Communicable Diseases

INFECTIOUS DISEASE NURSING Host

 Man or animal
COMMUNICABLE DISEASES – diseases that can be transmitted  Consider the susceptibility (degree of resistance) of the
through: host
 Direct – person-to-person; face-to-face encounter with
an infected person (e.g. skin contact, kissing); droplet 4 types of Host

Droplet Airborne  Patient – infected with signs and symptoms; isolate

Source of Respiratory Droplet Respiratory Droplet and observe precautionary measures; least source of
Infection (droplet nuclei) (droplet nuclei) infection
Respiratory Bigger, heavy Smaller,  Carrier – harbors/carries microorganisms but without
Droplet (remains in the carried/suspended in signs and symptoms; also a/potential source of
surface), can be the air, lighter infection.
carried for some  Contact – close contact/exposure to infected person
time only  Suspect – medical history and symptoms suggest
Distance Within 3ft of the No limitation, more infectious presence of disease.
patient extensive than droplet
*airborne transmission is not direct transmission Agent
 Indirect – from source to other person with intermediary  Microorganism
object o not all possesses pathogenicity (capacity of
o Vehicle-borne – fomites, inanimate objects/non- microorganism to cause an infection) and
living things (e.g. stethoscope, BP cuff, eating virulence (strength and power of microorganism
utensils) to cause infection)
o Vector-borne – insects, arthropods, rodents
*opportunistic microorganism
 Break in Skin Integrity
o Inoculation (BT, sharps and needles) Virus Bacteria

 Airborne – stands alone, another mode of transmission  only multiply in living things
(e.g. Chicken pox, TB, Measles)  can pass through filters in
*uses N95 mask – airborne droplet can pass through the body
an ordinary mask. o blood-brain barrier
*doors should always be closed o placental barrier
 Rubella/German
* ALL THESE FOUR (4) are HORIZONTAL TRANSMISSION Measles (1st trimester)
 self-limited/self-limiting
VERTICAL TRANSMISSION o Colds – 2-3 days
 Mother to unborn child transmission (perinatal o Influenza – 1 week
transmission/trans-placental transmission)  treated according to
symptoms (no specific viral
INFECTIOUS DISEASES – Presence of living organisms in the body agents)
which may not be transmitted through ordinary contact.  give us permanent immunity
 management: rest, nutrition
CONTAGIOUS DISEASES – easily transmitted
Protozoal
*ALL COMMUNICABLE DISEASES are INFECTIOUS but NOT ALL are
CONTAGIOUS  Amoebiasis
 Malaria
*ALL CONTAGIOUS DISEASES are INFECTIOUS and at the same  Gardiasis
time COMMUNICABLE  PCP
IDNAP – Infectious Disease Nurses Association of the Philippines
EPIDEMIOLOGIC TRIAD
Environment
 multiply both in living and
non-living things
 cannot pass through filters in
the body (big in size)
 self-limited/self-limiting
o Colds – 2-3 days
o Influenza – 1 week
 Treponema pallidum (C.A.
of Syphillis) – can pass
through placental barrier
after the 16th week of
pregnancy (2nd to 3rd
trimester)
o 3rd trimester – highly fatal
 give us temporary immunity
Fungal
 Tinea (ring worm)
o capitis (head, scalp)
o corporis (body)
o pedis (feet) –athlete’s
foot
o ugeuna (nails)
o cruris (inguinal) – jock’s
itch
o barbae (beard) –
barber’s itch

*Ricketsia – typhus fever (Phonazeki) – bites of lice on head

(causes falling of hair)

ENVIRONMENT
Host Agent  Conducive and favorable to the growth and
multiplication of microorganisms.

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
IMMUNIZATION
IMMUNITY
 State of being resistant to infection; state of being free Active
from infection.  Weakened microorganism/toxin
 Stimulate antibody production
Two Types:  Effect: 4-7 days
 Continuously produces antibody (long-lasting
 Natural immunity)
o Inherent in the individual’s body tissues and fluids  EPI: BCG, OPV, MMR, DPT, AMV
(born with it and die with it) – rare  Tetanus Toxoid, Anti-rabies, HBV, Pneumovax,
o Race (lahi) Varivax, Fluvax
o Genetic abnormality
Passive
 Acquired  Antibodies
 Provide high titer of Antibodies (TX)
A. Active – actual participation of the  Effect: immediate
individual’s body tissues and fluids in the  Not long-lasting/short-lived immunity
production of antibodies.  ATS/TAT, TIg, Equinae, Rabies Ig, HRIg, ADS, PIg, VZIg
 Active (toxins) and Passive (antibodies) Immunization
1.) Naturally Acquired – produce antibodies by – do not inject on the same side/site.
natural means; unintentionally
 previous infection CHAIN OF INFECTIOUS PROCESS
 Subclinical Immunity – developed
due to constant exposure to a
certain infection.

2.) Artificially Acquired – artificial means; Causative

intentionally done Agent
 (vaccines – attenuated/weakened
microorganisms)
Susceptible
B. Passive – presence of antibodies in the serum not Reservoir
Host
coming from the individual himself (get antibodies)

1.) Naturally acquired – get antibodies by natural

means/unintentionally
 placental transfer of maternal
antibodies
 Baby protected up to 6mos.
(antibodies from mom)
 infection under 6mos. (mom’s fault) Portal of
Portal of Exit
Entry
 WHO – no immunization must be
given earlier than 2mos. (mom’s
antibodies will fight infection Mode of
Transmission
 Exception to the rule – in a country
or state where infectious
diseases are constantly present,
they can give vaccine before two
months
Vehicle of Transmission – source of infection
 Mother with HIV = baby with
antibodies = doesn’t mean baby
*can be cut anywhere but it will be easier if the weakest link
is infected
would be cut
 Mother’s antibodies stay up to
*portal of exit before portal of entry
18mos.
In taking care of an infected person,
 >18mos. = body (+) HIV antibodies
1. Know C.A.
= baby has HIV
2. Know vehicle of transmission
3. Know mode of transmission
 Breastfeeding (IgA) – colostrum

General Nursing Care

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
I. Preventive – no infection yet, not allow infection to set in  PD 856
o Gonorrhea – once a month
A. Health Education o Syphillis – twice a month
- Knowledge *with certificates
- Attitude
- Skills  PD 825 – Anti-littering Law
o Php 2000 – 5000
 doctor – ultimately responsible for giving health o Imprisonment of 6mos.-1yr
education
 nurse – key person/ provider D. Proper Supervision of Food Handlers
 DOH (doctors)
B. Immunization  FDA –monitor foods, drugs, and cosmetics if
EPI – P.D. 996 - ↓8y/o they are safe for consumption
UN Goal (UCI) – Proc. No. 6 - ↓6 y/o
Yr. 2000 (NID) Proc. No. 46 - ↓5y/o II. Control (with infection) – limit spread
A. Isolation
7 Childhood Diseases  Infected person during period of
1. TB communicability
2. Diphtheria o Strict – protect others
3. Pertussis o Protective – protect patient;
4. Tetanus microorganism away from patient
5. Poliomyelitis
6. Hepatitis B Quarantine
7. Measles  Limitation of freedom of movement of a
well person during longest incubation
Permanent Contraindications to Immunization period

1. Allergy B. Disinfection
 MMR – egg and neomycin  Killing of pathogenic microorganism by:
– made of chick embryo and neomycin o Physical – washing, boiling
 Hepatitis B – baker’s yeast o Chemical – use of chemical agents
– Saccharomyces cerevisiae  sterilization
 IPV (salk vaccine) – neomycin (streptomycin)
 Flu – chicken and chicken products Disinfestation
 Killing of small undesirable animal forms
2. Encephalopathy without known cause or o Arthropods and rodents
convulsion within 7 days after vaccine
a. If with convulsion Fumigation
 No DPT = DT only  Gaseous agents
 May have permanent  Kill arthropods and rodents
neurologic disorder (neurologic
encephalopathy C. Medical Asepsis
 24o crying inconsolably  Hand washing
o 10 to 15 secs
Temporary Contraindications o Length is not considered anymore =
1. Pregnancy FRICTION
a. Live vaccines – never given to pregnant o Medical Asepsis
individuals – may affect growth and  Hands are lower than the elbow
development of fetus – congenital o Surgical asepsis
problems  Hands are higher than elbows

Live Vaccines  Use of barrier precaution (personal protective

- OPV - MMR equipment)
- BCG - Varivax o Used when in direct contact with
patient
2. Very severe disease/severe febrile disease o Used as necessary
3. Immunocompromised situation (receiving o Use only PPEs that needs to be worn
corticosteroids) o Wearing: Mask  goggles  bonnet
4. Recent receipt of blood products, wait for 2-3 gown  gloves
months o Remove: gown  gloves 
a. AMV handwashing  bonnet  goggles 
b. Varivax mask  handwashing
c. MMR
 No amount of immunization will give you full protection
(vaccine failure)  Use of Placarding Principle
o No smoking
o Arm precaution
C. Environmental Sanitation

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
Revised Isolation Precaution  Anaerobic – w/o oxygen
1. Standard Precaution  Protected against oxygen because it is in the
 Primary strategy for preventing nosocomial infection form of spore
 Took the place of universal precaution  Very difficult to destroy - Sterilization
 Applies to the following:  Inside the body - vegetative form – not
o All patients regardless of their diagnosis protected from oxygen
o Blood and all body fluids, excretions and  MOT: Break in skin integrity (wound) – any kind of
secretions except sweat wound
 Universal precaution – visible blood  Tetanus Neonatorum – poor cord care
o Non-intact skin  IP: 3 days to 4 weeks
o Mucous membrane  The shorter the incubation period is, the poorer is
the prognosis
 Essential Elements of Standard Precaution  S/Sx:
o Use barrier precaution o Initially signs of wound inflammation
o Prevent inadvertent percutaneous exposure 5 Cardinal Signs of Inflammation
 Needle prick injury  Rubor - redness
 Do not recap – one-hand technique  Callor - warmth
– scooping, fishing  Dolor - pain
 Do not bend  Tumor - swelling
 Do not break  Function loss
 Do not manipulate o Increased muscle tone near the wound
o Immediate hand washing and washing of o Tachycardia, profuse sweating
other skin surface area o Low grade fever
o Painful involuntary muscle contraction
2. Transmission Based Precaution
 Communicable Diseases  Tetanolysin – dissolves RBC
 Instituted to patients infected with highly transmissible  Tetanospasmin – causes muscle spasm
infection o Affects the myoneural junction of the muscles
 Precautions beyond those set forth in standard and internuncial fibers of the spinal cord and the
precaution brain
 Transmission based + standard precaution
 Muscles affected:
 Airborne Precaution o Masseter muscle – closing of the mouth
o Use of respiratory protection (particulate  Lockjaw – trimus – rigidity of the jaw
respirator) muscle
 HEPA filter – high efficiency particulate air o Facial muscle
filter  Risus sardonicus – sardonic smile/ grin
o Measles, TB, varicella  Smiling with eyebrows raised
o SARS, Avian flu – droplet o Extensor muscles of the spine
 Opisthotonus position – arching of the
 Droplet Precaution back
o Contact to the conjunctiva, nasal or oral o Abdominal muscle
mucosa  Board-like abdomen
o PPE: regular mask and goggles
o Ex: Meningitis, Hib infections, pneumonia  Dx Exam: Clinical observation + history of wound
 Med Mgt: Objectives
 Contact Precaution o Neutralize the toxin
o Activities that require physical contact  ATS (Anti-tetanus serum) / TAT (Tetanus
o Contact with inanimate objects anti-toxin)
o PPE: gloves and gown o ATS – from animal products –
o Ex: GI infections, skin infections, STI’s, Ebola perform skin testing
 TIg (Tetanus Immuniglobulin)
CENTRAL NERVOUS SYSTEM o Kill the microorganism
 Bacteria  Antibiotic – Penicillin
o Tetanus  Daily cleansing of wound - NSS
o Meningitis o Thin dressing
 Virus o Prevent and control spasms
o Encephalitis  Muscle relaxants
o Poliomyelitis o Diazepam – IV push, IV drip
o Rabies o Methocarbamol (Robaxin,
Robaxisal)
o Lionesal (Baclofen)
1. TETANUS o Epirison (Myonal)
 AKA: Lockjaw  Osterized feeding (NGT) – patient cannot
 CA: Clostridium Tetani feed through the mouth
 Soil, clothes, dust
 Intestines of herbivores – manure – soil – pasture  Nursing Care:
areas  Maintain adequate airway and ventilation

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
o Padded tongue depressor  CA: Virus, fungus, bacteria
 Maintain an IV line o Cytomegalovirus (CMV) - Virus
o Should be patent (for medications)  Opportunistic - low body resistance - AIDS
 Monitor clients for signs of arrhythmia o Cryptococcal Meningitis (C. Neoformans) - Fungus
 Prevent client from having spasms  Opportunistic – low body resistance – AIDS
o Exteroceptive stimuli – external  SOI: Excreta of birds
environment o TB Meningitis - Bacterial
 Dim and quiet environment  Common cause of meningitis in the
o Interoceptive stimuli – within patient Philippines
 Stress – limit visitors  Not necessarily secondary to tuberculosis
 Flatus and Coughing – turn to sides o Staphyloccocal
o Proprioceptive stimuli – participation of o Streptococcal
patient and other person  Secondary to respiratory infection
 Touching – gentle handling – inform o Meningococcal Meningitis/ Meningococcemia/
before touching Neisseria Meningititis
 Turning – not done frequently – at  Deadliest type
least once/shift  Affects vascular system  DIC  prone to
 Jarring the bed intravascular bleeding  vascular collapse
 Minimal handling of the patient  death – 10%
o Avoid unnecessary disturbing  Waterhouse Friderichsen Syndrome – group
of the patient of symptoms - death within 6 to 24 hours
o Organized and cluster nursing  MOT: Direct (droplet)
care  IP: 2 to 10 days
 Protect client from injury  S/sx:
o Never leave the patient o Nasopharynx – URTI – cough, colds
alone o Bloodstream
o Padded side rails  Petechiae – pinpoint red spots on the skin
o Call light is within the reach of o Apply pressure and redness remain –
the client tumbler test (clear glass)
 Prevention: o Extremities first then body
o Immunization  Ecchymosis – blotchy purpuric lesions
 DPT o Area of bleeding – obstruction – may
o 6 wks after birth become necrotic
o 3 doses with 4 wks (1 month) interval  Spotted fever
o 0.5 cc o Meninges
o IM/ Vastus lateralis  Pathognomonic sign: nuchal rigidity – entire
o Fere – antipyretic neck is rigid
o Observe – signs of convulsion for 7 days  + Kernig sign
o Warm compress (immediately) – o Supine and flex knees towards the
vasodilation and better drug absorption abdomen
o Cold compress 20 mins after – o Pain/ difficulty extending the less after
vasoconstriction -  or prevent swelling knee flexion
o If there is swelling already – apply cold o Pain – hamstring – back of the thigh
compress  + Brudzinski sign
o Warm compress 24 to 36 hours after o Flex neck towards the chest
injury sets in o Involuntary drawing up of extremities or
 Tetanus Toxoid hips upon flexion of neck
o 2nd trimester   ICP – obstruction in the subarachnoid
o 2 doses with 1 month interval space - CSF
o 0.5 cc IM/ deltoid – non-dominant hand o Severe headache
o Projectile vomiting – 2 to 3 ft away
1st dose Anytime
o Seizures/ convulsion – inflamed
1 month after 1st
2nd dose meninges – altered pressure in the
dose
cranial cavity
3rd dose 6 months
o Altered vital signs -  Temp,  PR, 
4th dose 1 year RR,  Systolic and normal diastolic,
5th dose 1 year Widened pulse pressure
o Diplopia – choking of optic disk –
o Low risk – booster dose – every 10 yrs double vision
o High risk – booster dose – every 5 yrs o ALOC
 Proper wound care  Dx Exam:
o Thin dressing – air vent o Lumbar puncture – CSF
 Avoid wounds  Color
o Yellowish, turbid, cloudy – bacterial
etiology
o Clear – normal or viral
2. MENINGITIS  Laboratory exam
 Inflammation of the covering of the brain and spinal o Bacterial -  Protein,  WBC,  Sugar
cord

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
o Viral -  Protein,  WBC, Normal Sugar  Post-vaccine encephalitis – Anti-rabies
 Culture & Sensitivity – type of drug vaccine
 CIE (Counter immunoelectrophoresis) – virus  Wear mask – previous infection
or protozoa  Common in the Philippines
 Contraindication - Highly increased ICP –
herniation of brain o Toxic Encephalitis
o Blood Culture  Metal poisoning
o Lead poisoning
o Mercurial poisoning
 Med Mgt:
o Antimicrobial therapy  S/sx:
o Corticosteroids – Dexamethasone o Same as meningitis
o Osmotic Diuretics – I & O o ALOC
o Anticonvulsant Agents – Dilantin (Phenytoin) o Lethargic – abnormally sleepy, difficult to
 IV - Sandwich with NSS – crystallization of drug awaken
 Oral – Gingival hyperplasia – frequent oral  Dx Exam:
care or gum massage o Lumbar puncture – clear
o Laboratory exam -  Protein,  WBC, Normal
 Nursing Care: Sugar
o Assess neurologic function o EEG – extend of brain involvement
o Maintain adequate nutrition and elimination
o Ensure client’s comfort  Med Mgt: Symptomatic
 Diversionary activities
 Rest  Nursing Care: Same as meningitis
 Massage
o Effleurage – figure of 8 or circular  Prevention:
manner o Eradication of source of infection
o Petrissage – friction; thumb, index or o Use of insecticide
middle finger o Use of insect repellants
o Tapotement – edge of hand o Screening doors and windows
o Kneading o 4S
 Quiet and dim environment  Search and destroy breeding places
 Limit visitors  Self-protection
o Symptomatic and supportive  Stop indiscriminate fogging – drive away
 Maintain fluid and electrolyte imbalance only
 Safety  Seek early consultation

 Prevention 4. POLIOMYELITIS
o Immunization – 10 years and below
 BCG  AKA: Infantile Paralysis
 Hib Vaccine Acute Flaccid Paralysis – soft,
 Meningococcemia vaccine flabby, limp
o Proper disposal of nasopharngeal secretions Heine – Medin’s Disease
o Covering of nose and mouth when coughing and
sneezing  CA: Poliovirus (Legio Debilitans)
o Type I – Brunhilde – permanent immunity –
3. ENCEPHALITIS common in the Philippines
 Inflammation of the encephalon/ brain o Type II – Lansing – temporary immunity
 AKA Brain fever o Type III – Leon – temporary immunity
 CA: Arbovirus (Arthropod borne virus) – carried and
transferred by an arthropod  MOT: Early stage – direct (droplet) – 1st 4 days –
 Classifications: microorganism in the nasopharynx
o Primary Encephalitis Late stage – fecal-oral – Day 5 onwards
 Affects the brain directly  Enterovirus – intestines
 St. Louise, Japanese B, Australian X, Effects on CNS
Equine (E – W)  Severe muscle pain
 MOT: Mosquito bites o Do not turn or hold patient
o Aedes sollicitans o No amount of massage or positioning can
o Culex Tarsalis relieve pain of patient
 Ticks of horses o Warm compress/ narcotic drugs can relieve
 Migratory birds pain
 No need to wear mask  (x) Morphine and Nubain – may cause
 Not common in the Philippines respiratory depression
 (/) Codeine

o Secondary Encephalitis  Stiffness of hamstring

 There was a previous infection  Hoyne’s sign – head drop
 Complication o if shoulders are lifted, head will drop

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
 Poker spine – Opisthotonus with head retraction  Low forms of animals – warm blooded - dogs, cats
 Tripod position – maintain a sitting position  CA: Rhabdo virus - neurotropic – strong affinity to
o Lean backward, not forward nerves and neurons
 MOT: Contact with saliva of a rabid animal
Paralytic Stage (Flaccid) Organ transplantation - rare
 Bulbar
o Affects Cranial Nerve IX and X
o May cause respiratory paralysis Rhabdo
 Spinal
o Anterior Horn Cell Virus
o Affects the motor function of patient
o Extremities, intercostal muscle
 BulboSpinal Peripheral Efferent
o Cranial Nerve and Anterior Horn Cell nerves nerves
o CN IX and X + Motor function

* Not all patients will develop paralysis Central nervous

* As long as the patient does not develop paralysis/ has Salivary gland
system (Negri bodies
not reached paralytic stage, patient has good prognosis - pathologic lesions
that are formed as
 Dx Exam: microorganism
o Lumbar puncture - result same as Encephalitis multiplies; 10% of (-) Negri bodies
rabid animals (-)
o Throat washing – 1st 4 days of the pharynx
negri bodies)
o Stool exam – 5th day onwards

 Medical Management:
o Supportive
o Iron lung machine – mech vent used for polio  10% of rabid animals (-) negri bodies
patients  If bitten by a dog/animal, do not kill them immediately
 Principle of negative pressure breathing  Cage the animal for observation
 No problem in the lungs but with o Rabid if dies or have behavioral stages within 10
nerves/muscles days
 Life-saving measure
 Months and years  S/sx:
 Weaning o Animals - 3 to 8 weeks
 7 machines in the Philippines  Dumb Stage – complete changes in behavior
o Withdrawn – depressed
 Nursing Care: o Overly affectionate
o Supportive o Hyperactive – Manic
 Turn to sides
 Furious Stage
 Prevention: o Easily agitated
o Immunization o Easily bites
 OPV (Sabin) o Vicious or fierce look
o 5 weeks after birth o Drooling of saliva
o 3 doses with 4 weeks interval o Dies
o 2-3 gtts/orem
o Vomiting: Give again o Humans – 10 days to years
o Diarrhea: Administer but does not  Invasive Stage
count – repeat after 4 weeks – OPV 2 o Site of the bite
o Continuous stimulation to produce  Itchy
antibodies  Painful
o Be careful with disposal of feces – virus  Numbness
is excreted in the feces
o Contraindication: If with relatives who o Flu-like symptoms
are immunocompromised – IPV  Sore throat
 IPV (Salk)  Fever
o 0.5 cc/ Intramuscular  Headache
o Not sensitive to neomycin and  Body malaise
streptomycin
o Avoid mode of transmission o Marked insomnia
 Proper disposal of oropharyngeal secretions  Restless
 Covering of nose and mouth when  Irritable
coughing and sneezing  Apprehensive
 Do not put anything in the mouth o Slight photosensitivity

5. RABIES  Excitement Stage

 AKA: Hydrophobia, Lyssa, La Rage o Aerophobia

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
o Hydrophobia  Site: Vastus lateralis
 Not a phobia – avoided  Given within 7 days – body has not yet
because it causes pharyngeal produced antibodies
spasms
o Maniacal behavior  Nursing Mgt:
 Benadryl – relax patient o Supportive/ Symptomatic
 Antipsychotic – Haloperidol  Keep water out of sight
(Haldol)  Dim and quiet environment
o Normalizes behavior  Room should be away from sub utility room
 Paralytic Stage  Restrain before maniacal behavior
o Spasm stops  Provision of comfort measures
o Paralysis sets in – rapid and progressive
o From toes going up  Prevention:
o Be a responsible pet owner
* Rabies is preventable but not curable – dies within o Have the animals immunized
24 to 72 hours – 100% mortality o Keep animals caged or chained
o Preventable but not curable
 Dx Exams:
o Done before symptoms are manifested CIRCULATORY SYSTEM
(animals)  Virus
o No exams are done on humans o Dengue Hemorrhagic Fever
– results will be (-) if no s/sx  Protozoa
o Brain biopsy o Malaria
o Direct Fluorescent Antibody Test
o Observation of animal (10 days) 6. DENGUE HEMORRHAGIC FEVER
 Site of the bite  CA: Dengue Virus (Arbovirus) – carried by one to
o Waist up – no need to observe, another by arthropod
vaccine is administered o Dengue Virus 1-4
 Extend of the bite o Oinyongnyong
o Deep, multiple, big bite - no need to o Chikungunya (less harmful than DHF)
observe, vaccine is administered o West Nile Virus
o Reason for the bite o Flavi Virus
 Provoked – no need to worry
 Unprovoked – worry!  MOT: Mosquito bites
o Aedes Aegypti; Aedes Albopictus
 Biological Transmitter
 8-11 days after the mosquito bit a
 Medical Mgt: Post-exposure prophylaxis person, it will be able to pass the virus
o Active immunization  Transfers virus to its offspring
 PVRV (Purified Vero Cell Vaccine) - ID
o VERORAB (0.5 mL/vial) o Culex Fatigans
 PCEV (Purified Chick Embryo Vaccine) - IM  Mechanical transmitter
o RABIPUR (1 mL/vial)  After it acquires the virus, only the very
 IM with sensitivity test – Deltoid first person it will bite will get the
disease
Day 0 2 vials
Day 7 1 vial o Aedes Aegypti (day and night biting)
Day 21 1 vial  Breed on a clear, stagnant water
 (X) on dirty water – no O2 – larva
 ID will not survive
 Low-flying – bites on lower extremities
Day 0 0.1 mL on each site
(usual)
Day 3 0.1 mL on each site  With white stripes on the legs, gray
wings, lands parallel on the skin
Day 7 0.1 mL on each site
Day 21 0.1 mL on each site  S/Sx:
o Dengue Grade 1 or Dengue without warning sign
 Avoid drinking alcohol – interferes with  High grade fever for 3-5 days
antibody production  Pain
 Headache
o Passive Immunization  Retroorbital
 ERIg – Equine Rabies Immunoglobulin  Joint and bone
o ARS (Anti rabies serum) 0.2 cc/ kg  Abdominal
BW * misdiagnosed for influenza
o Equirab  Nausea/vomiting
 Petechiae/Herman’s sign (generalized
 HRIg – Human Rabies Immunoglobulin flushing/redness of the skin)
o Imogam 0.133 cc/ kg BW
o Rabuman 0.133 cc/ kg BW

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
* Dengue fever only 7. MALARIA
* Aka Dandy fever, Break bone fever  AKA:
 CA: Plasmodium
o Grade 2 or Dengue with warning signs o Vivax –most common
 With spontaneous bleeding  Falciparum – most common/most
o Epistaxis, gum bleeding fatal
o Hematemesis, melena (GIT) o Ovale
 Coffee ground (blood was acted o Malariae
upon by the digestive enzymes)  MOT: Mosquito bite (Female) – Anopheles Mosquito
o Hematochezia (LGI) (Biological Mosquito)
o Night Biting Mosquito
o Grade 3 or Severe DHF o Breeding sites: clear, slow-flowing water
 With signs of circulatory failure o Most common in:
o Cold, clammy skin  Palawan
o Cold extremities  Saranggani
o Prolonged capillary refill  Davao
 Cagayan Valley
o Severe Shock Syndrome
 Anemic (RBC’s are destroyed as the microorganism
 Dx Exam: reproduces)
o Rumpel Leede Test  Microorganism in the bloodstream = fever; several
 Test for Capillary Fragility RBC’s destroyed
 Presumptive Test
 S/Sx: 3 Stages
o Tourniquet test o Cold Stage (15mins.)
 BP = (S + D)/ 2 = ? mmHg  Chilling sensation (shaking of the body)
 Amount of inflation  Keep patient warm (provide with blanket,
 Obscure for Petechial Formation warm drinks, expose to droplight, hot
 Count how many in a square inch water bag as ordered on soles of feet
 (+) result = ≥ 20 patches in a square inch o Hot Stage (2-6 hours)
 High grade fever
Criteria for Tourniquet Test  Vomiting
1. Age = 6 mo. or older  Abdominal pain
2. Fever more than 3 days
3. No other signs of DHF Nursing Obj: Lower down temperature
 TSB
o Blood Tests  Cold compress over forehead
 Plt count ↓  Light, loose clothing
 Hct determination ↑  Provide fluids
o X ↑OFI – aggravate
 Medical Mgt:
o Symptomatic o Wet Stage
o Prevention of bleeding  Profuse sweating
 Feeling of weakness
 Nursing Care
o Prevention and control of bleeding Nursing Obj: make patient comfortable
 Control of nose bleeding  Keep warm and dry
o Avoid forceful blowing  Provide fluids to prevent dehydration
o Avoid nose picking
 Prevention of gum bleeding o Falciparum
o Last resort: soft-bristled toothbrush  Severe Anemia
 Prevent GI Bleeding  Cerebral Hypoxia
o Avoid irritating foods (spicy, hot, etc.) 1. Restlessness
o If with bleeding already – 2. Confusion
 Ice compress on epigastric area 3. Delirium
 NPO 4. Convulsions
 Comfort measures 5. Loss of Consciousness
 If not relieved, refer to MD 6. Coma
 Avoid dark-colored foods
o Avoid red meat (for occult blood test) o Black Water Fever
o No salmon  Black urine/dark red urine
o Increase Oral Fluid intake
o ↑ body resistance
o Supportive Care
 Dx Exam:
 Prevention o Malarial Smear
o Eradicate mosquitos (4S)  Timing is IMPORTANT!

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
 Collect blood when patient is at the  Types:
peak of fever (microorganism in the o Paucibacillary
bloodstream) o Multibacillary

o Quantitative Buffy Coat (QBC)  S/Sx

 Rapid Malarial Test o Early Manifestations
 No fever needed 1. Color changes on skin that does not
disappear even with treatment
 Medical Mgt: 2. Skin lesions that does not heal even with
o Chloroquine (mainstay), Primaquine, Arabnine treatment
o Fansidar, Quinine, Antemethen (1st choice) 3. Pain and redness of the eyes
 Quinine – 1st developed; parenteral; not 4. Muscle weakness and paralysis of the
regularly used (for severe cases only)( extremities
o Used cautiously in pregnant women – 5. Nasal obstruction and nose bleeding
abortifacient 6. Area affected – loss of sensation
o If not treated = neonatal malaria = severely  Loss of growth
anemic = death  Anhydrosis
o Doesn’t give permanent immunity
o Late manifestations
 Prevention: Eradicate Mosquito (4S) 1. Lagopthalmus – inability to close eyelids
2. Madarosis – loss of eyebrow, eyelashes
INTEGUMENTARY SYSTEM 3. Sinking of the bridge of the nose (Saddle-nose
 Bacteria deformity)
o Leprosy  Absorption of small bones
 Virus  “Natural Amputation”
o Measles 4. Contractures (clawing of fingers and toes)
o German measles 5. Chronic skin ulcers
o Chicken pox  Integumentary: may be infected
o Herpes Zoster already but remains unnoticed due to
patient’s loss of sensation
Macule – flat rashes 6. Gynecomastia (males)
Papule – elevated rashes
Vesicle – elevated rashes filled with fluid  Dx Test:
Pustule – elevated rashes filled with pus o Skin Smear Test
o Skin Lesion Biopsy
1. LEPROSY o Lepromin Test
 AKA: Hansen’s Disease; Hansenosis o Wassermann Reaction Test
o Lepers – Hansenites
 CA: Mycobacterium Leprae (closely associated with M.  Medical Mgt: Multiple Drug Therapy
tuberculosis) o Combination of Drugs to:
 MOT: prolonged intimate skin-to-skin contact 1. Prevent drug resistance (esp. Dapsone –
 Research: droplet (highly concentrated in mainstay drug)
respiratory secretions 2. Hasten recovery

 Cardinal Signs 3. Lessen period of communicability (1-2

o Peripheral Nerve Enlargement weeks)
o Lossof sensation o Reportable Side Effects:
o (+) skin smear test for M. leprae (discontinue treatment)
 Rifampicin – hepatotoxicity s/sx
Paucibacillary Multibacillary
Types Paucibacillary Multibacillary
Tuberculoid Lepromatous
Leprosy Leprosy  Rifampicin – once/month  Rifampicin – once/month
Previously called - non-infectious - Infectious  Dapsone – OD  Dapsone – OD
- benign -Malignant  Duration: 6-9 mos.  Lamphen – OD (SE:
hyperpigmentation of
Severe skin)
Severity Mild Fatal without  Duration: 12-18 mos.
treatment
Leonine Face  Dapsone – generalized itchiness; dryness
Milder with skin and flaking of skin
(Lagopthalmus,
Unique S/Sx lesions, peripheral
Madarosis, Saddle-
enlargment o Microorganism dies → toxin → Leprae Reaction
nose Deformity)
1-5 patches >5 patches → do not discontinue treatment; go to health
Defined by WHO center
associated with associated with
as
leprosy leprosy
Possibly – high o Leprae Reaction – manage symptomatically
Is the person concentration on  MILD
No
infectious? respiratory
secretions
University of Santo Tomas – College of Nursing / JSV
 Communicable Diseases
 R – reddening in and around the
nodule  Dx Exam: Clinical observation
 E – edema
 S – sudden ↑ in the number of lesions  Med Mgt: Symptomatic
 T – tenderness and pain on nerves o Antibiotics – to prevent secondary bacterial
 SEVERE infection
 I – Iritis o Cause of death – pneumonia
 S – sudden acute paralysis
 A – acute uveitis  Nrsg Care: Supportive
o Avoid Draft
 Nursing Mgt: o Adequate rest
o Psychological Aspect of Care o Adequate nutrition
 ↓ self-esteem o Communicable
 Social stigma  4 days before and 5 days after
o Skin Care appearance of rashes
 Skin injury because of loss of sensation  Hightly communicable: BEFORE rashes
 Chronic skin ulcer appear
o Provide/encourage physical exercise  More respiratory secretions before =
o Provide drug information more/highly communicable before
appearance of rashes
* does not give permanent immunity o Gives permanent immunity
 Prevention:
 Prevention o Immunization
o Immunization (BCG)  AMV – 9 mos.
o Avoid MOT (contact with patient with Leprosy) o 0.5 mL/ SC
o PPE: Contact precaution; Droplet Precaution o Deltoid
o May have fever
2. MEASLES (Rubeola) o May experience mild rash reaction –
 AKA: Rubeola, Morbilli, Hard Measles, Little Red NORMAL
Disease, 7 day measles, 9 day measles, 1st Disease  MMR – 12 to 15 months
 1st Measles o Same dosage, route, site and
2nd Scarlet Fever/Scarletina instructions
3rd German measles o Female of child bearing age – no
4th Duke’s Disease pregnancy within 3 months
5th Erythema Infectiosum / Slapped cheek  Congenital defect
disease o Endemic – may be given as early as 6
6th Roseola Infantum, Exanthem Crotiam, months then revaccination at 15
Exanthem Subitum, Tigdas Hangin months
 CA: Paramyxovirus (Rubeola virus) o Proper disposal
 MOT: Airborne (Respiratory Droplet)
 S/sx: 3. GERMAN MEASLES (Rubella)
o Pre-eruptive Stage  AKA: 3 day disease, Rubella, Roteln
 High grade fever (3 to 4 days)  CA: Pseudoparamyxovirus (Togavirus/Rubella virus)
 3 C’s  MOT: Direct (droplet)
o Cough  S/sx:
o Colds/ coryza o Pre-eruptive Stage
o Conjunctivitis  Presence or absence of fever (1 to 2 days)
 Eyes are res, excessive lacrimal  Mild cough or mild colds
discharges  Hallmark sign : Forschheimer’s Spots
 Photosensitivity o Fine red spots/ Petechial spots
 Koplick Spots o Soft palate
o Fine red spots with bluish or grayish white
spot at the center o Eruptive Stage
o Within the inner cheek  Maculo-papular rashes
o Pinkish, discreet – smaller/finer rashes
o Eruptive Stage o Cephalocaudal – starts at the face
 Maculo-papular rashes o 24 hrs entire body
o Reddish, blotchy  Enlargement of lymph nodes – differentiating
o Cephalocaudal – 1st appears behind the factor between measles and German
ears, face, neck, extremities measles
o Appears 3rd day of illness (2 to 3 days o Suboccipital
entire body) o Posterior auricular
o Posterior cervical
o Post-eruptive Stage
 Fine branny
 Desquamation o Post-eruptive Stage
 If the spots start to peel off – on the road to  Rashes disappears (3rd day of illness)
recovery  Enlarged lymph node gradually subsides

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
o No diet restriction
 Dx Exam: Same as measles o Permanent immunity
 Med Mgt: Same as measles o Communicable: Until all the rashes dry
 Nrsg Care: Same as measles o Not Communicable: all rashes are dry; not
 Prevention: Same as measles necessarily fall or peel off
o Communicable during the entire course of the  Prevention:
disease – includes incubation period o Immunization:
o Permanent immunity  Varivax
o Fatal – Pregnancy during the 1st to 2nd trimester o 12 to 18 months
(acquired or exposure) o 0.5 mL/ SC
 Even exposure could cause defect o Deltoid
 If exposed, needs gammaglobulin within 72 o  13 y/o – single dose
hours o  13 y/o – 2 doses with 1 month interval
 Congenital defects o May have rash or fever
o Microcephaly o Same as measles
o Congenital Heart Defect o Proper disposal of nasopharyngeal secretions
o Congenital Cataract  Blindness o Covering of mouth and nose when coughing and
o Deafness and Mutism sneezing
5. HERPES ZOSTER
 Dormant type/ Inactive type
4. CHICKEN POX  Cannot have herpes zoster without chicken pox first
 AKA Varicella  Adults
 CA: Varicella-zoster virus  AKA Shingles, Zona, Acute Posterior Ganglionitis –
o Nasopharyngeal secretions ganglion of the posterior nerve roots
o Secretions of rashes  CA: Varicella-zoster virus
 Can cause disease if the virus entered  MOT: Direct (droplet)
the nasopharynx  S/sx: Same as chicken pox
 MOT: Airborne o Vesiculo-pustular rashes
 S/sx:  Painful – up to 2 months
o Pre-eruptive Stage – 24 to 48 hours  Unilateral distribution – follows the nerve
 Presence of absence of low grade fever pathway
 Headache, body malaise, muscle pain o Vertical
 Appears in cluster
o Eruptive Stage  Dx Exam: Clinical observation
 Vesiculo-papular/ pustular rashes  Med Mgt: Symptomatic
o Macule  Papule  Vesicle   Nrsg Care: Supportive
Vesiculopapular o NO permanent immunity
o Common: Vesiculo-pustular  Prevention:
o Itchy – Pock Marks o Chicken pox and herpes zoster can appear
 Take a bath everyday simultaneously
o Generalized distribution
o Covered part of the body first –
trunk and scalp RESPIRATORY SYSTEM
o Abundantly found on the  Bacteria
covered parts o Diptheria
o Unifocular appearance – one at o Pertussis
a time and never fuses together o Pneumonia
o Different sizes o Tuberculosis
 Virus
o Post-eruptive Stage o Colds
 Rashes start to dry o Influenza
 Crusts (dry), falls off (peels off)
o DO NOT peel it off by yourself 1. DIPTHERIA
o Let it fall of by itself  Contagious disease
 Leave pock marks  All ages
 On the road to recovery  Generalized toxemia – causes systemic infection and
signs and symptoms
 Dx Exam: Clinical Observation  CA: Corynebacterium Diphteriae (Klebs-Loeffler
Bacillus)
 Med Mgt: Symptomatic  MOT: Direct (droplet)
o Acyclovir (Zovirax)  S/sx:
o Antipruritic Agents o Irritating nasal discharge – sero-sanguinous; foul
 Temporary relief of itchiness mousy odor
o Permanent relief: take a bath daily o Sore throat
 Tepid water o Dysphagia
o Neck edema – bullneck appearance
 Nrsg Care: Supportive o Hoarseness of voice, aphonia
o Increase body resistance  Temporary, larynx is affected

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
o Barking cough – dry metallic cough, dry husky
cough o Paroxysmal/ Spasmodic
o Pseudomembrane – grayish white membrane  5 – 10 successive forceful coughing,
(pathognomonic sign) which ends in a prolonged inspiratory
 Nasal septum phase or a whoop
 Larynx  Congested face
 Soft palate  Congested tongue (purple) – pressure of
 Uvula teeth when coughing
 Pillars of the tonsils  Teary red eyes w/ eyeball protrusion
 Distended face and neck vein
 Dx Exam:  Involuntary micturition and defecation
o Nose and throat swab – Definitive Test  Abdominal hernia
o Schick Test – Immunity/ susceptibility  Chokes on mucous/ vomiting
o Moloney Test – Hypersensitivity to diphtheria
antitoxin o Convalescent – No longer communicable
 Signs and symptoms subsides
 Med Mgt:  On the road to recovery
o Antidiphteria serum (ADS) – neutralize toxin
o Antibiotic – Penicillin – kill the microorganism
 Dx Exam:
 Nrsg Care: o Nasal swab – Catarrhal stage – plenty of nasal
o Provide complete bed rest – prevent Myocarditis discharges
 Some toxin goes to the heart muscles o Nasopharyngeal culture – Definitive test
 Waits until the resistance of the heart is  Bordet-gengou
decreased and invades  Agar plate
 Signs of Myocarditis  Cough plate
o Marked facial pallor
o Very irregular PR  Med Mgt:
o  BP o Antibiotic
o Chest pain/ epigastric pain  Erythromycin – drug of choice
o Maintain patent airway  Penicillin
 Independent: o Pertussis Immune globulin
o Proper positioning o Fluid and electrolyte replacement
o Increase oral fluid intake o Codeine with mild sedation
o Chest physiotherapy
o Encourage deep breathing and  Nrsg Care:
coughing exercises o Provide adequate rest – conserve energy and
o Turn to sides at least every 2 hours decrease O2 consumption
 Dependent: o Maintain fluid and electrolyte balance
o Inhalation therapy o Maintain adequate nutrition with aspiration
o O2 precaution
o Nebulization  Feed upright
o Steam inhalation  NPO when child starts coughing
o Suctioning  Bottle feeding – should have a small hole
o Postural drainage o Apply abdominal binders – prevent abdominal
o Provide adequate nutrition – soft hernia
o Provide comfort measures o NOT permanent immunity but second attack is
o TEMPORARY IMMUNITY rare

 Prevention:  Prevention:
o Immunization o Same as measles
o Proper disposal of nasopharyngeal secretions
o Covering of the nose and mouth when sneezing 3. PNEUMONIA
and coughing  Inflammation of the lung parenchyma
o Never kiss the patient  CA: Virus, Protozoa, Bacteria (common)
o PCP – Pneunocystis Carinii Pneumoniae
(protozoa)
2. PERTUSSIS –  6 y/o o CAP – Streptococcus (bacteria)
 AKA: Whooping Cough, Chin Cough o HCAP – Staphylococcus, Gram (-) Bacteria
 CA: Bordetella Pertussis, Hemophilus o ICU - Pseudomonas, Klebsiella
Pertussis o Inhalation of noxious substances
 MOT: Direct (droplet)  Aspiration pneumonia
 IP: 7-10 days  Lipid pneumonia – use of oil for cleaning
 S/sx: the nose or as lubricant
o Catarrhal stage - highly communicable for 1  MOT: Direct (droplet)
week  S/sx:
 colds, fever, nocturnal coughing o Cardinal Signs:
 tiredness and listlessness  Fever

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
 Shaking chills (rigor)
 Productive cough
 Sputum production
o Rusty – Strepto
o Creamy Yellow – Staph
o Greenish – Pseudomonas
o Currant Jelly – Klebsiella
o Clear – No infection
 Pleuritic/ chest pain – friction between
the pleural layers of the lungs
o Splint the chest wall
o Apply chest binder
o Turn to sides (affected side)
o Tuberculin Test/ PPD Test (Purified Protein
Derivative)
o Screening Test
o (+) result – exposure to TB
o Consistently (+) – developed sensitivity to
microorganism
o Uses purified protein derivative
o Administered intradermally
o Interpreted 48 to 72 hours
o (+) result of tuberculin testing > 10 mm
induration
o Immunocompromised > 5 mm
induration

o IMCI o Sputum Exam (AFB Stain)

 Fast breathing o Chest X-ray – extent of the disease

1 wk to 2 mos. 60 bpm
2 mos. to 12 mos. 50 bpm
12 mos. to 5 y/o 40 bpm
 Chest indrawing
o Minimal PTB
o Subcostal retraction – use of
o Moderate Advanced PTB
accessory muscles
o Far Advanced PTB
 Stridor – harsh breath sound during
INSPIRATION
 Wheezing – high pitched sound during
 Med Mgt:
EXPIRATION
o Antitubercular agents – SCC – Short course
chemotherapy
 Dx Exam:
o Rifampicin
o Chest X-ray – Confirmatory test
o Hepatotoxic
 Lung consolidation
o Avoid alcoholic beverages
 Patchy infiltrates
o Monitor liver enzymes
o Sputum exam
o Remove contact lenses and replace with
 Specific cause
glasses
o Turn to color orange
 Med Mgt:
o Isoniazid
o Antibiotic
o Hepatotoxic
o Inhalation therapy – nebulization
o Avoid alcoholic beverages
o Monitor liver enzymes
 Nrsg Care:
o Peripheral neuritis
o Maintain patent airway
o Vitamin B6 Pyridoxine
o Provide adequate rest
o Pyrazinamide
o Provide adequate nutrition
o Hyperuricemia – Gout/ Kidney Stone
o Provide comfort measures
o Alkaline urine
 Increase OFI
 Prevention:
 Increase milk intake
o Immunization
 Increase vegetable intake
o Proper disposal of nasopharyngeal secretions
o Ethambutol
o Covering of the nose and the mouth when
o Optic neuritis
sneezing and coughing
o Irreversible
o Color blindness
4. TUBERCULOSIS
o Difficulty differentiating red and
 AKA: Koch’s Infection, Phthisis, Galloping
green
Consumption, PTB
o Streptomycin
 CA: Mycobacterium Tuberculosis Hominis (human)
o Nephrotoxicity
o Bovis – Bovine – Cattles
o Monitor I and O
o Avis – Avium – Birds
o Monitor creatinine level
 MOT: Airborne
o Ototoxicity
 S/sx:
o Monitor for signs of vertigo and
o Low grade fever, night sweats
tinnitus
o Anorexia, weight loss, fatigability
o Body malaise, chest/ back pain
o Productive cough, hemoptysis, dyspnea
o Erosion of lung capillaries – NO CPT
 Nursing Care:
o Provide adequate rest
 Dx Exam:
o Provide adequate nutrition – increase immunity
o Encourage drug compliance

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
o DOTS – program to encourage drug o Maintain fluid and electrolyte balance
compliance  Monitor I and O
 Assess for signs of DHN - # 1 sign within 24 hrs
 Prevention – weight loss
o Same as pneumonia  Fluids per orem
o BCG – at birth  Regulate IVF
o 0.05/ ID o Provide adequate nutrition
o Deltoid  Small but frequent feeding
o Abscess formation  heal  scar (within 2  Pedia – NPO 4 to 8 hrs – rest the GI tract
to 3 months)  Clear liquid diet  soft diet  DFA
o Indolent Abscess – Koch’s o Provide comfort measures
Phenomenon  Prevention: TEMPORARY IMMUNITY
 Wrong technique by the nurse o Immunization – CDT – Cholera, Dysentery, Typhoid
o Child had exposure to a patient with o Avoid the 5 Fs
active TB – usually asymptomatic  Feces – proper disposal
o Bring back child to health center – I &  Fingers – hand washing
D  Food – preparation, handling, storage
o Give prophylaxis – INH  Flies – environmental sanitation
 Effect:  Fomites – Avoid putting anything to our
o Children - 6 mos to 8 mos mouths – ballpen
 Immunocompromised – 12 mos
o No booster 2. LEPTOSPIROSIS
 AKA: Mud Fever, Canicola Fever, Swamp Fever,
GASTROINTESTINAL TRACT Pre-tibial Fever, Ictero-hemorrhagica
 Bacteria Disease, Weil’s Disease, Swineherd’s Disease
o Typhoid  CA: Leptospira (Spirochete)
o Leptospirosis  Source: Rats
o Bacillary  MOT: Skin penetration
o Cholera  IP: 2 days to 4 weeks
 Protozoa – Amebiasis  Affects striated muscles, Liver, Kidneys
 Virus – Hepatitis o Cause of death: Kidney failure
 Helminths – Parasitism
 S/sx:
o Fever, headache, vomiting
1. TYPHOID FEVER o Muscle tenderness, pain (calf)
 CA: Salmonella typhosa  Patient does not stand up or walk
 MOT: Fecal-oral o Jaundice with hemorrhage
o 5 Fs o Orange eyes/ skin
 Food o Oliguria/ Anuria – Kidney failure
 Fingers
 Flies  Dx Exam:
 Feces o Microscopic Agglutination Test (MAT)
 Fomites  Med Mgt:
 Target organ: Peyer's patches o Antibiotic – Doxycycline
 Prophylaxis - 200 mg twice a day for 3 days
 S/sx:  Nrsg Care:
o Fever, dull headache, abdominal pain o Supportive
o Vomiting, diarrhea/ constipation o UO – consistency, frequency and amount
o Clinical features:  Refer if with changes
 Ladderlike fever
 Rose spots – Abdomen  Prevention: TEMPORARY IMMUNITY
 Spleenomegaly o Eradicate the source of infection (rats)
 Dx Exam: o Use of protective barrier when walking in flood
o Blood culture
o Widal Test – Antigen left by the microorganism 3. DYSENTERY
 AgO – Somatic – Presently infected * see table
 AgH – Flagellar – Exposed/ Had an
immunization 4. HEPATITIS
o Thyphidot – Antibody  Inflammation of the liver
 IgM – presently infected  Causes:
 IgG – some form of immunity/ recovering o Alcoholism
o Drug intoxication
 Med Mgt: o Chemical intoxication – Arsenic
o Antibiotic o Microorganism
 Chloramphenicol – drug of choice
o Fluid and electrolyte replacement  Viral Hepatitis
o Hepatitis A
 Nrsg Care:  Infectious hepatitis

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
 Catarrhal jaundice hepatitis  Tea-colored urine
 Epidemic hepatitis  Acholic stool – clay-colored
 CA: Hepatitis A Virus (RNA)  Some pre-icteric symptoms may persist but
 Feces and blood a lesser degree
 MOT: fecal-oral
 At risk: Children and food handlers
 IP: 2 to 6 weeks Bilirubin
(unconjugated)
o Hepatitis B – Serum Hepatitis
 Homologous Hepatitis
 Viral Hepatitis – most fatal
 Blood, sputum and other body fluids
 MOT:
Bloodstream Kidneys - 2x
 Parenteral – BT, sharps and needles
o At risk: Blood recipients, drug
addicts
 Oral – oral
Liver Urine
o Kissing
o 6 to 8 gallons
 Sexual contact
o Seminal and cervical fluids
 Vertical Un/conj
o Mother and child
o Childbirth
 IP: 6 wks to 6 months

o Hepatitis C Intestines
 Post Transfusion Hepatitis
 CA: Hepatitis C virus
 MOT: Parenteral
 IP: 5 to 12 wks
 At risk: Paramedical team, drug addicts, BT Stools
recipients

o Hepatitis D
 Dormant type of Hepatitis B
 CA: Hepatitis D / Delta virus Acholic
 Delta virus cannot multiply by itself – needs
the help of the B virus
 MOT: Same as hepatitis B
 IP: 3 to 13 wks o Post-icteric
 Jaundice disappears
o Hepatitis E  Signs and symptoms subsides
 CA: Hepatitis E virus  Energy level increases
 Source: Feces  Avoid alcoholic beverages and OTC drugs
 MOT: Same as hepatitis A for at least 1 year
 IP: 3 to 6 wks o Liver recovers

o Hepatitis G  Dx Exam:
 CA: Hepatitis G virus o Liver Enzyme Test
 MOT: Same as hepatitis C  ALT Alanine Aminotransferase
 IP: Unknown o 1st to shoot up if liver problem is
present even if asymptomatic
 S/sx:  AST Aspartate Aminotransferase
o Pre-incteric o Increases upon onset of jaundice
 Fever, RUQ pain o Not reliable
 Fatigability, weight loss, body malaise  ALP Alkaline Phosphatase
o inability to convert glucose to o Obstructive jaundice
glycogen – source of energy  GGR Gamma Glutanyl Transferase
 Anorexia, nausea and vomiting – o Toxic Hepatitis due to toxic substances
deamination of CHON (e.g. alcohol, drugs, substances)
 Anemia -  lifespan RBC (60 to 120 days)  LDH Lactic Dehydrogenase
o Bilirubin – end product of RBC o Increase = Liver Damage
destruction - accumulates – jaundice o Serum Antigen Antibody Test

o Icteric  Med Mgt: Symptomatic

 Jaundice, pruritus - accumulation of bile o Hepatic Protection (Liver aid) - ↓ effort of
salts on the skin metabolism, allow liver to relax

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
 Essentiale, Sillymarin, Jettipar (pedia)
o Antiviral – Lamivudine OD for 1 year Taeniasus
o Immune Stimulant – Chronic Hepatitis B, C, D  AKA Tapeworm
 IM  Taenia Saginata
 Interferon o Ingestion of insufficiently cooked or raw beef
 2-3x/wk. for 6mos.  Taenia Solium
o Rest and Nutrition o Pork
 Diphyllobothrium Latum
 Nrsg Care: o Fish
o Rest – liver recovery  Hymenolepsis Nana
o Nutrition o Dwarf tapeworm
  Fats – no enough bile released by the liver o Person to person
for emulsification of fats; increases tendency o Hand to mouth transmission
for bleeding  Get it as a whole – regenerate
  CHO every now and then – spare CHON
metabolism – ammonia – encephalopathy Paragonimiasis
 Butterball diet – hard candy (source of  Flatworm, Oriental lung fluke
energy)  CA: Paragonimus westermani
o Infected Moderate CHON  Source: ingestion of insufficiently cooked crab or
o Recovery Period High CHON crayfish
o Complications Low CHON  S/sx: productive cough and hemoptysis
 Prevention: o Misdiagnosed as TB
o Immunization
 Hepatitis B vaccine Parasitism through skin of the feet
o 0.1 mL
o 3 doses Ancylostomiasis
o IM – Vastus Lateralis  Hookworm
o 2 kg: 0-6-14  Only blood-sucking worm
o <2 kg (4 doses): 0-6-10-14  Loss of 50 mL of blood/ day
o No special instructions  Ancylostoma Duodenale
o Side effects:  Necatur Americanus
 soreness at injection site
 slight increase in ALT Stongyloidiasis
o Avoid mode of transmission  Threadworm
 Strongyloide Stercoralis
Parasitism through Ingestion
Enterobiasis S/sx:
 AKA Pinworm infection, Seatworm, Oxyuriasis  Voracious appetite
 CA: Enterobius Vermicularis  Weakness, pot belly, anemia
 MOT: Ingestion  Stunted growth
 S/sx:
o Nocturnal ani – night itchiness Dx: Stool exam
 Female worm goes out of the intestinal
 Well-fitted underwear Med Mgt:
 Dx Exam:  Antihelminthic – Albendazole
o Not diagnosed with stool exam
o Cellophane tape test Nursing Care: Supportive
 Morning
Prevention:
Ascariasis  Personal hygiene
 AKA Giant intestinal roundworms  Cutting long nails
 CA: Ascaris Lumbricoides  Wearing slippers
 MOT: Ingestion  Taking a bath
 S/sx: Intestinal obstruction  Proper preparation of food
o Passing out or vomiting of worms
GENITO-URINARY SYSTEM
Trichuriasis  Bacterial
 AKA Whipworm o Gonorrhea
 CA Trichuris Trichiuria o Syphillis
 MOT: Ingestion  Virus
o HIV
Trichinosis
 Roundworm
 Trichiniasis
 Trichinellosis 1. GONORRHEA
 CA: Trichinella Spiralis – Helminth  AKA Clap, Strain, Jack, G.C., Gleet, Morning drop,
 MOT: Ingestion “Tulo”
 Source: Insufficiently cooked or raw meat o Pus draining from the genitalia in the morning

University of Santo Tomas – College of Nursing / JSV

 Communicable Diseases
 GA: Neisseria Gonorrhea
 MOT: Sexual Contact
 IP: 3 to 21 days
 S/sx:
o Male – obvious signs because same opening for
reproduction and urination
 Urethritis, dysuria
 Redness and edema of urinary meatus
 Purulent urethral discharge
 Frequent gonorrhea - scar in the
epididymis – obstruct flow of sperm cell -
sterility
o Female – shows symptoms if they have PID;
urethra is not usually affected
 Urethral discharge
 Frequent gonorrhea - Narrowing of the
fallopian tube – ectopic pregnancy/
sterility
o Gonococcal septicemia
 Tender papillary skin lesion (pustular,
hemorrhagic or necrotic)
 Migratory polyarthralgia, polyarthritis,
tenosynovitis
 Dx Exam:
o Culture and sensitivity
 Urethral discharge
o Swab/scrape directly on the
anterior urethra
o Cervical smear/ Pap smear
 Med Mgt:
o Antibiotic
 Penicillin – Benzathine Penicillin G
o IM use only
o Large muscle – preferably on the
buttocks
o Big gauge needle – Gauge 19
o Only penicillin that is NOT given per
IV – death – readily coagulates –
embolus
o Given to patients with gonorrhea
and RHD
 Cephalosporin – Ceftriaxone, Cefuroxime
o If Gonorrhea does not heal – (+) Chlamydial
Infection – clear discharge
 Tetracycline – Doxycycline
 Nursing Care:
o Psychological aspect of care
o Health education – prevent recurrence and
spread of infection
 Prevention:
o Safe sex practices
 No sex
 Long term mutually monogamous
relationship
 Mutual masturbation without direct
contact
o Holding part but no sexual contact
o Education and Counseling
o Behavior modification
 Stick to one partner
o Use of condom – PREVENTIVE measure only, NOT
part of safe sex practice
 Chlamydial infection
University of Santo Tomas – College of Nursing / JSV
o Opthalmia Neonatorum (effect to child)
 Crede’s Prophylaxis
2. SYPHILIS
 AKA Pox, Lues, Bad Blood Disease
 CA: Treponema Pallidum – crosses placental
barrier – 2nd to 3rd trimester
 MOT: Sexual contact, blood transfusion (rare)
 IP: 10 – 90 days
 S/sx:
o Primary
 Chancre
o Painless moist ulcer that heals
spontaneously w/ or w/o treatment
o Genitals or extragenitally (face, fingers,
tongue, anal, lips)
 Regional lymphadenopathy
o Secondary/ Infectious
 Highly communicable
 Flu-like symptoms
 Fever, headache, body malaise, sore throat
 Skin rashes, condyloma lata/ condylomata
lata
o Lesions fused together found under the
breast or genitalia
 Oral mucous patches
 Patchy alopecia
 Thinning of pubic hair
 Generalized lymphadenopathy
o Latent Phase
 Asymptomatic (1 to 2 yrs)
 May still spread infection
o Tertiaty/ Late Stage
 Gumma – infiltrating tumor (skin, bone, liver)
 Not communicable
 CV changes – aortitis, aneurysms
 CNS degeneration – paresthesia, abnormal
reflexes, shooting pains, dementia, psychosis
 Dx Exam:
o Darkfield microscope
o Serologic test
 FTA-ABS (Flourescent Treponema Antibody
Absorption Test) – DEFINITIVE
 VDRL (Venereal Disease Research Laboratory)
 RPR (Rapid Plasma Reagin)
 Med Mgt: Antibiotic
 Nrsg Care: Same as gonorrhea
 Prevention: Same as gonorrhea
 Pregnancy – fetal death or congenital anomaly
3. HIV IINFECTION / AIDS
 HIV is the early stage of AIDS
 CA: Human Immunodeficiency Virus (Retrovirus)
 Fragile – easily destroyed by:
o Alcohol 70%
o Chlorine
o 56 C
o Na Hypochloride – 1: 10 parts of water
 Survive outside of the body
o With body fluids – 4 hours
o With blood – 12 hours
 Dead patient – cremated or sealed metal coffin
o Buried within 24 hrs – not embalmed
 MOT:
Single exposure
 Communicable Diseases
 Children – 2 major, 2 minor
Blood transfusion 90%
o Opportunistic Infections
Sexual contact 0.1 to 1%  MAC
Exposure to infected blood  CMV
0.1 to 0.5%
products or tissue  PCP
Perinatal transmission 30% (without treatment)  CA – Kaposi’s Sarcoma
(Pregnancy) 5% (with treatment) o Malignancy of blood vessel wall
Sharing needles or syringes 0.1 to 5% o Manifested in the skin
 Leopard Look - pink or purple
painless pus on the skin
 Dx Exam:
Cell Mediated Immunity Humoral Immunity o ELISA Test – Enzyme Linked Immuno Sorbent Assay –
Screening
o Western Blot
 T cells  B cells  Prerequisite: 2 positive ELISA test
o Synthesis of o Produces  Definitive
secretions of antibodies o HIV Viral Load
leukotrienes o Stimulated by  Monitors replicating activity of the virus
o Backbone of Helper T cells  Low value – T cell count is maintained
immune system  Monitored in an HIV woman who wants to
 Killer T cells be pregnant
o Cytotoxic o CD4 cell count
o Traces down and kills  1200 cells
infected human cells  Monitors stage of infection
 Helper T cells  > or = 200 – HIV infection
o Stimulates B cells  < 200 – AIDS – may develop opportunistic
 Suppresor T cells infections
o Time-keeper o Newborn/ Pedia
o Infection is under  Blood Culture for HIV
control  Immune-complex-dissociated p24 assay
o Tells immune system o Check for antigen
to relax
 Med Mgt: Does not kill virus, only prevents viral
multiplication
 MO  detected macrophage  alert T cells  o ARV Drugs
stimulate B cells  antibodies  MO  Cocktail Drugs – 21 tablets/ day
 HIV  reverse transcriptase  becomes T cells (allow o Neucloside reverse transcriptase inhibitor (NRTI)
virus to multiply)  damaged T cell  Virus will leave  Blocks or terminates viral multiplication
the T cell  virus will retrovert  AZT (Azidothymidine), zidovudine, retrovir
 Macrophages does not easily detect virus – symptoms  Agranulocytosis
not seen easily  CBC every 2 weeks
o Non-nucleoside reverse transcriptase inhibitor
 S/sx: (NNRTI)
o AIDS Related Complex Symptoms  Blocks DNA activity of virus
 Fever w/ night sweats w/o a cause  Nevirapine (Viramune)
 Enlarged lymph nodes w/o a cause o Protease Inhibitor (PI)
 Fatigability, weight loss, body malaise  Prevents and inhibits viral maturation
 Altered sleeping patterns  Saquinavir (Invirase), Indinavir (Crixivan),
 Temporary memory loss Ritonavir (Novir)
 Altered gait o Fusion inhibitor
 Prevents fusion of the virus to human cell
o AIDS Defining Disease
 Major signs  Nrsg Care:
o Persistent fever 1 month and above o Promote knowledge and understanding
o Chronic diarrhea 1 month and above o Promote quality of life – unpredictable
o 10 % weight loss (stunted growth) o Provide self-care and comfort
 Minor signs
o Persistent cough 1 month and above  Prevention:
o Persistent generalized o Same with other STIs
lymphadenopathy
o Generalized pruritic dermatitis
o Oropharyngeal candidiasis
o Recurrent herpes zoster
o Progressive disseminated herpes
simplex

 Adults – 2 major, 1 minor

University of Santo Tomas – College of Nursing / JSV

 Community Health Nursing
DYSENTERY

Bacillary Violent Amebic

Synonym Shigellosis Bloody Flux Cholera Eltor Amebiasis

Shigella Vibrio Cholerae Entamoeba Histolytica

 Shiga  Comma
o Flexneri o Ogawa 2 stages:
o Boydii o Inaba  Inactive – cyst - harmless
Causative Agent o Bonnet o El Tor  Active – trophozoides – becomes active when
passes the intestines

Mode of Fecal-oral
Transmission
Mucoid stool Rice watery stool one after the Mucopurulent blood streaked stool with foul smell
Blood streak if severe other  Dissolved intestinal tissue
 Vibriolytic substances   Stool has pus
peristalsis  s/sx
 Rapid DHN
Signs and
 Washerwoman’s hand
Symptoms
o Dry, wrinkled
 Waten bed
o Hole and pail for the
stool

Stool Examination Stool Examination Stool Examination

Rectal Swab Rectal Swab Rectal Swab
Diagnostic Exams  Fresh – w/in 30 mins
 Trophozoides  cyst

Antibiotic (Ciprofloxacin) Antibiotic (Tetracycline) Antibiotic (Metronidazole)

Oral rehydration Therapy IV Therapy *Chloroquine – antiprotozoal
Medical Oral rehydration Therapy
Management

Nursing Care Same as typhoid

Prevention Same as typhoid

University Of Santo Tomas – College Of Nursing Page 20