NCM 104 lec PRELIMS 1

RESPIRATORY SYSTEM 1. Avoid MOT

DIPHTHERIA 2. Immunization – DPT 0.5cc IM – vastus lateralis
ö acute contagious disease characterized by - given at the same time with OPV 6,10,14 wks
general toxemia emanating from localized  after DPT don’t massage to prevent lump forming
inflammatory process characterized by the  put hot moist compress if with lump formation
formation of “pseudomembrane” commonly in  expect fever within 24 hrs -- give Paracetamol
the face area & tonsils, & the elaboration of a q4hours for 24 hours
powerful exotoxin affecting the impt. viscera as  check pt’s temp before giving DPT
the heart & kidneys & the peripheral nervous  don’t give succeeding doses if with convulsion
system. STREPTOCOCCAL SORETHROAT
ö “Group A streptococcus or Strep A.
C.A. – Corynebacterium diphtheriae or Klebs Loffler ö secrete 70+ variety of enzymes or toxins;
bacillus common to abusing voice.
MOT
 Direct contact – discharges form respiratory CA – Group A beta hemolytic Streptococcus
passages; saliva MOT – droplet, direct
 Indirect contact – though various articles S/Sx
including toys & clothing contaminated by  sudden onset
infected individual  high-grade fever, rapid pulse, chills
 enlarge, tender cervical lymph nodes
Incubation period – 1 to 7 days  inflamed tonsils with whitish muco-purulent
S/Sx exudates
1. Nasal
 headache, abdominal pain
- dryness & excoration of upper lip & nares
 beefy red throat
with serosanguinous secretions & presence of
Dx/exam:
pseudomembrane in nasal system.
2. Pharyngeal  throat culture – det strep throat to a patient
- pseudomembrane on throat (oropharynx)  throat swab – det antigen
- bull neck appearance Nsg Care:
3. Laryngeal  bedrest, no sweets
- laryngeal stridor – harsh sound heard on  oral hygiene with oral antiseptic or with saline
inspiration. gargle
- Hoarseness of voice leading to aphonia (no Saline solution – 1 glass lukewarm water + 1 tsp
voice) reversible rocksalt taken 3 - 4x a day
- Signs of respiratory distress Prevention:
4. Cutaneous or extra pulmonary  Avoid MOT
- spread of causative agent outside of Complications:
respiratory tract (ears, eyes, wound)  RHD
Dx/Exam:  AGN
1. Nose & throat culture – there must be 3 Tx:
consecutive (-) result  Erythromycin – oral 10 days
2. Schick’s test – det susceptibility & immunity to  Single shot IM Benzathine (Penicillin) 1.2 MU
diphtheria. single dose (adult)
3. Molony test – det hypersensitivity to diphtheria
anti-toxin PERTUSSIS
Tx: ö whooping cough, one hundred day cough,
1. Drugs – (ADS) anti-diphtheria serum  to Tuspirina
neutralize toxins = IM, IV ANST ö contagious dse char by peculiar
2. Antibiotics – Penicillin G. Sodium, Eythromycin  to paroxysmal cough ending in a whoop.
kill the m.o. ö Prolong cough 5 – 10 mins. 20 to 40 times
3. Supportive a day
- O2 inhalation
- Tracheostomy CA – Bordetella pertussis – aerobic
- Suction secretions MOT – Nasopharyngeal secretion
Nsg Care:
1. TSB for fever S/Sx
2. Provide liquid to soft diet with minimal CHON & 1. Catarrhal stage – most communicable stage
sufficient CHO ö Fever, watery eyes, frequent sneezing
3. Strict isolation ö Watery nasal discharges dry cough at night
4. CBR – no early ambulation
5. Increase fluid intake 2. Paroxysmal stage
6. Small frequent feedings ö Coughs worsens – becomes rapid, successive,
7. Maintain patent airway paroxysmal 3 to 10x during expiration with
8. Proper disposal of naso-pharyngeal secretions prolonged inspiratory phase.
9. Diversional activities to children ö Force of coughing may cause involuntary
Complications: micturation/defacation
1. Myocarditis – dec apical pulse < 60 lead to ö The whoop follows the end of a series of short
cardiac arrest. explosive cough with no time to catch a bread
2. Peripheral neuritis between cough.
3. Broncho pneumonia
ö Protrusion of eyeballs, protruded tongue.
Prevention
ö Swollen head & neck veins.
 NCM 104 lec PRELIMS 2
ö Abdominal hernia  Avoid crowding & contact with infected
ö Vomiting signals end attack. individuals
Tx:
3. Convalescence stage Symptomatic
- Symptoms subsides, frequency of paroxysmal Vit C
attacks are reduced. Increase fluids
Dx/exam:
- Cough plate – Bordet Genghou agar plate
Complication:
 Children – otitis media, bronchopneumonia
 Adult – sinusitis
Tx:
 Erythromycin
 Ampicillin INFLUENZA
 Antitusive (Pertix) Sinecod (new generation) ö flu (tangkaso)
ö Highly contagious disease characterized by
Nsg Care: sudden onset of aches and pains.
 CBR
 Provide quiet & non-stimulating room CA – influenza virus A,B,C
 Proper positioning during attacks MOT – droplet infection, contact with nasoparyngeal
 Abdominal binders- Used in Infants to prevent secretions
abdominal hernia. Incubation period – 18 – 36 hrs
 Keep pt warm & out of drafts or wind S/Sx:
 Mouth & nose must be kept clean 1. Respiratory – most common may lead to
 Light but nutritious diet with plenty of fruit juices pneumonia end empyema
but no seasoned foods.  Fever
 O2 inhalation  Chills
 Avoid factors that precipitate on neck (huwag  Coryza
sundutin)  Bitter taste
 Avoid emotional physical stress  Anorexia
 Avoid irritating fumes & gases  Muscle pains and aches
 Diet no spices  Sore throat
Prevention:  Pain behind the eyeballs
 Avoid MOT 2. Intestinal
 Immunization – DPT  Vomiting
Complication:  Fever
 Bronchopneumonia  Severe diarrhea
 Hemorrhages  Severe abdominal pain
 Convulsion  Obstinate constipation
 Hernia 3. Nervousness
 Severe malnutrition  Headache
 Fever
CORYZA – common colds, Acute Viral Rhinitis  Arthralgia
ö viral infection of the lining of the nose, sinuses,  Myalgia – lead to encephalitis or meningitis
throat and large airways. Produces coryza
(profuse discharge form nostrils) Nsg care – same as cold
Prevention:
CA – Adenovirus & Rhinovirus  Avoid MOT
MOT – droplet infection, direct contact  Maintain optimum health
S/Sx:  Immunization – influenza vaccine
 Preceded by feeling of burning & irritation in the  Educate re-hazard form spitting, sneezing &
nasopharynx coughing.
 Frequent sneezing, copious nasal discharge, teary
eyes GASTROINTESTINAL DISORDERS
 Diminished sense of taste, smell, hearing
 Cough, headache, malaise (tiredness) LEPTOSPIROSIS
 Later, nasal discharge become purulent ö Weil’s dse, Canicola fever, Swineherd’s dse,
Nsg care: Icterohemorrhagica, Mud fever.
 Rest ö Seasonal dse; dse of lower form of
 Increase fluid intake animals/domestic animals like pig, skunk rat;
 Well balanced nutrition diet common during rainy season.
 Warm saline gargle ö Rat- main host
 Cover nose/ mouth when coughing, sneezing
Prevention: CA – Leptospira interrogans – inhabitant moist humid soil
 Avoid MOT MOT – direct inoculation into broken skin, mucus
 Frequent handwashing membrane. Eg bathing in flooded water
 Proper disposal of oral and nasal discharges - ingestion of urine/ fecally contaminated food &
 Disinfect eating & drinking utensils water
 NCM 104 lec PRELIMS 3
Source of infection – urine and excreta of rodents, Dx exam:
infected form and pet animals like rabbits. 1. Hemoculture – confirmatory of typhoid
Incubation period – 7 – 13 days (+) organism after 1 week
S/Sx 2. Widal’s test/ blood serum agglutination
 sudden onset with chills, vomiting & headache (+) end of 2nd week
followed by severe fever and pains in the 3. Fecalysis – don’t eat red meat 1-2 days
extremities. prior – rectal swab
 Intense itching of the conjunctivae – orange eyes 4. Typhi Dot test- new method det IgH, IgG
 Myalgia/myosites particularly calf pain
 Abdominal pain
 In some cases, acute renal failure – complication

Dx/exam:
1. Blood culture Nsg Care;
2. LAT – leptospira agglutination test  Supportive care
LAAT – Leptospria Antigen Antibody test  Position patient to prevent aspiration
Nsg Care- supportive and symptomatic Prevention:  Use of enteric precautions
 Eradication or rodents  TSB for high fever
 Environmental sanitation  Increase fluid intake
 Urine precaution  Five meds as prescribed
Tx:  Monitor for complications
Drugs
ö Penicillin Prevention:
ö Antiserum or convalescent serum  Handwashing
 Decontamination of water sources milk
Common among/risk pasteurization,
 Miners Immunization – vaccine of C.T. cholera typhoid,
 Farmers oral vivotif.
 Veterinarian
 Sewer workers Complications:
 Swimmers 1. Perforation of the intestine – rupture
blood vessels of intestine.
TYPHOID FEVER 2. Intestinal hemorrhage
3. Relapse
ö enteric fever
4. Thrombophlebitis
- gen infection characterized by the hyperplasia of 5. Urinary infection
the lymphoid tissues, esp. enlargement and 6. Meningitis
ulceration of the Peyer’s patches & enlargement Tx:
of the spleen, by parenchymatous changes in
 Chloramphenicol – 14 days
various organs and liberation of an endotoxin in
 Amoxicillin – oral in cases resistant to
the blood.
chloramphenicol
o monitor CBC to det chlormphenicol
CA – Salmonella Typhosa
MOT – Fecal or oral toxicity SE of chloramphenicol: Bone
Sources: contaminated food and water depression
S/Sx:
1. Prodromal – flulike symptom CHOLERA
 Fever, headache ö EL Tor
 Anorexia, lethargy ö acute bacterial, diarrheal dse with profuse watery
 Constipation or diarrhea, vomiting stools, occasional vomiting & rapid dehydration
 Abdominal pain
CA – Vibro cholerae, Vibro comma (ogawa, Inoba)
 Feeling of unwellness
MOT –
2. Fastigal
ö Fecal – oral route via contamination of water, milk
 Ladder like curve temp – stairway curve
and other foods.
 Rose spots – maculo popular rashes appear
ö ingestion of food or water contaminated with
on chest or abdomen of pt usually appear on
stools or vomitus of patients.
7 – 12 days.
ö Flies, soiled hands and utensils also serve to
 Spleenomegaly transmit infection.
 Typhoid state – “typhoid Psychosis” brain S/Sx:
affected naloloko  Profuse diarrhea – watery, whitish, grayish or
1. altered LOC greenish slightly muccid stools without any fecal
2. Coma – vigil look; pupils dilated & matter, called rice water stools “fishy odor”
patient appears to start without
 Stools are passed repeatedly, later becoming all
seeing
 Signs of severe dehydration – sunken fontanel &
3. Locomotive disturbance carphologia –
eyeballs
invol picking up of linens
- prominences of sutures
4. Sultus tendium – involuntary
- loss of turgor & elasticity of the skin
twitching of tendons part of wrist.
- (+) skin folds sigh with wrinkling of the finger tips
3. Defervescence
- cold clammy sweat and decreased BP
 Fever gradually subsides – fever mild & sx
- vomiting, muscle cramps and inc exhaustion
subsides
 NCM 104 lec PRELIMS 4
- symptoms of severe dehydration – washer > Bacterial Protozoan
woman’s hand. M.O.T. Fecal/oral Fecal/oral Fresh/raw
Contaminated Fresh raw vegetables
Nsg care: water vegetables Fresh raw
1. Isolation of patient; entire precautions Sea shells, vegetables
2. Care of the buttocks – should dry & clean oysters
3. Proper disposal of excreta Sx. Explosive Fever, > On & off
4. Proper preparation of food/ food -diarrhea, diarrhea diarrhea
sanitation vomiting a. stool – solid greenish
5. Boil water for drinking > dehydration (initial) stool
6. Replacement of fluids & electrolytes > death – rigor b. mucoid > Mucoid
7. Antiseptic mouthwash in case of vomiting mortis sets in blood streak blood
8. Fluids is given as soon as he can tolerate (stiffening of > some signs streak
it muscle) of dehydration > Bubbly
Dx/exam: ATP – >
- stool exam responsible for Flatulence
Tx: stiffening of
 IVF – lactated Ringers Solution muscle
 Tetracycline Washer woman’s
hand
Pathog RICE WATERY MUCOID
STOOLS BLOOD
DYSENTERY STREAKED
STOOL
A. Bacillary dysentery
ö acute bacterial infection of the lining of the small
& large intestine; Mgt:
ö Monitor I&O particularly the amount consistency,
CA – Shigella Dysenteriae frequency of stool, vomitus
MOT ö Assess degree of dehydration
ö Eating contaminated foods, hand to mouth ö Replace fluids & electrolytes loss with IVF as
transfer of contaminated materials, flies, objects ordered ORESOL100ml fluids.
and soiled with discharges of infected person/ ö Handwashing
contaminated water. ö Enteric precaution
ö Perianal care
S/Sx: ö Avoid gas forming fatty foods
 Chills, fever ö Proper disposal of exreta
 N/V ö Proper preparation of food/food sanitation
 Colicky abdominal pain with tenderness ö Increase fluid intake
 Diarrhea with tenesmus – painful straining during
defecation or feeling to defecate. (watery, Tx: Tetracycline ,Cotrimoxazole ,Metronidazole
mucoid, with blood streaks) (Flagyl)
- Stain of teeth
Dx/exam: - Below 8 y/o don’t give
- Contraindication ot pregnant because it inhibit
 Stool exam- should be submitted 1 to 2 hrs after
growth of long bones
collection because organism will dry.
Nsg care:
Prevention:
 Monitor I & O – frequently & amount, consistency
- Immunization
of stool
- Good sanitation / hygiene practices
 Replacement of fluids & electrolytes - Safe water supply
 Enteric precaution - Handwashing
 Pre-anal care - Avoid 5 F’s
 Investigation of source of infection (food, water, Flies
milk etc) Food
Fingers
Prevention: Fomites
 Good sanitation/ hygienic practices Feces
 Safe water supply – boiling water
 Handwashing PARISITISM
 Avoid 5 F’s ö parasite worms defind; worms affect not only the
gastrointestinal system but also found in the
Tx: Cotrimoxazole lungs, heart & other body systems.
ö As parasite, they feed off the host which leads to
Cholera Bacillary D. Amoebic variety of symptoms.
D. 3 main group of helminthes
Synon El tor Shigellosis Amoebiasis 1. Cestode – flat forms – tapeworm
ym 2. Nematode – roundworms
C.A. Vibrio comma Shigellosis Entamoeba 3. Trematode – fluke
Vibrio cholerae Shigella Hystolitica
>Bacteria Dysenteriae > A. Tapeworm - Taeniasis
 NCM 104 lec PRELIMS 5
ö from beef, fish and pork – common in  sputum exam – eggs in brown spots
pork
ö eating inadequately cooked meat.

S/Sx:
1. abdominal pain
2. muscle soreness
3. nervousness
4. nodular fict like mass

B. Giant intestinal roundworms (Ascariasis)

CA – Ascaris Lumbricoides
Sx – Voracious appetite, thin

C. Whipworm – Trichuriasis “pot bellied”

CA – Trichuris trichura
Sx – diarrhea with tenesmus – rectal prolapse

D. Pinworm – Enterobiasis or seatworm

CA – Oxyuriasis, Enterobius vermicularis
Source – fomites, autoinfection, fecal
contamination, from food, meat, inhalation and
finger – most common

Symptoms – itching around the anus, nocturnal,

convulsion in children.
Incidence: affects one in family & invariably infects
entire family

Dx: Tape test – early in the morning before washing.

E. Threadwrom – strongyloidiasis
CA – stronglyoides stercoralis SCHISTOSOMIASIS
Prevention – wear shoes & use sanitary toilets
ö Bilhariasis, snail fever, Oriental Schisosomiasis
Symptom – intermittent diarrhea
CA – Schistosoma Japonicum
F. Hookworm – Ancyclostosomiasis
I. host snail – oncomelania quadrasi
- by walking barefoot
MOT – life cycle of Schistosoma Japonicum
Symptoms : sama with thread worm
S/Sx –
 Anemia chronic – Pica (severe anemia)
 Diarrhea
eating non edible food.
 Infectious to snail - Maracidia
 Diarrhea
 Bloody stools
 Mental & growth retardation
 Infections to man – Cercaria
 Dermatitis
 Enlargement of abdomen
 Obstruction of the biliary or pancreatic
 Spleenomegaly
duct
 Weakness
G. Capillariasis – endemic in the Phil  Anemia
- Inadequately cooked bagoong fish-  Inflamed liver
brackish water
- Burborygmic gurgling sound in abdomen Dx/exam
 Direct fecal smears – det eggs in stool
H. Paragonimiasis – lung fluke mystery dse before  Stool exam – in early & heavy infections
- eating of fresh or inadequately cooked  Intradermal test
crabs. (Kinilaw)  Immunodiagnostic test – rec in view of the
- Manifestation like PTB that most often is difficulty of demonstrating eggs in feces.
misdiagnosed
Incidence: Endemic – Mindoro, Camarines Sur,
Camarines Norte Tx:
CA – Paragonimus westermani Praziquantel (Biltricide)
Metacercariae – infective larvae Nitidozole
Symptoms: Prevention:
1. Cough of lung duration  Avoid washing cloths and bathing in streams
2. Hemoptysis  Proper & sanitary disposal of human feces
3. Chest back pain  Destruction of snail host – snail control use of
4. PTB like symptoms not responding to anti chemicals
TB meds  Improve irrigation & agriculture practices –
Dx/exam reduce snail habitat
 NCM 104 lec PRELIMS 6
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.