Diphtheria

• Acute bacterial disease characterized by elaboration of an exotoxin.

Etiologic agent

• Corynebacterium diphtheria

• Klebs- Loeffler bacillus

Incubation period

• 2-5 days

Mode of transmission

• Respiratory droplets

• Direct contact with respiratory secretions

• Indirect contact with articles

Signs and symptoms

• Nasal Diphtheria

o Bloody discharge from the nose

o Excoriated nares and upper lip

• Tonsilopharyngeal Diphtheria

o Low grade fever

o Sore throat

o Bull- neck appearance

o Psuedomembrane- group of pale yellow membrane over tonsils and at

the back of the throat as an inflammatory response to powerful
necrotizing toxins.

• Laryngeal Diphtheria

o Hoarseness

o Croupy cough

o Aphonia
 o Membrane lining thickness airway obstruction

o Suffocation, cyanosis or death

• Wound or Cutaneous Diphtheria

o Yellow spots or sores in the skin

Diagnostic procedures

• Schick’s Tests- susceptibility and immunity to diphtheria

• Maloney’sTest- determines hypersensitivity to diphtheria anti-toxin

Complications

• Myocarditis (epigastric or cest pain)

• Peripheral paralysis (tingling, numbness, paresis)

• Broncho-pnuemonia (fever, cough)

• Heart failure

• Decrease in respiratory rate

• Respiratory arrest

• Death

Treatment modalities

• Diphtheria anti-toxin

o Requires skin testing

o Early administration aimed at neutralizing the toxin present in the

circulation before it is absorbed by the tissues

• Anti-biotic therapy

o Penicillin G

o Erythromycin

Nursing Management

• Isolation: 14 days (until 2-3 cultures, 24 hrs apart)

 • Bed rest for 2 weeks

• Care for nose and throat (gentle swabbing)

• Ice collar (decrease pain of sore throat)

• Diet (soft food, small frequent feedings)

Pertussis

• Repeated attacks of spasmodic coughing

• 100 days of cough

• Whooping cough

Incubation period

• 7-14 days

Mode of transmission

• Respiratory droplets

• Direct contact with respiratory secretions

• Indirect contact with articles

Stages

• Catarrhal stage

o Last for 1-2 weeks

o Most communicable stage

o Begins with respiratory infection, sneezing, nocturnal cough and fever

o Cough becomes more frequent at night

• Paroxysmal stage

o Last for 4-6 weeks

o Sneezing, tickling, itching of throat

o Cough, explosive outburst ending in “whoop”

 o Mucus is thick, ends in vomiting

o Becomes cyanotic

o With profuse sweating, involuntary urination and exhaustion

• Convalescent stage

o End of 4th -6th week

o Decrease in paroxysms

Diagnostic procedure

• CBC- increase in lymphocytes

Complications

• Convulsion (brain damage from asphyxia)

• Otitis media (invading organisms)

• Bronchopneumonia (most dangerous complication)

Treatment modalities

• Erythromycin- drug of choice

• Ampicillin- if resistant to erythromycin

• Betamethasone (corticosteroid)- decrease severity and length of paroxysms

• Albuterol(bronchodilator)

Nursing Mnagement

• Isolation: 4-6 weeks from onset of illness

• Supportive measures (bed rest, avoid excitement, dust, smoke and warm
baths)

• Safety (during paroxysm, patient should not be left alone)

• Suctioning (kept at bedside for emergency use)

Measles
 • Rubeola

• 7 day fever

• A contagious exanthematous disease with chief symptoms to the upper

respiratory tract

Etiologic agent

• Filterable virus of paramyxoviridae

Incubation period

• 10-12 days (20 days)

Mode of transmission

• Droplet method

• Direct contact with respiratory discharge

• Indirect with soiled linens articles

Period of communicability

• 4 days before and 5 days after the appearance of rashes

Signs and symptoms

• Koplik’s spot

o bluish white spots surrounded by a red halo

o Appear on the buccal mucosa opposite the premolar teeth

• Presumptive stage

o Cough

o Coryza

o Conjunctivitis

o Fever (high grade)

o Photophobia

• Eruptive stage

o Rashes
  Elevated papules

 Begins on the face and behind the ears

 Spread o trunks and extremities

 Dark red- purplish hue- yellow brown

• Stage of convalescence

o Desquamation

o Rashes fades from the face downwards

Complication

• Pneumonia

• Otitis media

• Severe diarrhea (leading to dehydration)

• Encephalitis

Treatment modalities

• Vitamin A- helps prevent eye damage and blindness

• Antipyretics- for fever

• Penicillin- given only when secondary infection sets in

Nursing Management

• Darkened room to relieved photophobia

• Diet: should be liquid but nourishing

• Warm saline solution for eye to relieve eye irritation

• For fever: tepid sponge bath and anti-pyretic

• Skin care: during eruptive stage, soap is omitted; bicarbonate of soda in

water or lotion to relieve itchiness

• Prevent spread of infection: respiratory isolation

German measles

• Rubella
 • A benign communicable exanthematous disease caused by rubella virus

Etiologic agent

• Rubella virus

Incubation period

• 14-21 days (24 days)

Mode of transmission

• Droplet method

• Direct contact with respiratory discharge

• Indirect with soiled linens articles

Period of communicability

• 1 week before and 4 days after the appearance of rashes

Signs and symptoms

• Forcheimer’s spots

o Small, red lesions

o Soft palate to mucus membrane

• Presumptive stage

o Fever

o Headache

o Malaise

o Coryza

o Conjunctivitis

• Eruptive stage

o Rashes

 Pinkish, maculopapular

 Begins on the face

  Spread to trunk or limbs

o No pigmentation or desquamation

• Stage of convalescences

o Posterior auricular and sub occipital lymphadenopathy

Complications

• Encephalitis

• Congenital rubella syndrome

o Spontaneous abortion

o Intrauterine growth retardation (IUGR)

o Thrombocytopenia purpura “blueberry muffin skin”

o Cleft lip, cleft palate, club foot

o Heart defects (PDA, VSD)

o Eye defects (Cataract, glaucoma)

o Ear defects (Deafness)

o Neurologic (microcephaly, mental retardation,behavioral disturbances

Treatment modalities

• Aspirin- help reduce inflammation and fever

Nursing Management

• Darkened room to relieved photophobia

• Diet: should be liquid but nourishing

• Warm saline solution for eye to relieve eye irritation

• For fever: tepid sponge bath and anti-pyretic

• Skin care: during eruptive stage, soap is omitted; bicarbonate of soda in

water or lotion to relieve itchiness

• Prevent spread of infection: respiratory isolation

Tuberculosis
 • Is a chronic, sub acute, or acute disease that most commonly affects the
respiratory system, usually the lungs

• Characterized by the formation in the tissues of tubercles, which tend to

undergo caseation, necrosis and calcification which tend to spread to the
tissues.

• Consumption

• Phthisis

Etiologic agent

• Mycobacterium tuberculosis

o a bacterium that resembles a fungus multiples slowly

o acid-fast aerobic microorganisms

o Can be killed by heat, sunshine, drying and ultraviolet light

Incubation period

• 2-10 weeks

Mode of transmission

• Air borne- inhalation of droplet nuclei

• Direct- person to person

Signs and symptoms

• Generalized systemic signs and symptoms

o General malaise, anorexia, easy fatigability

o Afternoon fever

o Night sweats

o Weight loss

• Pulmonary signs and symptoms

o Cough for 2-3week

o Fine crepitant rales

o Hemoptysis and chest pail

 o Dyspnea

Diagnostic Examination

• Sputum ,smear and culture

• Bronchoscopy

• Tuberculin test (Mantoux test)

oStandard dose- 5 Tuberculin units (0.1 mL).

o2 tuberculin units (TU) is injected intracutaneuosly into the volar
surface of the forearm to form a wheel measuring5 - 7 mm in dm
o The test should be read 48 to72 hours later noting the size of the
Induration.
o 10 mm or more ² indicates positive reaction
• Chest X-ray
Treatment modalities

• Rifampicin (RMP)- oral for 6 months

• Isoniazid (INH)- oral at least1 year

• Pyrazinamide

• Ethambutol (EMB)- oral for 6 months

• Streptomycin (SM)- IM,3 months in most cases

Nursing Management

• BCG Vaccine(BacillusCalmette Guerin)

o Live-attenuated bacteria

o 1st dose-Any time after birth 0.05 ml IM

o 2nd dose School entrance 0.01 ml

• Early diagnosis and treatment

• Isolation

• TB education program

• Hand washing
AUJERO, Loida O.
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