Professional Documents
Culture Documents
• Communicable disease are most often the leading cause from a mother to her infant during
of illness in our country today childbirth
• Knowing what type of communicable disease could • Three Primary routes (Contact, droplet and airborne)
prevent a health care provider from acquiring or • Two lesser routes ( Vehicle and vector)
harboring the disease
Primary Routes
COMMON TERMS • A. Contact- most frequent source of nosocomial infection
• Epidemiology – science that study the patterns of • 1. Direct contact- transmission body to body and physical
health and disease, its occurrence & distribution for the transmisssion (sexual intercourse, kissing or touching)
prevention and control of disease. • 2. Indirect contact- contact with contaminated
• Sporadic – occasional or intermittent occurrence of intermediate object ( needle, dressing or dirty hands)
disease with no specific pattern • B. Droplet- transmission of large particle droplets ( larger
• Endemic - constant or continuous occurrence of disease the 5 microns) Diphtheria, pertusis, pnuemonia, etc.
• Epidemic – sudden increase in # of cases in short • C. Airborne- transmission of small particle droplets or
period of time, an outbreak residue of 5 microns ( measles, varicella, TB)
• Pandemic – worldwide epidemic
• Attack rate Two lesser routes
• is the number of cases developing in a group • Common Vehicle: transmission by contaminated items
people who were exposed to the infectious such as food, water or devices.
agent INFECTIOUS DISEASE PROCESS or CHAIN OF INFECTION • Vector borne: Mosquitoes, fleas, rats, etc.
• Morbidity rate • Infectious Agent 5. Portal of entry
• calculated as the number of cases of illness • Reservior • Mucous membrane, gastrointestinal (GI) tract,
given time period divided by the population at • Portal of Exit Genitourinary (GU) tract, Respiratory tract, Nonintact
risk. • Route of Transmission of MO skin
• Mortality rate • Portal of Entry 6. Susceptibility of the host
• the percentage of population that dies from • Susceptible Host • A host who is immunosuppressed, fatigue,
disease malnourished, weakened by other diseases, elderly,
• incidence Six links form the chain of infection stressed, or hospitalized with wounds, IV’s and catheters
• described as the number new cases in a are at high risk.
specific time period in a given population risk 1. Infectious agent (Microorganism): Bacteria, virus, fungi, etc.
• way of measuring the risk of an individual • A. Capability of producing an infection depends on: TRIAD OF DISEASE CAUSATION –
contracting the disease • i. Virulence and number of organisms present Epidemiologic Triad
• Prevalence • ii. Susceptibility of the host. 1. Host (suscepibility)
• reflects the number of total existing cases (both • iii. Existence of portal of entry - intrinsic or extrinsic characteristics
old and new) • iv. Affinity of host to harbor MO 2. Agent
• useful to assess the overall impact of the 2. Reservoir: Provide survival for organism 3. Environment
diseases on society • People, equipment, water, etc. - Medium for culture of MO and MOT
• Outbreak • A. Appropriate environment for growth and multiplication
• generally implies a cluster of cases occurring of microorganism must be present. Characteristics of an Agent
during a brief time interval and affecting a • B. Reservoir include respiratory, gastrointestinal, • Infectious dose – number of causative agent
specific population reproductive and urinary tracts, and the blood
3. Portal of exit
• Pathogenecity – ability to cause the disease
• Allows the microorganism to move from reservoir to host • Virulence / Potency – extent/severity of toxin quality
The Infectious Process • Antigenecity – ability to stimulate an anti-body response
• For an infection to occur a process involving six links or ( includes excretions, secretions, skin, droplets)
steps must be present 4. Route of transmission of MO (five routes)
• Types of transmission of pathogens: Viruses
• A. if any of the links are missing, the infection will not
– Horizontal transmission • can only multiply in living things as its reservoir
occur
• from one person to another through • can pass through the filters of the body, Blood
• B. Infection control measures can interrupt the process
contact, ingestion of food or water, or Brain Barrier & Placenta Barrier
by eliminating one or more of the steps.
via a living agent such as insect. • self limiting
– Vertical transmission • lasts for a specific length of time with or without
treatment,
• patients are treated according to the symptoms Goal: The person will have a change of KSA which eventually TB – BCG, DPT – DPT vaccine, Poliomyelitis – OPV,
• it’s the body’s own resistance that will fight the lead to a change in behaviour towards health or do some Hepatitis B , Measles
infection modification of behaviour.
• Bacteria 4 Temporary Contraindications for Immunization
• can multiply in both living and non-living things -doctor is the primary giver of health education (main
• can not pass through the filters of the body responsibility) • pregnancy
except for Treponema Palladium causing
-nurse is the key provider of information • immunocompromised
Syphilis which passes the placental barrier after
the 16th week (4th month of pregnancy)
B. Immunity/ Immunization • very severe disease
• INFECTIOUS DISEASES – disease caused by living MO
which may not be transmitted through ordinary contact. • Immunity - state of being resistant to infection or a state • recently received blood products
• CONTAGIOUS DISEASES – are diseases that can be of being free from infection
easily transmitted. 2 Permanent Contraindications for Immunization
• All communicable diseases are infectious but not all are • Immunization – the process of rendering immunity to an
easily transmitted individual • Allergy
• All infectious diseases are communicable but not all are
contagious 2 types of Immunity
• All contagious diseases are both communicable and
• encephalopathy without known cause or convulsions
within 7 days after pertussis vaccine
infectious 1. Active immunization occurs when a person’s own immune
system is activated and generates a primary immune response. C. Environmental Sanitation
Stages of Communicable Disease
• Communicabilty period- entry of MO a. Natural Acquired Active Immunity – the body 1. PD 856 – integrated all those working in night clubs
• Incubation period – time interval from the 1st exposure will contracts the disease and recovers and beer gardens to submit themselves for STD exams at least
from disease to appearance of the 1st s/sx. once a month and for gonorrhea at least twice a month.
• Prodromal – time interval from the 1st s/sx to b. Artificial Acquired Active Immunity- chemically
appearance of the characteristics sx of the disease. killed bacteria, weakened forms 2. PD 825 – anti-littering law or proper disposal of
• Stages of Illness – period when the characteristic sx of garbage
the disease are manifested by patient and others. - vaccine, toxoid
Fine: P2,000-5,000 or 6 months-1year imprisonment
• Convalescence – period of recovery, s/sx are gradually
2. Passive immunization - receives antibodies that were created in
disappearing D. Proper Supervision of Food Handlers
another person or animal.
3 Nursing Concerns in Dealing with a Patient with 1. DOH responsibility
a. Naturally Acquired Passive Immunity – maternal transfer of
Communicable Disease
antibodies (IgG/IgA)
• Know the causative agent 2. BFAD – monitor food and drugs for safe consumption
• Know what body secretions harbour the MO
b. Artificially Acquire Passive Immunity – intentionally given for
• Know the mode of transmission • II. Control Aspect – there is already infection but control
immediate protection from infection (ex: human immunoglobulin,
human serum, anti-toxin, anti-tetanus) or limit the spread of infection
General nursing Care for Patients with Communicable
Diseases
3 Laws of Immunization: • A. Isolation - separation of the infected person
• Preventive Aspect
– Health education based on the longest period of communicability of the
1. Expanded Program on Immunization (EPI) – PD #996
– Immunization disease.
– Environmental control
2. UN Goal: Universal Child Immunization (UCI) –
– Proper Supervision of Food Handlers
Proclamation #6
– Control Aspect
– Isolation
– Quarantine • Strict isolation – protecting other person by containing
– Disenfection the MO within the patient
3. Health for Filipino CY 2000: National Immunization
– Medical asepsis Day (NID) – Proclamation #46
I. Preventive aspect
Goal: To prevent the 7 Childhood Diseases for children
A. Health Education under 5 years old
• Reverse Isolation – protecting the patient • Airborne Precaution – use of respiratory protection such – death is usually due to complications (pneumonia)
wherein MO will be away from the patient as use of special types of mask = ultra filter mask or
particulate mask – affects children < 2y/o, malnourished
2 Revised Isolation Precaution to be practiced • Droplet Precaution – use ordinary mask and goggles CA: Paramyxovirus – rubeola virus
1. Standard Precaution • Contact Precaution – use of gloves and gowns MOT: Droplet spread or direct contact in some instances it is
Airborne
2. Transmission Based Precaution • B. Quarantine – limitation of freedom of movement of a
well person during the longest incubation period; Incubation period- 10 days from exposure
1. Standard Precaution – the primary strategy for preventing
nosocomial infection - quarantine of person with no disease but were 1. Pre-eruptive Stage – highly contagious stage
exposed.
• applies to all pts regardless of their dx - high grade fever – 3-4 days
• C. Disinfection – killing/destruction of pathogen by - 3 C’s – cough, colds, conjunctivitis
• applies to all body fluids, secretions and excretions mechanical or chemical
except sweat
- (+)Stimson sign / measle eye – puffiness of
the eyelid with linear congestion of the lower conjunctiva
• applies to non intact skin and mucous membrane
2 Ways of Attaining Disinfection: - Photosensitivity
Elements of Standard Precaution
CDC
• Concurrent – done when a person is still the - (+) enathem, fine red spot (grayish pecks) at the center
Centers for Disease Control and Prevention
source of infection found in the inner cheek just opposite the molars
• Handwashing - (Koplik’s spot) –pathognomonic
• Terminal – done when the patient is no longer the source
• Wear gloves if there is a possibility of direct contact with of infection 2. Eruptive Stage
blood or bodily secretions
• Sterilization - killing of all MO including spores – Rashes appear on the 3rd day - maculopapular,
• Gloves must be worn when in contact with items or
reddish, and blochy
surfaces soiled with blood or body fluids • Disinfestation - destruction of MO, insects, rodents or
• Removal of false fingernails
animals that are living in the human habitat that can – cephalo-caudal in distribution
transmit disease to man.
• Protect clothing with gowns or plastic aprons if there is 3. Post-eruptive Stage
possibility of being splashed or direct contact with • Fumigation – killing of arthropods and rodents using
contaminated material gaseous agents – fine, branny desquamation – peeling off
• Wear mask and/or goggles or face shields to avoid being D. Medical Asepsis from red color rashes, it will fade to brown then peel off excluding
splashed, suctioning, irrigations, during OR and skin
deliveries • Hand washing – the no. 1 principle
• Do not break needles into receptacles; rather discard • Use of protective barrier (PPE)
them intact and uncapped into containers
• Placarding – no smoking sign
• 2. Transmission Based Precaution – is instituted to
patients with highly transmissible infections. Precautions Integumentary System
are beyond the set for the standard precautions.
Measles
3 Ways to Practice Transmission Based Precaution:
-aka RUBEOLA, Morbilli, Little Red Disease, 7 day measles, 9
day measles, Hard measles of First Disease
Preventive Measures • Rubella Titer test – to determine the titer of
antibodies to german measles
• Avoid MOT
• If given to women who wants to bear a child à
• Immunization with Anti-measles vaccine (AMV) – 9 wait for 3 months
months old, 0.5cc SQ deltoid muscle
Treatment
– child may experience fever, mild rash formation
3-4 days after • Medical and Nursing treatment : Supportive care
– Extension of the extremities (gastrocnemius) Health teaching: fever, swelling and • MOT: Contact with saliva of a rabid animal, scratching,
tenderness, signs of convulsions w/in 7 days licking of wound by dogs
– Diaphoresis
Tetanus Toxoid given to pregnant women on the 2nd tri- • Incubation Period: animals = 3-8 weeks; humans = 10
– Low grade fever mester of pregnancy, 2 doses days-years
– Type of contraction: tonic Tetanus Toxoid given for persons in high risk to tetanus 2 Stages of Manifestations in Animals
3 Objectives in Nursing Management of tetanus: 1. Dumb Stage - depressive stage, manic behaviour
1. To prevent pt from having spasm – 2. Furious Stage – agitated, fierceful, drooling of saliva → will die.
Medical Management • ↓
Bacteria – common cause
• Mannitol - osmotic diuretic, removes CSF • Invasive or Abortive –stage when virus invades the host
• Preventive Measures: Proper disposal of nasal - flaccid (soft, flabby and limp) paralysis – • Muscle testing – test for threshold for pain
secretions, covering of mouth and nose, avoid MOT pathognomonic sign
• EMG
• Immunity: No permanent immunity 4 Types
• Stool exam – (+) all throughout the process
Poliomyelitis • Bulbar – CN9 (glossopharyngeal) and 10th (vagus)
affectation • Throat swab – maybe (+) in 2 weeks of the dse course
• aka Infantile Paralysis or Heine-Medin’s dse
- swallowing, vocal cord and respiratory • Supportive and Symptomatic
• high risk – below 10y/o paralysis
• Preventive Measurement:
• Spinal – c0mmon type, AHC affectation
• CA: Legio Debilitans virus
1. Immunization: OPV – Sabin Vaccine, given 6 weeks after birth
- paralysis of U/L extremities – uni or bilateral
Type 1 – Brunhilde – common in the Phil.
Instructions to mothers:
- intercostal muscle paralysis
Type 2 – Lansing
a. Don’t feed child 30 mins before administration
Type 3 – Leon • Bulbo-spinal – CN and AHC are both affected
b. If vomiting occurs, repeat dose
• Early Stage: Nasopharyngeal secretions • Landry’s – ascending paralysis (quadriplegia)
c. Be careful in handling the stool of the child who had
MOT: droplet received OPV
2. Avoid MOT
• Late Stage: found in stool
West Nile virus d. pathological vascular changes: petechiae and • Hematocrit (Hct) determination - ↑ in DHF due to
Herman sign (generalized flusing/redness of the skin hemoconcentration
Flavivirus
e. diagnosed as Dengue Fever or Dandy Fever or • Symptomatic treatment
• MOT: biological transmitter – Aedes Aegypti Breakbone Fever
• Antipyretic – but never give Acetyl Salicylic or Aspirin
mechanical transmitter – Celux fatigan • Grade 2 (ASA)
• day biting and low flying mosquito a. persistence of s/sx of Grade 1 + Bleeding • Reye’s Syndrome – a neurologic d/o associated with
viral infection (<12y/o)
• breed in clear stagnant water
b. bleeding from: 1. nose – epistaxis • Vit K (Aquamephyton, Phytomenadion, Synkavit and
• urban area Konakion)
• white stripes on legs, gray wings 2. gum - gum bleeding
• Vit C
3. stomach -
• Blood Transfusion
Mosquito (Aedes Aegypti) 4. hematemesis, melena,
hematochezia • 1. To prevent and control bleeding
↓
• Grade 3 a. Epistaxis
Bloodstream
a. persistence of s/sx of Grade 2 + Circulatory Failure b. Gum Bleeding
↓
b. cold clammy skin c. Hematemesis
Creates multiple lesions in the bloodstream
c. check for capillary refill d. Melena
----------------------------------------------------
d. hypotension, very rapid weak pulse and rapid • Supportive & Symptomatic
↓ respiration
• Increase body resistance – proper nutrition and
↓
• Grade 4 adequate rest
↑ capillary fragility ↑ capillary permeability
a. persistence of s/sx of Grade 3 + Hypovolemic Shock • Preventive Measures:
( easily bleeds ) (allows shifting of fluid fr 1 → Death
CLEAN Program of DOH
comp to another)
• Torniquet Test or Rumpel Leede Test - presumptive
C- hemically treated mosquito net
↓
↓ • Test for capillary fragility
L- arva eating fish
Thrombocytopenia edema, ascites, and • 3 Criteria before performing Torniquet test
E- nvironmental Sanitation
hemoconcentration
1. 6 months or older
A- nti mosquito soap/off lotion
2. fever > 3 days
N- atural mosquito repelant trees
• Grade 1
3. (-) signs of DHF- fever of 3 days
• Immunity: No permanent immunity ---------------------------------- Tuberculosis
4. Plasmodium Ovale • Hot Stage – fever, chills, vomiting, abdominal pain (4-6 • S/Sx:
hours)
- Only female mosquitoes suck blood 1. low grade fever with night sweats
Nursing Care:
- P. Vivax and P. Falciparum – common causes of 2. anorexia and weight loss
• Wet Stage – profuse sweating, feeling of weakness
malaria in the Phils. 3. fatigability
Nursing Care: Make patient comfortable
• MOT: mosquito bite, blood transfusion 4. chest pain and dyspnea
Keep patient warm
5. dry cough à productive (yellowish/greenish) à
• Night biting from dusk til dawn
blood streak sputum/hemoptysis – pathognomonic sign
Increase fluid intake
6. back and epigastric pain
• Cerebral Hypoxia – caused by P. falciparum causes
• Breeds in a clear slow flowing water anemia 7. anemia and amennorhea in female
• Rural areas – mountains and forest • Diagnostic Examinations: • Tuberculin skin testing – screening, ID
• Lands on surface – 45 degrees angle/slanting 1. Malarial Smear/ Blood Smear – blood is extracted at - a presumptive test
peak of fever
- Mantoux test – most reliable skin test for TB.
2. Quantitative Buffy Count (QBC) – no need for the
height of fever to set in - 0.1 cc Purified Protein Derivative, volar aspect
• Medical Management: - bleb or wheal formation
1. Chloroquine (Aralen) – mainstay =<or = to 4mm à negative
2. Other Drugs: Primaquine, Atabrine, fansidar and = 5-9 mm à doubtful (repeat the test)
Quinine (reserve drug for severe cases)
If infected by mosquito = > or = 10mm à positive
• Used cautiously for pregnant women
↓ • Sputum Examination – confirmatory, done in 3 series
• Immunity: No permanent immunity
Blood stream
• 3. Chest X-ray - not definite test, tells only the extent of c. Pyrazinamide (P)– causes hyperurecemia Diphtheria
involvement of the lungs
d. Ethambutol (E)– causes irreversible optic neuritis that • acute contagious dse char by generalized toxaemia
• According to extent of disease based on cavitations brings about blindness coming from a localized inflammatory process known as
within the lungs PSEUDOMEMBRANE.
• 2. Standard Regimen(SR) – Streptomycin, Isoniazid &
a. Minimal Ethambutol (SIE) • CA: Corynebacterium diphtheria or Klebs-Loeffler
bacillus
b. Moderately advanced a. Streptomycin (S)
• MOT: Droplet (direct contact) – affects all ages
c. Advanced – (+) of cavitations within the lungs Side Effects: 1. Nephrotoxicity
• Nasal
• According to clinical manifestations 2. Ototoxicity – CN8
(tinnitus/vertigo) - dryness, excoriation of upper lip and nares
a. Active PTB
• 3. Directly Observed Treatment Short Course (DOTS) - (+) of pseudomembrane in the nasal
b. Inactive PTB WHO- “tutuk gamutan” turbinate– pathognomonic sign
• According to American Pulmonary Society 5 Elements: - grayish-white membrane with
leathery consistency
a. TB 0 – (-) exposure (-) infection (-) tuberculin testing 1. Political will to support the program
b. TB I- (+) exposure (-) infection (-) tuberculin testing • Pharyngeal – (+) bullneck appearance (enlargement of
2. Microscopic availability the cervical lymphnode)
c. TB II – (+) exposure (+) infection (+) tuberculin testing 3. Steady supply of medicine
(-) s/sx • Laryngeal – (+) respiratory distress
4. Personnel – RN and midwife - (+) hoarseness/aponia
d. TB III – (+) exposure (+) infection (+) tuberculin testing
(+) s/sx 5. Documentation and recording - (+) laryngeal stridor – brassy metallic cough
• Short Course Chemo therapy – Rifampicin, Isoniazid, D – iet - small frequent nutritious foods
Pyrazinamide Ethambutol (RIPE) • Nose and Troat Culture
D – rugs - adequate drugs and emphasize
a. Isoniazid (INH) – mainstay drug importance of compliance • Shick’s Test – to determine resistance or susceptibility to
diphtheria
- 6mons for carrier & inactive adult patient R – est - conserve energy
• Moloney’s Test – to determine hypersensitivity to
- 9mons for children • Contraindicated Nursing Care: Do not do chest diphtheria
physiotherapy
- 12mons for immunocompromised patients *Removal of the pseudomembrane is not encouraged à facilitate
• Avoid MOT bleeding and fast regrowth
Side Effects: 1. Peripheral neuropathies/neuritis
• Immunization with BCG immediately after birth 0.5cc ID • Neutralize toxin
a. Foods rich in Vit B6 ® deltoid area
(pyroxidine) ADS – IM,IV ANST; if (+) give in fractional
Instruction to mothers: don’t massage the dose – desensitization
2. Hepatotoxicity – (+) jaundice area, (+) fever, (+) abscess formation on
the site of injection →scar IV fluid to dilute toxin
a. Monitor liver enzymes
• Proper disposal of nasopharyngeal secretions • Antibiotic – Penicillin
b. Avoid alcohol
• Covering of mouth when sneezing • Supportive – O2 inhalation, tracheostomy
b. Rifampicin (R) – causes orange color of tears, urine
and stool • Immunization : Gives temporary immunity • Strict Isolation – highly contagious
• CBR – to limit the circulation of toxin • 2. nocturnal coughing 3. Fluid and Electrolyte Replacement
Prognosis mortality mortality b. Hepatitis B • MOT: Sexual Contact, transferred to baby during birth
9. Proper Screen blood Screen
Prevention handwashin donors blood - Hep B Surface Antigen (HBsAG): (+) acute hepatitis B • Incubation Period: 3-21 days
g, sanitation, donors
screen food - Hep B Protein Independent Antigen (HBeAa)= (+)chronic hep B • Manifestation: Male- Urethritis
handlers,
enteric 3. Routine Test Female – Cervicitis
precautions
a. Bilirubin Testing • For Male:
3. Post-Icteric Stage – jaundice and other s/sx starts to disappear 2. Low fat diet, High CHON intake to spare protein
metabolism
- energy starts to increase and patient is on the road to
recovery In US, “butterball” diet
• For Female:
- it takes 3-4 months for the liver to recover (avoid • Immunization: Hep B vaccine is given at 6 wks after
– dysuria and urinary frequency
alcohol for 1year and ASA & acetaminophen) birth, 3 doses at one month interval, Dose: 0.5cc IM, VL
1. Liver Enzyme Test – determine extent of liver damage • Avoid MOT – itchy, red and edematous meatus, if cervix is
affected
ALT, AST, GGT, ALP, LDH • Immunity: Don’t give a permanent immunity
– burning pain and purulent discharges, if urethra
2. Serum Antigen- Antibody (Ag-Ab) Test • is affected
b. Doxycycline (Tetracycline)
MOà detected by macrophageàalert T Cells
• Psychological aspect of care – low self-esteem
6 Minor Sx: 1. persistent cough – 1 month & above b. Non-Nucleoside reverse Transcriptase (NNRTI)
4. oropharyngeal candidiasis 2. Protase Inhibitor (PI) prevets virus to multiply during the last
phase of call division
5. recurrent herpes zoster
a. Indinavir
6. progressive dessiminated herpes zoster
b. Retonavir
Opportunistic Infection:
c. Saquinavir
• TB is the most common of the Avium Type (from birds)
d. Nalfinavir
• PCP
3. Fusion Inhibitor- Fuseon (Enfuritide)
• CMV
• Promote knowledge and understanding
• CNS à lungs à eyes
• Promote quality of life
• Cancer : Kaposi Sarcoma à malignancy of blood vessel
(skin) – appearing as pink/purple painless sots on the
• Provide self care and comfort
skin called Leopard Look
• Preventive Measures:
• Enzyme Link Immunoassorbent Assay (ELISA) Test –
screening test
• 1. Practice ABCD of HIV: A – bstinence
Nucleus Analogs prevent the virus to multiply during the initial • 3. Counselling
phase of cell division
• 4. Behavior Modification
a. Nucleoside Reverse Transcriptase Inhibitor (NRTI)