Linlyn A.

Quinatadcan December 9, 2011 Section A

SLH Communicable Diseases Ma am Narcar Hernandez

20 Common Communicable Diseases 1. German measles Other Names: Rubella; Three-day Measles Etiologic Agent: Rubella Virus or RNA containing Togavirus (Pseudoparamyxovirus) Incubation Period:10-21 days Period of Communicability: 1 week before 4 days after the onset of rashes. Mode of Transmission: - Airborne and Droplet - Direct contact with nasopharyngeal secretions - Transplacenta Predisposing factors: Haven't had chickenpox; Haven't been vaccinated for chickenpox; Work in or attend a school or child care facility Clinical symptoms: - Prodromal Symptoms: fever, headache, malaise, lymphadenopathy. - Forscheimer spots: red pinpoint patches on the oral cavity. - Maculopapular - rashes; sore throat Complications: Congenital Heart Diseases; Congenital cataract Modalities of treatment: - Paracetamol for fever - Increased fluid intake - Cool clothing - Stop scratching Nursing Management: - Instruct the mother to avoid pregnancy for three months after receiving MMR vaccine. - Isolation - Bedrest until fever subside - Prevent spread of infection - MMR is given at 15 months of age and is given intramuscularly. - Treatment is supportive/symptomatic Methods of Prevention and control: - MMR vaccine - Pregnant women should avoid exposure to patients infected with Rubella - Administration of immune Serum Globulin one week after exposure to Rubella. 2. Hepatitis A (infectious hepatitis; catarrhal jaundice) - A liver disease caused by the hepatitis A virus. Incubation Period: - The incubation period for hepatitis A ranges from 15 60 days, or 3 5 weeks; mean, 30 days Period of Communicability: - The infected patient is capable of transmitting th eorganis, a week before and a week after the appearance of symptoms Mode of Transmission: - By ingestion of contaminates drinling water or ice, uncooked fruits and vegetables, grown in or washed with contaminated water - Fecal-oral pathway - By infected food handlers Predisposing factors: - Troops living under crowded conditions at military camps or in the field - Homosexual men are increasingly at risk of HIV infection from oral-anal sexual contact. Pathology: - As hepatophilic virus enter and infect the liver, interlobular infiltration with mononuclear cells results to necrosis and hyperplasia of kuffer cells resulting to failure of bile to reach the intestine in normal amount, resulting to obstructive jaundice in which patient manifest dark urine, pale feces, and usually itchiness. Clinical symptoms: - Flu-like illness with chills and high fever

- Diarrhea, fatigue, and abdominal pain - Loss of appetite - Jaundice and dark colored urine - The infection in young children is often mild and asymptomatic Complications: - Progressive encephalopathy - GIT bleeding progressing to stupor and later coma - Edema and ascitis Modalities of treatment:  No specific treatment, although bed rest is essential  Intravenous therapy  High CHO, low fat, low CHON diet  Isoprinosine, may enhance the cell-mediated immunity of the T-lymphocytes Nursing Management: - Isolation of the patient - Promote rest during acute or symptomatic phase - Improve nutritional status increase in ability to carry out activities. Methods of Prevention and control: - A thorough handwashing every after use of toilet - Travelers should avoid water and ice if unsure of their purity - Screen food handlers carefully - Practice safe preparation and serving food - Educate the public on the mode of transmission of the disease 3. Rabies a specific, acute, viral infection communicated to man by the saliva of an infected animal. Etiologic Agent: Rhabdovirus a bullet-shape filterable virus with strong affinity to the CNS. It is sensitive to sunlight, ultraviolet light, ether, formalin, mercury, and nitric acid. The organism is resistant to phenol, merthiolate and common antibacterial agents. Incubation Period: - 1 week to 7 months in dogs - 2 8 weeks in human - Incubation period depends upon the following factors: 1. Distance of the bite to the brain, 2. Extensiveness of the bite, 3. Specie of the animal, 4. Richness to blood supply, 5. Resistance of the host, 6. Protection provided by clothing. Mode of Transmission: - The disease is transferred from a bite of an infected animal. - Non-bite means: leaking, scratch, inhalation/airborne (bats) Two kinds of Rabies: 1. Urban or canine transmitted by dogs 2. Sylvatic disease of wild animals and bats which sometimes spread to dogs, cats, and livestock Period of Communicability: - The patient is communicable 3 5 days before onset of symptoms until the entire course of the illness. Pathogenesis: - From the site of the bite, the organism proceeds to the CNS through the exoplasm of the peripheral nerves. - Experimental studies have shown that the virus stay for some time in the inoculation site and the multiplication of the virus occurs in the myocytes. - It has been observed that the period between inoculation and nerve invasion is the only time when prophylactic vaccine is effective. - Once the virus infect the individual, the spread is both centripetal and centrifugal - After infection of the CNS, the virus spread through the peripheral nerves, to the salivary glands, and also to other organs such as the lungs, the adrenals, the kidneys, the bladder, and the testicles. Clinical manifestations:(3 phases)  Prodromal/ invasion phase - Characterized by fever, anorexia, malaise, sore throat, copious salivation, lacrimation, perspiration, irritability, hyperexcitability, apprehensivesness, restlessness, sometimes drowsy, mental depression, melancholia and insomnia. - Pain at the original site of the bite, headache and nausea - Sensitive to light, sound and temperature - Pain and aches in different parts of the body.  Excitement or neurological phase

- Marked excitation, apprehension, and even terror may occur. - Delirium, maniacal behavior, eyes are fixed and glossy, skin is cold and clammy - Pain in swallowing, Aerophobia, hydrophobia, profuse drooling of saliva, tonic or clonic contraction of the muscles. - DEATH may occur during the episode of spasm or from cardiac/respiratory failure. - If patient survive during this phase, patient deteriorates rapidly and enters to the terminal phase.  Terminal/paralytic phase - Patient becomes quiet and unconscious - DEATH occurs due to respiratory paralysis, circulatory collapse, or heart failure. Treatment: 1. Thoroughly wash the bite wounds with soap and running water for at least 3 minutes. 2. Give tetanus toxoid if needed 3. Tetanus antiserum infiltrated around the wound or given intramuscularly after a negative skin test. 4. Anti-rabies vaccine, both passive and active, depending upon the site and extensiveness of the bites well as the condition of the biting. Nursing Management: - Wash wound with soap immediately. - Provide optimum comfort - Darken the rooms, provide quite environment - Patient should not be bathe and there should not be any running water in the room or within the hearing distance of the patient. - If an IV fluid has to be given it should be wrapped and needle should be securely attached and anchored in the vein to avoid dislodging in times of restlessness. - Concurrent and terminal disinfection should be carried out. Prevention and Control: - Vaccination of all dogs - Enforcement of regulation for pickup and destruction of astray dogs - Confinement for 10 14 days of any dog that has bitten a person - Public education, especially children, in avoiding and reporting all animals that appea 4. Tetanus Other Names: Lock jaw Etiologic Agent: Clostridium tetani (anaerobic spore-forming) Incubation Period: varies from 3 days to 1 month, falling between 7 14 days Mode of Transmission: - Indirect contact- inanimate objects, soil, street dust, animal and human feces, punctured wound. Predisposing factors: - age 50; burns; ear infection; Pathology: - After CI. Tetani enters the body; it causes local infection and tissue necrosis. While producing, they are also releasing toxins that enter the bloodstream and the lymphatics and eventually spread into the central nervous system or absorbed by the motor nerve ending and passes up through the axon cylinder, to the anterior horn cells of the spinal cord. This stimulates contraction of the muscles supplied by the neurons to which the toxin diffuses. Clinical symptoms: - Risus sardonicus- devil smile - Opisthotonus- arching of back - Early symptoms: trismus masseter muscle spasm/ lock jaw , stiff neck, dysphagia, rigidity of the abdominal muscle, lumbar hip and thigh muscle - Descending presentation: headache, restlessness, irritability down. - For Newborn: difficulty of sucking, excessive crying, stiffness of jaw, body malaise Complications: airway obstruction; pneumonia; respiratory arrest, heart failure Modalities of treatment: a. Antibiotics b. Bed rest c. Muscle relaxers such as diazepam Nursing Management:  Antitoxin: antitetanus serum (ATS) and tetanus Immunoglobulin (TIG) (if the patient has allergy, should be administered in fractional doses)  DOC: Penicillin G (for children); Metronidazole (for adults); Diazepam for muscle spasms

 Maintain patent airway in the presence of respiratory muscle spasms, laryngeal obstruction - Provide cardiac monitor - Wound care - Place patient in a quiet, semi-dark room - Avoid sudden stimuli and light Methods of Prevention and control: - DPT Immunization - Tetabus toxoid (artificial active) immunization among pregnant women - Training and licensing of midwives/ hilots - Health Education of mothers - Puncture wounds are best cleaned by thorough washing with soup and water. 5. Measles Other Names: Morbilli; Rubeola Etiologic Agent: RNA containg paramyxovirus; Morbilli virus Incubation Period: - 10 12 days - 14 days- rashes appear (8 to 13 days) Period of Communicability: - 4 days before and 5 days after the appearance of rash Mode of Transmission: - Airborne and direct contact - Indirectly, through articles or fomites freshly contaminated with respiratory excretions. Predisposing factors: - no vaccination; international travel; vitamin A deficiency Clinical symptoms: - Pre-eruptive stage: Fever, conjunctivitis, coryza, cough, and malaise; Koplik s spots- whitish/bluish pinpoint pathches on the buccal cavity; Stimson s line- bilateral red line on the lower conjunctiva; - Eruptive stage: cephalocaudal appearance of maculopapular rashes; - Convalescent stage: fever subsides; rashes fade in the same manner as they appeared. Complications: Pneumonia; Encephalitis Modalities of treatment:  IV fluids  Medications to control pain and fever  Vitamin A supplements Nursing Management: - Vaseline applied to edges of eyelids to prevent them from sticking. - Antipyretics for fever - Monitor for other bacterial infections - Hydrate the patient - Diet: rich in Vitamin C and A Methods of Prevention and control: - Measles Vaccine - Disinfection of soiled articles - Isolation of cased from diagnosis until about 5 to 7 days after onset of rash. 6. Leptospirosis Other Names: Weil s disease; Mud fever; Trench fever; Flood fever; Spirochetal Jaundice; Japanese Seven Days fever Etiologic Agent: - Leptospira Interrogans- which has more than serovars; Leptospira icterohaemorrhagiae (carried by rats); L. canicola (carried by dogs); L. pamona (carried by cattle / swine) Incubation Period: - 7-19 days, average of 10 days Period of Communicability: - Leptospira are found in the urine between 10-20 days after onset. Mode of Transmission: - Ingestion of food contaminated by urine or through contact of the skin and Mucous membrane (open wounds) with contaminated water, moist soil or Vegetation.

Predisposing factors: occupational exposure- farmer, slaughter workers, loggers; recreational Activities- fresh water swimming, trail biking in warm areas; household Exposure: pet dogs, domesticated livestock, rainwater catchment system, infected rodents Clinical symptoms: - Anicteric Phase: high fever, chills, headache, cough, abdominal pain, nausea, vomiting, and myalgias; - Icteric Phase or Weil s syndrome: jaundice, hepatic dysfunction, myocarditis, decreased renal function hemorrhagic manifestations Complications: - Pulmonary complications; meningitis, severe bleeding Modalities of treatment: - DOC: Penicillin/Erythromycin; Tetracycline - Administration of fluid and electrolyte and blood as indicated. Nursing Management: a. Careful attention to fluid and electrolyte balance b. Dialysis as needed; BT as needed c. Isolate the patient d. Keep under surveillance e. Eradicate rats Methods of Prevention and control: - Protective clothing, boots and gloves - Eradication of rats - Segregation of domestic animals - Awareness and early diagnosis - Improve education of people - Avoid wading and swimming in water contaminated with urine of infected animals - Concurrent disinfection of articles soiled with urine - Oral prophylaxis o doxycycline 200mg/week 7. Dengue Hemorrhagic Fever Other Names: H-fever; Brakbone fever; Dandy fever Etiologic Agent: Dengue virus 1, 2, 3 , and 4 which are classified as Flaviviridae; Chikungunya virus Incubation Period:Uncertain. Probably 6 days to 1 week. Period of Communicability: - Unknown. Presumed to be on the first week of illness up to when the virus - Is still present in the blood; Occurrence is sporadic throughout the yea; Epidemic usually occur during the rainy seasons (June to November); Peak months: September and October. Mode of Transmission: - Bite of infected mosquito (Aedes aegypti) Pathology: - Infectious virus is deposited in the skin by the vector and initial replication occurs at the site of infection and in local lymphatic th th tissue. Within a few days viremia occurs, lasting until 4 or 5 day after onset of symptoms. Evidence indicates that macrophages are the principal site of replication. At the site of petechial rash, a non-specific change has been noted. Clinical symptoms:  Febrile/Invasive Stage (1-4 days) - Starts abruptly as fever, abdominal pain, headache, vomiting, conjunctival infection, epistaxis  Toxic Hemorrhagic Stage (4-7 days) - Decrease in temperature, severe abdominal pain, GIT bleeding, unstable BP (narrowed pulse pressure), shock, death may occur  Recover / Convalescent Stage (7-10 days) - Appetite regained, BP stable Complications: - Epistaxis; GI bleeding; Metabolic acidosis; Hyperkalemia Modalities of treatment: - Analgesic drug other than aspirin; BT; O2 therapy; Sedatives maybe needed. Nursing Management: - Paracetamol for fever; Analgesics for pain - Rapid replacement of body fluids-most important treatment (ORESOL)

- Blood transfusion - Bbed rest - DIET: low fat, low fiber, non irritating, non-carbonated - Noodle soup may be given - Avoid dark colored foods - ALERT! No aspirin Methods of Prevention and control: - 4 o clock habit- stay inside as much as possible during hours when mosquitoes are biting. - Chemically treated mosquito net. - Larva eating fish - Environmental sanitation - Antimosquito soap - Neem tree (eucalyptus) - Eliminate vector - Avoid too much hanging clothes inside the house - Residual spraying with insecticide - Daytime fumigation - Use of mosquito repellents - Wear long sleeves, pants, and socks - For the control of H-fever, knowledge of the natural history of the disease is important - Environmental control; kill larvae and eliminate breeding places like swamps, used tires - Screen living and working quarters - Provide on-going community 8. Malaria Etiologic Agent: Plasmodium vivax; P. falciparum (most fatal, most common in the Philippines) ; P. ovale P. mmalariae- attacks the RBC Incubation Period:1-4 weeks, but sometime more than a year; sometime may remain dormant in the liver and cause relapse. Period of Communicability: untreated or insufficiently treated patient may be source of mosquito  infection for more than 3 years in P. malariae. Mode of Transmission: Indirect- bite of infected female anopheles mosquito (night time biting, high  Flying, rural areas, clear running water); may also occur via parenteral injection or congenitally. Pathology: - The organism invade the RBC where they grow and undergo asexual schizogony - The parasite i=enters the mosquito s stomach through the infected human blood obtained by biting or during blood meal. Clinical symptoms:  Cold stage: severe, recurrent chills; Hot stage: fever; Wet stage: profuse sweating; intermittent chills and sweating, wax and wane fever, anemia / pallor, tea-colored urine due to hemoglobinuria, malaise, easy fatigability, hepatomegaly, splenomegaly, abdominal pain and enlargement. Complications: kidney failure, meningitis, liver failure, pulmonary edema Nursing Management: - TSB - Keep patient warm - Change wet clothing - Encourage fluid intake - Avoid drafts - QUININE- oldest drug to treat malaria Methods of Prevention and control: - CLEAN technique - Insecticide- treatment of mosquito net - House spraying (night time fumigation) - Avoid outdoor night activities (9pm to 3am) - On stream clearing- cutting of vegetation overhanging along stream banks - Wearing of clothing that cover the arms and legs in the evening - Use mosquito repellents - Take chemoprophylaxis when travelling to endemic areas 9. Amoebic Dysentery

Other Names: Amoebiasis Etiologic Agent: Entamoeba histolytica- protozoan (slipper-shaped body) Incubation Period: - 3 days insevere infection; several months in sub-acute and chronic form. In average case vary from 3 4 weeks. Period of Communicability: - For duration of the illness. Mode of Transmission: - Fecal-oral route - Direct contact Predisposing factors: - living in a crowded environment; weakened immunization; have oral or anal sex Clinical symptoms: - Intestinal amoebiasis fever, abdominal cramping, bloody mucoid stool more than 6x a day, jaundice, anorexia, weight loss and tenesmus Complications: Perforation, Peritonitis Modalities of treatment:  Medication: Metronidazole  Bed rest  Increased fluid intake  Pain killers and muscle relaxants Nursing Management:  Metronidazole (Flagyl)- avoid alcohol because of its Antabuse effect can cause vomiting  Proper disposal of stools  Keep on bed rest  Give IVF to correct ffluid and electrolytes imbalances  DIET: high protein Methods of Prevention and control: - Proper hand washing - Proper food and water handling - Boil potentially contaminated water for 5 minutes - Wash fruits and vegetables in potable water and keep dry - Dispose human feces in a sanitary manner - Community education 10. Typhoid Fever Other Names: Enteric Fever; Typhus abdominalis Etiologic Agent: Salmonella typhosa Incubation Period: - Usual range 1 to 3 weeks, average 2 weeks Period of Communicability: - Variable. As long as the pt. is excreting the microorganism, he is still capable of infecting others. Mode of Transmission: Fecal-oral route Predisposing factors: - travel to areas where typhoid fever is endemic; drink contaminated water; Weakened immune system Pathology: - Toxin is absorbed by the blood stream, almost all organs of the body are affected, most commonly the heart, the liver, spleen and mesenteric lymph glands are swollen. Clinical symptoms: - Rose spots: in the chest and abdomen (balancing pink papules 2-4 mm in diameter) Ladderlike fever; Splenomegaly and diffuse abdominal tenderness; Typhoid state: patient appears toxic, weak, very ill and delirious. Diarrhea, sometimes bloody, with foulsmelling greenish-yellow stool Complications: - intestinal bleeding, pneumonia, kidney and bladder infection Modalities of treatment: - Ampicillin; Co-trimoxazole; - DOC: Chloramphenicol. Nursing Management: - DOC: Chloramphenicol

- Antipyretics for fever - Steroids (Prednisone) to hasten improvement - Increase fluid intake - Good positioning - Give high calorie, low residue diet Methods of Prevention and control: - Proper hand washing - Proper food and water handling - Treatment of community water - Sanitary disposal of human feces - Control of flies - Cook shellfish, peel/wash vegetables and fruits - Use enteric precautions around patient - Public education on personal hygiene 11. Gonorrhea a sexually transmitted bacterial disease involving the mucosal lining of the genito-urinary tract, the rectum and pharynx. Etiologic Agent: Neisseria gonorrhea or gornococcus Incubation Period: 3-21 days (ave.3-5 days) Period of Communicability: - The period of communicability of the disease is variable. The infected person remains communicable as long as the organisms are present in secretions and discharges. Mode of Transmission: - By contact with exudates from the mucus membrane of infected persons, usually a result of sexual activity - Direct contact with contaminated vaginal secretions of the mother as the baby cones out of the birth canal. Pathology: - After infection, gonococci became adherent to the urethral epithelium. Clinical symptoms: Females: - Burning and frequent urination - Yellowish purulent vaginal discharge - Redness and swelling of genitals Males: - Dysuria with purulent discharges from the urethra 2-7 days after exposure - Rectal infection is common in homosexuals - Prostitis, pelvic pain and fever Complications: - Sterility and pelvic infection in women - Epididymitis, arthritis, endocarditis, conjunctivitis and meningitis. Modalities of treatment: - For uncomplicated gonorrhea in adults ceftriaxone - Aqueous procaine penicillin Nursing Management: - All information concerning the patient is considered confidential. There should be no discussion concerning the patient and Lab reports. - Isolation of the patient until she /he recovers from disease Methods of Prevention and control: - Sex education not only in school but in the community, emphasizing the mode of transmission and the source of infection - Case finding, contact tracing - Report cases immediately. 12. Diphtheria an acute bacterial disease that can affect the body in two areas; the throat (respiratory diphtheria) and the skin (skin or cutaneous diphtheria). Etiologic Agent: - Corynebacterium diphtheriae (klebs Leoffler bacillus Incubation Period: - After being exposed to the bacterium, it usually takes 2-5 days for symptoms to develop. Period of Communicability:

- Variable; more than 2-4 weeks in untreated patients or 1-2 days in treated patients. Mode of Transmission: - Contact with patient or carrier, or with articles soiled with discharges of infected persons. Pathology: - The toxin is absorbed into the mucous membrane and causes destruction of the epithelium and superficial inflammatory response takes place. - The larger the membrane, the more toxin are present in the blood streams and in the tissues - Commonly seen over the tonsils, pharynx, so that any attempt to remove the pseudo membrane, exposes and tears the capillaries, thus resulting in bleeding. Signs & symptoms: - Feeling of fatigue, malaise, slight sore throat and elevation of temperature, apathy with rapid pulse rate. - In severe cases, the entire neck becomes swollen with edema (bull s neck) extending to the chest. - Breathing difficulty, husky voice, stridor, nasal discharges, swelling of palate, low-grade fever and yellow spots or sores on the skin. Complications: 1. Myocarditis, polyneuritis, and airway obstruction may lead to death through asphyxiation. Treatment: 1. Penicillin is usually effective in treating respiratory diphtheria before it releases toxins in the blood. 2. Anti-toxin can be given with penicillin 3. Erythromycin Nursing Management: - Absolute bed rest for at least two weeks, patient not permitted to bathe by himself, avoid exertion during defecation in order to conserve energy and decrease workload of the heart. - Diet. Soft food; small frequent feeding is advised - Fruit juice rich in vitamin C - Ice collar applied to the neck and care of the nose and throat. Prevention and Control: - Mandatory reporting of cases. - Patients are isolated for a minimum of 14 days. - Contact with children and food handling should be restricted until it examinations are negative. - Children under 5 years old should be given booster dose of diphtheria tetanus vaccine. - Mandatory DPT immunization foe babies. 13. Influenza (la Grippe) - An acute viral infectious disease affecting the respiratory disease. Etiologic Agent: RNA containing myxoviruses, types A, A-prime, B, and C. Incubation Period: the usual incubation is from 24-48 hours. Period of Communicability: - Until the 5th day of illness - Up to 7 days in children Mode of Transmission: - Airborne spread among crowded populations - Direct contact through droplet spread - Influenza virus persist for hours in dried mucus Pathology: - Influenza virus is airborne and first invade the respiratory mucosa, specifically that of the nasal, tracheal, and bronchial, where rapid inflammation damages the ciliated epithelium of the tracheobronchial tree, rendering the patient vulnerable to the development of secondary invaders such as, pneumococci, or staphylococci, streptococci, and other organism which later regenerayes with more squamous type of cells. Clinical symptoms: - Onset is sudden chilly sensation, hyperpyrexia, malaise, sore throat, coryza, rhinorrhea, myalgia, and headache. - Severe aches and pain at the back with sever sweating Complications: - Hemorrhagic pneumonia - Encephalitis and other neurologic syndromes - Myocarditis. - Otitis media - Sinusitis Modalities of treatment:

- No specific treatment. - Paracetamol for fever - Ibuprofen or other anti-inflammatory drugs Nursing Management: - Stay at home and drink plenty of fluids - TSB - Isolate the patient to decrease risk of infecting others - Limit strenuous activity specially in children - Watch out for complications specially people at risk Methods of Prevention and control: - Immunization - Avoidance of crowded places - Educate the public and health care personnel in basic personal hygiene. 14. AIDS - Acquired Immune Deficiency Syndrome - It involves an immune deficiency. When a person s immune system breaks down, he or she becomes susceptible to many infections which eventually end up death. Etiologic Agent: - HIV refers to Human Immunodeficiency Virus which causes AIDS Incubation Period: - 3- 6 months to 8-10 years Mode of Transmission: - Sexual contact with infected person - Injection of infected blood or blood products - Perinatal or vertical transmission. (from pregnant woman to the fetus during pregnancy, child delivery, or breast feeding. - Organ donation Pathology: - We produce antibodies against specific infections. When HIV infection takes place, anti-HIV antibodies are produced but they do not appear immediately. This has been called the window effect . When HIV is in the circulation, it invades several types of cells; the lymphocyte, macrophages, the Langerhans cells, and the neurons within the CNS. HIV attacks the body s immune system. The organism attaches to a protein molecule called CD4 which are found in the surface of T4 cells. Clinical symptoms: - A person may remain asymptomatic, feel and appear healthy for years even though he or she is infected with HIV. While they do not have AIDS, their immune system is impaired. MINOR signs: - Persistent cough for one month - Generalized pruritic dermatitis - Oropharyngeal herpes zoster - Generalized lymphadenopathy MAJOR signs: - Loss weight 10% of body weight - Chronic diarrhea for more than one month - Prolonged fever for one month Modalities of treatment:  Reverse transcriptase inhibitors they inhibit the enzyme called reverse transcriptase which is needed to copy information for the virus to replicate, and these drugs are: Zedovudine, Zalcitabine, Stavudine  Protease inhibitors they inhibit the enzyme protease which is needed for the assembly of viral particles. (saquinavir, ritonavir, etc.) Nursing Management: - Four C s in the management: - Compliance gives information and counsels the client resulting in client following treatment, prevention and recommendation successfully. - Counseling/education - Instruction about treatment - Information about the disease - Guidance on how to avoid STD again - Facts about HIV and AIDS

- Contact tracing tracking out and providing treatment on partners - Condoms promoting condom use to married couple, instructing about their use and providing them. Methods of Prevention and control: - Abstinence - Be faithful to partners - Condom - Sterilize needles, syringes, and instruments used for cutting operations - Proper screening of blood donors - Avoid promiscuous sexual contact. 15. Pertussis Etiologic Agent: Bordetella pertussis; Hemophilus pertussis; Bordet-gengou bacillus; Pertussis bacillus Incubation Period: 7 10 days but not exceeding 21 days. Period of Communicability: Starts from 7 days after exposure to 3 weeks after typical paroxysms. Mode of Transmission: - Pertussis is primarily spread by direct contact and droplet Predisposing factors: - Common in infants and young children; adolescents and adults Pathology: - After the incubation period, large # of B. pertussis are confined to the trachea-bronchial mucosa entangled in the cilia where it produces progressively tenacious mucus. Clinical symptoms: - sneezing, coughing, thicken secretions; loud inspiration of whoop , exhaustion, - vomiting of swallowed secretions, paroxysmal cough followed by continuous - non-stop accompanied by vomiting; gradual shift from paroxysmal coughing to - Chronic coughing. Complications: - Pneumonia, Otitis media, sinusitis, intracranial bleeding, hernia Modalities of treatment:  Antibiotics such as erythromycin  Oxygen tent with high humidity  Fluid and electrolyte replacement Nursing Management: a) DOC: Erythromycin 40-50mg/kg/day for 2 weeks b)Complete bed rest c) Avoid pollutants - Abdominal binder to prevent abdominal hernia - Promote adequate nutritional support during catarrhal period - Identify ways to remove tenacious secretions as necessary Methods of Prevention and control: - DPT Immunization - Booster: 2 years and 4-5 years - Patients should be segregated until after 3 weeks from the appearance of Paroxysmal cough. 16. Tuberculosis Other names: Koch s Disease; Consumption; Phthisis; Weak Lungs Etiologic Agent: Mycobacterium tuberculosis; TB bacillus; Koch s bacillus; Mycobacterium bovis Incubation Period: 4-6 weeks Period of Communicability: - As long as bacillus is contained in the sputum. - Primary complex in children is NOT contagious. - Good compliance to regimen renders person not contagious 2-4 weeks after initiation of treatment. Mode of Transmission: - Airborne-droplet - Direct or indirect contact with infected persons, usually by discharges from the respiratory tract - By contact with contaminated eating or drinking utensils - Direct invasion through mucous membrane and skin breaks in the skin (very rare) Predisposing factors:

- HIV and AIDS patients; older adults, babies, diabetic and cancer patients, - Malnourished individuals Pathology: - After gaining access into the body, the organism penetrate the lining of the respiratory tract or the intestinal mucosa, is picked up by the lymph or blood channels and reached the lungs or other organs where it lodges and produces original lesion, the tubercle, from where the disease gets its name Clinical symptoms:  usually asymptomatic; low-grade fever in the afternoon; night sweating; loss of Appetite, weight loss, easy fatigability due to oxygen demand; temporary Amenorrhea; productive dry cough; hemoptysis Modalities of treatment: - Short course chemotherapy (6) mo. Treatment with RIPE. - Pt. with drug resistance may be given with 2nd line drugs such as capreomycin, streptomycin, - WHO recommends DOT (Direct observed Therapy) Nursing Management: 1. Place the patient in a negative pressure room and in a private room. 2. All nurses and visitors entering the patient's room should wear an N-95 mask. 3. Put a mask on the patient during transportation to other departments. 4. Keep the door to the patient's room shut and place an isolation sign at a visible location near the door. 5. Use standard precautions when providing direct care to the patient. This includes wearing gloves, gowns and effective hand washing. 6. Teach patient how to avoid spreading the disease by sneezing or coughing into doubly ply tissue instead of their bare hands, washing their hands after this and disposing of the tissue into a closed plastic bag. 7. Teach the tuberculosis patient to stay in well ventilated areas and limit contact to other people while he or she is still able to spread the infection. Methods of Prevention and control: - BCG Immunization to all infants. - Respiratory precautions - Cover the mouth and nose when sneezing to avoid mode of transmission. - Improve social conditions. 17. Chicken Pox (Varicella) an acute and highly contagious disease of viral etiology that characterized by vesicular eruptions on the skin and mucous membrane with mild constitutional symptoms. Etiologic Agent: - Chicken pox is caused by varicella-zoster virus, a type of herpes virus Incubation Period: - 2-3 weeks, commonly 13 to 17 days. Period of Communicability: - From as early as 1 to 2 days before the rashes appear until the final lesion have crusted. Mode of Transmission: - Direct contact or droplet spread. Indirect through articles fresh soiled by discharges of infected persons. Predisposing factors: - Universal among those not previously attacked. Severe in adults. Pathology: - Man is the only source of infection. - All lesions appear in different stages at one time or it will pass through the following stages: macule, papule, vesicles, pustule, crust. Signs & symptoms: - slight fever, mild constitutional symptoms and eruptions which are maculopapular for a few hours, vesicular for 3-4 days and leaves granular scabs - Rashes begin on the trunk and spread peripherally, vesicular lesion are very pruritic. Complications: 1. Secondary infection of the lesions: furuncles, cellulites, skin abscess, erysipelas 2. Meningoencephalitis, pneumonia, and sepsis. Treatment: Zoverax, oral acyclovir, oral anti-histamine to symptomatic pruritus, calamine lotion, and antipyretic for fever. Nursing Management: - Respiratory isolation until all vesicles has crusted. - Hygienic care of the patient to prevent secondary infection.

- Attention should be given to nasopharyngeal secretions and discharges and disinfection of linens by sunlight or boiling. - Cut finger nails short and wash hands more often in order to minimize bacterial infections that may be introduced by scratching. - For a child, apply mittens. Provide activities to keep child occupied to lessen pruritus. Prevention and Control: - Active immunization with live attenuated varicella vaccine. - Avoid exposure as much as possible to infected persons. 18. Leprosy a chronic systemic infection characterized by progressive cutaneous lesions. Etiologic Agent: - Mycobacterium leprae Incubation Period: - Ranges from5 and a half months to 8 years. Period of Communicability: - Until the 5th day of illness - Up to 7 days in children Mode of Transmission: - Through respiratory droplet - Inoculation through the skin break and mucous membrane Pathology: - M. leprae attacks the peripheral nerves, especially the ulnar, radial, posterior popliteal, anterior-tibial, and facial nerves. When the bacilli damage the skin s fine nerves, they cause anesthesia, anhudrosis, and dryness. Clinical symptoms: - Clawhand, footdrop, and ocular manifestations, such as corneal insensitivity and ulceration, conjunctivitis, photophobia and blindness. - Loss of eyelashes and eyebrows - Raised, large erythematous plagues appear on the skin with clearly defined boarders. Modalities of treatment: - Sulfone therapy - Multiple drug therapy - Rehabilitation, recreational and occupational therapy Nursing Management: - If the patient is admitted to the hospital, isolation and medical asepsis should be carried out. - Moral support and encouragement Methods of Prevention and control: - Report all cases and suspects of leprosy - Newborn infants should-be separated from leprous mother - BCG vaccine - Health education as to the mode of transmission. 19. Cholera (El Tor) an acute bacterial enteric disease of the GIT characterized by profuse diarrhea, vomiting, massive loss of fluid and electrolytes that could result to hypovolemic shock, acidosis, and death. Etiologic Agent: - Vibrio Cholerae / Vibrio coma these organisms are slightly curved rods, gram negative and motile with a single polar flagellum. They can survive well in ordinary temperature; can survive longer in refrigerated foods. Incubation Period: - A few hours to 5 days; usually 1 3 days. Period of Communicability: - 7-14 days after onset, occasionally 2-3 months. Mode of Transmission: Fecal oral route via contamination of water, milk, and other foods Ingestion of food or water contaminated with stools or vomitus of patient Flies, soiled hands and utensils also serve to transmit the infection Pathology: - The fluid loss is attributed to the enterotoxin elaborated by the organism as they lie in opposition to the lining cells of the intestines. - The toxin stimulates adenylate cyclase, resulting in conversion of the adenosine triphosphate (ATP) to cyclic adesine monophosphate (CAMP).

- The toxin acts upon the intact epithelium on the vasculator of the bowel, thus, results to outpouring of intestinal fluids. Fluid loss of 5% - 10% of the body weight results in dehydration and metabolic acidosis. Signs & symptoms: - There is an acute, profuse, watery diarrhea with no tenesmus or intestinal cramping. - Initially, the stools are brown and contain fecal materials but soon become pale gray, rice-water in appearance with an inoffensive, slightly fishy odor. - Vomiting occurs after the diarrhea has been established. Diarrhea causes fluid loss amounting to 1 30 liters/day. - Tissue turgor is poor, eyes are sunken, skin is cold, the fingers and toes are wrinkled assuming the characteristic washerwoman s hand . - Cyanosis, voice become hoarse, speaks in whisper (aphonia), breathing is rapid and deep, oliguria and even develop anuria. Complications: If treatment is delayed or inadequate, acute renal failure and hypokalemia become secondary problem. Treatment: 1. Intravenous treatment this is achieved by rapid intravenous infusion of alkaline saline solution containing sodium, potassium, chloride and bicarbonate ions in proportions comparable to those in water-stools. 2. Oral therapy rehydration can be completed by oral route (ORESOL, HYDRITES) unless contraindicated or, if the patient is not vomiting. 3. Maintenance after rehydration has been completed, the volume of fluid and electrolyte loss must be replaced. This is done by careful intake and output measurement. 4. Antibiotics: tetracycline, furazolidone, chloramphenicol and Co-trimoxazole. Nursing Management: - Medical aseptic protective care and enteric isolation - Accurate recording of vital signs, accurate measurement of intake and output. - Provide a thorough and careful personal hygiene and proper disposal of excreta. - Concurrent disinfection, proper preparation of food and environmental sanitation. Prevention and Control: - Protection of food and water supply from fecal contamination. - Water should be boiled or chlorinated - Milk should be pasteurized - Sanitary disposal of human excreta and sanitary supervision 20. Filariasis (Elephantiasis) a parasitic disease caused by an African eye worm, a microscopic thread-like worm. Causative organism: - Wuchereria bancrofti, a 4-5 cm long thread-like worms that affect the body s lymph nodes and lymph vessels. Incubation Period: - 8-16 months. Mode of Transmission: - The disease is transferred from person to person by mosquito bites. Pathology: - When a mosquito bites a person with lymphatic filariasis, microscopic worms circulating in the person s blood enter and infect the mosquito. - The microscopic worms pass from the mosquito through the skin and travel to the lymph vessels where they grow into adults. - A person needs many mosquito bites over several months to years to get Filariasis. Signs & symptoms: - Symptoms vary, depending of the type of parasitic worms, all infections usually begin with chills, headache, and fever between 3 months to 1 year after the insect bite. - There may also be swelling, rednees, and pain in the arms, legs or scrotum. Complications: - Hyperplasia of the skin and subcutaneous tissue, damage of the kidneys and the lymph system. Treatment: 5. Ivermectin, albendazole, or diethylcarbamazine (DEC) used to treat by eliminating larvae and killing the adult worms. 6. Surgery may be used to remove surplus tissue. Nursing Management: - Elephantiasis of the legs can also be helped by elevating the legs and providing support with elastic bandages. - Educate client to apply preventive measures. Prevention and Control: - Mosquitoes that carry the microscopic worms usually bite between the hours of dusk and dawn. - The people living in an area with filariasis should: 1. Sleep under a mosquito net; 2. Use mosquito repellant; 3. Take yearly dose of medicine that kills the worms circulating in the blood.