NCM104.Communicable Diseases

7/31/2019 NCM104.Communicable Diseases

1/18

injection n the skin of Sporozoite

travels in the bloodstream and live/mature in theliver

release of merozoites in the bloodstream

manifestations of Signs and Symptoms

invasion of RBCs

RBC's lyse and release new parasites

invasion of new RBC's by the newgen parasites

Take up by Anopheles mosquito

Malaria

Acute and chronic parasitic disease transmitted by the bite of infected mosquitoes and it is confined mainly to tropical and subtropical areas

EtiologyP. falciparum, P. vivax, P. malariae, P. ovale

Bite form Anopheles species mosquito Diagnostic Exams Medical Management Nursing ManagementIncubation period 12-30 days

Pathophysiology Clinical Manifestations

CBC_Low Hemoglobin,

low hematocrit

Malarial Smear_

presence of malarial

antigen

Rapid diagnostic

test(RDT)_ detect

malarial parasite antigen

in the blood

Anti-malarial drugs

Chloroquine

Quinine

Sulfadoxine for the

resistant P.

falciparum Primaquine for relapse

of P. vivax & ovale

Erythrocyte exchange

transfusion for rapid

production of high

levels of parasites in

the blood

Monitor VS

Monitor I and O,

Bilirubin and parasitic

levels

TSB during febrile

periods

Offer large amount of

fluids

Monitor for quinine

toxicity

Monitor for bleeding

Pathognomonic sign:

P-rofuse sweatingH-epatomegalyA-nemiaS-pleenomegalyE-levated temperature

Fever

Shaking chills

muscle pains

back pain

nausea

headache

Myalgia, with feeling of

well-being in between

Vomiting

Changes in sensorium

Orthostatic

hypotension

Health TeachingAdvise to avoid being bitten by mosquitoes, use long clothes, and avoid using

perfumes of colognes, and use repellants such as lotions, etc. especially during dusk

to dawn.


2/18

Meningitis

Inflammation of the lining around the brain and spinal cord caused by a bacteria or virus.

Etiology

Neisseria meningitides

thru droplet transmission of pharyngeal secretions

penetrating head or spinal wound

direct invasion from otitis mediaDiagnostic Exams Medical Management Nursing Management

Incubation period 1 to 10 days


Lumbar

Puncture/CSF Gram

staining-low glucose,

high protein, highWBC

CT/MRI-see shift in

skull contents

Cephalosphorins-

(ceftriaxone)

Ampicillin

Aminoglycosides Digitalis

Acetaminophen

Mannitol

anticonvulsants

monitor vital signs

monitor neurologic

status

maintain adequate

nutrition andelimination

follow strict aseptic

technique when

carrying out

procedure

isolation

Pathognomonic sign:

nuchal rigidity

neck, shoulder and

back stiffness

opisthotonus

+ kernigs sign

+brudzinskis sign

Headache

Fever w/ chills

Photophobia

petechial,

purpuric, or

ecchymotic

hemorrhages

alteration in LOC

Health Teaching eat foods rich in protein

teach patient the purpose of his isolation Provide support to the family and patient.

Entry of microorganism in the bloodstream

crossing the blood brain barrier

proliferation of microorganism in the CSF

release of cell wall fragments andpollysaccharides

inflammation

increase ICP


3/18

Dengue Hemorrhagic Fever

an acute febrile disease caused by infection with one of the serotypes of dengue virus

Etiology Bite of mosquito (Aedes specie)Diagnostic Exams Medical Management Nursing Management

Incubation period 3-14 days commonly 7-10 days


Tourniquet test-

fragile veins

Rumpel Leads test-

more than 20

petechiae in a square

inch

CBC-low platelet

count, elevated

hematocrit Guaiac stool exam-

presence of blood

Analgesics except

aspirin

IV fluids for

replacement

Oxygen therapy

Monitor vital signs

Apply cold ice pack to

patients nose bridge

and forehead during

epistaxis

Keep patient in a

mosquito free

environment

Position patient-trendelenburg;

Avoid puncturing the

patients skin

isolation

Pathognomonic Sign

S hock

H igh fever and

H emoptysis

A bdominal pain

M elena

E pistaxis

Bleeding gums

Purple blanched skinwith rash

convulsions

Anorexia

Vomiting

Myalgia

Health Teaching

Avoid too many hanging clothes outside the house

Change water in the vase everyday, dont leave clean water unsealed

Use insecticides

Use mosquito repellants

virus deposited in the skin

replication of virus at site of infection and lymphatictissue

viremia 4-5 days after onset of symptoms

macrophages are the initial site of infection

increase in vascular permeability, hypotension,hemoconcentration, thrombocytopenia, with increased

platelet agllutinability and moderate DIC

hypovolemic shock


4/18

Chickenpox/Varicella

An acute and highly contagious disease caused by Varicella zoster, characterized by vesicular eruptions on the skin and mucous membrane with mild constitutional

symptoms.

Etiology Airborne and contact with infected personDiagnostic Exams Medical Management Nursing Management

Incubation period 10-21 days


Complement Fixation

Test to determine

the V-Z Virus

Electron Microscopic

Exam of the vesicular

fluid

Zoverax

Oral antihistamine

Calamine lotion

Antipyretic

RespiratoryIsolationis a must until all

vesicles have crusted.

Prevent secondary

infection of the skin

lesion through hygienic

care of the patient.

Linens must be

disinfected under the

sunlight or through

boiling. Cut fingers nails short

and wash hands more

often.

Provide activities to

keep child occupied to

lessen pruritus

pre-eruptive

mild fever and malaise

Eruptive Stage

a. Rash starts from

the trunk, then spread

to other parts of the

body.

b. Initial lesions are

distinctivelyredpapules where

contents become milky

and a pus-likewithin 4

days.

Health Teaching tepid bathing or cool compresses may help to alleviate itching Advise stay away from work or school until fully recovered

entry of virus(inhalation)

viral replication in regional lymph nodes

production of immunoglobulins

spread of viral particles over the skin

appearance of vesiculo-papular rash

crusting(convalescence)


5/18

Influenza

An acute viral infectious disease affecting the respiratory system caused by influenza virus A,B, and C.

EtiologyAirborne and contact with infected person and indirectly through

articles Diagnostic Exams Medical Management Nursing ManagementIncubation period 24-72 hours


CBC-elevated WBC

PCR testing-presence

of influenza virus

Influenza specific

antibody

Antipyretics

Monitor VS

TSB

Encourage enough

fluid intake-replace

fluid loss

Promote bed rest

Encourage to deepbreathe

Give antipyretics

Fever

headache,

myalgia

lethargy

coryza

sore throat

cough

nausea

vomiting

diarrhea

Croup

Health Teaching Encourage proper body hygiene and regular hand washing

Advise family no to use same things as the patient

Advice not to use aspirin.

entyr of microorganism in the body

bacteria travels in the bloodstream

bacteria damages the epithelium of thetracheobronchial tree

activation of immune processes

fever and other signs and symptoms


6/18

Leptospirosis

Zoonotic infectious bacterial disease carried by animals, both domestic and wild, whose urine contaminates water or food which is ingested or inoculated through the

skin.

EtiologyLeptospira interrogans

Urine of animals (esp. rats) contaminated with this

bacteria Diagnostic Exams Medical Management Nursing ManagementIncubation period 24-72 hours


Serologic Test:

Microscopic

Agglutination test

(MAT)

Isolation of

Leptospires:

= 1 7 days - from blood= 4 10 days - from CSF

(during acute stage

= after 10th day - from

urine

Penicillin GNa Tetracycline

erythromycin

Peritoneal Dialysis

Administration of fluidand electrolyte and

blood as indicated.

Isolate the patient,

urine must be

properly disposed of.

Keep patient under

close surveillance.

For home care, dirty

places, pools, andstagnant water must

be cleaned.

Eradicate rats androdents.

Fever lasting 4 7

days

Chills, headache,

anorexia, abdominalpain

With or without

jaundice

Convulsions

Health Teaching Encourage proper body hygiene Tell how the disease is acquired and the possible prevention methods.

entry of bacteria through broken skin or mucousmembrane

damage in the blood, kidney and liverparenchyma

activation of antibodies and immune cascade

lysis of the infected cell

malfunction of the affected organs and blood

blood stream invasion of leptospire and retentionto other tissues


7/18

Pertussis/Whooping cough

infectious disease characterized by repeated attacks of spasmodic coughing which consists of a series of explosive expirations, typically ending in a long-drawn forced

inspiration which produces a crowing sound, the whoop & usually followed by vomiting

Etiology Bordetella pertussis Contact with respiratory droplets Diagnostic Exams Medical Management Nursing Management



PCR test-Positive for

B.pertussis RNA

Nasopharyngeal swabs

Sputum culture

CBC (Leukocytosis)

Fluid & electrolyte

replacement

adequate nutrition

oxygen therapy

Antibiotics

(erythromycin &ampicillin)

DPT vaccine

Isolation and asepsis

should be carried out.

Should not leave the

patient alone.

Suctioning equipment

should be ready at all

times for emergency

use to avoid airway

obstruction.

Sunshine & fresh air

are important. Provide warm baths,

keep the bed dry &

free from soiled

linens.

Intake & output

should be closely

monitored.

Pathognomonic Sign:

Whooping cough

Coryza

Sneezing

Lacrimation

Cough

low-grade fever

Health Teaching Advise to submit to immunization

entry of bacteria through airways

attachment to bronchial epithelium

proliferation of bacteria

inflammation

mucopurulent discharges which can lead tosanguinous discharges

compromised airways

respiratory failure


8/18

Measles/Rubeolla/Morbilli

An acute, contagious and enanthematous disease caused by Morbilivirusthat usually affects children which are susceptible to URTI.

EtiologyDroplet spread of infected person or indirectly through soiled

articles Diagnostic Exams Medical Management Nursing Management



CBC

Anti-measles IGM

Measles RNA

Nose and throatswab

Anti-viral drugs

(Isoprenosine)

Antibiotics if with

complicationSupportive therapy

Monitor VS

Isolate the

patient(strict

isolation)

Provide Enough fluids

TSB for fever

Oral hygiene and skin

care

Pathognomonic Sign:Kopliks spot3 Cs: Conjunctivitis,

Coryza and Cough

Fever

Red blotchy rashappears on the 3rd

day to 7th day in

cephalocaudal

direction

Hot Skin

Sore throat

Health Teaching Advise to submit to immunization

entry of virus through the upper respiratory

multiplication and spread of virus to lymphatic tissue

establishment of infection in the skin and tissues of resp.tract.

koplik's spots

development of rashes


9/18

Leprosy/Hansens Disease

a slowly progressive bacterial infection involving the cooler body tissues, skin, superficial nerves, nose, pharynx, larynx, eyes and testicles

EtiologyMycobacterium leprae

Through droplet transmission and thru break in the skin and

mucous membraneDiagnostic Exams Medical Management Nursing Management

Incubation period 9 months to 20 yearsPathophysiology Clinical Manifestations

Slit Skin Smear -

determines the

presence of M. leprae;

Lepromin Test

determines

susceptibility toleprosy (+)-

tuberculoid;(-)-

lepromatous.

Mitsuda Reaction

PAUCIBACILLARY

Rifampicin

Dapsone

MULTIBACILLIARYRifampicin

Dapsone

Lamprene

Monitor patients

vital

Maintain a clean

environment to avoid

secondary infection

Avoid contact with

children/infants Avoid prolonged skin

to skin contact with

the patient

Maintain balance

nutrition, sleep and

rest

skin color change- red or

white

sensation loss

Loss of sweating and hair

growth

Thickened and painful

nerves

Muscle weakness or

paralysis

Pin and redness of the

eyes Nasal obstruction/

bleeding

Ulcers that do not heal

Late Signs:

Madarosis

Loss of eyebrows

lagophthalmos

Clawing of fingers and toes

Contractures

Chronic ulcers

Sinking of the nosebridge

gynecomastia

Health Teaching Advice vaccination-BCG Advice to maintain a good hygiene

M. lerprae enters the system upon droplet orprolonged contact

Agent spreads out in the system and navigates thebody through thermoreceptors into cell membrane of

the bacteria

M. leprae proliferates to cooler areas of the bodyavoiding the warm interior areas in the viscera

M. leprae accumulates and duplicates to theperipheral nerves, mucosa, epidermis, surface of the

nose and mouth

Bacteria attacks the skin and produces skin lesions,light-colored patches of skin that often develop

anesthesia, or loss of sensation

Trauma/injury aggravates these skin lesions and thebody fails to develop to respond and repair to the

injury

These lesions lead to severe disfigurement of thepatient


10/18

Tetanus/ Lock Jaw

A highly fatal disease caused by anaerobic bacteria characterized by muscle spasm and rigidity.

EtiologyClostridium tetani

Indirect contact ,soil, street dust, animal and human

feces, punctured woundDiagnostic Exams Medical Management Nursing Management

Incubation period 3 days to 1 month


No Specific

diagnostic exam,only a history of

punctured wound

ATS

Tetanus Toxoid Diazepam

Pen G

Maintain an

adequate airway

Adequate fluid

and electrolytes

No restraints Proved quiet semi

dark environment

Skin test before

administering

serums

Pathognomonic Sign:Risus Sardonicus /

Sardonic Smile

Lock jaw/ Trismus

Opisthotonus

Laryngeal/ pharyngeal

spasm Generalized muscular

rigidity

Health Teaching Advise patient to always clean wounds with soap and water.

entry of bacteria

production of toxins

circulation of the toxins through the body

entry of the toxins in the spinal cord

uptake by neuromuscular junction of thetoxin

after 3 days to 1 month- muscle spasm

signs and symptoms

death


11/18

Diphtheria

characterized by formation of pseudomembranre commonly in the faucial area and tonsils by the exotoxin produced by Corynebacterium diphtheriae

Etiology Corynebacterium diphtheriathru dropletDiagnostic Exams Medical Management Nursing Management



schicks test

determine

susceptibility or

immunity

nose and throat swab

maloneys test

determinehypersensitivity to

diphtheria toxoid

Diphtheria

Antitoxin

Penicillin or

Erythromycin

Tracheostomy for

laryngeal

obstruction

Assess the

patients ability to

swallow before

giving medications

Provide ice packs

to relieve pain

Isolate patient

with respiratory

precautions

Pathognomonic Sign:

Pseudomembrane

Bull neck Dysphagia

Dyspnea

Health Teaching

Advise to take adequate fluids Encourage to maintain oral hygiene

Encourage to deep breath and cough effectively

absorption of toxins in the mucous membrane

destruction of epithelium

superficial inflammation

formation of pseudomembrane( necroticepithelium, leukocytes, fibrin)

bacilli continue to produce toxins

parenchymatous degeneration, fatty inflitration,necrosis of heart muscles, liver, kidney, adrenals

nerve damageparalysis of soft palate, eye musclesand extremities


12/18

Rabies/Lyssa/Hydrophobia

severe viral infection of the CNS that is communicated to human in the saliva of infected animals or human caused by rabies virus

Etiology Rhabdovirus of the genus lyssavirusDiagnostic Exams Medical Management Nursing Management

Incubation period 2-8 weeks

Pathophysiology

Clinical Manifestations

1. negri bodies in the

brain

2. history of exposure

3. flourescent RABIES

ANTIBODY (FRA)

TECHIQUE highly

preferred diagnostic

exam wherein the

fluorescent rabies

antibody is allowed to

react with its specificantigens in culture or

smear and the result is

in precipitate form -

positive

Immunizations

Anti-rabies vaccine

Human diploid cell vaccine

(hdcv)Duck embryo vaccine

RABUMANHYPER RAB

IMOGRAM Symptomatic

treatment/no cure

Monitor patient

for signs and

symptoms

Administer the

prescribed

immunization

Pathognomonic Sign:

hydrophobia

paralysis

fever

PRODROMAL

Headache

Sore throat

Unusual salivation

Diaphoresis

Low grade fever

EXCITEMENT

Increased anxiety

Hydrophobia Pharyngospasm

Photophobia

Aerophobia due to

laryngospasm

Maniacal behavior

PARALYTIC

Die of paralysis

Respiratory or

cardiac arrest

Health Teaching Tell patient to wash bite wounds with soap and water and immediately go to a

health center

Advise patient to take care of their animals

entry of virus in the body

attachment of viral glycoprotein in the nicotinicacetylcholine receptor of muscle

initial replication in the myocytes

virus spreads until it reach the spinal cord and CNS

virus spreads in the skin, intestine, salivaryglands(shed in saliva)

deterioration of CNS

death


13/18

Tuberculosis

An infectious disease that primarily affects the lung parenchyma and can be transmitted to other parts of the body.

Etiology Mycobacterium tuberculosisDiagnostic Exams Medical Management Nursing Management

Incubation period 4 6 weeks


Sputum examination or

the Acid-fast bacilli

(AFB) / sputum

microscopy

Chest X-ray

Tuberculin Test

purpose is to

determine the history

of exposure to

tuberculosis

Rifampicin

Isoniazid

Pyrazinamide

Ethambutol

Streptomycin

Isolate patient

Monitor vital signs

Maintain a patient

airway

Collaborate with

dietician for diet

Pathognomonic Sign:

Blood-tinged sputum

Fever and chills

Night sweats

Dyspnea

Non-productive

/productive cough with

purulent sputum Loss of appetite

Weight loss

Health Teaching Encourage patient to adhere to treatment regimen Promote activities and encourage rest between deeds

bacteria is inhaled by the host

travels in the airways and in the blood stream

damages the lung parenchyma

macrophages and lymphocytes attack the bacteria

production of mucopurulent and blood tingedsputum

other bacteria proliferates in the lymphatic tractand in the blood stream which damages other

organ and systems


14/18

German Measles/Rubella

An acute contagious virus disease that is in milder form compared to measles but is damaging to the fetus when occurring early in pregnancy and is caused by togavirus.

Etiology RUBELLA VIRUS thru direct or indirect contactDiagnostic Exams Medical Management Nursing Management

Incubation period 3 days


Rubella Titer-

indicates

susceptibility to

rubella

MMR

Analgesic and

antipyretics

TSB for fever

Oral hygiene

Give enough fluids

Provide skin care

Promote bed rest

Pathognomonic Sign:

Forscheimer spots

Maculopapular rashes

Headache

Low-grade fever

Sore throat

lymphadenopathy

Health Teaching Advise the mother not to get pregnant three months after receiving MMR Tell the patient that the disease is self-limiting

entery of bacteria directly, indirectly ortransplacentally

travels in the blood stream

initiation of inflammation

nasal congestion

swelling of the glands and fever

travels in the skin and produces rash

in the placenta, it prodeuces congenital anomalies


15/18

Hepatitis B

A fatal hepatitis that tends to persist in the blood serum and is transmitted by contact in infected blood and body fluids.

Etiology Hepatitis B virus thru blood, body fluids, placentaDiagnostic Exams Medical Management Nursing Management



Hepatitis B surface

agglutination

(HBSAg) test

Liver enzymes,

such as serum

aspartateaminotransferase

and alanine

aminotransferase

levels, are elevated

Hepatits

immunoglobulin

lamivudine [Epvir] adefovir [Hepsera

Promote a diet

rich in protein,

vitamins and

minerals

Monitor vital signs

Promote bed rest

Assess patient for

bleeding

tendencies

Provide pain reliefmeasures such as

heat, back rubs,

positioning,

relaxation

techniques, and

age-appropriate

diversion

clay-colored stools

jaundice

steatorrhea

right-sided

abdominal pain yellowish sclera

anorexia

nausea and vomiting

Health Teaching encourage patient to avoid greasy foods discuss ways to avoid acquiring the disease

entry of virus in thebody

virus travels in thebloodstream

release of viral DNA inthe hepatocytes

infection

direct cell lysis

appearance of signsand symptoms

activation of theantibodies

antibodies acts on theinfected cells of the

liver

lysis of the infectedcell

appearance of signsand symptoms


16/18

Filariasis

It is a parasitic disease caused by an African eye worm, a microscopic thread-like worm. The adult worm can only live in human lymphatic system and can cause extensive

disability and gross disfigurement.

EtiologyWuchereria bancrofti

through the bite of Aedes mosquito Diagnostic Exams Medical Management Nursing ManagementIncubation period 8 to 16 months


Circulating filarial

antigen- finger

prick blood droplet,

taken any time of

the day and gives

result in a fewminutes

Nocturnal blood

examination-

performed at night

time pass 8:00 pm

diethycarbamazine

citrate (hetrazan)

surgical treatment for

hydrocele

monitor vital signs

During chronic

stages, provide

safe environment

to reduce

incidence of injury

Monitor intake and

output and weigh

daily forevaluation

Reduce noxious

environment to

relieve pain and

discomfort

Presence of filariae

in the blood

Lymphadenitis

Lymphangitis Affectation of male

genitalia

Hydrocele

Lymphedema

Elephantiasis

Health Teaching

Reinforce compliance to treatment regimen

Stress importance of good handwashing technique and proper body hygiene Stress importance of mobility during chronicity

Use of mosquito repellents; Anytime fumigation

Wear a long sleeves, pants and socks

entry of worms in the mosquito's body after biting aninfected person

mosquito bites an uninfecetd person

worms live for 7 years in the lymphatic system andreleases microfilaria in the bloodstream

the person can transmit again filariae via mosquitobites

the larvae matures in the lymph nodes

the person must have several bites

damage in the kidney and lymph vessels

swelling in the arms, genitals, legs

enlargement of tissues due to blood vesselobstruction by the worms


17/18

Bacterial Pneumonia

Disease of the lungs that is characterized by inflammation and consolidation of lung tissue followed by resolution is accompanied by fever, chills, cough, and difficulty in

breathing and is mainly caused by infection.

EtiologyPneumococcus, streptococcus

pneumoniae, staphylococcus aureus, Klebsiella pneumonia

Droplet transmissionDiagnostic Exams Medical Management Nursing Management

Incubation period 2-3 daysPathophysiology Clinical Manifestations

Chest x-ray

Sputum culture for

confirmation

Signs and

symptoms Dull percussion of

lungs

Oxygen inhalation

Antibiotics

Mucolytics

Bronchodilators suctioning

Monitor vital signs

Monitor O and I

Promote bed rest

Increase OFI

TSB for fever

Promote optimal

positioning

CPT

Pathognomonic Sign:

Rusty sputum

Chest pain

Intercostal retraction

tachypnea Nasal congestion

Cough

orthopnea

Health Teaching Teach patient breathing and coughing exercise

Tell the patient necessary precautions to avoid transmission

Encourage to adhere to treatment regimen

entry of microorganism in the body

travel of microorganism in the bloodstream

infection of the alveoli

production of exudates and cell-bacteria debris duecellular immunity which fill the alveolar spaces

scattering of infection in the lungs

stiffening of the lungs due to scarring which can leadto hypoxemia

hypoxemia and other signs and symptoms


18/18

Cataracts are the leading cause of preventable blindness among adults in the United States. The incidence of cataracts in the United States is 1.2 to 6.0 cases per 10,000 people. A cataract is defined asopacity of the normally transparent lens that distorts the image projected on the retina. The lens opacity reduces visual acuity. As the eye ages, the lens loses water and increases in size and density, causing

compression of lens fibers. A cataract then forms as oxygen uptake is reduced, water content decreases, calcium content increases, and soluble protein becomes insoluble. Over time, compression of lens fiberscauses a painless, progressive loss of transparency that is often bilateral. The rate of cataract formation in each eye is seldom identical. Without surgery, a cataract can lead to blindness.

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NCM104.Communicable Diseases

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