Академический Документы
Профессиональный Документы
Культура Документы
RESPIRATORY SYSTEM
DIPHTHERIA
ö acute contagious disease characterized by general toxemia emanating from localized inflammatory
process characterized by the formation of “pseudomembrane” commonly in the face area & tonsils, & the
elaboration of a powerful exotoxin affecting the impt. viscera as the heart & kidneys & the peripheral
nervous system.
MOT
Direct contact – discharges form respiratory passages; saliva
Indirect contact – though various articles including toys & clothing contaminated by infected individual
STREPTOCOCCAL SORETHROAT
ö “Group A streptococcus or Strep A.
ö secrete 70+ variety of enzymes or toxins; common to abusing voice.
PERTUSSIS
ö whooping cough, one hundred day cough, Tuspirina
ö contagious dse char by peculiar paroxysmal cough ending in a whoop.
ö Prolong cough 5 – 10 mins. 20 to 40 times a day
Nsg Care:
CBR
Provide quiet & non-stimulating room
Proper positioning during attacks
Abdominal binders- Used in Infants to prevent abdominal hernia.
Keep pt warm & out of drafts or wind
Mouth & nose must be kept clean
Light but nutritious diet with plenty of fruit juices but no seasoned foods.
O2 inhalation
Avoid factors that precipitate on neck (huwag sundutin)
Avoid emotional physical stress
Avoid irritating fumes & gases
Diet no spices
Prevention:
Avoid MOT
Immunization – DPT
Complication:
Bronchopneumonia
Hemorrhages
Convulsion
Hernia
Severe malnutrition
Complication:
Children – otitis media, bronchopneumonia
Adult – sinusitis
4
INFLUENZA
ö flu (tangkaso)
ö Highly contagious disease characterized by sudden onset of aches and pains.
GASTROINTESTINAL DISORDERS
LEPTOSPIROSIS
ö Weil’s dse, Canicola fever, Swineherd’s dse, Icterohemorrhagica, Mud fever.
ö Seasonal dse; dse of lower form of animals/domestic animals like pig, skunk rat; common during rainy
season.
ö Rat- main host
Source of infection – urine and excreta of rodents, infected form and pet animals like rabbits.
Incubation period – 7 – 13 days
S/Sx
sudden onset with chills, vomiting & headache followed by severe fever and pains in the extremities.
Intense itching of the conjunctivae – orange eyes
Myalgia/myosites particularly calf pain
Abdominal pain
5
In some cases, acute renal failure – complication
Dx/exam:
1. Blood culture
2. LAT – leptospira agglutination test
LAAT – Leptospria Antigen Antibody test
Nsg Care- supportive and symptomatic Prevention:
Eradication or rodents
Environmental sanitation
Urine precaution
Tx:
Drugs
ö Penicillin
ö Antiserum or convalescent serum
Common among/risk
Miners
Farmers
Veterinarian
Sewer workers
Swimmers
TYPHOID FEVER
ö enteric fever
- gen infection characterized by the hyperplasia of the lymphoid tissues, esp. enlargement and ulceration of
the Peyer’s patches & enlargement of the spleen, by parenchymatous changes in various organs and
liberation of an endotoxin in the blood.
CA – Salmonella Typhosa
MOT – Fecal or oral
Sources: contaminated food and water
S/Sx:
1. Prodromal – flulike symptom
Fever, headache
Anorexia, lethargy
Constipation or diarrhea, vomiting
Abdominal pain
Feeling of unwellness
2. Fastigal
Ladder like curve temp – stairway curve
Rose spots – maculo popular rashes appear on chest or abdomen of pt usually appear on 7 – 12
days.
Spleenomegaly
Typhoid state – “typhoid Psychosis” brain affected naloloko
1. altered LOC
2. Coma – vigil look; pupils dilated & patient appears to start without seeing
3. Locomotive disturbance carphologia – invol picking up of linens
4. Sultus tendium – involuntary twitching of tendons part of wrist.
3. Defervescence
Fever gradually subsides – fever mild & sx subsides
Dx exam:
1. Hemoculture – confirmatory of typhoid (+) organism after 1 week
2. Widal’s test/ blood serum agglutination (+) end of 2nd week
3. Fecalysis – don’t eat red meat 1-2 days prior – rectal swab
4. Typhi Dot test- new method det IgH, IgG
Nsg Care;
Supportive care
Position patient to prevent aspiration
Use of enteric precautions
TSB for high fever
6
Increase fluid intake
Five meds as prescribed
Monitor for complications
Prevention:
Handwashing
Decontamination of water sources milk pasteurization,
Immunization – vaccine of C.T. cholera typhoid, oral vivotif.
Complications:
1. Perforation of the intestine – rupture blood vessels of intestine.
2. Intestinal hemorrhage
3. Relapse
4. Thrombophlebitis
5. Urinary infection
6. Meningitis
Tx:
Chloramphenicol – 14 days
Amoxicillin – oral in cases resistant to chloramphenicol
o monitor CBC to det chlormphenicol toxicity SE of chloramphenicol: Bone depression
CHOLERA
ö EL Tor
ö acute bacterial, diarrheal dse with profuse watery stools, occasional vomiting & rapid dehydration
Nsg care:
1. Isolation of patient; entire precautions
2. Care of the buttocks – should dry & clean
3. Proper disposal of excreta
4. Proper preparation of food/ food sanitation
5. Boil water for drinking
6. Replacement of fluids & electrolytes
7. Antiseptic mouthwash in case of vomiting
8. Fluids is given as soon as he can tolerate it.
Dx/exam:
- stool exam
Tx:
IVF – lactated Ringers Solution
Tetracycline
7
DYSENTERY
A. Bacillary dysentery
ö acute bacterial infection of the lining of the small & large intestine;
CA – Shigella Dysenteriae
MOT
ö Eating contaminated foods, hand to mouth transfer of contaminated materials, flies, objects and soiled
with discharges of infected person/ contaminated water.
S/Sx:
Chills, fever
N/V
Colicky abdominal pain with tenderness
Diarrhea with tenesmus – painful straining during defecation or feeling to defecate. (watery, mucoid, with
blood streaks)
Dx/exam:
Stool exam- should be submitted 1 to 2 hrs after collection because organism will dry.
Nsg care:
Monitor I & O – frequently & amount, consistency of stool
Replacement of fluids & electrolytes
Enteric precaution
Pre-anal care
Investigation of source of infection (food, water, milk etc)
Prevention:
Good sanitation/ hygienic practices
Safe water supply – boiling water
Handwashing
Avoid 5 F’s
Tx: Cotrimoxazole
Prevention:
- Immunization
- Good sanitation / hygiene practices
- Safe water supply
- Handwashing
- Avoid 5 F’s
Flies
Food
Fingers
Fomites
Feces
PARISITISM
ö parasite worms defind; worms affect not only the gastrointestinal system but also found in the lungs, heart
& other body systems.
ö As parasite, they feed off the host which leads to variety of symptoms.
3 main group of helminthes
1. Cestode – flat forms – tapeworm
2. Nematode – roundworms
3. Trematode – fluke
A. Tapeworm - Taeniasis
ö from beef, fish and pork – common in pork
ö eating inadequately cooked meat.
S/Sx:
1. abdominal pain
2. muscle soreness
3. nervousness
4. nodular fict like mass
E. Threadwrom – strongyloidiasis
CA – stronglyoides stercoralis
Prevention – wear shoes & use sanitary toilets
Symptom – intermittent diarrhea
F. Hookworm – Ancyclostosomiasis
- by walking barefoot
Symptoms : sama with thread worm
Anemia chronic – Pica (severe anemia) eating non edible food.
Diarrhea
Mental & growth retardation
Dermatitis
Obstruction of the biliary or pancreatic duct
SCHISTOSOMIASIS
ö Bilhariasis, snail fever, Oriental Schisosomiasis
CA – Schistosoma Japonicum
I. host snail – oncomelania quadrasi
Dx/exam
Direct fecal smears – det eggs in stool
Stool exam – in early & heavy infections
Intradermal test
Immunodiagnostic test – rec in view of the difficulty of demonstrating eggs in feces.
Tx:
Praziquantel (Biltricide)
Nitidozole
Prevention:
10
Avoid washing cloths and bathing in streams
Proper & sanitary disposal of human feces
Destruction of snail host – snail control use of chemicals
Improve irrigation & agriculture practices – reduce snail habitat
Dx/exam :
All stool exam except pinworm,
HEPATITIS
ö Widespread inflammation of the liver tissue with liver cell damage due to hepatic cell degeneration &
necrosis, proliferation & enlargement of the Kupffer cells & inflammation of the periportal areas thus may
cause interruption of the bile blow.
Hepatitis
ö infection of liver cause by bacteria or virus A,B,C,D,E,G or substances that are toxic to liver.
S/Sx:
1. Pre-icteric stage
Flu-like symptoms
Slight RUQ pain
Anorexia
N/V
11
Fatigue
Constipation or diarrhea
Wt loss
Hepatomegaly
Spleenomegaly
Lymphadenopathy
2. Icteric stage
Light colored stools (alcoholic stool)
Jaundice – sclera
Tea colored urine (dark)
Pruritus
Continued hepatomegaly with tenderness
3. Post-icteric
Fatigue but increased sense of will-being
Hepatomegaly; gradual decreasing
Symptoms gradually subsides
Dx/exam:
1. All 3 types
a.) SGPT (ALT) serum
b.) SGOT (AST) enzyme all inc in pre-icteric
c.) Alkaline phosphate LF test
d.) Bilirubin
2. Ultrasound of liver
3. liver agglutination test
4. Liver biopsy
5. HbsAg – Hepa B
anti – HAV – hepa A
anti – HCV – hepa B
Tx:
1. Essential phospholipids – Jelapor
2. Sylimarine – helps liver regenerate
Nsg Care:
1. Bedrest – conserve energy
2. increase CHON, CHO low fat diet – simple case only
protein restricted for further progress – hepatoencelopathy
sugar – encourage high CHO increase sugar (eg hard candy)
3. oral care
4. psychological support
3 – 6 mos – 1 yr before liver can regenerate
5. monitor / relieve pruritus – cool, moist compress, emollient lotion.
Prevention:
ö Importance of not donating blood
ö Avoid persons with known infections
Hepa A
ö Good hand washing
ö Good personal hygiene
ö Control & serving of food handlers
12
ö Passive immunization - ISG to exposed individual & prophylaxis for travelers to developed
countries
Hepa B
ö Screen blood donors Hb3Ag
ö Use disposable needles & syringes
ö Registration of all carriers
ö Passive immunization ISG – hepatavax B vaccine & formation treated hepatitis B vaccine given in
3 doses.
AIDS
ö Acquired Immune Deficiency syndrome
ö an acquired immune deficiency chac a defect in natural immunity.
C.A.
ö Retrovirus – human immunodeficiency virus (HIV-I & HIV – 2)
ö Previously referred to as human T – lymphotropic virus type III (HTLV-III)
MOT
Blood, sexual contact
Contaminated needles
Perinatal transmission
Fx of T4
Identify organisms
Mobilize other elements to act against invading organism
Help fight infection through reproducing
Tx:
1. Nutritional rehabilitation
2. Tx of opportunistic infection
3. AZT (Zidovudine - Anti viral drug)
4. Anti – retroviral drugs
Reverse transcriptase inhibits (RTI)
Protease inhibitors (PI’S)
Nuclosides reverse transcriptase inhibitors (NRTI)
Nsg care:
Provide frequent rest periods
Provide skin care
Provide high-calorie, high CHON diet to prevent wt loss
Provide good oral hygiene
Provide measures to reduce pain
Protect the client form secondary; carefully assess for early signs
Encourage verbalization of feelings
Teach client the importance of:
ö informing sexual contacts of diagnosis
ö not sharing needle with other individuals
ö continuing medical supervision
Prevention:
Abstinence
Be faithful
Safe and non penetrative sex practices – condom
4 Folds:
1. Education – familiar with dse / symptoms
14
2. Training – health workers
- commercial health workers
3. Screening – blood donor
4. Counseling – voluntary – CSW, military personnel ,
SYPHILIS
ö Lues, Pox, Bad blood disease
ö contagious dse that leads to many structural & cutaneous lesions
CA: Treponema pallidum
MOT – sexual partners & 3 P’s (parenteral, placental, peructaneous)
Incubation period – 10 – 90 days
S/Sx:
Adult syphilis
1. Primary
Chancre on genitalia – painless pimple moth or anus
Male -- glans penis
Female -- labia majora, minor
Serous drainage form chancre
Enlarged by lymphnodes
Maybe painful or painless
Highly infectious
2. Secondary
Skin rash on palms & soles of feet
Reddish copper- colored lesions on pals of hands & soles of feet
Condylomata – moist popular eruption – observe on skin and genital area
Sore throat, mucous patches of the mouth
Alopecia
Enlarged lypmphnodes
3. Tertiary
Gumma formation – necrotic tissue that can be found on blood vessels supplying blood to the
essential organs of the bodies heart, brain, lungs
Cardiovascular changes
Ataxia
Stroke, blindness
Dementia praecox – neurological
Dx/exam:
1. Darkfield examination
2. Serologic test
ö VDRL – Venereal dse research lab
ö CRPR – CT
ö FTA – ABS – Fluorescent Treponemal Antibody Absorption Test – most reliable, more
sensitive.
Complications:
Still birth
Child born with syphilis
Placenta is bigger than the baby
Persistent vesicular eruptions & nasal discharge
Old man feature
Mucus patches on mouth & anus
Child born with late syphilis (s/sx after 2 yrs)
Deafness
Hutchinson’s teeth – sawlike teeth
15
Saddle nose – pango
High palate
Keratitis – blindness
Nsg Care:
Explain need to complete course of antibiotic therapy
Symptomatic
Medical asepsis
Prevention:
Practice monogamy
Sex education
Strict personal hygiene in a absolute requirement
Tx: Penicillin
GONORRHEA
ö Strain, Clap, Jack
ö an infectious dse which causes inflammation of the mucus membranes of the genitourinary tract.
Complications:
1. Male – bilateral epididymitis, sterility
2. Female – pelvic inflammatory dse, sterility
3. Opthalmia neonatorium- mother to child
Nsg care:
Monitor urinary & bowel elimination
Make arrangements for follow-up culture 2 weeks therapy is initiated.
Educate men/women to recognize signs of gonorrhea & treat immediate tx
Medical asepsis
Symptomatic
Prevention:
Credes prophylaxis
Avoid contact with secretions
Practice monogamy
Important to treat sexual partner, as client may become reinfected
16
KAWASAKI DISEASE
ö Mucocutaneous lymph node syndrome
ö dse most common cause of acquired heart disease in 5 yo & below among children.
ö Common in USA, Japan & England
ö Common in children of Asian ancestry
S/Sx:
Fever for 5 days
Unresponsive to antipyretic & antibiotic
Bilateral non purulent conjunctivitis – both sides
Cervical lymphodenopathy – 1.5cm diameter 1 side of neck
Change in mouth & lips – dry crack lips
Strawberry tongue & red dry lips
Changes in hands feet & integumental area
Erythema
Swelling & edema
Desquamation
Dx/exam:
No specific
5 to 6 symptoms
Tx:
High dose of aspirin
Parenteral injection of immuno globulin (gamma globulin)
Nsg mgt:
Symptomatic & supportive
Emphysema importance of follow-up checkup
2D echogram 2 mos.
Complications:
1. Endocarditis, ischemia
Coronary arteritis, aneurismal thromosis or rupture
Coronary arteritis, myocardial infarction, CHF
2. Aspirin toxicity
17
SCABIES
ö “galis”
ö An infection of the skin produced by the burrowing action of a parasite mite resulting in irritation &
the formation of vesicles or pustules.
ö Associated with poverty, poor environmental sanitation, hygiene.
MOT
ö direct contact with affected persons
ö indirect contact through soiled bed linens, clothing & others
S/Sx:
Itchy papulo – vesicular eruptions on warm folder & areas of friction of the body.
Intense itching especially at night
Sites – bet fingers or feet or surfaces of wrists & palms, aroung nipples, umbilicus, in axillary folds, near
groin or gluteal fold, penis, scrotum
Typical symptom – weeping itch
Oozing serosanguinous secretion
Dx/exam:
Culture of wound secretion
Presence on skin of female mite, ova & feces upon skin scraping.
Tx:
Precipitate of sulfur in petrolatum
Crotamiton (Eurax) – cream/lotion safer then Kwell
Lindane loton (Kwell) – contraindicated to pregnant women & young children.
Nsg Care:
Contact isolation
Encourage to change clothing frequently
Launder & iron soiled clothes – dry under sun
All members of the family should be treated at the same time
Take a warm soapy shower/bath to remove a scaling debris form crusts.
Preventions:
Personal hygiene & cleanliness
Avoid playing with affected dog.