communicable diseases - antipona

7/29/2019 Communicable Diseases - Antipona

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CommunicableDisease NursingMr. Regie P. De Jesus, MAN


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Communicable Disease is an illness due to an infectious agent or its toxic

products which is easily transmitted or communicateddirectly or indirectly from one person or animal to

another


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Communicable Diseases Communicable Diseases are Primary Cause

of Mortality Gap between Rich and Poor

Countries Non-communicable diseases account for

59% of all deaths worldwideestimated to

rise from 28m in 1990 to 50m in 2020


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Communicable Diseases About 60% of deaths caused by communicable

diseases can be attributed to:

HIV/AIDS

Malaria

Tuberculosis

Measles

Diarrheal disease

Acute respiratory infection


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INFECTIOUS

DISEASE


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Dengue Fever, H-Fever, DandyFever, Breakbone Fever, PhilHemorrhagic feverAcute Febrile Disease

Flavivirus, dengue virus 1,2,3,4, ChinkungunyaVirus, Onyungyong Virus

Incidence: Rainy season, urban areas

IP: 3 to 10 days ( average 4-6 days)

** Life span of the mosquito is 4 months


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Dengue Fever, H-Fever, Dandy Fever,

Breakbone Fever, Phil Hemorrhagic fever

Pathogenesis1. increased capillary fragility d/t immune complexreactions2. thrombocytopenia d/t faulty maturation ofmegakaryocytes

3. decreased blood clotting factors

THE DISEASE PRESENTS WITH FEVER AND

HEMORRHAGIC MANIFESTATIONS AND

LABORATORY FINDINGS OF

THROMBOCYTOPENIA ANDHEMOCONCENTRATION


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Vector- Aedes aegypti

- Day biting mosquito ( they appear 2 hours aftersunrise and 2 hours before sunset. Low flying ( Tigermosquito white stripes, gray wings )- Breeds on clear stagnant water


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CRITERIA FOR DIAGNOSIS:

Fever ,acute, high continuous, lasting for

2-7 days

Positive torniquet test

Spontaneous bleeding

(petechiae,purpura,ecchymoses,epistaxis,gum bleeding, hematemesis, melena)

Laboratory: thrombocytopenia


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Assessment:

Tourniquet test (Rumpel Leades test) -screening test, done by occluding the arm veinsfor about 5 minutes to detect capillary fragility.

Keep cuff inflated for 610 minutes ( child); 10-

15 minutes ( adults)

Count the petechiae formation 1 square inch ( 20

petechiae/sq.in)(+)TT

Platelet count ( decreased)confirmatorytest


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Classification of Dengue Fever

according to severity

Grade IDengue fever, saddleback fever plusconstitutional signs and symptoms plus positivetorniquet test

Grade IIStage I plus spontaneous bleeding,epistaxis, GI, cutaneous bleeding

Grade IIIDengue Shock Syndrome, all of thefollowing signs and symptoms plus evidence of

circulatory failure Grade IVGrade III plus profound shock and

massive bleeding, undetectable BP and pulse


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Laboratory criteria DHF:

Platelet count Thrombocytopenia


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Other :

PT (Prothrombin Time) Normal range is 11-16

secondsAPTT (Activated Partial Thromboplastin Time)

Normal range is 30-45 seconds.

Bleeding time

Coagulation time

Period of communicabilitypts. are usuallyinfective to mosquito from a day before the

febrile period to the end of itThe mosquito becomes infective from day 8 to

12 after the blood meal & remains infective all

throughout life


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pathophysiologyDengue Fever

Vector caries virus (AEDES aegypti)

Bite host ( IP 3-10d)

s/sx : Fever , headache, myalgia ,anorexiaVomiting, sorethroat, rashes

Febrile phase

2-7 days

IMPROVE

First 2 daysVascular injury

Plasma leakage

(+) petechiae , (+) TT

3rd day WBC, PLT Ct , Hct >20% (+) Pleural effussion

Dengue progressCirculatory failure

-hypotension

-narrow pulse pressure

,20mm Hg (shock)

death

DHF


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S/sx:

Mild dengueabrupt onset of fever, headache,muscle and joint pains, anorexia, abdominalpain. Petecchiae, Hermans rash (5th-7th day;

purplish macules w/ blanched areas onextremities)

Severe dengueDHF/DSS

*TRIAD: fever, rashes and muscle painBleeding leading to hypovolemic shock


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Medical MX There is no effective antiviral therapy for dengue

fever. Treatment is entirely SYMPTOMATIC Paracetamol for headache ( never give ASPIRIN)

IVF for hydration & replacement of plasma

BT for severe bleeding

O2 therapy is indicated to all patients in shock

Sedatives for anxiety & apprehension

No IM injections

Nasal packing with epinephrine


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Nursing Mx Symptomatic tx

Mosquito free environment to avoid furthertransmission of infection

Keep patient at rest during bleeding episodes

VS must be promptly monitored

For nose bleeding, maintain pts position inelevated trunk, apply ice bag to bridge of nose

Observe for signs of shock

Restore blood volume ( supine with legs elevated)

Gum bleedingsoft bristled toothbrush, give icechips


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Dengue hemorrhagic Fever

PREVENTION : DOH 1995 Program

C- hemically treated Mosquito Net

Larvae eating fishGold fish Environmental Sanitation4 0 clock habit

Aantimosquito soaplanzones peeling

Natural mosquito repellantNeem tree , eucalyptus, oregano
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PREVENTION Cover water drums and water pails at all times to

prevent mosquitoes from breeding. Replace water in flower vases once a week.

Clean all water containers once a week. Scrub thesides well to remove eggs of mosquitoes sticking

to the sides. Clean gutters of leaves and debris so that rain

water will not collect as breeding places ofmosquitoes.

Old tires used as roof support should be puncturedor cut to avoid accumulation of water.

Collect and dispose all unusable tin cans, jars,bottles and other items that can collect and hold

water


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Prevention & Control

The 4-S Against DENGUE

1. Searchand destroy breeding places

of dengue causing mosquitoes such asold tires, coconut husks, roofgutters, discarded bottles,flowervases & other containersthat can hold clean stagnant water


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2.Selfprotection measures such as wearingof long sleeve shirts and long pants and using

mosquito repellants are a must during daytime.

3.Seek early consultation when early signs suchas fever and rashes set in

4.Say NO to indiscriminate fogging except fordengue outbreak


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Leptospirosis (Weils disease) Weils disease, Mud fever, Trench fever, Flood

fever, Spirochetal jaundice, Japanese 7 Days fever,Leptospiral jaundice, Hemorrhagic jaundice,Swine Herds disease, Canicola fever

a zoonotic systemic infection caused by Leptospira, thatpenetrate intact and abraded skin through exposure to

water, wet soil contaminated with urine of infectedanimals.

Species:

L. Manilae, L. Canicola, L. Pyrogens

Incubation Period: 6-15 days


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Spirochete, Leptospira

interrogans, gram (-)Weils syndrome

severe form

MOT: Contact of skin or open wound from soil water

contaminated with urine or feces ofinfectedrats

(main host) INGESTION OF CONTAMINATEDFOOD/H2O
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S/SX:

Anicteric Type (without jaundice)

manifested by fever, conjunctival infection

signs of meningeal irritation

+ leptospires in the urine

Icteric Type (Weil Syndrome)

Hepatic and renal manifestation

Jaundice, hepatomegally Oliguria, anuria which progress to renal failure

Shock, coma, CHF

Convalescent Period


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Diagnosis

Clinical history and manifestation Culture

Blood: during the 1st week CSF: from the 5th to the 12th day Urine: after the 1st week until convalescent period

LAAT (Leptospira Agglutination Test) other laboratory BUN,CREA, liver enzymes


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Treatment

Specific

Penicillin 50000 units/kg/day

Tetracycline 20-40mg/kg/day

Non-specific

Supportive and symptomatic

Administration of fluids & electrolytes Peritoneal dialysis for renal failure


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LEPTOSPIROSIS

JAUNDICE IS A BAD PROGNOSTIC SIGN

CASE FATALITY RATE : 40%

Blood /vector-borne


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Prevention Control & Nursing

Considerations:

Avoidance of exposure to urine & tissues from infectedanimals ( flood)

Rodent Control

Hygienic control in slaughterhouses, farmyard buildings &bathing pools

Use of protective clothing & boots

Immediately wash extremities after possible exposures &disinfect with 705 alcohol

Primarily a disease of domesticated & wild animals

transmitted via direct or indirect contact. It enters the skin,mucus membrane, conjunctiva

Disease is usually short lived & mild but severe infection candamage kidneys & liver

Should not donate blood for at least 12 months after recovery


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Typhoid Fever Salmonella typhosa or typhi,

gram (-) Carried only by humans

Bacterial infection transmitted by contaminated

water, milk, shellfish ( oyster ) & other foodsInfection of the GIT affecting the lymphoid tissue (

Peyers patches) of the small intestine

Most severe form of salmonellosis caused bysalmonella typhi

MOT: oral fecal route

5 Fs : Fingers, Fomites, Flies, Feces, Food & Fluids


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Pathophysiology

Oral ingestion

Penetrates the intestinal lymphatics, mesenteric

Reticuloendothelial system (lymph node, spleen, liver)

Bloodstream

Peyers patches of SI necrosis and ulceration


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Typhoid Fever

Ulceration of the Peyer's Patches


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Typhoid Fever

Clinical Manifestations:

Incubation Period: 1-3 weeks

1.Prodromal1st week: Step ladder fever 40-41

deg, headache, abdominal pain, GI manifestations3 cardinal signs of pyrexial stage:

1.ROSESPOTS ( rose-colored macules that

disappears after applying pressure, found on thechest, abdomen, back, a.k.a. Evanescence rash

2. Remittent fever ( ladder like)

3. Spleenomegaly


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Typhoid Fever

Rose Spots


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2.Fastidial = 2nd week ( Typhoid)

a. High fever, typhoid psychosis w/hallucination, confusion, delirium

Drug of choice: Antibiotics

1. Chloramphenicol

2. Ampicillin

3. Cotrimoxazole

b. Severe abdominal pain

c Sordes typhoid state


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1st week step ladder fever (BLOOD)

2nd weekrose spot and fastidial

typhoid psychosis (URINE & STOOL)3rd week (complications) intestinal bleeding,

perforation, peritonitis, encephalitis,

4th week (lysis) decreasing S/SX5th week (convalescence)


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Dx: Blood culture (typhi dot) 1st week

Stool and urine culture 2nd week

Widal testagglutination test bestdone during the 8th day (2nd stage)

3 Antigens Being Used

(+) Ag O

Active typhoid stage

(+) Ag H past infection or vaccinated

individual

(+) Ag Vi

common in carriers


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Mgmt: Chloramphenicol (DOC)100mg/kg/day, Amoxicillin, Sulfonamides,Ciprofloxacin, Ceftriaxone

** Observe standard precaution until 3 negativestool culture**


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Nursing Interventions

EnvironmentalSanitation

Food handlerssanitation permit

Supportive therapy Assessment of

complications(occuring on the 2nd to3rd week of infection )

- typhoid psychosis,typhoid meningitis

- typhoid ileitis
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Chicken Pox, Varicella Acute & highly contagious disease of viral etiology

Childhood disease & adolescents (adultsmoresevere) Not common in infancy

Locally called Bulutong

Human beings are the only source of infection

CA = Varicella Zoster virus, Herpes virus IP10-21 days MOT: airborne spread

> nose & throat secretions

> Vesicles ( contagious in early stage oferuption


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Prodromal period: headache , vomiting, feverPapulovesicular rashes appear on trunk

spreading to face and extremities(CENTRIFUGAL)

Macules papules vesicles with clear fluidinside crusting and scar formation

The disease is communicable until the lastcrust disappear ( D1 before D6 after

appearance of rashes)


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Rashes:Maculopapulovesicular

(covered areas),Centrifugal rashdistribution, startson trunk and spreads

to entire body

Leaves a pitted scar(pockmark)

Period of Communicability5 days before rashes & 5 days

after rashescrusting - dry


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CX = secondary bacterial infection, furunculosis,pneumonia, meningoencephalitis ( rare)

Dormant: remain at the dorsal root ganglion andmay recur as shingles (VZV)


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Curative & Nursing Considerations:

If it feels itchy, give oral antihistamine or localantihistamine

Avoid rupture of lesions

Cut nails short/ mittens

Pay attention to nasopharyngeal secretions/discharges

Disinfection of linen ( sunlight or boiling)

Prophylactic antibiotics


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Treatment:

a. oral acyclovir (Zovirax)slow downmultiplication

b. Tepid water and wet compresses for pruritus

oatmeal bath for pruritus,baking soda + warm water to promote drying

c. Potassium Permanganate (ABO)

a. Astringent effectb. Bactericidal effect

c. Oxidizing effect (deodorize the rash)


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Exclusion from school for 1 week after eruptionappears

An attack gives lifetime immunity. Second attack

is rare

Immunoglobulins can be given ( 12 mos)

Drug of choice: Acyclovir ( Zovirax )topicalcream applied to crusts


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Preventive measuresActive immunization with LIVE

ATTENUATED VARICELLA VACCINE

Start at 1 yr old ( 1 dose )

booster4-12y

If >13 yrs = 2 doses

Given SC

Avoid exposure as much as possible to infected

person

P l T b l i ( K h


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Pulmonary Tuberculosis( Kochs

Disease/Pthisis/Consumption disease)

CA: Mycobacterium tuberculosis ( bacteria), acidfast bacilli

The organism multiplies slowly & is characterized as

acid fast aerobic organism which can be killed byheat, sunshine, drying & ultraviolet light.

Sputum of persons with TB is the most common

source of the organism spread through droplet (airborne)

Potts disease thoracolumbar

Milliary TBkidney, liver, lungs


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- Is a chronic, or subacute or acute respiratory

disease commonly affecting the lungs

characterized by formation of tubercles in thetissues which tend to undergo caseation, necrosis

and calcification.

IP: 2 10 weeksMode of Transmission: Direct: droplet ( sneezing, coughing)

Indirect: continuous exposure to infected persons

within the familySource of Infection:sputum, blood from

hemoptysis, nasal discharges and saliva


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Classification : Minimalslight lesion, small part of lobe/

lungs

Moderately advancedone or both lung may be

involved

Far advanced- more extensive

i i i i i


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Clinical classification: 1. inactive TB

Symptoms absent Sputum negative

CXRno evidence of cavity

2. Active

Tuberculin test positive

CXRprogressive

(+) of symptoms

Sputum (+) 3. Activity not determined


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Clinical manifestation:Afternoon rise of temperature for 1 mo. or more

Body malaise, weight loss

Cough, dry to productive (>2-3 weeks)

Dyspnea, horseness of voice

Hemoptysispathognomonic Occasional chest pain

Night sweating

(+) sputum for AFB


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PD 996Compulsory Immunization below 8 years

( 0 -7 yrs)

Proclamation # 6 WHOUniversal ChildImmunization


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Etiologic Factors that contribute heavily to thehigh Incidence & high mortality rate of TB:

Poverty / Overcrowded homes

Protein undernutrition

Deficiencies in Vit A,D,C

Children below 5 years oldprone to infectiondue to inadequate levels of immunity


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DX

1. Case Finding:A. Sputum Microscopy ( cheapest )

Results take about 3 weeks to confirm

Sputum sample shld be taken 1st thing in themorning upon arising

3 specimens:

1ston the spot = HC

2nd- upon arising = Home

3rdon the spot = HC


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2. Sputum Culture & Sensitivity -

Confirmatory

3. Chest X-rayextent of damage

4. Tuberculin Test

1. PPDPurified Protein Derivative

Mantoux Test- (more reliable) = ID injection oftuberculin extract into the inner aspect of forearm todetect infection/exposure to CA.

Localized reaction- detected in 48 to 72 hours(+) induration of 10 mm or above

Immunocompromised = >5mm

ONLY Exposure


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Tuberculin test. Erythema and induration at site of intradermal

injection of 5 tuberculin units in a child with primary tuberculosis.

This is an unusually severe reaction. Mantoux method.


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CATEGORIES OF TB

category I (new PTB) - (+) sputum(+) chest xray

category II (PTB relapse not less than 6 mos)

category III (active PTB case) - (-) sputum (+)chest x-ray, regression of infiltrates

Category 1Vpartially treated; poor compliance to

DOTS Category VPTB suspect ( (+) skin test; (+) family

member with PTB

Management:


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Management:

short course6-9 months

long course9-12 months DOTS- directly observe treatment short course

* 2 wks after medicationsnon communicable

3 successive (-) sputum - non communicable

rifampicin or INH- prophylactic


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Primary Anti TB Drugs

1. Rifampicin =

SE = orange colored urine, GI upset,

Jaundice, Renal failure, thrombocytopenia


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Primary Anti TB Drugs

2. Isoniazid (INH) = ( Bacteriostatic) inhibits

( Bactericidal ) kills

Used prophylactically to patients (+) of PPD

SE = Rashes (give anti-histamine); Peripheralneuritis ( Give Vit B6- Pyridoxine)50 mg;Jaundice

Hepatotoxicity

3 Pyrazinamide ( PZA)


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3. Pyrazinamide ( PZA)

SE = Hyperuricemia ( inc uric acid)

Mx: Inc fluid intake4. Ethambutol = 15-20mg/day

SE = Optic neuritis ( dec visual acuity)

Give Vit. B6(Pyrdoxine)

5. Streptomycin

SE = Ototoxicity, 8th cranial nerve damage

( Tinnitus, dizziness, N&V)


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MDT side effects

r-orange urine

i-neuritis and hepatitis

p-hyperuricemia

e-impairment of vision

s-8th cranial nerve damage


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TREATMENT: CATEGORY 1 - NEW PTB, (+) SPUTUM

GIVE RIPE 2 MONTHS, MAINTENANCE OF RI 4 MONTHS

CATEGORY 2 - PREVIOUSLY TREATED WITH RELAPSES

GIVE RIPES 1ST 2 MONTHS, RIPE 1 MONTH,MAINTENANCE RIE 5 MONTHS

CATEGORY 3 - NEW PTB (-) SPUTUM FOR 3X

GIVE RIPE 2 MONTHS, MAINTENACE RI 2 MONTHS

CATEGORY 4 - REFER

* IF RESISTANT TO DRUGS GIVE ADDITIONAL MONTH/S AS

PRESCRIBED

PTB- NURSING


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PTB NURSING

MANAGEMENT1. MAINTAIN REPIRATORY ISOLATION

2. Administer medicine as ordered

3. Always check sputum for blood or purulent expectoration

4. Encourage questions and conversation so that the patientcan air his or her feelings

5. Teach or educate the patient all about PTB

6. Encourage patient to stop smoking

7. Teach how to dispose secretion properly8. Advised to have plenty of rest and eat balanced diet

9. Be alert of drug reaction

10. Emphasize the importance of follow-up

PULMONARY TUBERCULOSIS


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( Kochs Disease/Phthisis/ consumption

Disease)

PREVENTION:

1. Submit all babies for BCG immunization

2. Avoid overcrowding

3. Improve nutritional and health status4. Advise persons who have been exposed to infected

persons to receive tuberculin test if necessary CXR

and prophylactic isoniazid.

Paralytic shellfish Poisoning


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y g

Red Tide Poisoning Pyromidium Bahamense ( Algae), Dinoflagellates

Plankton Ingestion of Saxitoxin in contaminated bi-valve shellfish

Saxitoxin binds w/ Na channels leading to loss of skeletalmuscle excitability

IP 15 min- 12 hrs

S/sx: Circumoral and extremity numbness, nausea andvomiting, headache ( bec of the toxins),dizziness, muscleand respiratory paralysis, rapid pulse, difficulty of speech

Dx: history

Mgmt: emesis/gastric lavage + activated charcoal,supportive

Paralytic shellfish Poisoning


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y g

Red Tide Poisoning

Dx: history

Mgmt:

1. Induce vomiting (gastric lavage + activated charcoal)

2. Drink pure coconut milk ( weakens toxins) in the early

stage3. Give NaHCO3(25 mgs) in glass of water

4. Avoid using vinegar in cooking shellfish affected by redtide ( 15x increase when mixed with acid)

5. Toxin of red tide is not totally destroyed in cooking6. Avoid eating tahong , halaan, Kabiya, abaniko during

red tide season

communicable diseases - antipona

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