COMMUNICABLE DISEASE NURSING

SUMMER REVIEW

- An agent that prevents bacterial multiplication but does not kill

microorganisms

COMMUNICABLE DISEASE

Disease caused by an infectious agent that are transmitted

directly or indirectly to a well person through an agency, vector or
inanimate object

CHAIN OF INFECTION

CONTAGIOUS DISEASE

Disease that is easily transmitted from one person to

another
INFECTIOUS DISEASE

Disease transmitted by direct inoculation through a break in

the skin
INFECTION
-Entry and multiplication of an infectious agent into the tissue of the
host
INFESTATION
- Lodgement and development of arthropods on the surface of the
body

INFECTIOUS AGENT

ASEPSIS
- Absence of disease producing microorganisms
SEPSIS
- The presence of infection

MEDICAL ASEPSIS
Practices designed to reduce the number and transfer of
pathogens
Clean technique
SURGICAL ASEPSIS
Practices that render and keep objects and areas free from
microorganisms
Sterile technique

CARRIER an individual who harbors the organism and is

capable of transmitting it without showing manifestations of the
disease

CASE a person who is infected and manifesting the signs

and symptoms of the disease

SUSPECT a person whose medical history and signs and

symptoms suggest that such person is suffering from that particular
disease

CONTACT any person who had been in close association

with an infected person
HOST
- A person, animal or plant which harbors and provides nourishment
for a parasite
RESERVOIR
- Natural habitat for the growth, multiplication and reproduction of
microorganism
ISOLATION
- The separation of persons with communicable diseases from other
persons
QUARANTINE
- The limitation of the freedom of movement of persons exposed to
communicable diseases

STERILIZATION the process by which all microorganisms

including their spores are destroyed

DISINFECTION the process by which pathogens but not

their spores are destroyed from inanimate objects

CLEANING the physical removal of visible dirt and debris

by washing contaminated surfaces
CONCURRENT
- Done immediately after the discharge of infectious materials /
secretions
TERMINAL
- Applied when the patient is no longer the source of infection
BACTERICIDAL
- A chemical that kills microorganisms
BACTERIOSTATIC

Any microorganism capable of producing a disease

RESERVOIR

Environment or object on which an organism can survive

and multiply
PORTAL OF EXIT
The venue or way in which the organism leaves the
reservoir
MODE OF TRANSMISSION

The means by which the infectious agent passes from the

portal of exit from the reservoir to the susceptible host
PORTAL OF ENTRY

Permits the organism to gain entrance into the host

SUSCEPTIBLE HOST

A person at risk for infection, whose defense mechanisms

are unable to withstand invasion of pathogens
STAGES OF THE INFECTIOUS PROCESS

Incubation Period acquisition of pathogen to the onset of

signs and symptoms

Prodromal Period patient feels bad but not yet

experiencing actual symptoms of the disease

Period of Illness onset of typical or specific signs and

symptoms of a disease

Convalescent Period signs and symptoms start to abate

and client returns to normal health
MODE OF TRANSMISSION
CONTACT TRANSMISSION

Direct contact involves immediate and direct transfer

from person-to-person (body surface-to-body surface)

Indirect contact occurs when a susceptible host is

exposed to a contaminated object
DROPLET TRANSMISSION

Occurs when the mucous membrane of the nose, mouth or

conjunctiva are exposed to secretions of an infected person within a
distance of three feet
VEHICLE TRANSMISSION

Transfer of microorganisms by way of vehicles or

contaminated items that transmit pathogens
AIRBORNE TRANSMISSION

Occurs when fine particles are suspended in the air for a

long time or when dust particles contain pathogens
VECTOR-BORNE TRANSMISSION

Transmitted by biologic vectors like rats, snails and

mosquitoes
TYPES OF IMMUNIZATION

ACTIVE antibodies produced by the body

NATURAL antibodies are formed in the presence of

active infection in the body; lifelong

ARTIFICIAL antigens are administered to stimulate

antibody production

PASSIVE antibodies are produced by another source

NATURAL transferred from mother to newborn through

placenta or colostrum

ARTIFICIAL immune serum (antibody) from an animal or

human is injected to a person
SEVEN CATEGORIES OF ISOLATION

STRICT- prevent highly contagious or virulent infections

Example: chickenpox, herpes zoster

CONTACT spread primarily by close or direct contact

CD-Bucud

Example: scabies, herpes simplex

RESPIRATORY prevent transmission of infectious
distances over short distances through the air

Example: measles, mumps, meningitis

TUBERCULOSIS indicated for patients with positive

smear or chest x-ray which strongly suggests tuberculosis

ENTERIC prevent transmission through direct contact with

feces

Example: poliomyelitis, typhoid fever

DRAINAGE prevent transmission by direct or indirect

contact with purulent materials or discharge

Ex. Burns

UNIVERSAL prevent transmission of blood and body-fluid

borne pathogens

Example: AIDS, Hepatitis B

CENTRAL NERVOUS SYSTEM

ENCEPHALITIS

MENINGITIS

MAIN PROBLEM

- Inflammation of
the brain

- Inflammation of
the meninges

ETIOLOGIC AGENT

MENINGOCOCCEMIA
- Acute infection of
the bloodstream and
developing vasculitis

- Streptococcus
- Staphylococcus
- Pneumococcus
- Tubercle bacillus

- Arboviruses

5-15 days

1-10 days

3-4 days

MODE OF TRANSMISSION

Bite of infected
mosquito

SIGNS AND SYMPTOMS OF MENINGOCOCCEMIA

DIC
URTI:
cough, sore
throat,
fever,
headache,
nausea and
vomiting

Hypotension
Death

ENCEPHALITIS

MENINGITIS

MENINGOCOCCEMIA
Vasculitis

Stiff neck

Nuchal rigidity

Photophobia

Opisthotonus

Lethargy

Brudzinskis

Convulsions

Kernigs sign

WaterhouseFriderichsen
syndrome
Petechiae with
the development
of hemorrhage

INCIDENCE

5-10 years old

< 5 years old

Virus enters neural cells

Lethargy
Convulsions
Seizures

Purpura
Shock

Respiratory droplets

SIGNS AND SYMPTOMS OF ENCEPHALITIS

Disruption in
cellular
functioning

Microthrombosis

Vasculitis:
petechial
rash in the
trunk and
extremities

SIGNS AND SYMPTOMS

- Neisseria meningitides

INCUBATION PERIOD

If the patient flexes the hips and knees in response to the

manipulation, positive for meningitis
KERNIGS SIGN
Place the patient in a supine position, flex his leg at the hip and knee
then straighten the knee; pain and resistance indicates meningitis

Perivascular
congestion

Headache
Photophobia
Vomiting
Stiff neck

Inflammatory
reaction

Fever
Sore throat

DIAGNOSTIC EXAM

Informed consent

Empty bowel and bladder

Fetal, shrimp or C position

Spinal canal, subarachnoid space between L3-L4 or L4- L5

After: bedrest

Flat on bed to prevent spinal headache

ENCEPHALITIS

MENINGITIS

MENINGOCOCCEMIA

TREATMENT MODALITIES

Dexamethasone

SIGNS AND SYMPTOMS OF MENINGITIS

6 months5
years old

Ceftriaxone

Mannitol

Penicillin

Anticonvulsants

Chloramphenicol

Antipyretics
PREVENTION

1. Japanese
encephalitis
VAX

1. HiB vaccine

Rifampicin
Ciprofloxacin

THREE SIGNS OF MENINGEAL IRRITATION

OPISTHOTONUS
State of severe hyperextension and spasticity in which an individuals
head, neck and spinal column enter into a complete arching position
BRUDZINSKIS SIGN
Place the patient in a dorsal recumbent position and then put hands
behind the patients neck and bend it forward.
CD-Bucud

ENCEPHALITIS

MENINGITIS

NURSING MANAGEMENT
1. Comfort: quiet,
well-ventilated
room
2. Skin care:
cleansing bath,
change in
position
3. Eliminate
mosquito
breeding sites:
CULEX
mosquito

MENINGOCOCCEMIA
1. Side boards

1. Respiratory
isolation 24-72
hours after onset
of antibiotic
therapy

2. Close contacts

2. Room protected
against bright
lights

S ame daycare
center

3. Safety: side-lying
position and
raised side rails

H ouse
I nfected person
kissing

S hare mouth
instruments
3. Antibiotics as
prophylaxis

RABIES

TETANUS

Acute viral disease

of the CNS by
saliva of infected
animals

Acute infectious
disease with systemic
neuromuscular
effects

ETIOLOGIC AGENT

Rhabdovirus

Clostridium tetani

Legio debilitans

Bullet-shaped

Anaerobic

Affinity to CNS

Gram positive

Killed by sunlight,
UV light, formalin

Drumstick
appearance

POLIOMYELITIS
MAIN PROBLEM
Acute infection of
the CNS muscle
spasm, paresis and
paralysis

Resistant to
antibiotics

RABIES

POLIOMYELITIS

TETANUS

Recovery within 72 hours and the disease passes by

unnoticed
PRE-PARALYTIC OR MENINGETIC TYPE

Slight involvement of the CNS

Pain and spasm of muscles

Transient paresis

(+) Pandys test (increased protein in the CSF)

PARALYTIC TYPE

CNS involvement

Flaccid paralysis

Asymmetric

Affects lower extremities

Urine retention and constipation

(+) HOYNES SIGN (when in supine position, head will fall

back when shoulders are elevated)

RABIES
PRODROMAL/INVASION PHASE

Fever

Anorexia

Sore throat

Pain and tingling at the site of bite

Difficulty swallowing
EXCITEMENT OR NEUROLOGICAL PHASE

Hydrophobia (laryngospasm)

Aerophobia (bronchospasm)

Delirium

Maniacal behavior

Drooling
TERMINAL OR PARALYTIC PHASE

Patient becomes unconscious

Loss of urine and bowel control

Progressive paralysis

Death

RABIES

POLIOMYELITIS
INCUBATION PERIOD

7-21 days

2-8 weeks
Distance of bite to
brain
Extensiveness of the
bite

Adult: 3 days-3
weeks
Neonate: 3-30 days

2. CSF culture
Bite of an infected
animal

- Indirect with soiled

linens and articles

POLIOMYELITIS

RABIES

SIGNS AND SYMPTOMS

1. Abortive type
2. Pre-paralytic
or meningetic
type
3. Paralytic type

RESPIRATORY
FAILURE

Paralysis of
respiratory muscles

1. Stool culture

MODE OF TRANSMISSION

- Direct contact with

respiratory secretions

COMPLICATION

DEATH

DIAGNOSTIC PROCEDURES

Resistance of the
host
- Direct contact with
infected feces

TETANUS

Direct inoculation
through a broken
skin

1. Throat washings

1. Blood exam

2. Flourescent rabies
antibody (FRA)
3. Negri bodies

ISOLATION PRECAUTION

Enteric isolation

Respiratory
isolation

POLIOMYELITIS

RABIES

TETANUS
R isus sardonicus

TREATMENT MODALITIES

1. Prodromal /
invasion
phase

O pistothonus

1. Analgesics

T rismus

2. Morphine

2. Excitement /
neurological
phase

C onvulsions

3. Moist heat
application

3. Terminal /
paralytic type

I rritability

H eadache

L aryngeal
spasm

4. Bed rest
5. Rehabilitation

1. Local
treatment of
wound

TETANUS
1. Tetanus immune
globulin (TIG)
2. Tetanus antitoxin
(TAT)

2. Active
immunization

3. Penicillin G

Lyssavac

5. Diazepam

Imovax

6. Phenobarbital

Antirabies vax
2. Passive
immunization

4. Tetracycline

7. Tracheostomy
8. NGT feeding

POLIO
ABORTIVE TYPE

Does not invade the CNS

Headache

Sore throat
CD-Bucud

RABIES

POLIOMYELITIS

TETANUS

BIRD FLU
COMPLICATIONS

NURSING MANAGEMENT

1. Enteric isolation

1. Isolation

1. Adequate airway

2. Proper disposal
of secretions

2. Optimum
comfort

2. Quiet, semi-dark
environment

3. Moist hot packs

3. Restful
environment

3. Avoid sudden
stimuli and light

4. Firm /
nonsagging bed
5. Suitable body
alignment
6. Comfort and
safety

PREVENTION

Salk vaccine
- Inactivated
polio vaccine
- Intramuscular
Sabin vaccine
- Oral polio
vaccine
- Per orem

Fluid accumulation in
alveolar sacs
Severe breathing difficulties

4. Emotional
support
5. Concurrent
and terminal
disinfection

2. If the dog dies or

shows signs
suggestive of
rabies

1. Aseptic
handling of
umbilical cord

4. Have domestic
dog 3 months to
1 year old
immunized

BIRD FLU

- Penicillin
- Erythromycin

- 150 mg BID x 2 days

2. Tetanus toxoid
immunization

- Tetracycline

RESPIRATORY SYSTEM

SARS

PREVENTION

SARS

MAIN PROBLEM

A new type of atypical pneumonia

that infects the lungs

ETIOLOGIC AGENT

Corona virus

INCUBATION PERIOD

3-5 days

SARS

TREATMENT MODALITIES

BIRD FLU

Avian influenza virus, H5N1

Respiratory failure

1. Amantadine/Rimantadine 1. No definitive treatment

for SARS
- Generic flu drugs
- H5N1 developed resistance 2. Antiviral drugs
(normally used to treat
2. Oseltamivir (TAMIFLU)
AIDS)
Zanamavir (RELENZA)
- RIBAVIRIN
- Primary treatment
- Within 2 days at onset of 3. Corticosteroids
symptoms

3. Antibiotic
prophylaxis

3. If dog is not
available for
observation

Flu infection in birds that

affects humans

Hypoxemia

DEATH
TETANUS

1. If the dog is
healthy

BIRD FLU

Severe viral
pneumonia

Multiple organ failure

RABIES

POLIOMYELITIS

Severe viral pneumonia

Acute respiratory distress
syndrome

SARS

2-8 days

MODE OF TRANSMISSION

Inhalation of feces and

discharge of an infected bird

Respiratory droplets

BIRD FLU

SARS

SIGNS AND SYMPTOMS

Body weakness or muscle

pain
Cough
Difficulty breathing
Episodes of sore throat
Fever
High fever >38Celsius
Chills

1.Culling killing of
sick or exposed
birds
2. Banning of
importation of
birds (Executive
order # 280)
3. Cook chicken
thoroughly

1.Quarantine
2. Isolation
3. WHO alert
on SARS
(March 12,
2003)

NURSING MANAGEMENT
BIRD FLU
WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD
FLU

Isolation

Face mask on the patient

Caregiver: use a face mask and eye goggles/glasses

Distance of 1 meter from the patient

Transport the patient to a DOH referral hospital

REFERRAL HOSPITALS

National Referral Center Research Institute for Tropical

Medicine (RITM) (Alabang, Muntinlupa)

Luzon San Lazaro Hospital (Quiricada St., Sta. Cruz,

Manila)

Visayas Vicente Sotto Memorial Medical Hospital

(Cebu City)

Mindanao Davao Medical Center (Bajada, Davao City)

SARS
SUSPECT CASE
1. A person presenting after 1 November 2002 with a history of:

High fever >38 0C

AND

Cough or breathing difficulty

AND

One or more of the following exposures during the 10 days

prior to the onset of symptoms:
Close contact, with a person who is a suspect or
probable case of SARS
CD-Bucud

History of travel, to an area with recent local

transmission of SARS
Residing in an area with recent local transmission of
SARS
2. A person with an unexplained acute respiratory illness resulting
in death after 1 November 2002, but on whom no autopsy has been
performed :
AND

One or more of the following exposures during the 10 days

prior to the onset of symptoms:
Close contact, with a person who is a suspect or
probable case of SARS
History of travel, to an area with recent local
transmission of SARS
Residing in an area with recent local transmission of
SARS
PROBABLE CASE
1. A suspect case with radiographic evidence of infiltrates
consistent with pneumonia or respiratory distress syndrome on Chest
x-ray.

2. A suspect case of SARS that is positive for SARS coronavirus by

one or more assays.
3. A suspect case with autopsy findings consistent with the
pathology of SARS without an identifiable cause.

DIPHTHERIA

PERTUSSIS

Begins with respiratory infection, sneezing, cough and

fever

Cough becomes more frequent at night

PAROXYSMAL STAGE

Lasts for 4 to 6 weeks

Aura: sneezing, tickling, itching of throat

Cough, explosive outburst ending in whoop

Mucus is thick, ends in vomiting

Becomes cyanotic

With profuse sweating, involuntary urination and

exhaustion
CONVALESCENT STAGE

End of 4th-6th week

Decrease in paroxysms

DIPHTHERIA

PERTUSSIS

DIAGNOSTIC PROCEDURES
CBC

SCHICKS TESTS
- Susceptibility and immunity to
diphtheria

increase in
lymphocytes

-ID of dilute diphtheria toxin (0.1

cc)
(+) local circumscribed area of
redness, 1-3 cm
MALONEYS TEST
-Determines hypersensitivity to
diphtheria anti-toxin
-ID of 0.1 cc fluid toxoid
-(+) area of erythema in 24 hours

MAIN PROBLEM

Acute bacterial disease

characterized by the elaboration
of an exotoxin

Repeated attacks of spasmodic

coughing

ETIOLOGIC AGENT

DIPHTHERIA

PERTUSSIS

COMPLICATIONS

Corynebacterium diphtheriae or
Klebs-Loeffler bacillus

Bordetella pertussis

INCUBATION PERIOD

7-14 days

2-5 days
MODE OF TRANSMISSION

Myocarditis
(epigastric
or chest
pain)

1. Respiratory droplets
2. Direct contact with respiratory secretions
3. Indirect contact with articles

DIPHTHERIA

PERTUSSIS

SIGNS AND SYMPTOMS

Types:
1.Nasal
2.Tonsilopharyngeal
3.Laryngeal
4.Wound or
cutaneous

Convulsions (brain

Toxins in the bloodstream

Heart
failure

Peripheral
paralysis
(tingling,
numbness,
paresis)

Decreased
in
respiratory
rate

damage from
asphyxia)

Bronchopneumonia
(fever,
cough)

Respirat
ory
arrest

Otitis media
(invading
organisms)

Bronchopneumonia
(most dangerous
complication)

DEATH

Stages:
1. Catarrhal
2. Paroxysmal
3. Convalescent

NASAL DIPHTHERIA

Bloody discharge from the nose

Excoriated nares and upper lip

TONSILOPHARYNGEAL DIPHTHERIA

Low grade fever

Sore throat

Bull-neck appearance

Pseudomembrane- Group of pale yellow membrane over

tonsils and at the back of the throat as an inflammatory
response to a powerful necrotizing toxins
LARYNGEAL DIPHTHERIA

Hoarseness

Croupy cough

Aphonia

Membrane lining thickens airway obstruction

Suffocation, cyanosis or death

WOUND OR CUTANEOUS DIPHTHERIA

Yellow spots or sores in the skin

PERTUSSIS
CATARRHAL STAGE

Lasts for 1 to 2 weeks

Most communicable stage

DIPHTHERIA

PERTUSSIS

TREATMENT MODALITIES

1. Diphtheria anti-toxin
- Requires skin testing
- Early administration
aimed at neutralizing the
toxin present in the
circulation before it is
absorbed by the tissues
2. Antibiotic therapy
- Penicillin G
- Erythromycin

DIPHTHERIA
NURSING MANAGEMENT

1. Isolation: 14 days (until

2-3 cultures, 24 hours
apart)
2. Bedrest for 2 weeks
3. Care for nose and
throat (gentle swabbing)
4. Ice collar (decrease pain
of sore throat)
5. Diet (soft food, small
frequent feedings)

1. Erythromycin drug of
choice
2. Ampicillin if resistant
to erythromycin
3. Betamethasone
(corticosteroid)
decrease severity and
length of paroxysms
4. Albuterol
(bronchodilator)

PERTUSSIS
1. Isolation: 4-6 weeks from
onset of illness
2. Supportive measures
(bedrest, avoid
excitement, dust, smoke
and warm baths)
3. Safety (during
paroxysms, patient
should not be left alone)
4. Suctioning (kept at
bedside for emergency
use)
CD-Bucud

AMOEBIASIS

MUMPS
MAIN PROBLEM
An acute contagious disease, with swelling of one or both of the
parotid glands
ETIOLOGIC AGENT
Filterable virus of paramyxovirus group
INCUBATION PERIOD
12-26 days
MODE OF TRANSMISSION
Respiratory droplets
PERIOD OF COMMUNICABILITY
6 days before and 9 days after onset of parotid swelling
SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS

1. Acute amoebic dysentery

Fever

- Diarrhea alternated with

constipation

Abdominal pain

- Tenesmus

Diarrhea and
tenesmus

- Bloody mucoid stools

2. Chronic amoebic
dysentery

Bloody mucoid
stool

- Enlarged liver
- Large sloughs of intestinal
tissues accompanied by
hemorrhage

PRODROMAL PHASE
F-ever (low grade)
H-eadache
M-alaise

AMOEBIASIS

PAROTITIS
F-ace pain
E-arache
S-welling of the parotid glands

SHIGELLOSIS

DIAGNOSTIC TESTS
1. Stool exam

COMPLICATIONS

Orchitis the most notorious complication of mumps

Oophoritis manifested by pain and tenderness of the

abdomen

CNS involvement manifested by headache, stiff neck,

delirium, double vision

Deafness as a result of mumps

NURSING MANAGEMENT
1.
Prevent complications

Scrotum supported by suspensory

Use of sedatives to relieve pain

Treatment: oral dose of 300-400 mg cortisone followed by

100 mg every 6 hours

Nick in the membrane

2. Diet
- Soft or liquid diet
- Sour foods or fruit juices are disliked
3. Respiratory isolation
4. Comfort: ice collar or cold applications over the parotid glands may
relieve pain
5. Fever: aspirin, tepid sponge bath
6. Concurrent disinfection: all materials contaminated by these
secretions should be cleansed by boiling
7. Terminal disinfection: room should be aired for six to eight hours

2. Blood exam
3. Sigmoidoscopy
TREATMENT MODALITIES

1. Metronidazole drug
of choice

1. Cotrimoxazole drug
of choice

2. Tetracycline
3. Chloramphenicol

AMOEBIASIS

SHIGELLOSIS

NURSING MANAGEMENT

1.Enteric isolation
2. Boil water for
drinking
3. Handwashing
4. Sexual activity
5. Avoid eating
uncooked leafy
vegetables

GASTROINTESTINAL TRACT

AMOEBIASIS

SHIGELLOSIS

SHIGELLOSIS

MAIN PROBLEM
Protozoal infection of the large
intestine

Acute infection of the lining

of the small intestine

CHOLERA

TYPHOID FEVER

MAIN PROBLEM

ETIOLOGIC AGENT

Entamoeba histolytica

Shigella group

- Prevalent in areas with ill

sanitation

1. Shigella flesneri most

common in the Philippines

-Acquired by swallowing

2. Shigella connei

- Trophozoites: vegetative form

3. Shigella boydii

- Cyst: infective stage

4. Shigella dysenterae most

infectious type

Acute bacterial disease of the

GIT characterized by profuse
secretory diarrhea

An infection affecting the

Peyers patches of the small
intestines

ETIOLOGIC AGENT

Vibrio cholerae

Salmonella typhi

INCUBATION PERIOD

1 to 3 days

1 to 3 weeks

MODE OF TRANSMISSION

1. Fecal-oral transmission
2. 5 Fs

CD-Bucud

CHOLERA

TYPHOID FEVER

SIGNS AND SYMPTOMS

Fever (ladder-like)

Rice-water stool
Abdominal cramps

Rose spots
Diarrhea

Vomiting

TYPHOID STATE

Intravascular
Dehydration

Sordes

Shock

Coma vigil

CHICKENPOX
PERIOD OF COMMUNICABILITY

One day before eruption

of 1st lesion and five days
after appearance of last
crop

PRODROMAL
PERIOD
- Fever (low-grade)
- Headache

Carphologia

TYPHOID FEVER

TREATMENT MODALITIES

1.Lactated Ringers
solution

1.Chloramphenicol
drug of choice
2. Ampicillin/
Amoxicillin for
typhoid carriers

2. Oral rehydration
therapy
3. Antibiotic therapy
- Tetracycline drug
of choice

3. Cotrimoxazole for
severe cases with
relapses

- Malaise

CHICKENPOX
SIGNS AND SYMPTOMS

Rashes

: Centrifugal
distribution
Rash stages: macule
papule
vesicle
pustule
crust
Pruritus

- Cotrimoxazole
- Chloramphenicol

CHOLERA

TYPHOID FEVER

NURSING MANAGEMENT

CHICKENPOX
COMPLICATIONS

1. Maintain and restore the fluid

and electrolyte balance
2. Enteric isolation
3. Sanitary disposal of excreta
4. Adequate provision of safe
drinking water
5. Good personal hygiene

One day before eruption

of 1st rash and five to six
days after the last crust

SIGNS AND SYMPTOMS

Subsultus Tendinum

CHOLERA

HERPES ZOSTER

SCARRING most common

complication; associated with
staphylococcal or streptococcal
infections from scratching
NECROTIZING FASCIITIS
most severe complication
REYE SYNDROME
abnormal accumulation of fat in
the liver plus increase of
pressure in the brain resulting to
coma, therefore leading to
DEATH

HERPES ZOSTER
Rashes

-Unilateral, band-like
distribution
-Dermatomal
- Erythematous base
- Vesicular, pustular or
crusting
Regional
lymphadenopathy
Pruritus
Pain stabbing or
burning

HERPES ZOSTER
RAMSAY-HUNT
SYNDROME - Involvement of
the facial nerve in herpes zoster
with facial paralysis, hearing
loss, loss of taste in half of the
tongue
GASSERIAN
GANGLIONITIS
Involvement of the optic nerve
resulting to corneal anesthesia
ENCEPHALITIS acute
inflammatory condition of the
brain

INTEGUMENTARY SYSTEM

CHICKENPOX

HERPES ZOSTER

MAIN PROBLEM

A highly contagious disease

characterized by vesicular
eruptions on the skin and
mucous membranes
ETIOLOGIC AGENT

An acute viral infection of

the sensory nerve

Varicella zoster virus

INCUBATION PERIOD

10-21 days
MODE OF TRANSMISSION

13-17 days
1. Droplet method
2. Direct contact
3. Indirect contact

CD-Bucud

CHICKENPOX

HERPES ZOSTER

- Soft palate to mucus membrane

MEASLES

GERMAN MEASLES

TREATMENT MODALITIES

1. Antihistamines
symptomatic relief of itching
Ex. Diphenhydramine
(Benadryl)

4. Corticosteroids antiinflammatory and decreased

pain
Ex. Prednisone

2. Analgesics and antipyretics

Ex. Acetaminophen
3. Antiviral agents for patient to
experience less pain and faster
resolution of lesions when used within
48 hours of rash onset

SIGNS AND SYMPTOMS

ERUPTIVE STAGE

2. ERUPTIVE STAGE
Rashes
- Elevated papules
- Begin on the face and behind
the ears
- Spread to trunk and
extremities
Color: Dark red purplish hue
yellow brown
3. Stage of Convalescence
- Desquamation
- Rashes fade from the face
downwards

1. Rash
- pinkish, maculopapular
- Begins on the face
- Spread to trunk or limbs
- No pigmentation or
desquamation
2. Posterior auricular and
suboccipital
lymphadenopathy

Ex. Acyclovir (Zovirax)

CHICKENPOX

HERPES ZOSTER

MEASLES

GERMAN MEASLES

NURSING MANAGEMENT

COMPLICATIONS

Strict isolation

Pneumonia
Otitis media
Severe diarrhea (leading

Prevent secondary infection (cut

fingernails short, wear mittens)

Eliminate itching: calamine

lotions, warm baths, baking soda
paste

to dehydration)

Encourage not going to school:

Encephalitis

usually 7 days

Disinfection of clothes and linen

with nasopharyngeal discharges
by sunlight or boiling

MEASLES

GERMAN MEASLES
A benign communicable
exanthematous disease caused
by rubella virus
Rubella virus

INCUBATION PERIOD

14-21 days

10-12 days

- Heart defects (PDA, VSD)

- Eye defects (Cataract,
glaucoma)
- Ear defects (Deafness)

MEASLES

GERMAN MEASLES

TREATMENT MODALITIES

ETIOLOGIC AGENT

Filterable virus of
paramyxoviridae

2. Congenital rubella syndrome

- Spontaneous abortion
- Intrauterine growth retardation
(IUGR)
- Thrombocytopenia purpura
blueberry muffin skin
- Cleft lip, cleft palate, club foot

- Neurologic (microcephaly,
mental retardation, behavioral
disturbances

MAIN PROBLEM

A contagious exanthematous
disease with chief symptoms to
the upper respiratory tract

1. Encephalitis

1.Vitamin A helps
prevent eye damage
and blindness
2. Antipyretics for
fever
3. Penicillin given
only when secondary
infection sets in

1.Aspirin help reduce

inflammation and
fever

MODE OF TRANSMISSION

1. Droplet method
2. Direct contact with respiratory discharges
3. Indirect with soiled linens and articles

MEASLES

GERMAN MEASLES

GERMAN MEASLES

NURSING MANAGEMENT

PERIOD OF COMMUNICABILITY

4 days before and 5 days after

the appearance of rashes

MEASLES

1. Darkened room to relieve photophobia

One week before and four days

after the appearance of rashes

2. Diet: should be liquid but nourishing

3. Warm saline solution for eyes to relieve
eye irritation

SIGNS AND SYMPTOMS

PRE-ERUPTIVE STAGE

PRE-ERUPTIVE STAGE

Cough
Coryza
Conjunctivitis
Fever (high-grade)
Photophobia

Fever
Headache
Malaise
Coryza
Conjunctivitis

KOPLIKS SPOT (Rubeola)

- Bluish white spots surrounded by a red halo
- Appear on the buccal mucosa opposite the premolar teeth
FORCHEIMERS SPOTS (Rubella)
- small, red lesions

4. For fever: tepid sponge bath and antipyretics

5. Skin care: during eruptive stage, soap is
omitted; bicarbonate of soda in water or
lotion to relieve itchiness
6. Prevent spread of infection: respiratory
isolation

SCABIES
MAIN PROBLEM
Infestation of the skin produced by the burrowing action of a parasite
mite resulting in skin irritation and formation of vesicles and pustules
ETIOLOGIC AGENT
Sarcoptes scabiei
CD-Bucud

INCUBATION PERIOD
Within 24 hours
MODE OF TRANSMISSION
Direct contact
Indirect contact

AIDS

SYPHILIS

SIGNS AND SYMPTOMS

OPPORTUNISTIC INFECTIONS

Sarcoptes scabiei
1. Yellowish white in color
2. Barely seen by the unaided eye
3. Female parasite burrows beneath the epidermis to lay eggs
4. Males are smaller and reside on the surface of the skin
SIGNS AND SYMPTOMS

Thin, pencil-mark lines on the skin

Itching, especially at night

Rashes and abrasions on the skin

PRIMARY LESIONS
NODULAR LESIONS
SECONDARY LESIONS
TREATMENT MODALITIES

SCABICIDE : Eurax ointment (Crotamiton)

PEDICULICIDE : Kwell lotion (Gamma Benzene

Hexachloride) contraindicated in young children and
pregnant women

Topical steroids

Hydrogen peroxide : cleanliness of wound

Lindane Lotion
NURSING MANAGEMENT

Apply cream at bedtime, from neck to toes

Instruct patient to avoid bathing for 8 to 12 hours

Dry-clean or boil bedclothes

Report any skin irritation

Family members and close contact treatment

Good handwashing

Terminal disinfection

1. Pneumocystis carinni
pneumonia
2. Oral candidiasis
3. Toxoplasmosis
4. Acute/chronic diarrhea
5. Pulmonary tuberculosis
MALIGNANCIES
1. Kaposis sarcoma
2. Non-Hodgkins lymphoma

AIDS
SIGNS AND SYMPTOMS

SYPHILIS
1. PRIMARY SYPHILIS
- CHANCRE: small, painless,
pimple-like ulceration on the
penis, labia majora, minora
and lips
- May erupt in the genitalia,
anus, nipple, tonsils or eyelids
- Lymphadenopathy

SEXUALLY TRANSMITTED DISEASES

AIDS

SYPHILIS

MAIN PROBLEM
Final and most serious stage
of HIV disease, which causes
severe damage to the immune
system

AIDS
SIGNS AND SYMPTOMS

Infectious disease caused

by a spirochete

2. SECONDARY SYPHILIS
- Skin rash
- Mucous patches
- Hair loss

ETIOLOGIC AGENT
Retrovirus Human T-cell
lymphotropic virus III
(HTLV-3)

SYPHILIS

- CONDYLOMATA LATA:
coalescing papules which
form a gray-white plaque
frequently in skin folds

Treponema pallidum

INCUBATION PERIOD
3 to 6 months to 8 to 10 years

10-90 days

AIDS

SYPHILIS

AIDS

SYPHILIS

MODE OF TRANSMISSION

Sexual

contact oral, anal or

vaginal sex
Blood transfusion
Mother-to-child
Indirect contact through soiled
articles

SIGNS AND SYMPTOMS

3. TERTIARY SYPHILIS
- 1 to 10 years after infection
- Appear on the skin, bones,
mucus membrane, URT, liver
and stomach
- GUMMA: chronic, superficial
nodule or deep
granulomatous lesion that is
solitary, painless, indurated

CD-Bucud

AIDS

SYPHILIS

COMPLICATIONS

DIAGNOSTIC PROCEDURES

1.ELISA
2. Western blot

4. PCR

3. VDRL

GONORRHEA

Women

1.Dark Field
Illumination test
2. Flourescent
Treponemal
Antibody
Absorption Test

3. RIPA

CHLAMYDIA

Pelvic inflammatory
disease
Ectopic pregnancy
Sterility
Men

Epididymitis
Newborn

Sterility

Conjunctivitis

Newborn

Otitis media

Gonococcal ophthalmia

Pneumonia

AIDS
TREATMENT MODALITIES

1. Antivirals
- Shorten the clinical
course, prevent
complications, prevent
development of
latency, decrease
transmission
- Example: Zidovudine
(Retrovir)

SYPHILIS
1. Penicillin G Benzathine

CHLAMYDIA
TREATMENT MODALITIES

- Disease < 1 year: 2.4 M units

once in two injection sites

1. Azithromycin
(Zithromax)

- Disease > 1 year: 2.4 M units

in 2 injection sites x 3 doses

- Drug of choice because

of single-dose treatment
effectiveness and lower
cost

2. Doxycycline if allergic to
penicillin
3. Tetracycline
- if allergic to penicillin
- Contraindicated for
pregnant women

2. Doxycycline
- Secondary drug of
choice

CANDIDIASIS
CHLAMYDIA

GONORRHEA

MAIN PROBLEM

Sexually transmitted disease caused by a bacteria

Purulent inflammation of mucous
membrane surfaces
ETIOLOGIC AGENT

Chlamydia trachomatis

Neisseria gonorrhea

INCUBATION PERIOD

2-3 weeks (males)

2-10 days

Sexual contact: Oral, vaginal or anal sex

GONORRHEA
Women

Women

Bleeding after intercourse

Abdominal or pelvic pain

Burning sensation during

urination

Bleeding after intercourse and

in-between menses
Unusual vaginal discharge

- Drug of choice
because of oral
efficacy, single dose
2. Ciprofloxacin
3. Ceftriaxone
4. Erythromycin

HERPES SIMPLEX
A viral disease
characterized by the
appearance of sores and
blisters on the skin

ETIOLOGIC AGENT

Candida albicans

2-3 weeks

MODE OF TRANSMISSION

SIGNS AND SYMPTOMS

Mild superficial fungal

infection

1. Cefixime

Herpes simplex virus

types 1 and 2

INCUBATION PERIOD

Asymptomatic (females)

CHLAMYDIA

MAIN PROBLEM

GONORRHEA

Yellow or bloody vaginal

discharge

Men
Burning with urination
Swollen, painful testicles
Discharge from the penis

White, yellow or
green pus from the
penis

CANDIDIASIS

2-12 days

HERPES SIMPLEX

MODE OF TRANSMISSION

1. Rise in glucose as in
diabetes mellitus

TYPE 1

2. Lowered body
resistance as in cancer

- Direct exposure to
infected saliva

3. Increase in estrogen
level in pregnant women

- Kissing and sharing

utensils

4. Broad-spectrum
antibiotics are used

TYPE 2

- Respiratory droplets

- Sexual or genital
contact

SIGNS AND SYMPTOMS (Candidiasis)

ONYCHOMYCOSIS

Red, swollen darkened nailbeds

Purulent discharge

Separation of pruritic nails from nailbeds

DIAPER RASH

Scaly, erythematous, papular rash

Covered with exudates

CD-Bucud 10

Appears below the breasts, between fingers, axilla, groin

and umbilicus

THRUSH

Cream-colored or bluish-white patches on the tongue,

mouth or pharynx

Bloody engorgement when scraped

MONILIASIS

White or yellow discharge

Pruritus

Local excoriation

White or gray raised patches on vaginal walls with local

inflammation

CANDIDIASIS

HERPES SIMPLEX

TREATMENT MODALITIES

1. Antifungals

1. Antivirals

- Fluconazole (Diflucan)

- Acyclovir (Zovirax)

- Ketoconazole (Nizoral)
- Imidazole (Nystatin)
- Used for oral thrush
- 48 hours until
symptoms disappear
- Cotrimoxazole

CD-Bucud 11

VECTOR-BORNE DISEASES

DENGUE

DENGUE
MALARIA

DIAGNOSTIC PROCEDURES
1. TORNIQUET TEST

MAIN PROBLEM
An acute febrile disease
The most common arboviral
illness transmitted globally

An acute and chronic parasitic

disease
The most deadly vector-borne
disease in the world

ETIOLOGIC AGENT

Screening test for dengue

A test for the tendency for blood

capillaries to break down or produce
petechial hemorrhage

Performed by examining the skin of

the forearms after the arm veins
have been occluded for 5 minutes

Plasmodium falciparum

2. PLATELET COUNT

Chikungunya virus

Plasmodium vivax

Confirmatory test for dengue

Onyongnyong virus

Plasmodium ovale

Decreased count is confirmatory

West Nile virus

Plasmodium malariae

MALARIA

3-14 days

MODE OF TRANSMISSION

TREATMENT MODALITIES

P. Falciparum 12 days

- acetaminophen

P. Vivax 14 days

2. Volume expanders

P. Ovale 14 days

- Used in the treatment of

intravascular volume deficits

P. Malariae 30 days

- Example: Lactated Ringers

Blood transfusion, contaminated

syringe or needle

Based on triad symptoms, 50%

accuracy

2. BLOOD SMEAR
-

Definitive diagnosis of infection is

based on demonstration of malaria
parasites in blood film

3. RAPID DIAGNOSTIC TEST

-

Uses immunochromatographic
methods to detect Plasmodiumspecific antigens

Takes about 7 to 15 minutes

Sensitivity and specificity > 90%

MALARIA
1. Chloroquine
2. Primaquine
3. Pyrimethamine

3. Blood transfusion for severe

bleeding

Bite of an infected mosquito

DENGUE

1. Analgesics and antipyretics

INCUBATION PERIOD

1. CLINICAL DIAGNOSIS

To detect unusual capillary fragility

Dengue virus types 1, 2, 3 and 4

DENGUE

MALARIA

4. Sulfadoxine
5. Quinine
6. Quinidine

4. Oxygen therapy
5. Sedatives

Trans-placentally

SCHISTOSOMIASIS
DENGUE

LEPTOSPIROSIS

MALARIA
MAIN PROBLEM

VECTOR

Aedes aegypti

Anopheles flavirostris

A zoonotic infectious disease

ETIOLOGIC AGENT

(Aedes albopictus)

1. SCHISTOSOMA JAPONICUM

White stripes on the back and

legs (Tiger mosquito)

Brown in color

Day biting (2 hours after sunrise

and 2 hours before sunset)

Night biting (9 PM-3 AM)

Breeds on clear stagnant water

Breeds on clear, flowing and

shaded streams

Urban-based

Rural-based

DENGUE

A slowly progressive disease

caused by a blood fluke

Leptospira interrogans

Intestinal tract, endemic in the

Philippines

2. SCHISTOSOMA MANSONI
-

Africa

3. SCHISTOSOMA HAEMATOBIUM
- Middle East countries like Iran and Iraq

SCHISTOSOMIASIS

LEPTOSPIROSIS

MALARIA
INCUBATION PERIOD

SIGNS AND SYMPTOMS

At least 2 months

FEVER

FEVER

HEADACHE

CHILLS

MALAISE
RASH

PROFUSE SWEATING

7 to 19 days

MODE OF TRANSMISSION
Ingestion
Skin penetration
Contact with the skin

EPISODES OF
BLEEDING

CD-Bucud 12

SCHISTOSOMIASIS

LEPTOSPIROSIS

VECTOR

SCHISTOSOMIASIS
TREATMENT MODALITIES

Oncomelania quadrasi

1. Praziquantel (Biltricide)

1. Thrives in fresh water

stream

- Taken for 6 months

- 1 tablet BID for 3 months

2. Clings to grasses and leaves

- 1 tablet OD for 3 months

3. Greenish brown in color

SIGNS AND SYMPTOMS

LEPTOSPIROSIS
Septic or Leptospiremic Stage
F ever (remittent

1. Cercarial dermatitis
(swimmers itch)

H eadache

2. Katayama syndrome

N ausea

H eadache and fever

A norexia and lethargy

M yalgia
V omiting
C ough
C hest pain

R ash
M - yalgia

SCHISTOSOMIASIS
SIGNS AND SYMPTOMS

LEPTOSPIROSIS
Immune or Toxic Stage

CHRONIC STAGE

- Lasts for 4 to 30 days

1. Hepatic: pain, abdominal

distension, hematemesis, melena

- Iritis, headache, meningeal

manifestations

2. Intestinal: fatigue, abdominal pain,

dysentery

- Oliguria, anuria with renal

failure

3. Urinary: dysuria, urinary

frequency, hematuria
4. Cardiopulmonary: palpitations,
dyspnea on exertion

- Shock, coma and congestive

heart failure

5. CNS: seizures, headache, back

pain and paresthesia

SCHISTOSOMIASIS
DIAGNOSTIC PROCEDURES
1. Fecalysis

1. Penicillin G drug of choice

2. Doxycycline
2nd line drugs

4. Amoxicillin

ACUTE STAGE

C - ough

1st line drugs

3. Ampicillin

4. Size is as big as the smallest

grain of palay

SCHISTOSOMIASIS

LEPTOSPIROSIS

LEPTOSPIROSIS

FILARIASIS
MAIN PROBLEM
A parasitic disease caused by an African eye worm
ETIOLOGIC AGENT
Wuchereria bancrofti
Brugia malayi
Brugia timori
INCUBATION PERIOD
8 to 16 months
MODE OF TRANSMISSION
Person-to-person by mosquito bites
ACUTE STAGE

Lymphadenitis (inflammation of lymph nodes)

Lymphangitis (inflammation of lymph vessels)

Male genitalia affected leading to funiculitis, epididymitis

and orchitis (redness, painful and tender scrotum)
CHRONIC STAGE

Develop 10-15 years from onset of first attack

Hydrocele (swelling of the scrotum)

Lymphedema (temporary swelling of the upper and lower

extremities)

Elephantiasis (enlargement and thickening of the skin of

the upper and lower extremities, scrotum and breast
LABORATORY EXAMINATIONS

Nocturnal blood examination (NBE) taken at patients

residence/hospital after 8PM

Immunochromatographic test (ICT) rapid assessment

method; an antigen test done at daytime
TREATMENT

Diethylcarbamazine Citrate (DEC) or HETRAZAN an

individual treatment kills almost all microfilaria and a good
proportion of adult worms.
PREVENTION AND CONTROL

Measures aimed to control vectors

Environmental sanitation such as proper drainage and

cleanliness of surroundings

Spraying with insecticides

PREVENTION AND CONTROL

Measures aimed to protect individuals and families:

Use of mosquito nets

Use of long sleeves, long pants and socks

Application of insect repellants

Screening of houses

2. Kato-Katz Technique
3. Cercum ova precipitin test
(COPT)
- Confirmatory test for
schistosomiasis

CD-Bucud 13