among population that has
Etiology:
poor ventilation and impaired respiratory cilliary function. certain
disease like measles may promote the development of pneumonia
Mode of
Droplet infection
transmission:
Incubation period: 24 to 72 hrs usually 48 hrs

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Nurse Licensure Examination Review Handouts

the organism enters the respiratory tract and if the cilliary mechanism
fails to prevent its further entry the organism then infects the lower
respiratory centers where it stimulate an inflammatory reaction. this
response leads to migration of WBC in particular with neutrophil hence
Pathophysiology:
leukocyte infiltration is seen in chest x-rays as consolidation. the build
up puss increases the alveolar presure causing in atelectasis once
collapsed alveoli cant participate in gas exchange anymore leading to
impaired DOB.
Rusty colored sputum is the pathognomonic sign this is caused by WBC
Signs and symptoms infiltrates, RBC and sputum. DOB, increased RR, coughing and in late
cases lethargy, cyanosis and death.
Diagnostic
sputum exam
procedure
Co Trimoxazole and gentamycin are the drug of choice. although Co-tri
is used more widely than gentamycin because of its oral preparation
which are allowed to be administered by midwives for patient in far flung
Management areas. instruct the mothers to continue the administration of antibiotic
for 5 straight days TSB if in case fever may arise Promote proper room
ventilation avoid crowding as much as possible Use Pneumococcal
vaccine as indicated

COLDS (CORYZA)
Description: The causative agent comes from adenovirus and rhino virus.
Mode of
Droplet infection, direct contact.
transmission:
Incubation period: 1 – 3 days
As the virus enters the respiratory tract, it attaches itself to the mucous
membrane and causes local irritation and inflammation. In response, the
mucous membrane releases mucous to flush out the virus. Since there is
an increased in the production of the mucous it usually flows back and
Pathophysiology:
causes rhino rhea and because of the naso-lacrymal duct, increased
mucous production impedes the drainage of tears thus watery eyes is
present. Complications: Children – otitis media and bronchopneumonia
Adult – sinusitis

•General malaise
•Fever, chills
Signs and symptoms
•Sneezing, dry and scratchy throat
•Teary eyes, headache
•Continues water discharge from nares
a. Provide adequate rest and sleep b. Increase fluid intake c. Provide
Management
adequate and nutritious diet d. Encourage vitamins specially vitamin C

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Nurse Licensure Examination Review Handouts

INFLUENZA (LA GRIPPE OF FLU)


A highly contagious disease characterized by sudden onset of aches
Description:
and pains.
Etiology: Influenza virus A, B, C
Mode of
Droplet infection, contact with nasopharyngeal secretions
transmission:
Incubation period: 24 – 48 hrs.
Upon entry in the upper respiratory tract, it is deposited in the same site
and penetrates the mucosal cells. Causing lysis and destruction of the
ciliated epithelium the virus releases neuramidase that decreases the
viscosity of the mucosa. Facilitating the spread of the infected exudates
Pathophysiology: to the lower respiratory tract, this causes intestinal inflammation, and
necrosis of the alveolar and bronchiolar epithelium. Thus, the alveoli are
filled with exudates containing WBC, RBC and hyaline cartilage. This
places the patient to increased possibility of acquiring bacterial
pneumonia usually caused by S. Aureus.
Respiratory – most common
• fever
• anorexia
• chills
• muscle pain and aches
• coryza
• sore throat
• bitter taste
Signs and symptoms • orbital pain
Intestinal
• vomiting
• severe abdominal pain
• fever
• obstinate constipation
• severe diarrhea
Nervous
• headache
a. provide adequate rest and ventilation b. tepid sponge bath to reduce
the temperature c. monitor the vital signs d. provide adequate nutrition e.
Management
assist the patient in conserving strength when she is very weak f. drug
of choice: · antibiotics · sulfonamides
INTEGUMENTARY SYSTEM

SCARLET FEVER (SCARLATINA)


Description: Is an acute, febrile, contagious condition characterized by sudden onset
usually with vomiting and by punctuate erythematous skin eruption
followed by characteristic exfoliation of the skin during convalescence,

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Nurse Licensure Examination Review Handouts

rapid pulse and sore throat.


Etiology: Group A hemolytic streptococcus group
Mode of
Direct contact, droplet infection and indirect contact
transmission:
Incubation period: 1 – 7 days
The bacterium releases erythrogenic toxins, which causes sensitivity
reaction in the body. The toxin can cause toxic injury to the small
capillaries of vascular epithelium found in the body. The skin is the site
Pathophysiology:
where the manifestations are most visible where one will observed
strawberry like tongue, rashes, etc. Complications: · sinusitis · nephritis ·
otitis media · myocarditis/endocarditis · mastoiditis
I. Prodomal stage
• fever
• tachycardia
• sore throat
• vomiting
• headache
• abdominal pain
• body malaise
II. Eruptive stage
• rashes: appears at the end of 24 hours on the chest spread
Signs and symptoms
gradually upward and downward
• enanthem: macular eruption on the hard palate
• pastia’s line: due to the grouping of macules found around the
folds of the skin particularly on the elbow
• tiny subcuticular vesicles: found in the cuticles of the nails
• strawberry tongue: tongue becomes red at the edges and enlarged
papillae show
• raspberry tongue: circumoral pallor
III. Desquamation (8 – 10 days) · skin begins to peel · shedding of the hair
and nails

• Scultz-Charlton rash extinction or blanching test – for sensitivity


to scarlet fever antitoxin
• Dick test – determines whether or not a person is naturally
immune to scarlatine
Diagnostic
• nasal swab
procedure
Laboratory:
• positive throat culture for strep
• elevated ASO titer
• white and differentiated count high as 50,000 increae in
eosinophils
Management
1. isolation – medical aseptic technique
2. bed rest
3. keep the patient warm at all times and avoid drafts

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4. apply ice cap/packs for high fever


5. give TSB for high temperature
6. increase oral fluid intake
7. take vital signs q 3 – 4 hrs
8. daily bath should be given: sodium bicarbonate or starch is
used in excessive itching and oil rub after bath is useful
9. use of mouthwashes and gargles for good oral hygiene
10. prevent exoriations by wiping nasal discharges with soft
tissues and application of cold creams
11. encourage daily elimination
12. diet should be of high calorie foods and fruit juices, milk
cream and soups
Medical management: a. antitoxins b. convalescent serum c. samma
globin – administered IM d. sulfonamides e. antibiotics – penicillin (for
cleaning the throat of streptococcus)

LEPROSY (HANSEN’S DISEASE,


HANSENOSIS, LEPRAE, LEONTHIASIS)
A chronic infectious disease characterized by the appearance of
Description: modules in the skin or mucous membranes or by changes in the nerves
leading to anesthesia, paralysis or other changes
Mycobacterium leprae (acid fast bacillus), sporadic/endemic cases,
occurs in tropical and semitropical countries throughout the world. It
can be contracted in childhood (manifested at age 15 and diagnosed by
Etiology: the age of 20 years). Prognosis: > the longer the time of active disease,
severe lesions, the more rapidly they have advanced without ability to
produce the lepromin reaction – the poorer the prognosis > case under
21 years old – high relapse rate
Mode of
Prolonged intimate skin to skin contact, nasal secretions
transmission:
Incubation period: Prolonged, undetermined and varies from one to many years
The bacterium, which is an acid-fast bacillus, attacks the skin tissues
Pathophysiology: and peripheral nerve, which causes skin lesions, anesthesia, infection
and deformities
Signs and symptoms Assessment:
1. Tuberculoid type – shows high resistance to Hansen’s bacilli.
Clinical manifestations are mainly in the skin and nerves and
usually are used or non-infectious.
2. Lepromatous type – minimal resistance to the multiplication,
existence of the bacillus, constant presence of large numbers in
the lesions and form globi (characteristic manifestations in the
skin and mucus membranes) and peripheral nerves.
3. Open or infectious cases
4. Inderterminate type – clinical manifestations are located chiefly in

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skin and nerves; lesions are flat macules.


5. Borderline
Clinical Manifestations: 1. Early stage · loss of sensation · paralysis of
extremities · absence of sweating (anhydrosis) · nasal obstruction · loss
of hair (eyebrows) · eye redness · change in the skin color · ulcers that
does not heal · muscle weakness 2. Late symptoms · contractures ·
leonine appearance (due to nodular and thickened skin of the forehead
and face) · madarosis (falling of eyebrows) · synecomastia · sinking of
bridge of nose 3. Cardinal signs · presence of Hansen’s bacilli · presence
of localized areas of anesrhesia · peripheral nerve enlargement

Diagnostic 1. Lepromin reaction – a positive test develops a nodule at the site of


procedure inoculation (first and third week)
2. Wassermann reaction
Planning and implementation
1. Prevention
o separate infants from lepromatous parents at birth
o segregate and treat open cases of leprosy
o require public health supervision and control of cases of
Hansen’s disease
2. Medical management
1. Multiple drug therapy · paucibacillary treatment – six months or until
negative (-) results occur · refampicin – once a month · dapsone - once a
Management
day 2. Multibacillary treatment – for 2 consecutive years or until negative
(-) for leprosy test · rifampicin once a month · lamprene once a day ·
dapsone once a day
3. full, wholesome generous diet
4. alcohol or TSB may be used for high fever
5. patient should have a daily cleansing bath and change of clothing
6. good oral hygiene
7. normal elimination should be maintained
h. meticulous skin care for ulcers

MEASLES (RUBEOLA, MORBILLI, 7 – DAY


MEASLES)
An extremely contagious exanthematous disease of acute onset which
Description: most often affects children and the chief symptoms of which are
referable to the upper respiratory passages.
Etiology: The causative agent is the paramyxo virus
Mode of
Nasal throat secretions, droplet infection, indirect contact with articles
transmission:
Incubation period: 8 – 20 days
Pathophysiology: As the virus enters the body it immediately multiplies in the respiratory
epiyhelium. It disseminate by way of the lymphatic system causing

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Nurse Licensure Examination Review Handouts

hyperplasia of the infected lymphoid tissue. As a result there is a


primary viremia which infects the leukocyte and involves the whole
reticuloendothelial system. As the infected cells die it necrose and
release more viruses to infect other leukocytes leading to secondary
viremia, which also causes edema of upper respiratory tract producing
its symptoms and it may predispose to pneumonia. Complications: ·
otitis media · bronchopnuemonia · severe bronchitis Prognosis: · death
rate is highest in the first two years of life (20%) · after 4 years –
uncommon · over all mortality – less than
Assessment:
1. Stages
1. incubation period (average of 10 days)

2. Pre-eruptive stage or stage of invasion (3-6 days) · from the


appearance of the first signs and symptoms to the earliest evidence of
the eruption. · fever, severe cold · frequent sneezing · profuse nasal
discharge · eyes are red and swollen with mucopurulent discharge (lids
stick together) · Stimson’s sign (puffiness of lower eyelids with definite
line of congestion on the conjunctivae) · redness of both eardrums ·
vomiting, drowsiness · hard, dry cough · Koplik’s spot (appears on
second day): small bright, red macules or papules with a tiny or bluish-
Signs and symptoms
white specks on the center and can be found on the buccal cavity ·
macupapular rashes (seen late in 4th day): appears first on the cheeks or
at the hairline · true measles rash: slightly elevated sensation to touch,
appears first on the face and spreads downward over neck, chest trunk,
limbs and appearing last on the wrist and back of the hand

3. Eruptive stage · characterized by a general intensification of all local


constitutional symptoms of the pre-eruptive stage with the appearance
of bronchitis and loose bowels · irritability and restlessness · red and
swollen throat · enlargement of cervical glands · fever subsides 4.
Desquamation stage · follows after the rash fades · follows the order of
distribution seen in the formation of eruption
Diagnostic
No specific diagnostic exam except only for the presence of leucopenia.
procedure
Management a. prevention · education of parents regarding the disease · passive
immunization of infants and children (gammaglobulin) · active
immunization (1st year of life)

b. management · drugs Ø antibiotics Ø sulfodiazine · isolation ·


meticulous skin care – warm alcohol rub to prevent pressure sores ·
good oral and nasal hygiene · increase oral fluid intake · proper care of
the eyes – eye screen to avoid direct light; wear dark glasses · ears
should be cleaned after bath if there is discharges – patient should lie
the affected ear down or towards the bed ·

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Nurse Licensure Examination Review Handouts

give ample of fluids during febrile stage

GERMAN MEASLES (RUBELLA, ROTHEIN,


ROSEOLA, 3-DAY MEASLES)
An acute infectious disease characterized by mild constitutional
Description: symptoms, rose colored macular eruption which may resembles measles
and enlargement and tenderness
Caused by myxovirus. Occurs mostly in spring and seen mostly in
Etiology:
children over 5 years of age
Mode of
Direct contact
transmission:
14 – 21 days Period of communicability – 7 days before to 5 days after
Incubation period:
the rash appears
As the virus gains entrance to the nasopharynx, it immediately invades
the nearest lymph gland causing lymphadenopathy. Later on, the virus
enters the blood stream that stimulates the immune response, which is
the cause of rashes found in the body of infected individual. If rashes
has appeared it means that viremia has subsided. Since the disease is
Pathophysiology: generally mild and serious complication has ha been very rare, what
should be watched out rather are its congenital effects because it can
cross the placental barrier, which may kill the fetus or cause congenital
rubella syndrome. Complications: · otitis media · encephalitis · transient
albuminuria · arthritis · congenital defects for babies who’s mother were
exposed in early pregnancy Prognosis: very favorable
· fever, cough · loss of appetite · enlargement of lymph nodes · sweating ·
leucopenia · vomiting (in some cases) · headache, mild sore throat ·
desquamation follows the rash · enanthem of uvula with tiny red spots ·
Signs and symptoms rash (cardinal symptom) accompanied with cervical adenitis: begins on
the face including the area around the mouth; oval, pale, rose-red
papules about the size of a pinhead; covers the body within 24 hours
and gone by the end of the 4th day
Planning and implementation

a. Prevention: vaccination · gamma globulin – given to pregnant women


with negative history and who have been exposed in the first trimester of
pregnancy · include in MMR given at 15months to the baby
Management
b. management · isolation – (catarrhal stage – to prevent infection to
others) · bed rest for first few days · meticulous skin care especially after
the rash fades · good oral and nasal hygiene (use of petroleum jelly if
lips become dry) · no special diet is necessary, increase oral fluid intake

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Nurse Licensure Examination Review Handouts

VARICELLA (CHICKEN POX)


A very contagious acute disease usually occurring in small children,
Description: characterized by the appearance of vesicles frequently preceded by
papules, occasionally followed by postules but ending in crusting
Etiology: Varicella zoster virus (airborne)
Mode of
Droplet infection, direct contact
transmission:
Incubation period: 2 -3 weeks
The virus gain entrance via the upper respiratory tract it crosses the
mucous membrane and cause systemic infection followed by
appearance of numerous macupapular rash. The rash are fluid filled that
contain polymorphonuclear leukocytes. Period of communicability:
Pathophysiology:
highly contagious from 2 days prior to rash to 6 days after rash erupt.
Full blown case imports permanent immunity. Complications: ·
pneumonia · nephritis · encephalitis · impetigo · pitting or scarring of the
skin
· slight fever: first to appear · body malaise, muscle pain · eruption
(maculopapular) then progresses to vesicle (3-4 days); begins on trunk
Signs and symptoms and spreads to extremities and face (even on the scalp, throat and
mucus membranes) · intense pruritus · vesicles ended as a granular
scab · irritability
1. Drugs · penicillin – can be used when the crusts are severe or infected
to prevent scarring or secondary invasion · alkalinizing agent to prevent
nephritis and to stop vomiting · acyclovir, immunosin – antiviral ·
hydrocortisone lotion 1% for itching
2. isolation in a room by itself
3. provide a well ventilated, warm room to the patient
Management
4. warm bath should be given daily to relieve itching; use a calamine
lotion
5. avoid injuring the lesions by using soft absorbent towel and the
patient should be patted dry instead of rubbed dry 6. maintain good oral
hygiene, if lesions are found in the mouth or nasal passages, antiseptic
prep may be used 7. diet should be regular

HERPES ZOSTER (SHINGLES)


Acute viral infection of the peripheral nervous system due to reactivation
of varicella zoster virus. The virus causes an inflammatory reaction in
Description: isolated spinal and cranial sensory ganglia and the posterior gray matter
of the spinal cord. Contagious to anyone who has not had varicella or
who immunosupressed.
· neuralgic pain · malaise · burning · fever · cluster of skin vesicles along
Signs and symptoms course of peripheral sensory nerves (unilateral and found in trunk,
thorax or face); appears 3-4 days

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Nurse Licensure Examination Review Handouts

1. drugs
o analgesics
o corticosteroids
o acetic acid compresses or white petrolatum
Management o anti-viral (acyclovir)
2. isolate client
3. apply drying lotion
4. administer medications as ordered
5. instruct client to preventive measures

SCABIES
An infection of the skin produced by burrowing action of a parasite mite
Description:
resulting in irritation and the formation of vesicles or postules.
Itchmite, sarcoptes scabei, occurs in individual living in area of poverty
Etiology:
where cleanliness is lacking.
Mode of Direct contact with infected persons, indirect contact through soiled bed
transmission: linens, clothing and others.
Incubation period: -
Both female and male parasites live on the skin. A female parasite
burrows into the superficial skin to deposit eggs. Pruritus occurs and
scratching of skin may produce secondary infection. Scattered follicular.
Pathophysiology:
Eruption contains immature mites. Inflammation may produce postules
and crust. Eggs is hatched in 4 days. Larvae undergo a series of matts
before becoming adult. Life cycle is complete in 1-2 weeks.
· intense itching especially at night · sites – between fingers or flexor
Signs and symptoms surfaces of wrists and palms, around nipples, umbilicus, in axillary folds,
near groin or gluteal folds, penis, scrotum.
Diagnostic
Presence on skin of female mite, ova and feces upon skin scrapping.
procedure

1. Take a warm soapy shower bath or bath to remove scaling debris


from crusts.
2. Apply prescribed scabicide such as:
Management
o lindane lotion (kwell) 1%
o crotamiton (Eurax) cream or lotion
o 6-10% precipitate of sulfur in petrolatum
3. encourage to change clothing frequently

RINGWORM (TRICHOPHYTOSIS)
A group of diseases caused by a number of vegetable fungi and
Description:
affecting various portion of the body in different ways (skin, hair, nails)
Etiology: TINEA PEDIS (Athlete’s foot) – a superficial fungal infection due to
trichophyton Rubrum, mentagrophytes, or epidermophyton floccosum
which may manifest itself as an acute, inflammatory, vesicular process

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or as chronic rash involving the soles of the feet and the inter-digital web
spaces. particularly common in summer, contracted swimming area and
locker rooms. TINEA CORPORIS or TINEA CIRCINATA – ringworm of the
body. TINEA CRURIS (Jock itch) – superficial fungal infection of the
groin which may extend to the inner thigh and buttocks areas and
commonly associated with tinea pedis. TINEA CAPITIS (ringworm of the
scalp) – caused by microsporum canis, trichophyton tonsurans. · usually
spread through child to child contact, use of towels, combs, brushes and
hats · kitten and puppies may be the source of the infection · primarily
seen in children before puberty ·
TINEA PEDIS · scaly fissures between toes, vesicles on sides of feet ·
pruritus · burning and erethema · lymphangitis and cellulites may occur
TINEA CORPORIS or TINEA CIRCINATA · intense itching · appearance:
begins as scaling erythematous lesions advancing to rings of vesicles
with central clearing and appears on exposed areas of body. TINEA
Signs and symptoms CRURIS · dull red brown eruption of the upper thighs and extends to
form circular plaques with elevated scaly or vesicular borders. · itching ·
seen most in joggers, obese individuals and those wearing tight
undercoating. TINEA CAPITIS · reddened, oval or round areas of alopecia
· presence of kerion: an acute inflammation that produces edema,
postules and granulomatous swelling
TINEA PEDIS · direct examination of scrapings (skin, nails, hair) ·
Diagnostic
isolation of the organisms in culture TINEA CAPITIS · wood’s lamp ·
procedure
microscopic evaluation
Management TINEA PEDIS
1. Prevention: instruct client to keep feet dry such as by using
talcum powder.
2. Management:
o Drugs: topical agent, clotrimazole, miconazole, tolnaftate
o Systemic anti-fungal therapy: griseofulvin, ketoconazole
o Elevate feet for vesicular type o pain infection.
TINEA CORPORIS or TINEA CIRCINATA
1. Prevention: infected pet is a common source and should be
inspected and treated by a veterinarian.
2. Management
o see treatment for tinea pedis
o wear clean cotton clothing next to skin
o use clean towel daily
o dry all areas and skin folds thoroughly
o use self monitoring for signs of re-infection after a course of
therapy.
TINEA CRURIS
1. Prevention: avoid nylon underclothing, tight-fitting underwear and
prolonged wearing of wet bathing suit.
2. Management:
o Drugs – topical therapy (miconazole cream); griseofulvin

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(oral)
o avoid excessive washing or scrubbing; wear cotton
underwear.
TINEA CAPITIS – same with other fungal infection
GASTROINTESTINAL DISORDERS
TYPHOID FEVER (ENTERIC FEVER)
A general infection characterized by the hyperplasia of the lymphoid
tissues, especially enlargement and ulcerations of the Peyer’s patches
Description:
and enlargement of the spleen, by parechymatous changes in various
organs and liberation of an endotoxin in the blood.
Salmonella typhosa, prevalent in temperate climates, high incidence in
Etiology:
fall, and mostly affected are the males and in youth and infant.
Mode of
Infected urine and feces and intake of contaminated food and water
transmission:
The organism enters the body via the GI tract and invades the walls of
the GI tract leading to bacteremia that localizes in mesenteric lymph
nodes, in the masses of lymphatic tissue, in the mucus membrane of the
intestinal wall (Peyer’s patches) and in small, solitary lymph follicles in
Pathophysiology:
the ileum and colon thus ulceration of the intestines may result.
Complication: · perforation of the intestine – from erosion of one of the
ulcers · intestinal hemorrhage – from erosion of blood vessels · relapse ·
thrombophlebitis · urinary infection · meningitis

1. Gradual onset
o severe headache, malaise, muscle pains, non-productive
cough
o chills and fever, temperature rises slowly
o pulse is full and slow
o skin eruption – irregularly spaced small rose spots on the
abdomen, chest and back; fades 3-4 days
Signs and symptoms
o splenomegally
2. Second week
· fever remains consistently high · abdominal distention and tenderness,
constipation or diarrhea · delirium in severe infection · coma-vigil look;
pupils dilate and patient appears to stare without seeing · sultus tendium
–twitching of the tendon sets
3. Third week
· gradual decline in fever and symptoms subsides
· white blood cell counts · blood or bone marrow culture · positive urine
Diagnostic
and stool cultures in later stage · blood serum agglutination – (+) at the
procedure
end of scond week
Management
1. Prevention: decontamination of water sources, milk
pasteurization, individual vaccination of high risk persons, control
carriers.

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2. Drugs
o chloramphenicol
o ampicillin
o sulfamethoxazole
o trimethoprim
o furazolidone
3. intravenous infusion – to treat dehydration and diarrhea
4. Nursing care
o give supportive care
o position the patient to prevent aspiration
o use of enteric precautions
o TSB for high fever
o encourage high fluid intake
o monitor for complications
5. intestinal decompression procedure, IV fluids and surgical
intervention – for perforation
6. withhold food, blood transfusions and bowel resection – for
intestinal hemorrhage

LEPTOSPIROSIS (WEIL’S DISEASE, CANICOLA


FEVER, HEMMORHAGIC JAUNDICE,
ICTEROHEMORRHAGIC SPIROCHETOSIS,
SWINEHERD’S DISEASE, MUD FEVER)
Worldwide in its distribution and especially in areas where sanitation is
Description: poorest; common in Japan. Usually those who are affected are the sewer
workers, miners and swimmers in polluted water.
Etiology: Leptospira icterohaemorrhagiae carried by wild rat
Incubation period: 5 – 6 days

• sudden onset with chills, vomiting and headache by severe fever


and pains in the extremities
• intense itching of the conjunctivae
Signs and symptoms • severe jaundice with hemorrhage in the skin and mucus
membranes
• hematemesis, hematuria and hepatomegaly for severe cases
• convalescence occurs in the third week unless there is a
complication
Diagnostic
Positive agglutination test
procedure
Prevention – eradication of rats and environmental sanitation Drugs –
Management antiserum or convalescent serum; penicillin Nursing care – supportive
and symptomatic

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Nurse Licensure Examination Review Handouts

DYSENTERY
BACILLARY DYSENTERY (shigellosis, bloody flux) – caused by shigella
dyseteriae and shigella paradysenteriae coming from bowel discharges
Etiology: of infected persons and carriers. VIOLENT DYSENTERY (Cholera) –
caused by vibrio cholera, vibrio comma (ogawa and inaba) from infected
feces or vomitus.
BACILLARY DYSENTERY – eating of contaminated foods, hand to mouth
transfer of contaminated material, flies, objects soiled with discharges of
Mode of
infected person, contaminated water. VIOLENT DYSENTERY – direct or
transmission:
indirect fecal contamination of water or food supplies by soiled hands,
utensils or mechanical carriers such as flies.
BACILLARY DYSENTERY – 1-7 days (average of 4 days) · period of
communicability – during acute phase and until (-) stool exam VIOLENT
Incubation period: DYSENTERY – from a few hours to five days (average 3 days) · period of
communicability – until the infectious organism is absent from the bowel
discharges (7-14 days) ·
BACILLARY DYSENTERY · chills · fever · nausea and vomiting ·
tenesmus · severe fiarrhea accompanied by blood and mucus ·
alternating episodes of diarrhea and constipation (chronic) VIOLENT
DYSENTERY
1. Onset
o acute colicky pain in the abdomen
o mild diarrhea (yellowish)
o marked mental depression
Signs and symptoms o headache, vomiting
o fever, may or may not be present
2. Collapse stage – after 1 or 2 days
· profuse watery stools (grayish white or rice water) · thirst ·
severe/violent cramps in the legs and feet · thickly furred tongue ·
sunken eyeballs · ash-gray colored skin
3. Reaction stage – after 3 days
· increased consistency of stools · skin becomes warm and cyanosis
disappear · peripheral circulation improves · urine formation increases
BACILLARY DYSENTERY
• stool exam
Diagnostic
• serologic test
procedure
VIOLENT DYSENTERY
• (+) stool exam/vomitus
Management BACILLARY DYSENTERY
1. Methods of control and prevention
o recognition of disease and reporting
o concurrent disinfection from bowel discharges
o investigation of source of infection (food, water and milk
supplies, general sanitation and search for carriers)

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o prevention of flybreeding, screening


o sanitary disposal of human excreta
o protection and purification of public water supplies and
prevention of subsequent contamination
2. Drugs
· kaolin · bismuth and paregoric (combination of sulfonamide) ·
chloramphenicol
3. Nursing care
· isolation by medical aseptic technique · daily cleansing bath · increase
oral fluids in acute stage · TSB for fever · record and the character of
stools passed, amount and frequency of vomiting VIOLENT DYSENTERY
1. Prevention
· immunization · screen the sickroom from flies · protect the food
supplies for contamination b. Drugs – tetracycline c. Replacement of
fluids and electrolytes d. Isolation e. Patient should be spared all
unnecessary efforts during the acute stage f. Buttocks should be kept
clean with warm water and soap and rubbed dry g. antiseptic mouthwash
in case of vomiting h. fluids is given as soon as they can be tolerated

MUMPS (INFECTIOUS OR EPIDEMIC PAROTITIS)


An acute contagious disease the characteristic feature of which is the
Description: swelling of one or both of the parotid glands usually occurring in
epidemic form.
Filterable virus, member of myxovirus family, infected oral and nasal
secretions is the source of infection Complication: orchitis or
Etiology:
epididymp-orchitis Prognosis: favorable in most cases of mumps,
complete recovery ordinarily takes place even complications take place.
Mode of Direct contact with a person who has the disease or by contact with
transmission: articles which is contaminated.

14 – 21 days
Incubation period:
• period of communicability: before the glands is swollen to the time
present of localized swelling

• pain in the parotid region


• headache
• earache
Signs and symptoms
• fever
• difficulty to open the mouth wide
• general malaise
• sore throat

Diagnostic • moderate leukocytosis


procedure • complement fixation test
• skin test for susceptibility to mumps

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Nurse Licensure Examination Review Handouts

a. Prevention: immunization (MMR given at 15 months) b. Drugs – aspirin


for fever, cortisone c. isolation d. absolute bed rest to prevent
complications (at least 4 days) e. daily bath should be given f. soft bland
Management
diet for sore jaw g. advise male to wear well fitting support to relieve the
pull of gravity on the testes and blood vessels h. TSB for fever i. ice
pack/collar application

PARASITISM
Description:
· PINWORM (Enteropiasis) – oxyuris vermicularis, occurs from fomites,
autoinfection, fecal contamination, affects one in family and invariably
infects entire family. · GIANT INTESTINAL ROUNDWORMS (Ascariasis) –
ascaris lumbricoides, from sputum and ova in soil. · THREADWORM –
strongyloides stercoralis, from fecal soil contamination · WHIPWORM
(trichuriasis) – from fecal soil contamination · HOOKWORM
Etiology:
(ancylostomiasis) – from larvae in fecal soil contamination · TAPEWORM
(taeniasis) Types:
• hymenolepis nana – from fecal contamination
• taenia saginata (beef) – from insufficiently cooked meat
• taenia solium (pork) – contaminated meat
• diphyllobothrium latun – poorly cooked infested fish
PINWORM – mouth GIANT INTESTINAL ROUNDWORMS – mouth
Mode of
THREADWORM – enter usually through the skin or feet WHIPWORM –
transmission:
mouth HOOKWORM – through skin of the feet TAPEWORM - mouth
PINWORM
• eosinophilia, itching around the anus, convulsions in children.
GIANT INTESTINAL ROUNDWORMS
• chest pain, cough after two months, malnutrition, indigestion,
diarrhea, colicky abdominal pain.
Signs and symptoms THREADWORM
• intermittent diarrhea
WHIPWORM – nausea and vomiting, diarrhea, anemia, stunted growth;
may cause prolapse of rectum in children and occasionally appendicitis.
HOOKWORM – anemia, diarrhea, stunted growth, bronchial symptoms,
obstruction of the biliary and pancreatic duct.
PINWORM – adults and ova in stool GIANT INTESTINAL ROUNDWORMS
Diagnostic – adults and ova in stool THREADWORM – larvae WHIPWORM – ova in
procedure stool HOOKWORM – ova in stool TAPEWORM – ova and segments of the
worm in the stool
Management THREADWORM – Prevention: wear shoes and use sanitary toilets
• use of sanitary toilets
• provide hygiene education of the family
• dispose of the infected stools carefully
• meticulous cleansing of skin especially anal region, hands and
nails

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• drugs – antihelminthic drugs, piperazine citrate, pyrantel pamoate,


mebendazole

HEPATITIS
Widespread inflammation of the liver tissue with liver cell damage due to
hepatic cell degeneration and necrosis; proliferation and enlargement of
Description:
the Kuffer cells and inflammation of the periportal areas thus may cause
interruption of bile flow.
TYPE A (infectious hepatitis) – occurs in crowded living conditions; with
poor personal hygiene or from contaminated food, milk, water or
shellfish. Common occurrence during fall and winter months usually
Etiology:
affecting children and young adults. TYPE B (serum hepatitis, SH virus,
viral hepatitis, transfusion hepatitis, homologous serum jaundice) TYPE
C (non-A, non-B hepatitis)
TYPE A – fecal/oral route TYPE B – blood and body fluids (saliva, semen,
Mode of vaginal secretions), often from contaminated needles among IV drug
transmission: abusers, intimate/sexual contact. TYPE C – by parenteral route, through
blood and blood products, needles and syringes
TYPE A – 15-45 days
• period of communicability – 3 weeks prior and one week after
Incubation period:
developing jaundice
TYPE B – 50-180 days TYPE C – 7-50 days
Pathophysiology: -
a. Pre-icteric stage · anorexia · nausea and vomiting · fatigue ·
constipation or diarrhea · weight loss · right upper quadrant discomfort ·
hepatomegaly · spleenomegaly · lymphadenopathy b. Icteric stage ·
Signs and symptoms
fatigue · weight loss · light colored stools · dark urine · jaundice · pruritus
· continued hepatomegaly with tenderness c. Post-icteric stage · fatigue
but increased sense of well being · hepatomegaly: gradually decreasing
a. All 3 types · SGPT, SGOT, alkaline phospatase, bilirubin, ER – all
increased in pre-icteric · leukocytes, lymphocytes, neutrophils – all
decreased · prolonged PT b. HEPA A: Hepa A (HAV) in stool before onset
· Anti-HAV (IgG) – appears soon after onset of jaundice, peaks in 1-2
Diagnostic months and persist indefinitely · Anti-HA (IgM) – positive in acute
procedure infection lasts 4-6 weeks c. HEPA B · HbsAG (surface antigen) – positive,
develops 4-12 weeks after infection · Anti-HbsAg – negative in 80% cases
· Anti-HBC associated with infectivity, develops 2-16 weeks after
infection · ABeAG – associated with ineffectively and disappears before
jaundice · Anti-Hbe – present in carriers, represents low ineffectivity
Management a. Prevention I. Type A · good hand washing · good personal hygiene ·
control and screening of food handlers · passive immunization – ISG, to
exposed individuals and prophylaxis for travelers to developing
countries II. Type B · screen blood donors HB3Ag · use disposable
needles and syringes · registration of all carriers · passive immunization
– ISG · active immunization – hepatavax B vaccine and formalin treated

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Nurse Licensure Examination Review Handouts

hepatitis B vaccine given in 3 doses b. Nursing management · promote


adequate nutrition – small frequent meals of high CHO, moderate to high
CHON, high vitamin, high caloric diet, avoid very hot or cold foods. ·
ensure rest and relaxation · monitor/relive pruritus – cool, moist
compresses, emollient lotion · administer corticosteroid as ordered ·
isolation procedures as required · provide client teaching and discharge
planning with regards to: Ø importance of avoiding alcohol Ø importance
of not donating blood Ø recognition/reporting of signs of inadequate
convalescence Ø avoidance of persons with known infections · Drugs –
liver protector (essentiale, jectofer, interferon drug)

FOOD POISONING
A gastroenteritis often produced by the presence of a disease organism
Description:
or its toxins.
SALMONELLA GASTROENTERITIS – salmonella typhimurium,
salmonella paratyphi A, B, and C; salmonella newport
Etiology: STAPHYLOCOCCUS GASTROENTERITIS – coagulase – positive, gram
positive: grows rapidly on food containing carbohydrates Recovery:
within 24 – 36 hours BOTILISM – clostridium botulinum
SALMONELLA GASTROENTERITIS – 6 to 48 hours after the ingestion of
Incubation period: contaminated food STAPHYLOCOCCUS GASTROENTERITIS – 2 to 6
hours after ingestion BOTILISM – 24 hours after the ingestion
SALMONELLA GASTROENTERITIS
• headache
• nausea and vomiting
• diarrhea (stools are usually fluid and contain mucus; bloody if in
severe infection)
STAPHYLOCOCCUS GASTROENTERITIS
• sudden abdominal pain
• excessive perspiration
Signs and symptoms
• vomiting
• diarrhea
• pallor weakness
BOTILISM
• peripheral nervous system
Ø vomiting Ø ataxia Ø constipation Ø ocular paralysis Ø aphonia Ø other
neufromascular signs
• paralysis of the respiratory system which may lead to death
Diagnostic SALMONELLA GASTROENTERITIS – history of illness after ingestion of
procedure certain foods
Management SALMONELLA GASTROENTERITIS/STAPHYLOCOCCUS
GASTROENTERITIS
• replacement of fluids and salts
• sedatives and anticholinergic to reduce hypermobility of the
intestine

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• good oral hygiene


• application of heat to abdomen to relieve cramps
BOTILISM
• prevention
Ø regulation of commercial processing of canned foods Ø education of
housewives concerning proper processing of home canned foods Ø
canned foods should be boiled first to destroy the toxins Ø polyvalent
antitoxins (botulinum antitoxin)
• patient with botulinum should be placed on quiet room and
avoidance of unnecessary activity
• symptomatic
• intubation for feeding
• tracheostomy – in respiratory failure
• oxygen by IPPB

SEXUALLY TRANSMITTED DISEASE


GONORRHEA (STRAIN, CLAP, JACK,
MORNING DROP, G.C. GLEET)
An infectious disease, which causes inflammation of the mucous
Description:
membranes of the genitourinary tract. Complications: MALE – bilateral
epididymitis, sterility FEMALE – pelvic inflammatory disease, sterility
NEWBORN – opthalmia neonatorum – mother to child
Etiology: Neisseria gonorrhea
Mode of
Sexual contact
transmission:
Incubation period: 2 – 5 days
Signs and symptoms MALE
• burning sensation in the urethra upon urination
• passage of purulent (yellowish) discharge
• pelvic pain
• fever

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•painful urination
FEMALE
• burning sensation upon urination
• presence or absence of vaginal discharge
• pelvic pain
• abdominal distention
• nausea and vomiting
• urinary frequency

Diagnostic • culture and sensitivity


procedure • female: pap smear or cervical smear; male: urethral smear
• blood exam – VDRL

• educate men and women to recognize signs of gonorrhea and to


seek immediate treatment
• monitor urinary and vowel elimination
• important to treat sexual partner, as client may become re-infected
Management
• make arrangements for follow-up culture 2 weeks after therapy is
initiated
• Drugs – penicillin: drug of choice
Ø tetracyclines Ø ceftriaxone sodium (rocephin) Ø amoxicillin
(augmentin)

SYPHILIS (LEUS, POX, BAD BLOOD DISEASE)


A contagious disease that leads to many structural and cutaneous
lesions Complications: a. still birth b. child born with syphilis · placenta
is bigger than the baby · persistent vesicular eruptions and nasal
Description:
discharges · old man feature · mucus patches on mouth and anus c.
child born with late syphilis (signs and symptoms after 2 years) ·
hutchinson’s teeth · deafness · saddle nose · high palate
Etiology: Treponema pallidum
Mode of
Sexual contact
transmission:
Incubation period: 3 – 6 weeks
Signs and symptoms a. Primary syphilis
• chancre on genitalia, mouth or anus
• serous drainage from chancre
• enlarge lymph nodes
• maybe painful or painless
• highly infectious
b. Secondary syphilis
• skin rash on palms and soles of feet

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• reddish copper – colored lesions on palms of hands and soles of


feet
• condylomas: lesions/sores that fused together
• erosions of oral mucus membranes
• alopecia
• enlarged lymph nodes
• fever, headache, sore throat and general malaise
c. Tertiary syphilis
• gumma – the characteristic lesions
• cardiovascular changes
• ataxia
• stroke, blindness
a. positive test for syphilis · venereal disease research laboratory (VDRL)
· rapid plasma reagin circle card test (CRPR-CT) · automate reagin test
Diagnostic
(ART) · fluorescent treponemal antibody absorption test (FTA-ABS) ·
procedure
wessermann test · khan precipitation test · kline, hinton and mazzin tests
b. darkfield examination c. culture and sensitivity d.

• strict personal hygiene is an absolute requirement


• assist in case finding
• instruct client to avoid sexual contact until clearance is given by
Management
physician
• encourage monogamous relationship
• explain need to complete course of antibiotic therapy
• Drugs – penicillin, tetracyclins/kithramycin

ACQUIRED IMMUNE DEFICIENCY


SYNDROME (AIDS)
An acquired immune deficiency characterized by a defect in natural
Description:
immunity
Retrovirus, human immunodeficiency virus (HIV-1 and HIV-2) previously
Etiology:
referred to as human T-lymphotropic virus type III (HTLV-III)
Mode of Blood transfusion, sexual contact, contaminated needles, perinatal
transmission: transmission
Incubation period: 6 months to 9 years
Pathophysiology:
Signs and symptoms
• anorexia
• fatigue
• dyspnea
• night sweats
• fever

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• diarrhea
• enlarged lymph nodes
• HIV encephalopathy: memory loss, lack of coordination, partial
paralysis, mental deterioration
• HIV wasting syndrome, emaciation
• positive test for HIV antibody
• positive test for presence of HIV itself
• opportunistic infection: neumocystic carinii, cystomegalovirus,
kaposi’s sarcoma

Diagnostic • ELISA test (enzyme-linked immunosorbent assay) – a screening


procedure test
• western blot – a confirmatory test

• provide frequent rest periods


• provide skin care
• provide high-calorie, high protein diet to prevent weight loss
• provide good oral hygiene
• provide oxygen and maintain pulmonary function
Management • provide measures to reduce pain
• protect the client from secondary infection; carefully assess for
early signs
• encourage verbalization of feelings
• teach client the importance of:
Ø informing sexual contacts of diagnosis Ø not sharing needle with
other individuals Ø continuing medical supervision

CHLAMYDIAL INFECTION
A sexually transmitted disease that is highly contagious caused by
Description:
chlamydial organism
Etiology: Chlamydia trachomatis
Mode of
2 -3 weeks for males
transmission:
Incubation period: Sexual intercourse
Pathophysiology: -

• pruritus in vagina
• burning sensation in vagina
Signs and symptoms
• painful intercourse
• pruritus of urethral meatus in men
• burning sensation during urination
Diagnostic
Culture of aspirated material from vaginal, anal or penile discharges
procedure
Management
• doxycycline or azithromycin (recommended for pregnant woman)

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• universal precaution should be practiced

TRICHOMONIASIS
Another type of sexually transmitted disease that may also be
Description: transmitted by other means such as handling of infected fomites. It is
caused by a protozoan parasites.
Etiology: Trichomonas vaginalis
Mode of Sexual intercourse, contact with wet towels and wash clothes infected
transmission: by the organism
Incubation period: 4 – 20 days, usually 7 days

• vaginal discharge
Signs and symptoms • burning and pruritus of vagina
• redness of the introitus
• usually asymptomatic in men
Diagnostic
culture of obtained specimen
procedure

• metronidazole
Management • sitz bath may relieve symptom
• acid douches
• tetracyclines may be given on male who are also infected

BIOTERRORISM AND PANDEMICS Ø


In the recent course of international conflicts, which has lead to war, has used weapon
that are quite different from the conventional ones used before. The medical science is
being used not to prolong life but to cause immediate death by infection of various
biological organisms. The following gives an insight of these dangerous biological
terrorism leading to pandemics.

SMALL POX
For about two decades the WHO has declared that the world is already
Description: “small pox free”. Although eliminated in the world over, the specimen is
still kept in two laboratory facility in the United States.
Etiology: Variola virus (DNA virus)
Mode of
Direct contact or by droplet from person to person
transmission:
Incubation period: 12 days
Signs and symptoms
• high fever
• malaise

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• headache
• back ache
• maculopapular rash in the face, mouth and pharynx (the patients
are contagious after the appearance of the rash)

• generally supportive care


• before rendering care transmission precaution should be
Management
specifically indicated
• autoclaving of soiled linens is needed
• isolation is necessary until no longer contagious

ANTHRAX
Also known as whoolsorters disease, the capsulated form of this
Description: organism is found in soil worldwide. The organism needs to take about
8,000 to 50,000 to put a person at risk of contracting the disease.
Etiology: Bacillus anthracis

Mode of • inhalation of spores


transmission: • ingestion of spores
• entrance through skin lesions
Incubation period: For inhalation anthrax 60 days, for cutaneous anthrax 1-6 days
a. Inhalation anthrax · cough · headache · fever · vomiting · chills ·
weakness · dyspnea · syncope
Signs and symptoms
b. Cutaneous anthrax · nausea and vomiting · abdominal pain ·
hematochexia · ascites · massive diarrhea
a. standard precaution is already sufficient to control the spread of the
infection
Management b. ciprofloxacin/doxycycline is prescribed for mass exposure/casualty
with infecting organism c. important pharmacologic interventions are
penicillin, erythromycin, chlorampenicol and gentamycin

SEVERE ACUTE RESPIRATORY SYNDROME (SARS)


Latest among all the rest of pandemics which has its origin from China
Description: and has spread to USA, Canada, Philippines and other South East Asian
Country
Etiology: Corona virus
Mode of
Airborne
transmission:
Incubation period: 7 – 10 days

• fever
• cough
Signs and symptoms
• rapid respiratory compromise
• dyspnea
• atelectasis

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• supportive treatment
Management
• provide ventilatory assistance
• use N95 mask to avoid infection

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