HEALTH TEACHING

I. OBJECTIVES:

A. GENERAL OBJECTIVES:

I- General Objectives:
By Health Teaching the patient gain sufficient knowledge about the nature of
leptospirosis, and will apply their said knowledge to their daily living by means
of preventing their selves that will help them to have a healthy life.

II- Specific Objectives:

After 30 minutes of health teaching the patient will be able to:

a. Knowledge
1. Define leptospirosis
2. Identify the causes of leptospirosis
3. Know the signs and symptoms of leptospirosis
4. Know the different procedures and medicines for the treatment ofleptospirosis

b.Skills
1. Demonstrate the different nursing intervention for leptospirosis
2. Discuss and show the factors that contribute to leptospirosis, its
nature and magnitude
3. Guide the relatives or the primary health care giver in making
decisions about certain lifestyles that has a great effect on the
health problem.
b. Attitude
1. To develop trust and rapport between the patient and health care
provider

II. READINESS TO LEARN

 The patient is conscious, responsive and able to ambulate.

III. CAPABILITY TO LEARN

Both relatives and primary health care giver have a good memory recognition
and understanding. The relatives and care giver knows the patient’s condition and
they can understand and speak Filipino.

IV. METHODOLOGY

The method to be used in delivering the health teaching is the conventional

method which is discussion of the topic in its simplest form and according to the
understanding of the listener. Also, the selection of the topic is based on the
patient needs. The language to be used is vernacular form. In addition, we will
just used simple word in order for them to understand clearly and an illustration of
some points maybe given to increase comprehension.

V. PHYSICAL ENVIRONMENT

Before the health teaching is to be given the room should be properly

ventilated and lighted. This makes the room conducive to learning. In addition,
the listener is encouraged to take a meal before the health teaching and the place
should be cleaned. This makes the listener comfortable which increases the level
of understanding.
 leptospirosis

I. INTRODUCTION

Leptospirosis (also known as Weil's disease, Weil's syndrome, canicola fever,

canefield fever, nanukayami fever, 7-day fever, "Rat Catcher's Yellows", "Fort Bragg
fever," and "Pretibial fever"[1]:290) is a bacterial zoonotic disease caused by spirochaetes of
the genus Leptospira that affects humans and a wide range of animals, including
mammals, birds, amphibians, and reptiles. It was first described by Adolf Weil in 1886
when he reported an "acute infectious disease with enlargement of spleen, jaundice and
nephritis". Leptospira was first observed in 1907 from a post mortem renal tissue slice.[2]

Though being recognised among the world's most common zoonoses, leptospirosis is a
relatively rare bacterial infection in humans. The infection is commonly transmitted to
humans by allowing water that has been contaminated by animal urine to come in contact
with unhealed breaks in the skin, eyes or with the mucous membranes. Outside of tropical
areas, leptospirosis cases have a relatively distinct seasonality with most of them
occurring August–September/February–March.

Etiology
Leptospirosis is caused by a spirochaete bacterium called Leptospira interrogans.

Leptospirosis is caused by a spirochaete bacterium called Leptospira spp. that has at least
5 serovars of importance in the United States and Canada causing disease in dogs
(Icterohaemorrhagiae, Canicola, Pomona, Grippotyphosa, and Bratislava)[3] There are
other (less common) infectious strains. It should however be noted that genetically
different leptospira organisms may be identical serologically and vice versa. Hence, an
argument exists on the basis of strain identification. The traditional serologic system is
seemingly more useful from a diagnostic and epidemiologic standpoint at the moment
(which may change with further development and spread of technologies like PCR).

Leptospirosis is transmitted by the urine of an infected animal and is contagious as long

as it is still moist. Although rats, mice and voles are important primary hosts, a wide
range of other mammals including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons,
possums, skunks, and even certain marine mammals are also able to carry and transmit
the disease as secondary hosts. Dogs may lick the urine of an infected animal off the
grass or soil, or drink from an infected puddle. There have been reports of "house dogs"
contracting leptospirosis apparently from licking the urine of infected mice that entered
the house. The type of habitats most likely to carry infective bacteria are muddy
riverbanks, ditches, gulleys and muddy livestock rearing areas where there is regular
passage of either wild or farm mammals. There is a direct correlation between the amount
of rainfall and the incidence of leptospirosis, making it seasonal in temperate climates
and year-round in tropical climates.

Leptospirosis is also transmitted by the semen of infected animals.[4] Abattoir workers can
contract the disease through contact with infected blood or body fluids.

Humans become infected through contact with water, food, or soil containing urine from
these infected animals. This may happen by swallowing contaminated food or water or
through skin contact. The disease is not known to be spread from person to person and
cases of bacterial dissemination in convalescence are extremely rare in humans.
Leptospirosis is common among watersport enthusiasts in specific areas as prolonged
immersion in water is known to promote the entry of the bacteria. Surfers are especially
at high risk in areas that have been shown to contain the bacteria and can contract the
disease by swallowing contaminated water, splashing contaminated water into their eyes
or nose, or exposing open wounds to infected water.[5] Occupations at risk include
veterinarians, slaughter house workers, farmers, sewer workers, and persons working on
derelict buildings.[3]

Anatomy and Physiology

Lower Respiratory Tract:

It is composed of trachea, right and left main bronchus segmental bronchi,

subsegmental bronchi and terminal bronchioles. Smooth muscles wound around in these
structures and when it contracts it decreases the diameter of the airways therefore
increasing the air resistance.
Trachea – also knows as the windpipe. It extends from the larynx to the level of the 7th
thoracic vertebrae where it divides into 2 main bronchus. The point where it divides is
called carina.

Bronchi and Bronchioles

Right main bronchus is shorter and wider. It also extends more vertically
downwards. Foreign bodies tend to lodge there more compared to the left main bronchus.
The bronchi further divides and spread in an inverted tree like formation through each
lungs until it becomes bronchioles. The terminal bronchioles are the last airways of the
conducting system. It does not participate in the gas exchange.
Lungs
Lie on either side of the mediastinum (area containing heart, great blood vessels,
bronchi, trachea, esophagus)
Hilus: mediastinal surface of each lungs is where blood vessels of pulmonary and
circulatory systems enter and exit; where primary bronchus enters.
Apex of each lung lies just below clavicle; base rests on diaphragm.
Note: Two lungs differ in size and shape.
1. Left lung is smaller, has 2 lobes, 8 segments
2. right lung has 3 lobes, 10 segments
Vascular System
1. Pulmonary arteries and veins; pulmonary capillary network which surround
the alveoli
2. Bronchial arteries supply lung tissue and drained by bronchial and pulmonary
veins.

Alveoli
Alveoli cluster around alveolar sacs, which open into common chambers, atrium,
alveoli provide enormous surface area for gas exchange
External surface of alveoli covered with pulmonary capillaries which together
form respiratory membrane where gas exchange occurs by simple diffusion.
Alveoli walls have cells which secrete surfactant in fluid which maintains moist.

Note: gas exchange occurs in the respiratory membrane.

The alveolus comprises of 2 cell types namely: Type 1 pneumocytes which are incapable
of reproduction but are effective in gas exchange and Type 2 pneumocytes that do not
participate in gas exchange but produces surfactants.

PATHOPHYSIOLOGY
Modifiable/Precipitating Factor Non-Modifiable
/Non-precipitating factor
- Aspiration of food, fluids or vomitus - Young age
- Inhalation of toxic or caustic chemicals - History of Asthma
- Smoke, dust, gases - Upper respiratory infection
- Exposure to affected individual

Inhalation of infection particle

|
Inflammatory pulmonary response
|
Reactivation of pathogens
|
Disruption of the mechanical defenses
|
Inflamed and fluid filled alveolar sacs
|
Increase difficult to appreciate
- Fever
- Chills
- Sweating
- Pleuritic chest pain
- Sputum production
- Hemoptysis
- Dyspnea
- Headache
- Fever

DIAGNOSIS
On infection the microorganism can be found in blood for the first 7 to 10 days (invoking
serologically identifiable reactions) and then moving to the kidneys. After 7 to 10 days
the microorganism can be found in fresh urine. Hence, early diagnostic efforts include
testing a serum or blood sample serologically with a panel of different strains. It is also
possible to culture the microorganism from blood, serum, fresh urine and possibly fresh
kidney biopsy. Kidney function tests (Blood Urea Nitrogen and creatinine) as well as
blood tests for liver functions are performed. The latter reveal a moderate elevation of
transaminases. Brief elevations of aspartate aminotransferase (AST), alanine
aminotransferase (ALT), and gamma-glutamyltransferase (GGT) levels are relatively
mild. These levels may be normal, even in children with jaundice. Diagnosis of
leptospirosis is confirmed with tests such as Enzyme-Linked Immunosorbent Assay
(ELISA) and PCR. Serological testing, the MAT (microscopic agglutination test), is
considered the gold standard in diagnosing leptospirosis. As a large panel of different
leptospira need to be subcultured frequently, which is both laborious and expensive, it is
underused, mainly in developing countries.

Differential diagnosis list for leptospirosis is very large due to diverse symptomatics. For
forms with middle to high severity, the list includes dengue fever and other hemorrhagic
fevers, hepatitis of various etiologies, viral meningitis, malaria and typhoid fever. Light
forms should be distinguished from influenza and other related viral diseases. Specific
tests are a must for proper diagnosis of leptospirosis. Under circumstances of limited
access (e.g., developing countries) to specific diagnostic means, close attention must be
paid to anamnesis of the patient. Factors like certain dwelling areas, seasonality, contact
with stagnant contaminated water (Bathing swimming, working on flooded meadows,
etc) and/or rodents in the medical history support the leptospirosis hypothesis and serve
as indications for specific tests (if available).

Leptospira can be cultured in Ellinghausen-McCullough-Johnson-Harris medium, which

is incubated at 28 to 30 °C.[7] The median time to positivity is three weeks with a
maximum of 3 months. This makes culture techniques useless for diagnostic purposes,
but is commonly used in research.

Complications:

Complications include meningitis, extreme fatigue, hearing loss, respiratory distress,

azotemia, and renal interstitial tubular necrosis, which results in renal failure and often
liver failure (the severe form of this disease is known as Weil's disease, though it is
sometimes named Weil Syndrome[6]). Cardiovascular problems are also possible.

MEDICAL MANAGEMENT:
Aetiotropic drugs are antibiotics, such as cefotaxime, doxycycline, penicillin, ampicillin,
and amoxicillin (doxycycline can also be used as a prophylaxis).

TREATMENT:

Leptospirosis treatment is a relatively complicated process comprising two main

components: suppressing the causative agent and fighting possible complications.
Aetiotropic drugs are antibiotics, such as cefotaxime, doxycycline, penicillin, ampicillin,
and amoxicillin (doxycycline can also be used as a prophylaxis). There are no human
vaccines; animal vaccines are only for a few strains, and are only effective for a few
months. Human therapeutic dosage of drugs is as follows: doxycycline 100 mg orally
every 12 hours for 1 week or penicillin 1–1.5 MU every 4 hours for 1 week. Doxycycline
200–250 mg once a week is administered as a prophylaxis.[citation needed] In dogs, penicillin is
most commonly used to end the leptospiremic phase (infection of the blood), and
doxycycline is used to eliminate the carrier state.

Supportive therapy measures (esp. in severe cases) include detoxication and

normalization of the hydro-electrolytic balance. Glucose and salt solution infusions may
be administered; dialysis is used in serious cases. Elevations of serum potassium are
common and if the potassium level gets too high special measures must be taken. Serum
phosphorus levels may likewise increase to unacceptable levels due to renal failure.
Treatment for hyperphosphatemia consists of treating the underlying disease, dialysis
where appropriate, or oral administration of calcium carbonate, but not without first
checking the serum calcium levels (these two levels are related). Corticosteroids
administration in gradually reduced doses (e.g., prednisolone starting from 30–60 mg)
during 7–10 days is recommended by some specialists in cases of severe haemorrhagic
effects. Organ specific care and treatment are essential in cases of renal, liver or heart
involvement.

NURSING INTERVENTIONS
1. Do back rubbing for easy aid in respiration and easy expectoration of sputum
2. Do bronchial tapping and position the patient in side-lying position with the head
lowered than the trunk to facilitate expectoration of secretions. High take of fluids
may help to liquify viscous secretions in order to help expectorate easily.
3. Keep the patient absolutely at rest and avoid unnecessary and strenuous activities
in order to avoid strain on the heart (muscles) or extra strain for the lungs
4. Elevate the head and shoulders of the patient by means of a pillow often to relieve
labored breathing and to lessen coughing (coughing aggravated chest pain.)
5. Bony prominence should be cushioned when at rest, to prevent formation of
bedsores
6. Let patient in a daily routine bath unless contraindicated or if resisted, prefer
cleansing bed bath as necessary to keep the skin clear, clean and active, and to
relieve restlessness.
7. Instruct patient to have adequate and sufficient intake of fluid and elimination
8. Give nourishing high-calorie diet (fluid diet) at 2 hours intervals include milk
malted milk, gruels, beef juice, soup and fruit juices. Omit fluids and food that are
gas forming like softdrinks.
9. Measure and record intake and output to be sure that both the intake and
elimination are sufficient to the metabolic needs of the patients.
10. Teach and supervise effective coughing, turning and deep breathing techniques
11. Observed for increasing ineffective breathing patterns and chest pain associated
with respiration and report immediately to the physician on duty to prevent
complications such as respiratory distress and respiratory arrest
12. Turn the patient every 2 hours.