COMMUNICABLE DISEASES

COMMUNICABLE DISEASES
diseases caused by pathogenic microorganisms (MO) which can be transmitted from an infected person to a susceptible person by: Direct - meaning it comes in contact with infected person or person-person transmission Example: Droplets where MO remain in the surface with limitation of its distance of at least 3 feet; face to face encounter with an individual Through kissing, sexual contact and skin to skin contact

 Indirect - meaning from the source of infection to a new host with intermediary object in the form of: Vehicle-borne =non-living things such as water and fomites Vector-borne =living things but non human such as insects Break in the skin integrity through inoculation Example: Sharp needles and blood transfusions

 Airborne where MO are suspended in air with no limitation with regards to its distance. Infectious Diseases - diseases caused by living microorganisms which may not be transmitted through ordinary contact Contagious Diseases are diseases that can be easily transmitted All communicable diseases are infectious because they are caused by MO but not contagious because not all of them are easily transmitted. All infectious diseases are communicable but not all infectious diseases are contagious All contagious diseases are both communicable and infectious

Epidemiologic Triad of a Disease:

Host - a man or an animal where its susceptibility (degree of resistance) is considered 4 Types of Host: Patient Carrier Suspect Contact Agent pertains to MOs that have the greatest population on earth but are taken for granted because they cannot be seen by the naked eye. Virulence - strength and power of the microorganism to cause infection

 Pathogenicity - capability of the microorganism to cause infection Virulence + Pathogenicity = Infection Therefore, not all are susceptible, not all are virulent or pathogenic.

2 Microorganisms: Viruses can only multiply in living things as its reservoir can pass through filters of the body: blood brain barrier and placental barrier Viral Infections are self limiting diseases, have time frame, if not treated complication ensues patients are treated according to symptoms its the bodys own resistance that will fight the infections

 Bacteria can multiply in both living and non living things

cannot pass through filters of the body except for Treponema pallidum causing Syphilis which can pass the placental barrier after the 16th week (4th month of pregnancy)

Environment - should be conducive and favorable to the growth & multiplication of the microorganism

 state of being resistant to infection or a state of being free from infection 2 Types of Immunity: Natural Immunity is inherent in individual body tissues and fluids (born & die with it); very rare Example: Race Acquired Immunity is able to get it and produce antibodies; common type 2 Types of Acquired Immunity: Active Acquired Immunity - actual participation of the body tissues and fluids in producing immunity; you are the one who produce the antibodies

Immunity

 2 ways to produce antibody: Naturally acquired active immunityunintentional production of antibodies or there is a previous attack of the disease Artificially acquired active immunityintentionally acquired so that the body produces antibodies

 Passive Acquired Immunity-develop immunity due to presence of antibodies within the serum not coming from the individual himself; you dont produce it yourself
2 Ways:

Naturally acquired passive immunity Maternal transfer or placental transfer of antibodies Colostrum through breastfeeding Artificially acquired passive immunityintentionally given so that theres an immediate protection from infection

Chain (Cycle) of the Infectious Process:

6 Factors: Causative agent - pertains to microorganism

Reservoir-pertains to place where

Example: Dengue-arbovirus while aedes agypti is the vector

microorganism can live, multiply and grow

Example: Treponema pallidum- human (genitourinary)

Portal of Exit-pertains to from reservoir to way

out corresponds to the body system
Example: Measles- Respiratory system

Measles- human (nasopharynx)

Mode of transmission: pertains to means of transportation 2 General modes of transmission: Horizontal transmission - microorganism can be transferred in horizontal position
Direct mode of transmission- person to person Indirect mode of transmission- from the source of infections to a new host with an intermediary object (a bridge) Vehicle-borne- non living things Example: bed linens, tubings, catheter and eating utensils

 Vector-borne- living but non human Example: insects, rodents, flies, mosquitoes and cockroaches Break in skin integrity through inoculation and percutaneous Example: wounds, blood transfusions, needle punctures & animal bites Vertical transmission - from top to bottom Example: mother to child transmissiontransplacental or perinatal

 Portal of entry - pertains to individual body system

Example: Measles- Respiratory

Susceptible Host

Causative Agent
Susceptible Host Reservoir

Portal of Entry

Portal of Exit Mode of Transmission

3 Nursing Concerns in dealing with a patient with communicable disease:

Know the causative agent Know what body secretion harbors the microorganism Know the mode of transmission

General Nursing Care for Patients with Communicable Diseases:

Preventive Aspect- there is no infection yet; not to allow infection to occur Measures:
Health Education Goal: The person will have a change in knowledge, skills and attitude which eventually lead to change in behavior towards health or do some modification of behavior. The doctor is the primary giver of health education (main responsibility) The nurse is the key provider of information

 Immunization 3 Laws of Immunization: Expanded Program on Immunization (EPI) -PD # 996 UN Goal: Universal Child Immunization (UCI) -Proclamation # 6 Health for Filipino CY 2000: National Immunization Day (NID)-Proc. # 46 Goal: To prevent 7 Childhood Diseases for children under 5 years old
TB -BCG DPT (Diptheria, Pertussis and Tetanus) -DPT vaccine Poliomyelitis -OPV Hepatitis B Measles

 4 Temporary Contraindications for Immunization: Pregnancy do not give live vaccine Immuno-compromised situation Very severe disease immediately needs hospitalization Recently received blood products 2 Permanent Contraindications for Immunization: Allergy Encephalopathy without known cause or convulsions within 7 days after pertussis vaccine

 Environmental Sanitation PD 856 -integrated all those working in night clubs and beer gardens to submit themselves for STD examination at least once a month and for gonorrhea at least twice a month PD 825 -anti-littering law or proper disposal of garbage Fine: P2,000-5,000 or 6 months-1 year imprisonment Proper Supervision of Food Handlers DOH responsibility BFAD monitor food and drugs for safe consumption

 Control Aspect theres already infection but control or limit the spread of infection Measures: Isolationseparation of infected person during the period of communicability 2 Ways of Isolation: Strict isolation protecting other persons by containing the microorganism within the patient Protective isolation protecting the patient wherein microorganism will be away from the patient

2 Revised Isolation Precaution to be practiced: Standard Precaution is the primary strategy for preventing nosocomial infection and it slowly took the place of Universal Standard because it has a double standard choosing its patients. applies to all patients irregardless of their diagnosis; applies to all body fluids, secretions and excretions except sweat applies to non intact skin and mucous membrane

3 Elements of Standard Precaution:

Hand washing before & after coming in contact with the patient at least 10 to 15 seconds of friction applied in scrubbing Use of protective barrier mask must be worn first, goggles, cap, gown and lastly the gloves; when leaving the room, remove the gloves first, do hand washing then remove the rest up to mask, then hand washing again Avoidance of inadvertent needle stick and sharp injury

 3 Ways to Practice Transmission Based Precaution: Airborne precaution use of respiratory protection such as special type of mask=ultra filter mask or particulate mask
Example: Measles, TB, Chicken pox, SARS are airborne diseases

Droplet precaution use ordinary mask and goggles

Example: Diptheria, Pertussis, Meningitis, Mumps, Pneumonia, German measles and HiB infection

Contact precaution use gloves and gowns

Example: GI infections- cholera, amoebiasis Skin infections- scabies, ringworm, hepatitis & ebola infxn.

 Quarantine is limitation of freedom of movement of a well person during the longest incubation period; quarantine of person with no disease but exposed, no signs and symptoms yet Disinfection is killing of pathogenic MO by physical or chemical means

2 Ways of Attaining Disinfection: Concurrent is done when the person is still a source of infection
Example: All things of the patient should be boiled while confined

Terminal is done when the patient is no longer a source of infection

Example: Upon discharge of patient, the room is disinfected with UV or Lysol.

 Sterilization is killing of all MO including spores which is more extensive

Disinfestation is killing of undesirable small animal forms such as arthropods and rodents by physical or chemical means Example: Killing of mosquitoes, roaches and rats by poisoning Fumigation is killing of arthropods and rodents using gaseous agent

 Medical Asepsis
Hand washing (the #1 principle) Use of barrier protectors (Personal Protective Equipment): masks, goggles, cap, gown and gloves Placarding: No smoking sign, right arm precaution and protective isolation

Central Nervous System Diseases

Bacterial Etiology: Viral Etiology: Tetanus Meningitis Encephalitis Poliomyelitis Rabies

TETANUS a.k.a. LOCKJAW

an infectious disease characterized by painful muscle spasms (leg cramps) affecting the gastrocnemius muscle pain in tetanus is 10x the leg cramps almost all muscles have spasms Causative Agent: Clostridium tetani anaerobic, abundantly found in soil, clothing and even in dust

 Normal Habitat: found in the intestines of plant eating animals Mode of Transmission: Break in Skin Integrity such as wound splinter (saludsod), tooth decay, human & animal bite, pricking of pimple and poor cord care in NB MO stays in the wound and releases toxins that travel to the blood which produces the Signs and Symptoms of Tetanus

 Toxins released by the MO are: Tetanolysin that dissolves RBC causing anemia Tetanospasmin brings about muscle spasm affecting all the muscle particularly the myoneural junction of muscle and internuncial fibers of spinal cord & brain Immunity: No permanent immunity because it is bacterial Incubation Period: 3 days-1 month; 3-4 weeks=moderate, 3 days=severe The shorter the IP, the poorer the prognosis

Signs and Symptoms:

Initial signs of wound inflammation such as rubor (redness), calor (heat), dolor (pain), tumor (swelling) and loss of function Increase muscle tone near the wound Tachycardia and profuse sweating Low grade fever

 Painful involuntary muscle contraction and muscles affected are: Masseter Lockjaw or Trismus Facial muscleRisus sardonicus Muscle of spineOpisthotonus position=arching of the back (liyad) Respiratory muscleDOB/dyspnea GUTUrinary retention GITConstipation Abdominal musclerigidity described as board like, if soft=recovery Extremity musclestiffness of extremity=difficulty in flexing it;
Diagnosis: Wound history, clinical observation and examination Wound culture if there is presence of fresh wound

3 Objectives in Medical Management of Tetanus:

To neutralize the toxin
Anti-tetanus serum (ATS)/Tetanus antitoxin (TAT) Tetanus immunoglobulin

To kill the microorganism

Give the least toxic antibiotic (Penicillin) which is bactericidal For fresh wounds, daily cleansing with hydrogen peroxide then apply antiseptic (Betadine) and cover with thin dressing or gauze to allow air to circulate or better not put cover

 To prevent and control spasms by providing patient with muscle relaxant such as
Diazepam drip by incorporating it in IVF and titrated according to spasm (frequent spasm=fast regulation of IVF) If patient can tolerate oral form: Methocarbamol (Robaxin or Roboxisal) Baclofen (Lioresal) Epirisone (Myonal)

3 Objectives in Nursing Management of Tetanus

To prevent patient from having spasm, the nurse should know the possible stimuli that predisposes patient to spasm such as:
Exteroceptive stimuli -is coming from external or outside environment of patient

Measures: Place patient on a dim and quiet environment Practice minimal handling of patient & avoid unnecessary disturbance of patient Practice gentle handling of patient by informing patient first about the procedure such as turning and vital sign monitoring before touching him

 Interoceptive stimuli is coming from within the patient Propioceptive stimuli theres participation of patient and another person Reason why patient with tetanus is isolated to prevent exposing him to these 3 types of stimuli despite being not communicable

 To prevent patient from having injury Respiratory injury Airway obstruction

Put a padded tongue depressor prior to spasm to prevent tongue from drawing back which obstruct airway. Stay with patient during spasm because if cyanosis occurs, administer oxygen with nasal catheter

Respiratory infection brought about by not turning patient on his sides Respiratory aspiration

Falls Dont leave patient alone Put up padded side rails Call light must be near patients reach Assist patient when walking-fatigue is an interoceptive stimuli Fracture due to restraining of patient when having spasm To provide comfort measures to patient preventing mouth sores

Preventive Measures
Immunization DPT is given 6 weeks after birth for 3 doses at one month interval Dose: 0.50 ml IM Vastus lateralis Health Teachings: Tell mother to expect fever to set in-give Paracetamol If swelling and tenderness occurs on the site
apply cold compress within 24 hours

Observe for any sign of convulsions within 7 days which is a reaction to Pertussis component of the drug

 Tetanus Toxoid given to pregnant women on the 2nd trimester of pregnancy 2 doses Dose: 0.50 ml IM Deltoid muscle

 Tetanus Toxoid given for persons in high risk to tetanus such as the carpenter or construction workers 1st dose 2nd dose1 month after 3rd dose6 months after from last dose 4th dose1 year after from last dose 5th dose1 year after from last dose for high risk-give booster dose every 5 years for low risk-give booster dose every 10 years

 Proper wound care

Wash wounds immediately with soap and water Apply antiseptic solution

Avoid wounds to prevent portal of entry

MENINGITIS
inflammation of the meninges (covering of the brain and spinal cord) 3 Coverings:
Dura mater Arachnoid-subarachnoid spaces (found in between meninges) Pia mater

Causative Agents: Viruses: Cytomegalovirus (CMV) viral meningitis Fungus: Cryptococcal meningitis Bacteria: the most common cause
TB meningitis Staphylococcal meningitis Hemophilus influenza B

Meningococcal Meningitis/Spotted Fever/Meningococcemia

highly fatal and highly contagious type of meningitis vascular system is affected resulting to vascular collapse (DIC) Waterhouse Friedrichsen Syndrome caused by bacteria if exposed to patient with meningococcemia, nurse should received prophylaxis: Rifampicin 450 mg once/day for 3 days Ciprobay 500 mg once/day for 3 days

Causative agent: Neisseria meningitides Mode of Transmission: Droplet infection (direct) Immunity: No permanent immunity Incubation Period: 2-10 days Portal of Entry: Respiratory system via the nasopharynx Signs and Symptoms: fever, sore throat, headache, cough, colds and body malaise

Neisseria meningitides

Nasopharynx----Upper Respiratory Tract infection (URTI)

Bloodstream-----Vascular Changes:
Petechial Formation Ecchymosis

Meninges-------Theres meningeal irritation manifested by:

Nuchal rigidity (characteristic sign of meningitis) There are abnormal reflexes:

(+) kernig sign (+) Brudzinski sign

Theres an increase intracranial pressure due to accumulation of CSF in the subarachnoid space:

 Manifestations:
Severe headache Projectile vomiting Altered vital signs: Increase T, decrease PR, decrease RR, increase systolic but normal diastolic BP Convulsions Diplopia (double vision) due to choking of optic nerve/disc Altered level of consciousness (LOC)

Diagnostic Examination: Lumbar puncture - tap or aspirate CSF to evaluate

Color: yellowish, turbid, cloudy, clear CSF Laboratory Examination: increase CHON, increase WBC, decrease sugar Culture & Sensitivity: To determine causative agent & specific drug to kill microorganism Counter Immuno Electrophoresis (CIE) if CSF is clear it tells you if microorganism is viral or protozoa

Contraindication of Lumbar Puncture for patient with CNS Infection:

Patient with highly increased ICP Normal ICP: 10-11

Blood culture done if lumbar puncture cant be done yet because microorganism travels to the blood stream

Medical Management: Antimicrobials drugs a. Viral supportive treatment b. Fungus antifungal c. Bacteria antibiotic Corticosteroid Dexamethasone or Solu-cortef Mannitol - osmotic diuretic it removes excess CSF monitor intake and output to assess or evaluate effectiveness of drug assess hydration of patient Anticonvulsant drug Phenytoin (Dilantin)

Nursing Responsibilities:
If Phenytoin is given by IV, it should be sandwiched with NSS (NSS-Dilantin-NSS) because when mixed with IVF produces crystallization causing obstruction If given per orem, do oral care and gum massage because it causes gingival hyperplasia

Nursing Care for Meningitis: symptomatic and supportive

Nursing Diagnosis: Altered temperature/Hyperthermia

To lower temperature:
a. TSB b. Apply cold compress c. Wear light/loose clothing d. Increase fluid intake e. Provide adequate rest f. Give Paracetamol

Potential for injury due to convulsions

Never leave patient alone Provide padded side rails Put call line near patient

 Altered level of consciousness Alteration in comfort (pain)

4 types of massages: Petrissageuse of 2 fingers or thumb pressure Tapottementkarate style massage Kneadingas in kneading a dough Effleurage figure 8 massage or circular manner for back and chest Apply cold compress Elevate head of patient 15-20 degrees

 Risk for fluid and electrolyte imbalance through projectile vomiting

Assess for signs of fluid-electrolyte imbalance Monitor fluid intake and output Proper regulation of IVF Provide adequate fluid

Preventive Measures: Immunization - its not a permanent immunity

Source of infection: Nasopharygeal secretions

Proper disposal
Proper procedure: Place tissue paper in plastic bag and knot before throwing

Covering of mouth and nose of patient when coughing or sneezing.

Patient must wear mask whenever you transfer him from one area to another

ENCEPHALITIS a.k.a. BRAIN FEVER

inflammation of the encephalon or brain Causative Agent: Arbovirus is transferred from one person to another by an arthropod

Classification of Encephalitis: Primary encephalitis

the virus attacks the brain directly communicable St. Louise, Japan B, Australian X, Equine X (Eastern & Western) MOT: mosquito bites-a. Aedes solicitans b. Culex tarsalis Source of Infection: ticks of horses or migratory birds

 Secondary encephalitis
Previous infection- a complication of some diseases Example: Measles, Chicken pox and mumps Post vaccine-anti-rabies vaccine (active form)

Toxic Encephalitis
Lead poisoning Mercury poisoning

Manifestations: s/sxs=fever, headache,

projectile vomiting altered level of consciousness-lethargic state of consciousness

Diagnostic Examination:
Lumbar Puncture-CSF clear: increase protein, increase WBC and normal sugar Electroencephalogram (EEG)-to determine extent of brain involvement or damage=epilepsy

Medical Management: no specific treatment;

patient is treated symptomatically

Nursing Care: Supportive and Symptomatic

Preventive Measures: to eradicate the mosquitoes by practicing the CLEAN program of DOH:
C-hemically treated mosquito net using Permithrim then dry for 3-6 mos. L-arvivorous fishes (they eat the larvae of mosquitoes) E-nviromental sanitation: clean the surroundings A-nti-mosquito soap such as basil N-eem tree or eucalyptus tree plant (it drives away mosquitoes)

Immunity: Encephalitis does not give a permanent immunity

POLIOMYELITIS
also known as Infantile Paralysis or HeineMedins disease usually affected are infants high risk are children below 10 years old Causative Agent: Legio debilitans virus which has 3 strains:
Type 1-Brunhilde-- (common in PI) Type 2-Lansing Type 3-Leon

Mode of Transmission: Early Stage of infection

Source of infection: nasopharygeal secretions MOT: droplet Portal of entry: respiratory system by the nasopharynx

Late Stage of infection

Source of infection: found in stool MOT: fecal-oral route Portal of entry: digestive system by the mouth

 Poliomyelitis Legio debilitans -------- ---------------------------------------------Nasopharynx Mouth

Tonsils:

Sore throat Fever & chills HA & body malaise

Peyers patches of Intestine: Abdominal pain & anorexia Nausea &vomiting Diarrhea or constipation

Cervical Lymph Node (CLN)

Mesenteric Lymph Node (MLN)

BLOOD STREAM

CNS

Stages of Poliomyelitis: Invasive or Abortive Stage - when virus invades the host and S/Sxs disappear.
Severe muscle pain-apply warm compress, avoid turning, touching or massaging patient & give analgesic (Codeine not Morphine because it causes respiratory distress) Stiffness of hamstring especially back of thigh Presence of Hoyres sign Poker spine-Opisthotonus with head retraction

Pre-paralytic Stage - theres already involvement of CNS but without paralysis

 Paralytic stage-theres paralysis of patient where he appears flaccid (soft, flabby and limp)=pathognomonic sign of Poliomyelitis
3 Types of Paralysis: Bulbar type-CN 9th (glossopharygeal) and 10th (Vagus) are affected
S/Sxs:

a. Swallowing paralysis (choking & drooling of saliva) b. Vocal cord paralysis c. Respiratory paralysis

 Spinal type-most common type where anterior horn cells are affected
S/Sxs:

a. Paralysis of the upper and lower extremities-may be unilateral or bilateral b. Paralysis of the intercostals muscles Bulbo-spinal type-cranial nerves and anterior horn cells are both affected

Diagnostic Examinations:
Lumbar Puncture-(+) Pandy Test=increase protein, increase WBC and normal sugar Muscle Testing Electromyelogram (EMG) Stool Examination Throat Washing

Medical Management:
No specific treatment, symptomatically only If (+) respiratory paralysis, patient is placed in a mechanical ventilator called Iron Lung Machine

 Nursing Care:
Supportive and Symptomatic Psychological Aspect of Care including relatives

Preventive Measures:
Immunization by Oral Polio Vaccine (OPV-Sabin vaccine) given 6 weeks after birth Instructions to the mother: Dont feed child 30 minutes after administration If vomiting occurs, repeat dose of OPV Be careful in handling the stool of the child who had received OPV Dont administer to patient with immunocompromised family instead give Inactivated Polio Vaccine (IPV-Salk vaccine) 0.5 cc IM vastus lateralis in 3 doses at one month interval

 Avoid mode of transmission Proper disposal of nasopharygeal secretions Hand washing and proper disposal of feces Dont put anything in the mouth especially in children below 10 years old

RABIES
also known as Hydrophobia, Lyssa and LA Rage a disease of low form of animal that is accidentally transmitted to man through animal bites (canines, cats, bats, skunks, fox, dogs and wolves) Bats are the main source of virus Causative Agent: Neurotropic virus-has special affinity to neurons/CNS Rhabdo virus-transferred from animal to man

2 Pathways for Virus to Travel: Rhabdo Virus --------------------------------------------Peripheral Nerves Efferent Nerves

CNS

Salivary Glands of Animals

inclusion bodies develop called Negri Bodies

Mode of Transmission: Contact with saliva of a rabid animal, scratching, licking of wounds by dogs or corneal transplantation Incubation Period: For animals=3-8 weeks; For humans=10 days-years

2 Stages of Manifestations in Animals: Dumb Stage

Depressive Behavior-animal will be withdrawn, stays in one corner and remain quiet Manic Behavior-animal is overly affectionate, walking to & fro and hyperactive

Furious Stage-animal is easily agitated, fierceful or vicious look and drooling of saliva-----later will die

3 Stages of Manifestation in Human: Invasive Stage-the virus is easily transferred through saliva, by direct or indirect contact S/Sxs: a. Numbness on site b. Sore throat c. Marked insomnia d. Restlessness, irritable and apprehensive e. Flu-like symptoms f. Slight photosensitivity

 Excitement Stage-stage when patient is confined in the hospital Signs/Symptoms: Aerophobia (fear of air) & Hydrophobia (fear of water) Drooling of saliva and spitting Photosensitive Maniacal Behavior=fierceful look, agitated, bites, jumps out of window and runs like a rabid dog Mgt: Haloperidol (Haldol) with Benadryl is given to calm the patient Paralytic Stage-stage when spasm is no longer observed because paralysis sets in and within 24-72 hours patient will die

Diagnostic Examinations: Brain Biopsy of Animal to identify presence of negri bodies Direct Flourescent Antibody Test (DFAT) Observation of the animal for 10 days
if animal develops behavioral changes or die within 10 days, it has rabies Factors to consider in observing the animal:
Site of the bite-if from waist up (virus travels 3 mm/hour once in the body) Extent of bite-if multiple, deep or big bite Reason for the bite-if provoke=less worry if unprovoked=must worry

Medical Management: Giving vaccines is a post exposure prophylaxis only to lessen chances of developing rabies Active form of Vaccine Types: a. Purified Duck Embryo Vaccine (PDEV)-Lyssavac
b. Purified Vero Cell Vaccine (PVCV)-Verorab c. Purified Chick Embryo Vaccine (PCEV)

2 Ways of Administration: Per intramuscular (IM)-do skin testing first;deltoid & vastus lateralis m. Day 0-2 vials=1 vial for each site=one on Right & one on Left Day 7-1 vial =1 vial for one site =either right or left Day 21-1 vial =1 vial for one site =start counting from first dose if given 3 doses, it gives 3 years immunity Per intradermal (ID)-deltoid & vastus lateralis muscle

 Passive form of Vaccine

antibodies are given for immediate protection it should be given within 7 days never give active & passive form of vaccine in one site Example: one in deltoid and one in gluteus muscle Types:
From animal serum: Equine Rabies Immunoglobulin (ERIg) Human serum: Human Rabies Immunoglobulin (HRIg)

2 1 4 3 -------------------------------------------12 6 5 11 14 8 7 13 -------------------------------------------10 9

7.5 -buttocks

15cc
7.5 - site of
bite

Nursing Care:
Place patient in a dim and quiet room Room of patient should be away from sub-utility room Before maniacal behavior sets in, restrain the patient Wear complete protective barriers when entering the room

Preventive Measures:
Immunization-all dogs should be given immunization in the Barangay Centers Keep away from stray dogs Keep animal caged or chained. If bitten by a dog, wash with soap and running water to wash away virus then use strong antiseptic solution (betadine or iodine) and observe the dog

Diseases of the Circulatory System

Viral Etiology: Dengue Hemorrhagic Fever Protozoal Etiology: Malaria

DENGUE HEMORRHAGIC FEVER

Dengue Fever has affinity to circulatory system without bleeding (a mild form of hemorrhagic fever) Dengue Hemorrhagic Fever has affinity to circulatory system with bleeding (severe form of hemorrhagic fever)

Causative Agents:
Arbovirus-Dengue virus=Type 1, 2, 3 and 4 Onyong-nyong virus Chikungunya virus West Nile virus Flavivirus-brought epidemic in the Philippines

Mode of Transmission: Aedes aegypti and Aedes albopictus are biological transmitters. The mosquito is able to transfer DHF virus after 8-11 days from one person to another until it dies. Thus the virus becomes part of the system of mosquito Mosquito bite of Culex fatigan is a mechanical transmitter, the very first person it will bite will be the only one infected with DHF (Lifespan of mosquitoes: up to 4 months)

Characteristics of Aedes aegypti:

Day biting mosquito Low flying mosquito Breed in a clear stagnant water Geographical location: urban area (flower base or old tires) It has white stripes on legs, grey wings and lands on surface

Mosquito (Aedes aegypti)

Blood stream (multiply) Creates multiple lesions in the blood stream -----------------------------------------------------Increase capillary fragility (easily bleeds) Increase capillary permeability (allows shifting of fluid from one compartment to another)

Thrombocytopenia

Edema, ascites and hemoconcentration

 Signs and Symptoms of DHF according to Grade/Classification: DHF Grade 1

Persistent high grade fever which lasts for 3-5 days Complains of pain: Headache, peri-orbital pain, abdominal, joint & bone pains Nausea and vomiting Pathological Vascular Changes: Petechiae formation Herman Sign-generalized flushing/redness of the skin Diagnosed as Dengue Fever or Dandy Fever or Breakbone Fever

 DHF Grade 2 Persistence of S/Sxs of DHF Grade 1 + Bleeding Bleeding from: 1) Nose-epistaxis 2) Gum-gum bleeding 3) Stomach: a) Hematemesis b) Melena c) Hematochezia

 DHF Grade 3
Persistence of S/Sxs of DHF Grade 2 + Circulatory Failure Cold clammy skin Check for capillary refill (normal capillary pressure=less than 3 seconds) Low Blood Pressure (hypotension), very rapid weak pulse and rapid respiration

DHF Grade 4 - persistence of S/Sx of DHF Grade 3 + Hypovolemic Shock because of excessive blood loss due to uncontrolled bleeding-----DEATH

Diagnostic Examination:
Tourniquet Test or Rumpel Leede Test test for capillary fragility only a presumptive test for DHF 3 Criteria before performing Tourniquet Test: Individual should be 6 months older Fever of more than 3 days No other signs of DHF-fever of 3 days release the cuff, check and count the petechial formation per one square inch, if more than or equal to 20 petechial formation=(+) tourniquet test

 Platelet Count-decrease in DHF (NV: 150,000-400,000 mm3); definitive test Hematocrit (Hct) determination-increase in DHF due to hemoconcentration (NV: 0.37-0.54=37-54%)

Medical Management: Symptomatic treatment

Antipyretic for fever but never give Aspirin or Acetyl Salicylic (ASA) Aspirin is not given to children below 12 years old because it causes Reyes Syndrome-a neurologic disorder associated with viral infection Vitamin K (Aquamephyton, Phytomenadion, Synkavit and Konakion) Vitamin C preparation Blood Transfusion

Nursing Care: To prevent and control bleeding - a nursing priority Epistaxis-instruct patient to avoid forceful blowing of nose or for parents to do gentle nasal care Control Measures:
Apply ice pack/ice compress over nose bridge for vasoconstriction Place patient in upright position, leaning forward, ante-flexion then apply pressure on nose bridge MD will do nasal packing (gauze) to stop bleeding

 Gum bleeding
Control Measures: Give ice chips/ice cold NSS gargle or water gargle Use warm NSS as mouth gargle TID Use oral antiseptic solution as gargle BID Use cotton swab as mouth care OD Use soft bristle toothbrush

 Hematemesis
Control Measures: Place ice pack over epigastric region NPO because eating can stimulate contraction of stomach Place patient in upright position to prevent aspiration Provide oral care Refer to MD to perform NGT for gastric lavage

 Melena Inform patient to avoid dark colored food and drinks Dont give iron preparation

Supportive & Symptomatic Increase body resistance of patient by proper nutrition and adequate rest Preventive Measures: practice CLEAN program of DOH
Immunity: DHF gives no permanent immunity

MALARIA a.k.a. AGUE

king of tropical diseases manifested by indefinite period of fever and chills Causative Agent: Protozoa-Plasmodium which has 4 Species:
Plasmodium vivax Plasmodium falciparum-most fatal Plasmodium malariae Plasmodium ovale

only female mosquitoes suck blood for fertilizing egg P. vivax and P. falciparum are both most common causes in the Philippines

Mode of Transmission:
Mosquito bite-Anopheles mosquito Blood transfusion

Characteristics of Anopheles mosquito:

Night biting mosquito from dusk to dawn Breeds in a clear slow flowing water Geographical location: rural, mountainous and forested areas Lands on surface-45 degrees angle/slanting

If infected by mosquito
Blood stream -------------------------------------

RBC is penetrated (MO reproduce)

RBC

Liver (MO stay for 3-5years)

3 Stages of Manifestation of Malaria: Cold Stage-Chilling sensation: shaking of body & chattering of lips that lasts for 1015 minutes Nursing Care: Provide blanket Apply hot water bag over soles of feet Expose to heat lamp or drop light Provide warm drinks

 Hot Stage-Fever, headache, vomiting and abdominal pain lasts for 4-6 hours Nursing Care: TSB Cold Compress Increase fluid intake Provide adequate rest Loose and light clothing

 Wet Stage-Profuse or excessive sweating, feeling of weakness

Nursing Care: Make patient comfortable in bed Keep patient warm Increase fluid intake to prevent dehydration Chills followed by fever because of rupturing of membrane of Plasmodium In P. falciparum, theres severe anemia because of rapid destruction of RBC causing Cerebral Hypoxia

Diagnostic Examinations:
Malarial Smear/Blood Smear-blood is extracted at peak of fever Quantitative Buffy Count (QBC)- no need to wait for the height of fever to set in

Medical Management:
Chloroquine (Aralen) -mainstay drug of malaria Other Drugs: Primaquine, Atabrine, Fansidar and Quinine (a reserve drug for severe cases) Cautiously used for pregnant women because of its abortive effect and it crosses the placental barrier causing severe anemia to the child

Immunity: Malaria gives no permanent immunity

Diseases of the Integumentary System

Viral Etiology:
Measles German Measles Chicken pox Herpes zoster
are Eruptive fevers because all are manifested by eruptions or rashes

Bacterial Etiology:

Leprosy

2 Kinds of Eruptions: 1. Enanthem found in mucous membrane 2. Exanthem found in skin

4 Characteristics of Rashes: 1. Macule flat rashes 2. Papule elevated rashes 3. Vesicle elevated rashes filled with fluid 4. Pustule elevated rashes filled with pus

MEASLES a.k.a. RUBEOLA

Also known as Morbilli, Little Red Disease, 7 Day Measles, 9 Day Measles, Hard Measles or First Disease Causative Agent: Paramyxovirus rubeola virus (specific virus) Mode of Transmission: Airborne

3 Stages of Measles: Pre-eruptive stage highly contagious stage Manifestations: High grade fever which last for 3-4 days 3 Cs:
Cough Colds Conjunctivitis

 Conjunctivitis
inflammation of the conjunctiva presence of excessive mucopurulent lacrimal discharges Stimson Sign=puffiness of the eyelid with linear congestion of the lower conjunctiva photosensitivity

 Presence of enathem called Kopliks spot (pathognomonic sign of measles) =fine red spots with bluish white spot at the center found in the inner cheek just opposite the molars

 Eruptive stage
rashes will appear that is characterized as maculopapular, reddish in color and blotchy in appearance rashes appear first on the hairline, behind the ears, face, neck, trunk and extremities =Cephalocaudal in distribution rashes appear on the third day of illness, within 2-3 days the entire body is completely covered

 Post-eruptive stage
having a fine branny desquamation (peeling off) from red color rashes, it will fade to brown then it peels off excluding the skin

Diagnostic Examination: by clinical observation and physical examination Medical Management:

Symptomatic because it is viral Antibiotics are given for treatment of secondary infections only

Nursing Care: Supportive and Symptomatic

Increase or maintain body resistance of patient by providing adequate rest and nutrition No diet restrictions provided patient is not hypersensitive to hyper-allergenic food Keep patient warm and dry to prevent patient from exposure to draft

Hygienic Measures:
Skin care rashes of measles are not itchy in itself use tap or lukewarm water to bath or sponge for 15-20 minutes expose only body parts to be sponged remove clothing of child when sponging and provide bath blanket and bed linen

 Eye care clean by removing the discharge protect eye from sunlight because of photosensitivity Ear care to prevent otitis media Oral and nasal care in order to remove some organism lodging in the nose and mouth Immunity: Measles will give a permanent immunity It is highly contagious during 4 days before the appearance of rashes and 5 days after appearance of rashes

Preventive Measures: Immunization with Anti-measles vaccine (AMV) given to 9 months old, 0.5 cc SQ Deltoid muscle Instructions to mother after immunization:
Child may experience fever=give paracetamol Child may experience or develop mild rash formation 3-4 days after immunization

 Private physician gives MMR between 12-15 months old, 0.5 cc SQ Deltoid m. Instructions to mother after MMR: Ask mother if child has allergy to eggs and neomycin because MMR has chick embryo and neomycin component If allergic to egg, MD may still give MMR but if neomycin is the allergen dont give MMR because of higher neomycin component causing anaphylaxis If given on adolescence or female child bearing age, dont get pregnant within 3 months after MMR immunization because it may bring about congenital anomalies

 Proper disposal of nasopharygeal secretions Covering of mouth and nose when sneezing and coughing

GERMAN MEASLES a. k. a. RUBELLA

also known as 3- Day disease because duration of illness is 3 days Causative Agent: Pseudoparamyxovirus=Rubella virus or Togavirus Mode of Transmission: Droplet (direct)

3 Stages of German Measles:

Pre-eruptive stage presence or absence of fever, if present it lasts for 1-2 days mild cough or mild colds presence of enathem called Forscheimer spots=fine red or petechial spots found on soft palate before rashes come out

 Eruptive stage Presence of rashes described as maculopapular, pinkish in color with discrete appearance or finer to look at cephalo-caudal in distribution the entire body is completely covered with rashes within 24 hours Enlargement of lymph nodes=lymphadenopathy Post-eruptive stage occurs after 24 hours where rashes start to disappear and enlarged lymph nodes subside

Preventive Measures: similar to measles Immunity: German measles gives permanent immunity
It is communicable during the entire course of the disease=3 days Not fatal but could be on a pregnant woman during the 1st trimester of pregnancy because of chances of Congenital Anomaly

4 Possible Major Congenital Anomalies:

Microcephaly Congenital Heart Disease=Tetralogy of Fallot Congenital Cataract Deafness and Mutism If pregnant and exposed to German Measles, give gamma globulin 1 ampule or within 72 hours which gives temporary immunity.

CHICKEN POX a.k.a. VARICELLA

Causative Agent: Varicella zoster virus found in both nasophargeal secretions and secretions of rashes it causes infection if it enters the nasopharynx Mode of Transmission: Airborneonly the secretions from the nasopharynx are infectious Duration of Illness: 2 weeks

Signs and Symptoms:

Pre-eruptive stage presence or absence of low grade fever, body malaise, muscle pain and headache which lasts for 24-48 hours Eruptive stage the lesion begins as a macule about 5-10 crops then it become a papule later into vesicle then pustule while new macules come out on the same time during these different phases. presence of rashes is characterized as vesiculopustular which are itchy

provide skin care: dont rub or apply soap directly into skin bathe the patient using tap water may give antihistamine for children to prevent itchiness rashes have generalized distribution all over the body, it appears first on covered body parts (trunk and scalp) contagious from the time rashes appear until the last rash have dried or crusted Post-eruptive stage rashes start to dry or crust and eventually fall or peel off by itself

Diagnostic Examination: by clinical observation and physical examination Medical Management:

Treated symptomatically Antiviral agent may be given=Zovirax (Ayclovir) Anti-histamine or anti-pruritic agents

Nursing Care:
Skin care to prevent skin infection: cut fingernails, use mittens and daily bathing Increase resistance and adequate rest and nutrition to prevent encephalitis

Immunity: Chicken pox gives a permanent immunity

Preventive Measures:
Immunization using Varicella vaccine (Varivax) given at 12 months old, 0.5 cc SQ, deltoid, if given to children below 13=single dose children above 13=2 doses in 1 month interval Proper disposal of nasopharygeal secretions Cover mouth and nose when sneezing and coughing

HERPES ZOSTER a.k.a. SHINGLES

also known as Zona, Acute Posterior Ganglionitis because it affects the ganglion of posterior nerve root adults are usually affected inactive or dormant type of chicken pox Causative Agent: Dormant varicella zoster virus Mode of Transmission: Airborne and droplet Duration of Illness: 2 weeks

 Signs and Symptoms:

vesiculo-pustular rashes are present but painful instead of itchy because it affects nerve endings and the pain persists within 2 months even if patient had recovered rashes have unilateral distribution following the nerve pathway if rashes appear in the abdomen, it follows dermatome or skin pathway it gives a temporary immunity period of communicability is the same as chicken pox when all rashes are dried complications of herpes zoster: skin infection and encephalitis

 Diagnostic Examination: Clinical observations and physical examination Medical Management: MDs recommend applications of Potassium Permanganate (KMNO4) 3 Fold Effects of KMNO4: A-Astringent------------dries rashes B-Bactericidal----------decrease chance of skin infection O-Oxidizing Effect----deodorizes the rashes

 Analgesics for pain If rashes are on the abdominal area-----turn the patient on affected side to prevent stretching of the nerves-----less pain Zovirax can also be given

Nursing Care and Preventive Measures: same as Chicken Pox

LEPROSY/HANSENS DISEASE
also known as Hansenosis discovered by Dr. Hansen where he called patients as Hansenites Causative Agent: Mycobacterium lepraean acid fast bacilli Incubation Period: 3 months-8 years

3 Hypothesis in Mode of Transmission:

Prolonged intimate skin to skin contact (for intact skin) with MO in the lesion Droplet infection (from nasopharygeal secretions) Fomites (non-living things) but not proven yet

3 Cardinal Signs of Leprosy:

Peripheral nerve enlargement Loss of sensation on affected parts (+) Skin smear test for Mycobacterium leprae

4 Types of Leprosy:
Indeterminate Tuberculoid or Benign or Non-infectious few microorganisms Lepromatous or Malignant or Infectious plenty of Mycobacterium leprae in lesions Borderline possesses some characteristics of tuberculoid and lepromatous

Early Manifestations of Leprosy:

Color changes on the skin Skin ulcers which does not heal Patient have muscle weakness & paralysis of extremities Pain and redness of the eyes Nasal obstruction and nose bleeding Loss of sensation on affected area, loss of hair growth & anhydrosis

 Late Manifestations of Leprosy: Lagophthalmosinability to close eyelids, half open when sleeping Madarosisfalling off of eyebrows Sinking of the bridge of the nose due to microorganism that absorbs small bones like bridge of the nose, cartilages of the ears, fingers and toes Leonine face resembling a lions face because of madarosis & sinking of the nose Chronic skin ulcers Contractures such as clawing of fingers & toes Gynecomastia

Diagnostic Examination:
Skin Smear Test or Skin Lesion Biopsy Lepromin Testis similar to skin testing by introducing the microorganism through antigen & done to identify what type of leprosy the patient has Wasserman Reaction Testblood examination

Medical Management:
Use of Multiple Drug Therapy (MDT) combination of drugs Advantages of MDT: To prevent drug resistance to Dapsone (mainstay drug of leprosy) To hasten recovery To lessen period of communicability after 2 weeks of MDT, patient is no longer communicable

 2 Approaches in MDT depending on Mycobacterium leprae (+): Paucibacillary approach

for indeterminate and tuberculoid leprosy few Mycobacterium leprae in skin lesions Rifampicin once a month and Dapsone once a day for 6-9 months

 Multibacillary approach
for lepromatous and borderline leprosy plenty Mycobacterium leprae in skin lesions Rifampicin once a month, Dapsone once a day and Lamprene once a day for 24-30 months (2-2 years)

Nursing Care:
Psychological aspect because patient has low self esteem due to altered body image and social stigma Skin care to prevent skin injury due to loss of sensation Provide active & passive exercises Provide adequate information regarding drug therapy by informing patient on the advantages of MDT and to motivate patient to comply

 Discuss side effects of drug therapy that are harmless Example: Rifampicin-tears, sweat, saliva and urine becomes orange Lamprenetemporary hyperpigmentation of skin (blackish in color)

 Tell patient under MDT that he can have Leprae Reaction to MDT due to microorganism that release toxins

Mild Leprae Reaction:

R eddening in and around the nodules/lesions E dema S udden increase in # of lesions T enderness or pain on nerves

 Severe Leprae Reaction:

I ritis (inflammation of iris) S udden acute paralysis A cute orchitis (inflammation of testes)

 Leprosy is not hereditary but can be acquired It does not affect fetus in pregnant women because the bacteria does not cross placental barrier MDT can not be given immediately because Rifampicin has a teratogenic effect on the fetus After giving birth, separate mother from child for 1-2 weeks Dont breastfeed baby because milk is contaminated with the drugs which can be passed on to the baby

Preventive Measure:
Immunization with BCG Proper disposal of nasopharygeal secretions Cover mouth and nose when sneezing and coughing to avoid MOT Avoid intimate contact with individual with leprosy (skin to skin)

Diseases Affecting Respiratory System

Bacterial Etiology: Diphtheria Pertussis Tuberculosis Pneumonia Colds Influenza

Viral Etiology:

DIPHTHERIA
Affects the following: Respiratory Tract =Respiratory Diphtheria (most common type) Mucous Membrane=Cutaneous Diphtheria: a. Conjunctiva Conjunctival diphtheria b. Vaginal mucosa Vaginal diphtheria c. Prepuce or uncircumcised male Diphtheria of the prepuce Wounds of Individual=Wound Diphtheria Example: Burn patients Cutaneous diphtheria and Wounds are rare diphtheria

Causative Agent: Corynebacterium diphtheria or Klebs-Loeffler bacillus Mode of Transmission: Droplet (direct contact) it affects all ages

3 Types of Respiratory Diphtheria:

Nasal type affects the nasal passages Manifestations: Presence of irritating nasal discharge characterized by serosanguinous secretion which has a foul mousy odor, white with blood tinged With upper lip & nasal excoriations Presence of pseudomembrane, grayish white membrane found in the nasal septum.

Pathognomonic sign of diphtheria = presence of pseudomembrane that can be seen by using a nasal speculum to see if covered by nasal secretion

 Pharygeal or faucial type affects the pharynx and tonsils Manifestations: Presence of sore throat resulting to dysphagia Presence of pseudomembrane found in the soft palate, uvula & pillars of tonsils Presence of bull neck appearance brought about by inflammation and enlargement of anterior upper cervical lymph node

 Laryngeal type most fatal type affects the larynx (voice box) Manifestations: Hoarseness of voice Presence of aphoniatemporary loss of voice

 Presence of dyspnea (difficulty of breathing) because larynx also serves as an airway passage
Nursing Care: Make sure that the child is calm, not breast/bottle feeding and not crying when checking respiration because chest in drawing is always present in whatever position the patient is

Presence of pseudomembrane in the larynx causes airway obstruction Coughing described as barking cough, dry metallic cough, husky or croupy

Diagnostic Examination:
Nose and Throat Swab/Culture done to identify microorganism to determine if patient is still communicable patient is communicable until 3 consecutive negative results definitive/confirmatory test of diphtheria Schicks Test done to determine immunity or susceptibility to diphtheria Moloney Test done to determine hypersensitivity to diphtheria anti-toxin

 3 Objectives of Medical Management: Neutralize the toxin through the use of Equine Anti-Diptheria Serum (horse serum) Kill the microorganism by giving antibiotics use the least toxic antibiotic which is Penicillin Prevent respiratory obstruction perform emergency tracheostomy

Nursing Care:
Place patient in complete bed rest until 2 weeks after recovery to prevent the # 1 complication that brings about death=Myocarditis Signs and Symptoms of Myocarditis: Mark facial pallor Very irregular pulse rate Hypotension Chest or epigastric pain

 Maintenance of patent airway Positioning of patient Deep breathing & coughing exercises breath in through the nose and exhale through pursed lip breathing Perform chest physiotherapy Increase fluid intake to liquefy fluid secretions Turning patient every 2 hours

 With MDs orders: 1) Oxygen inhalation therapy 2) Postural drainage 3) Suctioning of secretions Provide adequate and nutritious diet Symptomatic and supportive treatment Provide comfort measures such as oral and nasal care

Immunity: Diptheria is highly contagious and gives no permanent immunity

Preventive Measures:
Immunization with DPT given 6 weeks after birth in 3 doses of 1 month interval Dose: 0.5 cc IM, vastus lateralis Instructions to Mother: a. Expect fever to set in b. Cold compress if theres swelling c. Warm compress d. Observe for inconsolable crying Proper disposal of nasopharygeal secretions Cover nose and mouth when sneezing and coughing Never kiss the patient

PERTUSSIS
also known as Whooping cough and Chin cough affects children below 6 years old above 6 years old has lesser risk for being infected Causative Agent: Coccobacillus a. Bordetella pertussis b. Hemophilus pertussis both are aerobic and anaerobic Incubation Period: 7-10 days Mode of Transmission: Droplet

3 Stages of Pertussis:
Catarrhal stage stage which is considered to be highly contagious child stays at home Signs and Symptoms: a. Presence of colds b. Nocturnal coughing c. Fever d. Tiredness and listlessness

Spasmodic or Paroxysmal stage 5-10 successive forceful coughing which ends on a prolonged inspiratory phase or whoop theres production of mucus (tenacious) plug on airway passage Other Manifestations: a. Congested face b. Congested tongue c. Teary red eyes with protrusion of eyeballs d. Distended face and neck veins e. Involuntary micturition and defecation f. Abdominal/inguinal hernia g. Deafness due to hemorrhage of vestibular apparatus of ear

 Convalescent stage Signs and symptoms start to disappear Patient is no longer communicable Patient is on the road to recovery

Diagnostic Examination:
Nasal Swab Bordet-Gengou TestAgar Plate Cough Plate

use nasopharygeal secretions

Medical Management:
Immunization: Pertussis Immune Globulin Antibiotics: Erythromycin Fluid and Electrolyte Replacement to prevent dehydration Mild form of Sedation: Codeine

Nursing Care:
Complete Bed Rest (CBR) Maintain Fluid and Electrolyte Balances Provide adequate nutrition Proper positioning (upright) of patient when feeding to prevent aspiration Provide abdominal binder to prevent hernia

Preventive Measure: same as Diptheria Immunity: No permanent immunity but 2nd attack is rare because child will not remain 6 years old

TUBERCULOSIS
also known as Kochs Infection, Phthisis, PTB and Galloping Consumption Causative Agent: Acid Fast Bacillia. Mycobacterium tuberculosis or tubercle bacilli b. Mycobacterium bovis c. Mycobacterium avium/avis

Mode of Transmission:
Airborne and droplet Ingestion of infected milk of cows Inhalation from birds Mycobacterium avian complex (MAC)

Incubation Period: 1-2 months (4-8 weeks)

Signs and Symptoms of TB:

Low grade fever with night sweats Anorexia and weight loss Fatigability and body malaise Chest pain and dyspnea Productive cough and hemoptysis Back and epigastric pain Anemia and amenorrhea in female

Diagnostic Examination: Screening test for TB Tuberculin Testing

A presumptive test (+) means exposure to TB and not infected Things to Consider: Uses Purified Protein Derivative (PPD) Introduced intradermally (ID) Interpretation after 48-72 hours (+) result show > 10 mm induration If patient has HIV, (+) result show >5 mm induration

3 Ways/Techniques of Tuberculin Testing: Mantoux Test most accurate and easiest way of TT interpret after 48-72 hours Tine/Multipuncture Test Vollmer & Perquet Test

 Confirmatory test for TB sputum examination a definitive test that identifies the microorganism the best time to collect the sputum is in the morning, upon rising and before oral care instruct patient to do deep breathing for 3-4 times then ask patient to open mouth widely with tongue place behind lower teeth then ask patient to cough out sputum Chest X-ray is not a definitive test because it tells only the extent of involvement of the lungs

Classification of TB:
According to extent of disease based on cavitations within the lungs Minimal Moderately advanced Advanced presence of cavitations within the lungs According to clinical manifestations Active PTB Inactive PTB

 According to American Pulmonary Society

TB 0 (-) exposure (-) infection (-) tuberculin testing TB I (+) exposure (-) infection (-) tuberculin testing TB II (+) exposure (+) infection (+) tuberculin testing, (-) S/Sxs TB III - (+) exposure (+) infection (+) tuberculin testing, (+) S/Sxs

Medical Management:
Short Course Chemotherapy Rifampicin, Isoniazid, Pyrazinamide=RIP (E, S)

Isoniazid (INH) is the mainstay drug of TB: 6 months for carrier& inactive adult patients 9 months for children 12 months for immunocompromised patients

Side Effects of INH: Peripheral neuropathy/neuritis a) instruct patient to eat food rich in Vit B6 beans b) give vitamin B6 (pyridoxine) to counteract neuritis Hepatotoxicity a) monitor liver enzymes b) avoid alcoholic beverages

 Rifampicin (R) it causes orange color of tears, urine and stool it is hepatotoxic Pyrazinamide (PZA) it causes hyperurecemia Ethambutol (EMB) it causes irreversible optic neuritis that brings about blindness

 Standard Regimen (SR) Streptomycin, Isoniazid and Ethambutol = SI(E) Streptomycin (S) Nephrotoxicity so monitor creatinine and BUN level of kidney Ototoxicity CN 8th is affected theres tinnitus vertigo

3 Important Aspects of Nursing Care:

D iet = small and frequent nutritious food D rugs = adequate drug and emphasize compliance R est = to conserve energy Contraindicated Nursing Care: Dont do chest physiotherapy (CPT) for patient with TB because it will stimulate or aggravate hemoptysis

Preventive Measures:
Immunization with BCG immediately after birth 0.5 cc ID right deltoid area for infants Instruction to mother: Dont massage site of injection because it will spill the drug The child may experience fever There will be abscess formation on the site of injection which will heal and develop into a scar within 2-3 months.

 Proper disposal of nasopharygeal secretions Covering of mouth and nose when coughing and sneezing Proper pasteurization

Immunity: Gives temporary immunity

PNEUMONIA
inflammation of the lung parenchyma Causative Agents: Microorganisms such as Virus Cytomegalovirus (CMV) SARS Protozoa Pneumocystis carinii pneumonia (PCP) Bacteria Streptococcus; Hemophilus B Inhalation of noxious chemical, oil is inhaled and vomitus enters the respiratory system=Lipid pneumonia Mode of Transmission: Droplet

5 Cardinal Signs of Pneumonia: Rapid or gradual onset of fever Shaking chills Productive cough

 Sputum production: Rusty -Streptococcus pneumonia Creamy Yellow -Staphylococcus Currant Jelly(like lychees) -Klebsiella Greenish -Pseudomonas Clear -no infection (Aspiration or Lipid Pneumonia) Chest or pleuritic pain aggravated by coughing Apply chest binders so it lessens pain when patient coughs

 In community setting, Integrated Management of Childhood Illnesses (IMCI), assess the child for 4 General Danger Signs: Is the child able to drink or breastfeed? Check if the child vomits everything Presence of convulsions Check if child is abnormally sleepy or difficult to awaken
Check for the presence of chest in-drawing: Check for the presence of stridor (abnormal harsh breath sounds heard during inspiration even without stethoscope)

Diagnostic Examination:
Physical examination by: doing percussion auscultation: crackles and rhonchi decrease breath sounds and decrease vocal fremitus Chest X-ray=presence of lung consolidation or patchy infiltration that confirms pneumonia Sputum examination=to determine specific microorganism that causes the disease

 Medical Management: Antibiotic-antimicrobial agents depending upon causative agent (bacteria or viral) PCP =Pentamidine Virus =Symptomatic Bacteria =Cotrimoxazole Inhalation Therapy Bronchodilators Mucolytics Nursing Diagnosis: Ineffective airway clearance R/T sputum (causes airway obstruction) production

 Nursing Care: similar with Diptheria Complete Bed Rest to conserve energy Maintain patent airway Increase body resistance by adequate rest and nutrition Provide comfort measures Preventive Measures: Immunization by Immunovirax Proper disposal of nasopharygeal secretions Cover nose and mouth when sneezing and coughing Immunity: No permanent immunity

Diseases of Gastro-Intestinal Tract

Bacterial : Typhoid Bacillary dysentery Cholera Leptopirosis Metazoal : Schistosomiasis Viral: Hepatitis Mumps Helminthic :Parasitism Protozoal : Amoebiasis

TYPHOID FEVER
Causative Agent: Salmonella typhosa invades Peyers patches - target organ Mode of Transmission: Fecal-oral transmission Sources of Infection: 5 Fs - Feces, fingers, food, flies and fomites

4 Stages of Manifestations of Typhoid Fever: Prodromal stage

microorganism is found in the blood stream fever, dull headache, nausea & vomiting, abdominal pain diarrhea or constipation

 Fastigial/Pyrexial stage
MO invades the Peyers patches 3 Clinical Features of Typhoid Fever: Rose spots are light pink red spots found in the abdomen and sometimes seen on the face in children=pathognomonic sign Ladder like fever Splenomegaly

 Typhoid Psychosis-increase body temperature due to release of toxins Patient have a coma vigil look Difficulty in protruding tongue Carphologia involuntary picking up of linen Sabsultus tendinum involuntary twitching of the tendon especially the wrist

 Defervescence stage
patient experience ulcer formation--intestinal perforation that causes bleeding or hemorrhage---spillage in peritoneal cavity Signs and Symptoms of Peritonitis: sudden and severe abdominal pain persistence of fever board-like rigid abdomen

 Convalescent/Lysis stage
signs/symptoms start to subside patient is on the road to recovery still have to observe patient because he may develop relapses

Diagnostic Examination:
Blood Culture Widal test Antigen O (Ag O) or Somatic antigen= presently infected Antigen H (Ag H) or Flagellar antigen= previously exposed to TF or has had an immunization Typhidot-uses blood specimen where it identifies antibodies Stool and Urine examination

Medical Management:
Antibiotic - Chloramphenicol Fluid and Electrolyte Replacement

Nursing Care:
Fluid and Electrolyte Management Assess patient for S/Sxs of fluid lossweight loss Monitor input and output of patient Proper regulation of IVF

 Provide adequate nutrition If patient has vomiting= small, frequent feedings If patient has diarrhea=avoid fatty foods Provide comfort measures

Preventive Measures:
Immunization by Cholera, Dysentery and Typhoid vaccine (CDT) Avoid 5 Fs: Feces-proper excreta disposal Fingers-handwashing Food-proper preparation, handling and storage Flies-environmental sanitation Fomites-avoid putting anything in the mouth

Immunity: No permanent immunity

LEPTOSPIROSIS
also known as Mud Fever, Swamp Fever, Canicola Fever, Pre-tibial Fever, Weil Disease, Swineherd Disease and IcteroHemorrhagica Disease a disease of low form of animals found in farms Source of Infection: Excreta of rats particularly urine

Causative Agent: 4 Different Species of Leptospira:

1. Leptospira (Spirochete)-bacteria 2. Leptospira canicola 3. Leptospira hemorrhagica 4. Leptospira enterogans-more common in the Philippines because of rats

Mode of Transmission: Skin penetration by entering pores of skin Incubation Period: 2 days-4 weeks People at Risk: Sewage workers, farmers, miners, slaughterhouses and Manila residents (because of walking in floods) Incidence: common during rainy season

Organs of body most commonly affected are:

Striated muscles Liver Kidneys-MO have special affinity

Signs and Symptoms:

Fever, headache and vomiting Muscle tenderness and pain particularly on calf muscle (gastrocnemius) Jaundice with hemorrhages on skin & mucous membrane icter-hemorrhagic yellow and red orange skin, orange eyes (pathognomonic sign) Oliguria to anuria

Diagnostic Examination:
Blood Examination: Leptospira agglutination test (LAT) Leptospira antigen-antibody test(LAAT) Microscopic agglutination test (MAT)

Medical Management:
Antibiotics-Tetracycline is the drug of choice Not given to: a. children below 8 years old because it causes staining of teeth b. pregnant women because of its teratogenic effect particularly on bone growth of fetus causing bone defect and stained teeth >never give tetracycline together with calcium rich food, antacid & iron preparations and milk

 Give penicillin to patient allergic to tetracycline give it 1 hour before meals or 2 hours after meals or empty stomach

Nursing Care: Symptomatic

Provide eye care for itchiness Apply warm compress for muscle pain Monitor urine output, consistency, frequency and amount

Preventive Measures:
Environmental sanitation by eradication of rats Avoid walking through floods

DYSENTERIES
Bacillary Dysentery Shigellosis Blood fluke
Shigella dysentery, Shigella flexneri, Shigella boydii, Shigella sonnei

Synonyms
Causative Agent

Violent Dysentery Cholera El Tor

Vibrio cholera, Vibrio ogawa, Vibrio inaba, Vibrio el tor

Amoebic Dysentery Amoebiasis

Entamoeba histolytica 2 stages: Inactive cysts Active trophozoites

Characteristic Mucoid stool, of Stool bloodstreaked if severe due to endotoxin released by the MO

Yellow water to rice watery due to the vibriolytic substance released by MO Abdominal pain Vomiting Washerwoma ns hands due to dehydration

Mucopurulent bloodstreaked with foul-smelling odor and greenish color +/- Fever +/- Vomiting Diarrhea with tenesmus alternating with constipation

Signs and Symptoms

+/- Fever +/- Vomiting Abdominal pain with tenesmus

Bacillary Dysentery
Medical Antibiotic: Management Cotrimoxazole ORT

Violent Dysentery
Antibiotic: Tetracycline IVT

Amoebic Dysentery
Antiamoebic: Metronidazole Antiprotozoa: Chloroqiuine ORT

Mode of Transmission: Fecal-oral Diagnostic Examination:

Stool Examination for Amoebic dysentery, stool must be submitted fresh within 30 minutes to identify the immature amoeboid protozoatrophozoites Rectal Swab

Nursing Care:
Maintain Fluid and Electrolyte Balance Monitor I and O Assess Signs & Symptoms of Dehydration Provide Fluids Provide Adequate Nutrition Small frequent feedings Avoid fatty foods Provide Comfort Measures

Preventive Measures:
Immunization: Cholera, Dysentery, Typhoid Vaccine (CDT) given by DOH Avoid 5 Fs

SCHISTOSOMIASIS
also known as Snail Fever or Bilharziasis Causative Agent: Metazoa in the form of Blood Flukes (parasitic flatworms) called Schistosoma-3 Types:
Schistosoma japonicum - affects both man & animal intestines Schistosoma mansoni - affects mans intestines Schistosoma haematobium - affects the choroid plexus of the urinary bladder producing urinary symptoms

Mode of Transmission: Skin Penetration

Heart

Cycle of Schistosoma (always in pairs): Pulmonary Artery (maturation)

Portal Circulation

Capillary Skin/Mucous Membrane Larvae (Cercariae)

Snail Oncomelania quadrasi 4-8 weeks snail

Intestine (lay eggs) Feces (Eggs) Larvae (Miracidium) 24-48 hours to look for

Manifestations:
Itchiness on the entry site of MO (Swimmers itch) Low grade fever, cough, myalgia Dysentery like symptoms (mucoid) Emaciated (skin & bones) Abdominal distension or enlargement Hepatomegaly & splenomegaly Lymphadenopathy

Diagnostic Examinations: Stool Examination Blood Examination: Circum Ova Precipitin Test (COPT)confirmatory test Enzyme Link Immuno-Sorbent Assay Test (ELISA) Rectal Biopsy Medical Management: Anti-Blood Fluke Agent: a. Fuadin b. Praziquantrel Snail Control

Nursing Care: Supportive and Symptomatic Preventive Measures:

Snail Control Use of snail poisons or molluscides Proper irrigation & cultivation of lands Creation of fish ponds for snail eating fish (Eg. milkfish)

 Environmental Sanitation Proper excreta disposal Proper wearing of footwear (Eg. boots) Keep all animals caged or chained Creation of foot bridges Health Education done by DOH

MUMPS
also known as Infectious Parotitis an inflammation of the parotid glands Causative Agent: Paramyxovirus Source of Infection: Saliva of an infected individual Mode of Transmission: Droplet infection

Manifestations:
Complains of earache Presence of fever Pain upon chewing or mastication Swelling of the parotid gland

Diagnostic Examination: Only through Clinical Observation & Physical Examination Medical Management: Symptomatic

Nursing Care:
Complete Bed Rest until swelling subsides Female patients develop oophoritis (inflammation of the ovaries) Male patients develop orchitis (inflammation of the testes) In children, the most common complication is Encephalitis

 Provide adequate nutrition by giving soft & bland diet (Eg. apple juice or water) Application of ice cap or ice collar over parotid gland lessens pain because it deadens the nerve endings (Eg. aniel dyetina & vinegar has cool effect)

Preventive Measures:
Immunization: MMR Cover nose and mouth Proper disposal of oropharygeal secretions

Immunity: Mumps give a permanent immunity

HEPATITIS
inflammation of the liver Causes:
Alcoholism Drug intoxication (ex. Rif and INH) Chemical intoxication (ex. arsenic) Microorganisms

Classifications: Hepatitis A, B, C, D, E, G and H (non-pathogenic in man)

Hepatitis A:
also known as Infectious Hepatitis, Catarrhal Jaundice Hepatitis & Epidemic Hepatitis Causative Agent: Hepatitis A virus or RNA containing virus Body Secretions that harbor the disease: Feces MOT: Fecal-oral transmission People at Risk: Children, those living in unsanitary conditions & those who practices anal-oral sex Incubation Period: 2-6 weeks

Hepatitis B also known as Serum Hepatitis, Homologous Hepatitis and Viral Hepatitis Causative Agent: Hepatitis B virus or DNA containing virus Body Secretions that harbor the disease: Blood & Body Fluids Example: CSF, tears, saliva, milk, synovial, seminal & cervical fluid and sweat

Mode of Transmission:
Percutaneous (most common) Oral to oral transmission Sexual transmission-found in seminal and cervical fluid Vertical transmission-placental barrier and amniotic fluid

People at Risk: Health workers, blood recipients, hemodialying patient, drug addicts and promiscuous individuals Incubation Period: 6 weeks-6 months

Hepatitis C also known as Post transfusion Hepatitis Causative Agent: Hepatitis C virus Body Secretions that harbor the disease: Blood MOT: Percutaneous People at Risk: Health workers, blood recipients, hemodialyzing patients & drug addicts Incubation Period: 5 weeks-12 weeks

Hepatitis D dormant type of Hepatitis B Causative Agent: Hepatitis D virus or Delta virus (it needs Hep B virus to multiply) Body Secretions that harbor the disease, MOT and People at Risk: same as Hepatitis B Incubation Period: 3 weeks-13 weeks

Hepatitis E also known as Enteric Hepatitis Causative Agent: Hepatitis E virus Body Secretion that harbors the disease: Feces MOT: Fecal-oral transmission People at Risk: same as Hepatitis A Incubation Period: 3 weeks-6weeks

Hepatitis G Causative Agent: Hepatitis G virus Body Secretion that harbors the disease: Blood MOT: Percutaneous People at Risk: same as Hepatitis C Incubation Period: unknown

3 Stages of Manifestation of Hepatitis

Pre-icteric Stage
Signs & Symptoms: Fever RUQ pain Fatigability, weight loss and body malaise Nausea, vomiting & anorexia Signs of anemia because of decrease lifespan of RBC

 Icteric Stage
presence of jaundice because of inability of liver to eliminate the normal amount of bilirubin Signs & Symptoms: Patient will have pruritus Urine is tea colored or brown Patient is passing out acholic (clay colored or no color) stool

2 Types of Bilirubin: Conjugated-passed the liver and goes to the intestine Unconjugated-goes to the kidney where it is filtered then goes to urine Persistence of symptoms of Pre-icteric Stage but to a lesser degree

 Post-icteric Stage
jaundice and other signs & symptoms start to disappear energy level starts to increase and patient is on the road to recovery it takes 3-4 months for the liver to recover so avoid alcoholic beverages for one year and over the counter drugs like acetaminophen and ASA

Diagnostic Examination: Liver Enzyme Tests to determine extent of liver damage Enzymes that can be checked are:
Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Alkaline phosphatase (ALP) Gamma glutamil transferase (GGT) Lactic dehydrogenase (LDH)

 Serum Antigen-Antibody (Ag-Ab) Test

Hepatitis A Hepatitis A Surface Antigen (HAsAg): (+) if 2 weeks after exposure to Hep A Anti HAV Hepatitis B Hepatitis B Surface Antigen (HBsAg): (+) acute hepatitis B Hepatitis B Protein Independent Antigen (HBeAg): (+) chronic hepatitis B

 Routine Tests
Bilirubin Testing Prothrombin Time Testing (PTT) Ultrasound or CT Scan of liver Urinalysis

Medical Management: Hepatic Protectors or Liver Aides contain vitamins, minerals and phospholipids
Essentiale for adults Jetepar or Silymarine for pedia

New Trends in treatment of Hepatitis

Antiviral: Lamivudine Immuno-modulating drug: Interferon

Nursing Care:
Provide rest to promote liver regeneration or recovery Low Fat Diet High CHON intake to spare protein metabolism In USA, butterball diet is given because CHO is used as a source of energy

Preventive Measures:
Immunization: Hepatitis B vaccine given at 6 weeks after birth, 3 doses at one month interval, Dose: 0.5 cc IM at the Vastus lateralis Avoid MOT

Immunity: Hepatitis doesnt give a permanent immunity

PARASITISM
MOT: Ingestion-hand to mouth Pinworm infection - Enterobiasis (Enterobius vermicularis), oxyuriasis & sitworm
S/Sxs: Nocturnal Ani-itchiness of the anus at night time because female pinworm get out of the intestinal wall & lay eggs to the anus Diagnostic Examination: Cellophane Tape Test
done in the morning upon rising

 Giant Round Worms/Ascaris - Ascariasis (Ascaris lumbricoides) causes intestinal obstruction Whipworm/Trichuris - Trichuriasis Roundworm/ Trichinella spiralis Trichinellosis/ Trichiniasis due to eating raw meat

 Tapeworm Infection - Taeniasis

Taenia saginata-raw beef (steak) Taenia solium-pork (BBQ) Diphyllobotrium latum-raw fish (sushi) Dwarf Tapeworm (Hymenolopsis nana)

Flatworm - Paragonimiasis westermanicrab/crayfish (talangka)

S/Sxs: productive cough and hemoptysis

MOT: Skin of feet or barefooted Hookworm - Ancylostomiasis=signs & symptoms of pneumonitis Threadworm - Strongyloidiasis

Common Manifestations:
Voracious appetite Weakness Pot Belly Anemia Stunted Growth Apathetic

Diagnostic Test: Stool Examination

Medical Management:
Antihelminthics:a. Mebendazole b. Pyrantel pamoate (Combantrin)

Nursing Management: Supportive Preventive Measures:

Personal Hygiene: Hand washing and Proper wearing of footwear Proper preparation of food

Diseases of the Genito-Urinary System

Sexually Transmitted Diseases (STD)/Sexually Transmitted Infection (STI): Bacterial Etiology: Gonorrhea Syphilis Viral Etiology: HIV/AIDS

GONORRHEA
also known as Jack, Gleet, Clap, Strain, GC (gonococcus) and Morning Drop Causative Agent: Neisseria gonorrhea MOT: Sexual contact, transferred to baby during childbirth Incubation Period: 3-21 days Manifestations: Male: urethritis Female: cervicitis

For Male:
Burning sensation upon urination
dysuria (painful urination) Redness & edema of urinary meatus acidic urine passes through causing burning sensation producing pain

 Purulent urethral discharges abundant in the morning morning drop

Abscess forms on the Prostrate Gland Prostatitis Epidydimitis

scar formation on the epidydimis

obstructs flow of sperm cell Sterility

For Female:
Dysuria and urinary frequency Itchy, red and edematous meatus, if cervix is affected If urethra is affected, there is burning pain and purulent discharges

 Abscess forms on the Bartholins & Skenes Gland

Endocervicitis & Endometritis

Constant scarring causes narrowing of fallopian tube Sterility

If pregnant, it will cause: ectopic pregnancy or ophthalmia neonatorum in newborn

Gonococcal Septicemia: migratory polyarthralgia, polyarthritis & tenosynovitis, tender papillary skin lesions Diagnostic Examination:
Culture & Sensitivity by mucosal scraping Paps Smear or Vaginal Smear

Medical Management:
Antibiotic: Ceftriaxone (Rocephin) Doxycycline (Tetracycline)

Nursing Care:
Psychological aspect of care-patient has low self esteem because of social stigma Health Education or Patient teaching about prevention measures: Safe Sex
No sex Long term mutual monogamous relationship Mutual masturbation without direct contact

Condom decreases the risk of having STD Behavior modification

CHLAMYDIAL INFECTION
Twin sister of gonorrhea because if you have gonorrhea, you have also Chlamydia Manifestations: same as gonorrhea except discharges are clear and thinner Diagnostic Examination:
Culture & sensitivity

Pap smear or vaginal smear

Management: Antibiotic:
Penicillin: Benzathine Pen G (Penadur) Given per IM Given also to patient with Rheumatic Heart Disease (RHD) Cephalosporin: Ceftriaxone (Rocephin) Doxycycline (Tetracycline): given to patient with both gonorrhea & chlamydial infection

Nursing Care: same as gonorrhea

SYPHILIS
also known as Pox, Lues, SY and Bad Blood Disease Causative Agent: Treponema pallidum-a spirochete that passes to the placental barrier during the 16 week of pregnancy (2nd & 3rd trimester) MOT: Sexual contact and vertical transmission Incubation Period: 10-90 days

3 Stages of Manifestation of Syphilis

Primary Stage
Chancre, a painless papular lesion Found in the face, lips, tongue, under the breast, fingers & genitals Regional lymphadenopathy

 Secondary Stage: highly infectious & contagious

Fever and malaise Skin rashes & Dermatitis: dry, hard, wart like lesions called Condyloma lata Oral mucous patches Alopecia-patchy, polka dot or moth eaten appearance of hair and thinning of pubic hair

 Tertiary Stage
Gumma described as an infiltrating lesion found on deeper tissues & body organs such as skin, bone and liver It involves the heart= aortitis & aneurysm It involves the CNS= paresthesias, abnormal reflexes, dementia and psychosis

Diagnostic Examinations:
Culture & Sensitivity by mucosal scraping Dark Field Microscope Serologic (Blood Exam) Test Venereal Disease Research Laboratory (VDRL): non specific Flourescent Treponema Antibody Absorption Test (FTA-ABS)confirmatory/definitive test Rapid Plasma Reaction (RPR)

Medical Management:
Antibiotic: Benzathine Penicillin G (Penadur)

Nursing Care & Preventive Measures: same as gonorrhea

HIV and AIDS

HIV infection means one is infected with AIDS virus AIDS = infected by virus + incompetent immuno-response Causative Agent: Human ImmunoDeficiency Virus (HIV) retrovirus

MOT:
Blood transfusion Sexual contact Exposure to infected blood, products or tissues Vertical (mother to child) or Perinatal (Pregnancy, Delivery & Breastfeeding) transmission Sharing needles

Normal Immune Response: MO-----detected by ----------Macrophage HIV Antibodies Alert T Cells stimulate B cells

Once HIV enters the body, it directly goes to T-cells. The virus will release reverse transferase that resembles the genetic cells of T-cells. Then T-cells will not destroy the virus leaving it to multiply and damage T-cells. Virus leaves the T-cells then retrovert to its own genetic sequence-not enough T-cells-not enough stimulation of B cell-not enough antigenantibody reaction.

Well Worried Infected with HIV------------------Asymptomatic Window Period (+) HIV Infection------------------- Adult Child---------------------2 Major 2 1 Minor 2 ARC Symptoms AIDS

Well worried person is infected with HIV: he will be asymptomatic because it takes time to produce antibodies. After 6 weeks to 6 months, he will be (+) to HIV infection because it takes about 6 months to produce antibodies known as the Window Period (time interval between infection of an individual to production of antibody) AID Syndrome.

AIDS Related Complex (ARC) Symptoms

Fever with night sweat without a cause Enlargement of lymph nodes (neck, axillary & inguinal) without a cause Fatigability Weight Loss Altered sleeping patterns Temporary memory loss Altered gait

Adults: 2 Major symptoms & 1 Minor symptom Children: 2 Major symptoms & 2 Minor symptoms 3 Major Symptoms:
Fever-1 month & above Diarrhea-1 month & above 10% Weight Loss/Stunted Growth for Pedia

6 Minor Symptoms:
Persistent Cough-1 month & above Persistent Generalized Lymphadenopathy Generalized Pruritic Dermatitis Oropharyngeal Candidiasis Recurrent Herpes Zoster Progressive Disseminated Herpes Zoster

Opportunistic Infections
TB is the most common of the Avium type (from birds) Pneumocystis carinii pneumonia (PCP) Cytomegalovirus (CMV) protozoa CNS Lungs Eyes (Retinal destruction) Cancer: Kaposi Sarcoma malignancy of blood vessel manifested through the skin appearing as pink/purple painless spots on the skin called Leopard Look

Diagnostic Examinations: Enzyme Link Immunosorbent Assay (ELISA) Test-screening test Western Blot-confirmatory test Viral Load Testing CD4 & T-Cell Count
If more than or equal to 200=patient is HIV infected If less than 200=AIDS

 Blood Examination/CBC-anemia, thrombocytopenia, leukopenia Blood Culture for pediatrics Immunocomplex dissociation (P24 assay) for pediatrics

Medical Management: Nucleoside Analogs prevent the virus to multiply during the initial phase of cell division: Nucleoside Reverse Transcriptase Inhibitor (NRTI) Azidothymidine (AZT)-Zidovudin, Retrovir Lamivudine-3TC, Epion Stavudine-Cd4T, Zerit Dideoxyinosine (DDI)-Didanosine Dideoxycytidine (DDC)-Zalcitabine, Hivid Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) Delavirdine Nevirapine

 Protease Inhibitor (PI) prevents virus to multiply during the last phase of cell division
Indinavir Retonavir Saquinavir Nalfinavir

Fusion Inhibitor-Fuseon (Enfuritide)

Nursing Care: Supportive & Symptomatic

Promote knowledge & understanding Promote quality of life Provide self care & comfort

Preventive Measures:
Practice ABCD of HIV A-bstinence B-e Faithful C-ondom D-ont use drugs Education Counseling Behavior Modification

THANK YOU