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COMMUNICABLE DISEASES
diseases caused by pathogenic microorganisms (MO) which can be transmitted from an infected person to a susceptible person by: Direct - meaning it comes in contact with infected person or person-person transmission Example: Droplets where MO remain in the surface with limitation of its distance of at least 3 feet; face to face encounter with an individual Through kissing, sexual contact and skin to skin contact
Indirect - meaning from the source of infection to a new host with intermediary object in the form of: Vehicle-borne =non-living things such as water and fomites Vector-borne =living things but non human such as insects Break in the skin integrity through inoculation Example: Sharp needles and blood transfusions
Airborne where MO are suspended in air with no limitation with regards to its distance. Infectious Diseases - diseases caused by living microorganisms which may not be transmitted through ordinary contact Contagious Diseases are diseases that can be easily transmitted All communicable diseases are infectious because they are caused by MO but not contagious because not all of them are easily transmitted. All infectious diseases are communicable but not all infectious diseases are contagious All contagious diseases are both communicable and infectious
Pathogenicity - capability of the microorganism to cause infection Virulence + Pathogenicity = Infection Therefore, not all are susceptible, not all are virulent or pathogenic.
2 Microorganisms: Viruses can only multiply in living things as its reservoir can pass through filters of the body: blood brain barrier and placental barrier Viral Infections are self limiting diseases, have time frame, if not treated complication ensues patients are treated according to symptoms its the bodys own resistance that will fight the infections
Environment - should be conducive and favorable to the growth & multiplication of the microorganism
state of being resistant to infection or a state of being free from infection 2 Types of Immunity: Natural Immunity is inherent in individual body tissues and fluids (born & die with it); very rare Example: Race Acquired Immunity is able to get it and produce antibodies; common type 2 Types of Acquired Immunity: Active Acquired Immunity - actual participation of the body tissues and fluids in producing immunity; you are the one who produce the antibodies
Immunity
2 ways to produce antibody: Naturally acquired active immunityunintentional production of antibodies or there is a previous attack of the disease Artificially acquired active immunityintentionally acquired so that the body produces antibodies
Passive Acquired Immunity-develop immunity due to presence of antibodies within the serum not coming from the individual himself; you dont produce it yourself
2 Ways:
Naturally acquired passive immunity Maternal transfer or placental transfer of antibodies Colostrum through breastfeeding Artificially acquired passive immunityintentionally given so that theres an immediate protection from infection
Mode of transmission: pertains to means of transportation 2 General modes of transmission: Horizontal transmission - microorganism can be transferred in horizontal position
Direct mode of transmission- person to person Indirect mode of transmission- from the source of infections to a new host with an intermediary object (a bridge) Vehicle-borne- non living things Example: bed linens, tubings, catheter and eating utensils
Vector-borne- living but non human Example: insects, rodents, flies, mosquitoes and cockroaches Break in skin integrity through inoculation and percutaneous Example: wounds, blood transfusions, needle punctures & animal bites Vertical transmission - from top to bottom Example: mother to child transmissiontransplacental or perinatal
Causative Agent
Susceptible Host Reservoir
Portal of Entry
Immunization 3 Laws of Immunization: Expanded Program on Immunization (EPI) -PD # 996 UN Goal: Universal Child Immunization (UCI) -Proclamation # 6 Health for Filipino CY 2000: National Immunization Day (NID)-Proc. # 46 Goal: To prevent 7 Childhood Diseases for children under 5 years old
TB -BCG DPT (Diptheria, Pertussis and Tetanus) -DPT vaccine Poliomyelitis -OPV Hepatitis B Measles
4 Temporary Contraindications for Immunization: Pregnancy do not give live vaccine Immuno-compromised situation Very severe disease immediately needs hospitalization Recently received blood products 2 Permanent Contraindications for Immunization: Allergy Encephalopathy without known cause or convulsions within 7 days after pertussis vaccine
Environmental Sanitation PD 856 -integrated all those working in night clubs and beer gardens to submit themselves for STD examination at least once a month and for gonorrhea at least twice a month PD 825 -anti-littering law or proper disposal of garbage Fine: P2,000-5,000 or 6 months-1 year imprisonment Proper Supervision of Food Handlers DOH responsibility BFAD monitor food and drugs for safe consumption
Control Aspect theres already infection but control or limit the spread of infection Measures: Isolationseparation of infected person during the period of communicability 2 Ways of Isolation: Strict isolation protecting other persons by containing the microorganism within the patient Protective isolation protecting the patient wherein microorganism will be away from the patient
2 Revised Isolation Precaution to be practiced: Standard Precaution is the primary strategy for preventing nosocomial infection and it slowly took the place of Universal Standard because it has a double standard choosing its patients. applies to all patients irregardless of their diagnosis; applies to all body fluids, secretions and excretions except sweat applies to non intact skin and mucous membrane
3 Ways to Practice Transmission Based Precaution: Airborne precaution use of respiratory protection such as special type of mask=ultra filter mask or particulate mask
Example: Measles, TB, Chicken pox, SARS are airborne diseases
Quarantine is limitation of freedom of movement of a well person during the longest incubation period; quarantine of person with no disease but exposed, no signs and symptoms yet Disinfection is killing of pathogenic MO by physical or chemical means
2 Ways of Attaining Disinfection: Concurrent is done when the person is still a source of infection
Example: All things of the patient should be boiled while confined
Disinfestation is killing of undesirable small animal forms such as arthropods and rodents by physical or chemical means Example: Killing of mosquitoes, roaches and rats by poisoning Fumigation is killing of arthropods and rodents using gaseous agent
Medical Asepsis
Hand washing (the #1 principle) Use of barrier protectors (Personal Protective Equipment): masks, goggles, cap, gown and gloves Placarding: No smoking sign, right arm precaution and protective isolation
Normal Habitat: found in the intestines of plant eating animals Mode of Transmission: Break in Skin Integrity such as wound splinter (saludsod), tooth decay, human & animal bite, pricking of pimple and poor cord care in NB MO stays in the wound and releases toxins that travel to the blood which produces the Signs and Symptoms of Tetanus
Toxins released by the MO are: Tetanolysin that dissolves RBC causing anemia Tetanospasmin brings about muscle spasm affecting all the muscle particularly the myoneural junction of muscle and internuncial fibers of spinal cord & brain Immunity: No permanent immunity because it is bacterial Incubation Period: 3 days-1 month; 3-4 weeks=moderate, 3 days=severe The shorter the IP, the poorer the prognosis
Painful involuntary muscle contraction and muscles affected are: Masseter Lockjaw or Trismus Facial muscleRisus sardonicus Muscle of spineOpisthotonus position=arching of the back (liyad) Respiratory muscleDOB/dyspnea GUTUrinary retention GITConstipation Abdominal musclerigidity described as board like, if soft=recovery Extremity musclestiffness of extremity=difficulty in flexing it;
Diagnosis: Wound history, clinical observation and examination Wound culture if there is presence of fresh wound
To prevent and control spasms by providing patient with muscle relaxant such as
Diazepam drip by incorporating it in IVF and titrated according to spasm (frequent spasm=fast regulation of IVF) If patient can tolerate oral form: Methocarbamol (Robaxin or Roboxisal) Baclofen (Lioresal) Epirisone (Myonal)
Measures: Place patient on a dim and quiet environment Practice minimal handling of patient & avoid unnecessary disturbance of patient Practice gentle handling of patient by informing patient first about the procedure such as turning and vital sign monitoring before touching him
Interoceptive stimuli is coming from within the patient Propioceptive stimuli theres participation of patient and another person Reason why patient with tetanus is isolated to prevent exposing him to these 3 types of stimuli despite being not communicable
Respiratory infection brought about by not turning patient on his sides Respiratory aspiration
Falls Dont leave patient alone Put up padded side rails Call light must be near patients reach Assist patient when walking-fatigue is an interoceptive stimuli Fracture due to restraining of patient when having spasm To provide comfort measures to patient preventing mouth sores
Preventive Measures
Immunization DPT is given 6 weeks after birth for 3 doses at one month interval Dose: 0.50 ml IM Vastus lateralis Health Teachings: Tell mother to expect fever to set in-give Paracetamol If swelling and tenderness occurs on the site
apply cold compress within 24 hours
Observe for any sign of convulsions within 7 days which is a reaction to Pertussis component of the drug
Tetanus Toxoid given to pregnant women on the 2nd trimester of pregnancy 2 doses Dose: 0.50 ml IM Deltoid muscle
Tetanus Toxoid given for persons in high risk to tetanus such as the carpenter or construction workers 1st dose 2nd dose1 month after 3rd dose6 months after from last dose 4th dose1 year after from last dose 5th dose1 year after from last dose for high risk-give booster dose every 5 years for low risk-give booster dose every 10 years
MENINGITIS
inflammation of the meninges (covering of the brain and spinal cord) 3 Coverings:
Dura mater Arachnoid-subarachnoid spaces (found in between meninges) Pia mater
Causative Agents: Viruses: Cytomegalovirus (CMV) viral meningitis Fungus: Cryptococcal meningitis Bacteria: the most common cause
TB meningitis Staphylococcal meningitis Hemophilus influenza B
Causative agent: Neisseria meningitides Mode of Transmission: Droplet infection (direct) Immunity: No permanent immunity Incubation Period: 2-10 days Portal of Entry: Respiratory system via the nasopharynx Signs and Symptoms: fever, sore throat, headache, cough, colds and body malaise
Neisseria meningitides
Bloodstream-----Vascular Changes:
Petechial Formation Ecchymosis
Theres an increase intracranial pressure due to accumulation of CSF in the subarachnoid space:
Manifestations:
Severe headache Projectile vomiting Altered vital signs: Increase T, decrease PR, decrease RR, increase systolic but normal diastolic BP Convulsions Diplopia (double vision) due to choking of optic nerve/disc Altered level of consciousness (LOC)
Blood culture done if lumbar puncture cant be done yet because microorganism travels to the blood stream
Medical Management: Antimicrobials drugs a. Viral supportive treatment b. Fungus antifungal c. Bacteria antibiotic Corticosteroid Dexamethasone or Solu-cortef Mannitol - osmotic diuretic it removes excess CSF monitor intake and output to assess or evaluate effectiveness of drug assess hydration of patient Anticonvulsant drug Phenytoin (Dilantin)
Nursing Responsibilities:
If Phenytoin is given by IV, it should be sandwiched with NSS (NSS-Dilantin-NSS) because when mixed with IVF produces crystallization causing obstruction If given per orem, do oral care and gum massage because it causes gingival hyperplasia
Proper disposal
Proper procedure: Place tissue paper in plastic bag and knot before throwing
Secondary encephalitis
Previous infection- a complication of some diseases Example: Measles, Chicken pox and mumps Post vaccine-anti-rabies vaccine (active form)
Toxic Encephalitis
Lead poisoning Mercury poisoning
Diagnostic Examination:
Lumbar Puncture-CSF clear: increase protein, increase WBC and normal sugar Electroencephalogram (EEG)-to determine extent of brain involvement or damage=epilepsy
Preventive Measures: to eradicate the mosquitoes by practicing the CLEAN program of DOH:
C-hemically treated mosquito net using Permithrim then dry for 3-6 mos. L-arvivorous fishes (they eat the larvae of mosquitoes) E-nviromental sanitation: clean the surroundings A-nti-mosquito soap such as basil N-eem tree or eucalyptus tree plant (it drives away mosquitoes)
POLIOMYELITIS
also known as Infantile Paralysis or HeineMedins disease usually affected are infants high risk are children below 10 years old Causative Agent: Legio debilitans virus which has 3 strains:
Type 1-Brunhilde-- (common in PI) Type 2-Lansing Type 3-Leon
Tonsils:
Peyers patches of Intestine: Abdominal pain & anorexia Nausea &vomiting Diarrhea or constipation
BLOOD STREAM
CNS
Stages of Poliomyelitis: Invasive or Abortive Stage - when virus invades the host and S/Sxs disappear.
Severe muscle pain-apply warm compress, avoid turning, touching or massaging patient & give analgesic (Codeine not Morphine because it causes respiratory distress) Stiffness of hamstring especially back of thigh Presence of Hoyres sign Poker spine-Opisthotonus with head retraction
Paralytic stage-theres paralysis of patient where he appears flaccid (soft, flabby and limp)=pathognomonic sign of Poliomyelitis
3 Types of Paralysis: Bulbar type-CN 9th (glossopharygeal) and 10th (Vagus) are affected
S/Sxs:
a. Swallowing paralysis (choking & drooling of saliva) b. Vocal cord paralysis c. Respiratory paralysis
Spinal type-most common type where anterior horn cells are affected
S/Sxs:
a. Paralysis of the upper and lower extremities-may be unilateral or bilateral b. Paralysis of the intercostals muscles Bulbo-spinal type-cranial nerves and anterior horn cells are both affected
Diagnostic Examinations:
Lumbar Puncture-(+) Pandy Test=increase protein, increase WBC and normal sugar Muscle Testing Electromyelogram (EMG) Stool Examination Throat Washing
Medical Management:
No specific treatment, symptomatically only If (+) respiratory paralysis, patient is placed in a mechanical ventilator called Iron Lung Machine
Nursing Care:
Supportive and Symptomatic Psychological Aspect of Care including relatives
Preventive Measures:
Immunization by Oral Polio Vaccine (OPV-Sabin vaccine) given 6 weeks after birth Instructions to the mother: Dont feed child 30 minutes after administration If vomiting occurs, repeat dose of OPV Be careful in handling the stool of the child who had received OPV Dont administer to patient with immunocompromised family instead give Inactivated Polio Vaccine (IPV-Salk vaccine) 0.5 cc IM vastus lateralis in 3 doses at one month interval
Avoid mode of transmission Proper disposal of nasopharygeal secretions Hand washing and proper disposal of feces Dont put anything in the mouth especially in children below 10 years old
RABIES
also known as Hydrophobia, Lyssa and LA Rage a disease of low form of animal that is accidentally transmitted to man through animal bites (canines, cats, bats, skunks, fox, dogs and wolves) Bats are the main source of virus Causative Agent: Neurotropic virus-has special affinity to neurons/CNS Rhabdo virus-transferred from animal to man
2 Pathways for Virus to Travel: Rhabdo Virus --------------------------------------------Peripheral Nerves Efferent Nerves
CNS
Mode of Transmission: Contact with saliva of a rabid animal, scratching, licking of wounds by dogs or corneal transplantation Incubation Period: For animals=3-8 weeks; For humans=10 days-years
Furious Stage-animal is easily agitated, fierceful or vicious look and drooling of saliva-----later will die
3 Stages of Manifestation in Human: Invasive Stage-the virus is easily transferred through saliva, by direct or indirect contact S/Sxs: a. Numbness on site b. Sore throat c. Marked insomnia d. Restlessness, irritable and apprehensive e. Flu-like symptoms f. Slight photosensitivity
Excitement Stage-stage when patient is confined in the hospital Signs/Symptoms: Aerophobia (fear of air) & Hydrophobia (fear of water) Drooling of saliva and spitting Photosensitive Maniacal Behavior=fierceful look, agitated, bites, jumps out of window and runs like a rabid dog Mgt: Haloperidol (Haldol) with Benadryl is given to calm the patient Paralytic Stage-stage when spasm is no longer observed because paralysis sets in and within 24-72 hours patient will die
Diagnostic Examinations: Brain Biopsy of Animal to identify presence of negri bodies Direct Flourescent Antibody Test (DFAT) Observation of the animal for 10 days
if animal develops behavioral changes or die within 10 days, it has rabies Factors to consider in observing the animal:
Site of the bite-if from waist up (virus travels 3 mm/hour once in the body) Extent of bite-if multiple, deep or big bite Reason for the bite-if provoke=less worry if unprovoked=must worry
Medical Management: Giving vaccines is a post exposure prophylaxis only to lessen chances of developing rabies Active form of Vaccine Types: a. Purified Duck Embryo Vaccine (PDEV)-Lyssavac
b. Purified Vero Cell Vaccine (PVCV)-Verorab c. Purified Chick Embryo Vaccine (PCEV)
2 Ways of Administration: Per intramuscular (IM)-do skin testing first;deltoid & vastus lateralis m. Day 0-2 vials=1 vial for each site=one on Right & one on Left Day 7-1 vial =1 vial for one site =either right or left Day 21-1 vial =1 vial for one site =start counting from first dose if given 3 doses, it gives 3 years immunity Per intradermal (ID)-deltoid & vastus lateralis muscle
2 1 4 3 -------------------------------------------12 6 5 11 14 8 7 13 -------------------------------------------10 9
7.5 -buttocks
15cc
7.5 - site of
bite
Nursing Care:
Place patient in a dim and quiet room Room of patient should be away from sub-utility room Before maniacal behavior sets in, restrain the patient Wear complete protective barriers when entering the room
Preventive Measures:
Immunization-all dogs should be given immunization in the Barangay Centers Keep away from stray dogs Keep animal caged or chained. If bitten by a dog, wash with soap and running water to wash away virus then use strong antiseptic solution (betadine or iodine) and observe the dog
Causative Agents:
Arbovirus-Dengue virus=Type 1, 2, 3 and 4 Onyong-nyong virus Chikungunya virus West Nile virus Flavivirus-brought epidemic in the Philippines
Mode of Transmission: Aedes aegypti and Aedes albopictus are biological transmitters. The mosquito is able to transfer DHF virus after 8-11 days from one person to another until it dies. Thus the virus becomes part of the system of mosquito Mosquito bite of Culex fatigan is a mechanical transmitter, the very first person it will bite will be the only one infected with DHF (Lifespan of mosquitoes: up to 4 months)
Thrombocytopenia
DHF Grade 2 Persistence of S/Sxs of DHF Grade 1 + Bleeding Bleeding from: 1) Nose-epistaxis 2) Gum-gum bleeding 3) Stomach: a) Hematemesis b) Melena c) Hematochezia
DHF Grade 3
Persistence of S/Sxs of DHF Grade 2 + Circulatory Failure Cold clammy skin Check for capillary refill (normal capillary pressure=less than 3 seconds) Low Blood Pressure (hypotension), very rapid weak pulse and rapid respiration
DHF Grade 4 - persistence of S/Sx of DHF Grade 3 + Hypovolemic Shock because of excessive blood loss due to uncontrolled bleeding-----DEATH
Diagnostic Examination:
Tourniquet Test or Rumpel Leede Test test for capillary fragility only a presumptive test for DHF 3 Criteria before performing Tourniquet Test: Individual should be 6 months older Fever of more than 3 days No other signs of DHF-fever of 3 days release the cuff, check and count the petechial formation per one square inch, if more than or equal to 20 petechial formation=(+) tourniquet test
Platelet Count-decrease in DHF (NV: 150,000-400,000 mm3); definitive test Hematocrit (Hct) determination-increase in DHF due to hemoconcentration (NV: 0.37-0.54=37-54%)
Nursing Care: To prevent and control bleeding - a nursing priority Epistaxis-instruct patient to avoid forceful blowing of nose or for parents to do gentle nasal care Control Measures:
Apply ice pack/ice compress over nose bridge for vasoconstriction Place patient in upright position, leaning forward, ante-flexion then apply pressure on nose bridge MD will do nasal packing (gauze) to stop bleeding
Gum bleeding
Control Measures: Give ice chips/ice cold NSS gargle or water gargle Use warm NSS as mouth gargle TID Use oral antiseptic solution as gargle BID Use cotton swab as mouth care OD Use soft bristle toothbrush
Hematemesis
Control Measures: Place ice pack over epigastric region NPO because eating can stimulate contraction of stomach Place patient in upright position to prevent aspiration Provide oral care Refer to MD to perform NGT for gastric lavage
Melena Inform patient to avoid dark colored food and drinks Dont give iron preparation
Supportive & Symptomatic Increase body resistance of patient by proper nutrition and adequate rest Preventive Measures: practice CLEAN program of DOH
Immunity: DHF gives no permanent immunity
only female mosquitoes suck blood for fertilizing egg P. vivax and P. falciparum are both most common causes in the Philippines
Mode of Transmission:
Mosquito bite-Anopheles mosquito Blood transfusion
If infected by mosquito
Blood stream -------------------------------------
3 Stages of Manifestation of Malaria: Cold Stage-Chilling sensation: shaking of body & chattering of lips that lasts for 1015 minutes Nursing Care: Provide blanket Apply hot water bag over soles of feet Expose to heat lamp or drop light Provide warm drinks
Hot Stage-Fever, headache, vomiting and abdominal pain lasts for 4-6 hours Nursing Care: TSB Cold Compress Increase fluid intake Provide adequate rest Loose and light clothing
Diagnostic Examinations:
Malarial Smear/Blood Smear-blood is extracted at peak of fever Quantitative Buffy Count (QBC)- no need to wait for the height of fever to set in
Medical Management:
Chloroquine (Aralen) -mainstay drug of malaria Other Drugs: Primaquine, Atabrine, Fansidar and Quinine (a reserve drug for severe cases) Cautiously used for pregnant women because of its abortive effect and it crosses the placental barrier causing severe anemia to the child
Bacterial Etiology:
Leprosy
3 Stages of Measles: Pre-eruptive stage highly contagious stage Manifestations: High grade fever which last for 3-4 days 3 Cs:
Cough Colds Conjunctivitis
Conjunctivitis
inflammation of the conjunctiva presence of excessive mucopurulent lacrimal discharges Stimson Sign=puffiness of the eyelid with linear congestion of the lower conjunctiva photosensitivity
Presence of enathem called Kopliks spot (pathognomonic sign of measles) =fine red spots with bluish white spot at the center found in the inner cheek just opposite the molars
Eruptive stage
rashes will appear that is characterized as maculopapular, reddish in color and blotchy in appearance rashes appear first on the hairline, behind the ears, face, neck, trunk and extremities =Cephalocaudal in distribution rashes appear on the third day of illness, within 2-3 days the entire body is completely covered
Post-eruptive stage
having a fine branny desquamation (peeling off) from red color rashes, it will fade to brown then it peels off excluding the skin
Hygienic Measures:
Skin care rashes of measles are not itchy in itself use tap or lukewarm water to bath or sponge for 15-20 minutes expose only body parts to be sponged remove clothing of child when sponging and provide bath blanket and bed linen
Eye care clean by removing the discharge protect eye from sunlight because of photosensitivity Ear care to prevent otitis media Oral and nasal care in order to remove some organism lodging in the nose and mouth Immunity: Measles will give a permanent immunity It is highly contagious during 4 days before the appearance of rashes and 5 days after appearance of rashes
Preventive Measures: Immunization with Anti-measles vaccine (AMV) given to 9 months old, 0.5 cc SQ Deltoid muscle Instructions to mother after immunization:
Child may experience fever=give paracetamol Child may experience or develop mild rash formation 3-4 days after immunization
Private physician gives MMR between 12-15 months old, 0.5 cc SQ Deltoid m. Instructions to mother after MMR: Ask mother if child has allergy to eggs and neomycin because MMR has chick embryo and neomycin component If allergic to egg, MD may still give MMR but if neomycin is the allergen dont give MMR because of higher neomycin component causing anaphylaxis If given on adolescence or female child bearing age, dont get pregnant within 3 months after MMR immunization because it may bring about congenital anomalies
Proper disposal of nasopharygeal secretions Covering of mouth and nose when sneezing and coughing
Eruptive stage Presence of rashes described as maculopapular, pinkish in color with discrete appearance or finer to look at cephalo-caudal in distribution the entire body is completely covered with rashes within 24 hours Enlargement of lymph nodes=lymphadenopathy Post-eruptive stage occurs after 24 hours where rashes start to disappear and enlarged lymph nodes subside
Preventive Measures: similar to measles Immunity: German measles gives permanent immunity
It is communicable during the entire course of the disease=3 days Not fatal but could be on a pregnant woman during the 1st trimester of pregnancy because of chances of Congenital Anomaly
provide skin care: dont rub or apply soap directly into skin bathe the patient using tap water may give antihistamine for children to prevent itchiness rashes have generalized distribution all over the body, it appears first on covered body parts (trunk and scalp) contagious from the time rashes appear until the last rash have dried or crusted Post-eruptive stage rashes start to dry or crust and eventually fall or peel off by itself
Nursing Care:
Skin care to prevent skin infection: cut fingernails, use mittens and daily bathing Increase resistance and adequate rest and nutrition to prevent encephalitis
Preventive Measures:
Immunization using Varicella vaccine (Varivax) given at 12 months old, 0.5 cc SQ, deltoid, if given to children below 13=single dose children above 13=2 doses in 1 month interval Proper disposal of nasopharygeal secretions Cover mouth and nose when sneezing and coughing
Diagnostic Examination: Clinical observations and physical examination Medical Management: MDs recommend applications of Potassium Permanganate (KMNO4) 3 Fold Effects of KMNO4: A-Astringent------------dries rashes B-Bactericidal----------decrease chance of skin infection O-Oxidizing Effect----deodorizes the rashes
Analgesics for pain If rashes are on the abdominal area-----turn the patient on affected side to prevent stretching of the nerves-----less pain Zovirax can also be given
LEPROSY/HANSENS DISEASE
also known as Hansenosis discovered by Dr. Hansen where he called patients as Hansenites Causative Agent: Mycobacterium lepraean acid fast bacilli Incubation Period: 3 months-8 years
4 Types of Leprosy:
Indeterminate Tuberculoid or Benign or Non-infectious few microorganisms Lepromatous or Malignant or Infectious plenty of Mycobacterium leprae in lesions Borderline possesses some characteristics of tuberculoid and lepromatous
Late Manifestations of Leprosy: Lagophthalmosinability to close eyelids, half open when sleeping Madarosisfalling off of eyebrows Sinking of the bridge of the nose due to microorganism that absorbs small bones like bridge of the nose, cartilages of the ears, fingers and toes Leonine face resembling a lions face because of madarosis & sinking of the nose Chronic skin ulcers Contractures such as clawing of fingers & toes Gynecomastia
Diagnostic Examination:
Skin Smear Test or Skin Lesion Biopsy Lepromin Testis similar to skin testing by introducing the microorganism through antigen & done to identify what type of leprosy the patient has Wasserman Reaction Testblood examination
Medical Management:
Use of Multiple Drug Therapy (MDT) combination of drugs Advantages of MDT: To prevent drug resistance to Dapsone (mainstay drug of leprosy) To hasten recovery To lessen period of communicability after 2 weeks of MDT, patient is no longer communicable
Multibacillary approach
for lepromatous and borderline leprosy plenty Mycobacterium leprae in skin lesions Rifampicin once a month, Dapsone once a day and Lamprene once a day for 24-30 months (2-2 years)
Nursing Care:
Psychological aspect because patient has low self esteem due to altered body image and social stigma Skin care to prevent skin injury due to loss of sensation Provide active & passive exercises Provide adequate information regarding drug therapy by informing patient on the advantages of MDT and to motivate patient to comply
Discuss side effects of drug therapy that are harmless Example: Rifampicin-tears, sweat, saliva and urine becomes orange Lamprenetemporary hyperpigmentation of skin (blackish in color)
Tell patient under MDT that he can have Leprae Reaction to MDT due to microorganism that release toxins
Leprosy is not hereditary but can be acquired It does not affect fetus in pregnant women because the bacteria does not cross placental barrier MDT can not be given immediately because Rifampicin has a teratogenic effect on the fetus After giving birth, separate mother from child for 1-2 weeks Dont breastfeed baby because milk is contaminated with the drugs which can be passed on to the baby
Preventive Measure:
Immunization with BCG Proper disposal of nasopharygeal secretions Cover mouth and nose when sneezing and coughing to avoid MOT Avoid intimate contact with individual with leprosy (skin to skin)
Viral Etiology:
DIPHTHERIA
Affects the following: Respiratory Tract =Respiratory Diphtheria (most common type) Mucous Membrane=Cutaneous Diphtheria: a. Conjunctiva Conjunctival diphtheria b. Vaginal mucosa Vaginal diphtheria c. Prepuce or uncircumcised male Diphtheria of the prepuce Wounds of Individual=Wound Diphtheria Example: Burn patients Cutaneous diphtheria and Wounds are rare diphtheria
Causative Agent: Corynebacterium diphtheria or Klebs-Loeffler bacillus Mode of Transmission: Droplet (direct contact) it affects all ages
Pathognomonic sign of diphtheria = presence of pseudomembrane that can be seen by using a nasal speculum to see if covered by nasal secretion
Pharygeal or faucial type affects the pharynx and tonsils Manifestations: Presence of sore throat resulting to dysphagia Presence of pseudomembrane found in the soft palate, uvula & pillars of tonsils Presence of bull neck appearance brought about by inflammation and enlargement of anterior upper cervical lymph node
Laryngeal type most fatal type affects the larynx (voice box) Manifestations: Hoarseness of voice Presence of aphoniatemporary loss of voice
Presence of dyspnea (difficulty of breathing) because larynx also serves as an airway passage
Nursing Care: Make sure that the child is calm, not breast/bottle feeding and not crying when checking respiration because chest in drawing is always present in whatever position the patient is
Presence of pseudomembrane in the larynx causes airway obstruction Coughing described as barking cough, dry metallic cough, husky or croupy
Diagnostic Examination:
Nose and Throat Swab/Culture done to identify microorganism to determine if patient is still communicable patient is communicable until 3 consecutive negative results definitive/confirmatory test of diphtheria Schicks Test done to determine immunity or susceptibility to diphtheria Moloney Test done to determine hypersensitivity to diphtheria anti-toxin
3 Objectives of Medical Management: Neutralize the toxin through the use of Equine Anti-Diptheria Serum (horse serum) Kill the microorganism by giving antibiotics use the least toxic antibiotic which is Penicillin Prevent respiratory obstruction perform emergency tracheostomy
Nursing Care:
Place patient in complete bed rest until 2 weeks after recovery to prevent the # 1 complication that brings about death=Myocarditis Signs and Symptoms of Myocarditis: Mark facial pallor Very irregular pulse rate Hypotension Chest or epigastric pain
Maintenance of patent airway Positioning of patient Deep breathing & coughing exercises breath in through the nose and exhale through pursed lip breathing Perform chest physiotherapy Increase fluid intake to liquefy fluid secretions Turning patient every 2 hours
With MDs orders: 1) Oxygen inhalation therapy 2) Postural drainage 3) Suctioning of secretions Provide adequate and nutritious diet Symptomatic and supportive treatment Provide comfort measures such as oral and nasal care
Preventive Measures:
Immunization with DPT given 6 weeks after birth in 3 doses of 1 month interval Dose: 0.5 cc IM, vastus lateralis Instructions to Mother: a. Expect fever to set in b. Cold compress if theres swelling c. Warm compress d. Observe for inconsolable crying Proper disposal of nasopharygeal secretions Cover nose and mouth when sneezing and coughing Never kiss the patient
PERTUSSIS
also known as Whooping cough and Chin cough affects children below 6 years old above 6 years old has lesser risk for being infected Causative Agent: Coccobacillus a. Bordetella pertussis b. Hemophilus pertussis both are aerobic and anaerobic Incubation Period: 7-10 days Mode of Transmission: Droplet
3 Stages of Pertussis:
Catarrhal stage stage which is considered to be highly contagious child stays at home Signs and Symptoms: a. Presence of colds b. Nocturnal coughing c. Fever d. Tiredness and listlessness
Spasmodic or Paroxysmal stage 5-10 successive forceful coughing which ends on a prolonged inspiratory phase or whoop theres production of mucus (tenacious) plug on airway passage Other Manifestations: a. Congested face b. Congested tongue c. Teary red eyes with protrusion of eyeballs d. Distended face and neck veins e. Involuntary micturition and defecation f. Abdominal/inguinal hernia g. Deafness due to hemorrhage of vestibular apparatus of ear
Convalescent stage Signs and symptoms start to disappear Patient is no longer communicable Patient is on the road to recovery
Diagnostic Examination:
Nasal Swab Bordet-Gengou TestAgar Plate Cough Plate
Medical Management:
Immunization: Pertussis Immune Globulin Antibiotics: Erythromycin Fluid and Electrolyte Replacement to prevent dehydration Mild form of Sedation: Codeine
Nursing Care:
Complete Bed Rest (CBR) Maintain Fluid and Electrolyte Balances Provide adequate nutrition Proper positioning (upright) of patient when feeding to prevent aspiration Provide abdominal binder to prevent hernia
Preventive Measure: same as Diptheria Immunity: No permanent immunity but 2nd attack is rare because child will not remain 6 years old
TUBERCULOSIS
also known as Kochs Infection, Phthisis, PTB and Galloping Consumption Causative Agent: Acid Fast Bacillia. Mycobacterium tuberculosis or tubercle bacilli b. Mycobacterium bovis c. Mycobacterium avium/avis
Mode of Transmission:
Airborne and droplet Ingestion of infected milk of cows Inhalation from birds Mycobacterium avian complex (MAC)
3 Ways/Techniques of Tuberculin Testing: Mantoux Test most accurate and easiest way of TT interpret after 48-72 hours Tine/Multipuncture Test Vollmer & Perquet Test
Confirmatory test for TB sputum examination a definitive test that identifies the microorganism the best time to collect the sputum is in the morning, upon rising and before oral care instruct patient to do deep breathing for 3-4 times then ask patient to open mouth widely with tongue place behind lower teeth then ask patient to cough out sputum Chest X-ray is not a definitive test because it tells only the extent of involvement of the lungs
Classification of TB:
According to extent of disease based on cavitations within the lungs Minimal Moderately advanced Advanced presence of cavitations within the lungs According to clinical manifestations Active PTB Inactive PTB
Medical Management:
Short Course Chemotherapy Rifampicin, Isoniazid, Pyrazinamide=RIP (E, S)
Isoniazid (INH) is the mainstay drug of TB: 6 months for carrier& inactive adult patients 9 months for children 12 months for immunocompromised patients
Side Effects of INH: Peripheral neuropathy/neuritis a) instruct patient to eat food rich in Vit B6 beans b) give vitamin B6 (pyridoxine) to counteract neuritis Hepatotoxicity a) monitor liver enzymes b) avoid alcoholic beverages
Rifampicin (R) it causes orange color of tears, urine and stool it is hepatotoxic Pyrazinamide (PZA) it causes hyperurecemia Ethambutol (EMB) it causes irreversible optic neuritis that brings about blindness
Standard Regimen (SR) Streptomycin, Isoniazid and Ethambutol = SI(E) Streptomycin (S) Nephrotoxicity so monitor creatinine and BUN level of kidney Ototoxicity CN 8th is affected theres tinnitus vertigo
Preventive Measures:
Immunization with BCG immediately after birth 0.5 cc ID right deltoid area for infants Instruction to mother: Dont massage site of injection because it will spill the drug The child may experience fever There will be abscess formation on the site of injection which will heal and develop into a scar within 2-3 months.
Proper disposal of nasopharygeal secretions Covering of mouth and nose when coughing and sneezing Proper pasteurization
PNEUMONIA
inflammation of the lung parenchyma Causative Agents: Microorganisms such as Virus Cytomegalovirus (CMV) SARS Protozoa Pneumocystis carinii pneumonia (PCP) Bacteria Streptococcus; Hemophilus B Inhalation of noxious chemical, oil is inhaled and vomitus enters the respiratory system=Lipid pneumonia Mode of Transmission: Droplet
5 Cardinal Signs of Pneumonia: Rapid or gradual onset of fever Shaking chills Productive cough
Sputum production: Rusty -Streptococcus pneumonia Creamy Yellow -Staphylococcus Currant Jelly(like lychees) -Klebsiella Greenish -Pseudomonas Clear -no infection (Aspiration or Lipid Pneumonia) Chest or pleuritic pain aggravated by coughing Apply chest binders so it lessens pain when patient coughs
In community setting, Integrated Management of Childhood Illnesses (IMCI), assess the child for 4 General Danger Signs: Is the child able to drink or breastfeed? Check if the child vomits everything Presence of convulsions Check if child is abnormally sleepy or difficult to awaken
Check for the presence of chest in-drawing: Check for the presence of stridor (abnormal harsh breath sounds heard during inspiration even without stethoscope)
Diagnostic Examination:
Physical examination by: doing percussion auscultation: crackles and rhonchi decrease breath sounds and decrease vocal fremitus Chest X-ray=presence of lung consolidation or patchy infiltration that confirms pneumonia Sputum examination=to determine specific microorganism that causes the disease
Medical Management: Antibiotic-antimicrobial agents depending upon causative agent (bacteria or viral) PCP =Pentamidine Virus =Symptomatic Bacteria =Cotrimoxazole Inhalation Therapy Bronchodilators Mucolytics Nursing Diagnosis: Ineffective airway clearance R/T sputum (causes airway obstruction) production
Nursing Care: similar with Diptheria Complete Bed Rest to conserve energy Maintain patent airway Increase body resistance by adequate rest and nutrition Provide comfort measures Preventive Measures: Immunization by Immunovirax Proper disposal of nasopharygeal secretions Cover nose and mouth when sneezing and coughing Immunity: No permanent immunity
TYPHOID FEVER
Causative Agent: Salmonella typhosa invades Peyers patches - target organ Mode of Transmission: Fecal-oral transmission Sources of Infection: 5 Fs - Feces, fingers, food, flies and fomites
Fastigial/Pyrexial stage
MO invades the Peyers patches 3 Clinical Features of Typhoid Fever: Rose spots are light pink red spots found in the abdomen and sometimes seen on the face in children=pathognomonic sign Ladder like fever Splenomegaly
Typhoid Psychosis-increase body temperature due to release of toxins Patient have a coma vigil look Difficulty in protruding tongue Carphologia involuntary picking up of linen Sabsultus tendinum involuntary twitching of the tendon especially the wrist
Defervescence stage
patient experience ulcer formation--intestinal perforation that causes bleeding or hemorrhage---spillage in peritoneal cavity Signs and Symptoms of Peritonitis: sudden and severe abdominal pain persistence of fever board-like rigid abdomen
Convalescent/Lysis stage
signs/symptoms start to subside patient is on the road to recovery still have to observe patient because he may develop relapses
Diagnostic Examination:
Blood Culture Widal test Antigen O (Ag O) or Somatic antigen= presently infected Antigen H (Ag H) or Flagellar antigen= previously exposed to TF or has had an immunization Typhidot-uses blood specimen where it identifies antibodies Stool and Urine examination
Medical Management:
Antibiotic - Chloramphenicol Fluid and Electrolyte Replacement
Nursing Care:
Fluid and Electrolyte Management Assess patient for S/Sxs of fluid lossweight loss Monitor input and output of patient Proper regulation of IVF
Provide adequate nutrition If patient has vomiting= small, frequent feedings If patient has diarrhea=avoid fatty foods Provide comfort measures
Preventive Measures:
Immunization by Cholera, Dysentery and Typhoid vaccine (CDT) Avoid 5 Fs: Feces-proper excreta disposal Fingers-handwashing Food-proper preparation, handling and storage Flies-environmental sanitation Fomites-avoid putting anything in the mouth
LEPTOSPIROSIS
also known as Mud Fever, Swamp Fever, Canicola Fever, Pre-tibial Fever, Weil Disease, Swineherd Disease and IcteroHemorrhagica Disease a disease of low form of animals found in farms Source of Infection: Excreta of rats particularly urine
Mode of Transmission: Skin penetration by entering pores of skin Incubation Period: 2 days-4 weeks People at Risk: Sewage workers, farmers, miners, slaughterhouses and Manila residents (because of walking in floods) Incidence: common during rainy season
Diagnostic Examination:
Blood Examination: Leptospira agglutination test (LAT) Leptospira antigen-antibody test(LAAT) Microscopic agglutination test (MAT)
Medical Management:
Antibiotics-Tetracycline is the drug of choice Not given to: a. children below 8 years old because it causes staining of teeth b. pregnant women because of its teratogenic effect particularly on bone growth of fetus causing bone defect and stained teeth >never give tetracycline together with calcium rich food, antacid & iron preparations and milk
Give penicillin to patient allergic to tetracycline give it 1 hour before meals or 2 hours after meals or empty stomach
Preventive Measures:
Environmental sanitation by eradication of rats Avoid walking through floods
DYSENTERIES
Bacillary Dysentery Shigellosis Blood fluke
Shigella dysentery, Shigella flexneri, Shigella boydii, Shigella sonnei
Synonyms
Causative Agent
Characteristic Mucoid stool, of Stool bloodstreaked if severe due to endotoxin released by the MO
Yellow water to rice watery due to the vibriolytic substance released by MO Abdominal pain Vomiting Washerwoma ns hands due to dehydration
Mucopurulent bloodstreaked with foul-smelling odor and greenish color +/- Fever +/- Vomiting Diarrhea with tenesmus alternating with constipation
Bacillary Dysentery
Medical Antibiotic: Management Cotrimoxazole ORT
Violent Dysentery
Antibiotic: Tetracycline IVT
Amoebic Dysentery
Antiamoebic: Metronidazole Antiprotozoa: Chloroqiuine ORT
Nursing Care:
Maintain Fluid and Electrolyte Balance Monitor I and O Assess Signs & Symptoms of Dehydration Provide Fluids Provide Adequate Nutrition Small frequent feedings Avoid fatty foods Provide Comfort Measures
Preventive Measures:
Immunization: Cholera, Dysentery, Typhoid Vaccine (CDT) given by DOH Avoid 5 Fs
SCHISTOSOMIASIS
also known as Snail Fever or Bilharziasis Causative Agent: Metazoa in the form of Blood Flukes (parasitic flatworms) called Schistosoma-3 Types:
Schistosoma japonicum - affects both man & animal intestines Schistosoma mansoni - affects mans intestines Schistosoma haematobium - affects the choroid plexus of the urinary bladder producing urinary symptoms
Heart
Portal Circulation
Intestine (lay eggs) Feces (Eggs) Larvae (Miracidium) 24-48 hours to look for
Manifestations:
Itchiness on the entry site of MO (Swimmers itch) Low grade fever, cough, myalgia Dysentery like symptoms (mucoid) Emaciated (skin & bones) Abdominal distension or enlargement Hepatomegaly & splenomegaly Lymphadenopathy
Diagnostic Examinations: Stool Examination Blood Examination: Circum Ova Precipitin Test (COPT)confirmatory test Enzyme Link Immuno-Sorbent Assay Test (ELISA) Rectal Biopsy Medical Management: Anti-Blood Fluke Agent: a. Fuadin b. Praziquantrel Snail Control
Environmental Sanitation Proper excreta disposal Proper wearing of footwear (Eg. boots) Keep all animals caged or chained Creation of foot bridges Health Education done by DOH
MUMPS
also known as Infectious Parotitis an inflammation of the parotid glands Causative Agent: Paramyxovirus Source of Infection: Saliva of an infected individual Mode of Transmission: Droplet infection
Manifestations:
Complains of earache Presence of fever Pain upon chewing or mastication Swelling of the parotid gland
Diagnostic Examination: Only through Clinical Observation & Physical Examination Medical Management: Symptomatic
Nursing Care:
Complete Bed Rest until swelling subsides Female patients develop oophoritis (inflammation of the ovaries) Male patients develop orchitis (inflammation of the testes) In children, the most common complication is Encephalitis
Provide adequate nutrition by giving soft & bland diet (Eg. apple juice or water) Application of ice cap or ice collar over parotid gland lessens pain because it deadens the nerve endings (Eg. aniel dyetina & vinegar has cool effect)
Preventive Measures:
Immunization: MMR Cover nose and mouth Proper disposal of oropharygeal secretions
HEPATITIS
inflammation of the liver Causes:
Alcoholism Drug intoxication (ex. Rif and INH) Chemical intoxication (ex. arsenic) Microorganisms
Hepatitis A:
also known as Infectious Hepatitis, Catarrhal Jaundice Hepatitis & Epidemic Hepatitis Causative Agent: Hepatitis A virus or RNA containing virus Body Secretions that harbor the disease: Feces MOT: Fecal-oral transmission People at Risk: Children, those living in unsanitary conditions & those who practices anal-oral sex Incubation Period: 2-6 weeks
Hepatitis B also known as Serum Hepatitis, Homologous Hepatitis and Viral Hepatitis Causative Agent: Hepatitis B virus or DNA containing virus Body Secretions that harbor the disease: Blood & Body Fluids Example: CSF, tears, saliva, milk, synovial, seminal & cervical fluid and sweat
Mode of Transmission:
Percutaneous (most common) Oral to oral transmission Sexual transmission-found in seminal and cervical fluid Vertical transmission-placental barrier and amniotic fluid
People at Risk: Health workers, blood recipients, hemodialying patient, drug addicts and promiscuous individuals Incubation Period: 6 weeks-6 months
Hepatitis C also known as Post transfusion Hepatitis Causative Agent: Hepatitis C virus Body Secretions that harbor the disease: Blood MOT: Percutaneous People at Risk: Health workers, blood recipients, hemodialyzing patients & drug addicts Incubation Period: 5 weeks-12 weeks
Hepatitis D dormant type of Hepatitis B Causative Agent: Hepatitis D virus or Delta virus (it needs Hep B virus to multiply) Body Secretions that harbor the disease, MOT and People at Risk: same as Hepatitis B Incubation Period: 3 weeks-13 weeks
Hepatitis E also known as Enteric Hepatitis Causative Agent: Hepatitis E virus Body Secretion that harbors the disease: Feces MOT: Fecal-oral transmission People at Risk: same as Hepatitis A Incubation Period: 3 weeks-6weeks
Hepatitis G Causative Agent: Hepatitis G virus Body Secretion that harbors the disease: Blood MOT: Percutaneous People at Risk: same as Hepatitis C Incubation Period: unknown
Icteric Stage
presence of jaundice because of inability of liver to eliminate the normal amount of bilirubin Signs & Symptoms: Patient will have pruritus Urine is tea colored or brown Patient is passing out acholic (clay colored or no color) stool
2 Types of Bilirubin: Conjugated-passed the liver and goes to the intestine Unconjugated-goes to the kidney where it is filtered then goes to urine Persistence of symptoms of Pre-icteric Stage but to a lesser degree
Post-icteric Stage
jaundice and other signs & symptoms start to disappear energy level starts to increase and patient is on the road to recovery it takes 3-4 months for the liver to recover so avoid alcoholic beverages for one year and over the counter drugs like acetaminophen and ASA
Diagnostic Examination: Liver Enzyme Tests to determine extent of liver damage Enzymes that can be checked are:
Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Alkaline phosphatase (ALP) Gamma glutamil transferase (GGT) Lactic dehydrogenase (LDH)
Routine Tests
Bilirubin Testing Prothrombin Time Testing (PTT) Ultrasound or CT Scan of liver Urinalysis
Medical Management: Hepatic Protectors or Liver Aides contain vitamins, minerals and phospholipids
Essentiale for adults Jetepar or Silymarine for pedia
Nursing Care:
Provide rest to promote liver regeneration or recovery Low Fat Diet High CHON intake to spare protein metabolism In USA, butterball diet is given because CHO is used as a source of energy
Preventive Measures:
Immunization: Hepatitis B vaccine given at 6 weeks after birth, 3 doses at one month interval, Dose: 0.5 cc IM at the Vastus lateralis Avoid MOT
PARASITISM
MOT: Ingestion-hand to mouth Pinworm infection - Enterobiasis (Enterobius vermicularis), oxyuriasis & sitworm
S/Sxs: Nocturnal Ani-itchiness of the anus at night time because female pinworm get out of the intestinal wall & lay eggs to the anus Diagnostic Examination: Cellophane Tape Test
done in the morning upon rising
Giant Round Worms/Ascaris - Ascariasis (Ascaris lumbricoides) causes intestinal obstruction Whipworm/Trichuris - Trichuriasis Roundworm/ Trichinella spiralis Trichinellosis/ Trichiniasis due to eating raw meat
MOT: Skin of feet or barefooted Hookworm - Ancylostomiasis=signs & symptoms of pneumonitis Threadworm - Strongyloidiasis
Common Manifestations:
Voracious appetite Weakness Pot Belly Anemia Stunted Growth Apathetic
Medical Management:
Antihelminthics:a. Mebendazole b. Pyrantel pamoate (Combantrin)
GONORRHEA
also known as Jack, Gleet, Clap, Strain, GC (gonococcus) and Morning Drop Causative Agent: Neisseria gonorrhea MOT: Sexual contact, transferred to baby during childbirth Incubation Period: 3-21 days Manifestations: Male: urethritis Female: cervicitis
For Male:
Burning sensation upon urination
dysuria (painful urination) Redness & edema of urinary meatus acidic urine passes through causing burning sensation producing pain
For Female:
Dysuria and urinary frequency Itchy, red and edematous meatus, if cervix is affected If urethra is affected, there is burning pain and purulent discharges
Gonococcal Septicemia: migratory polyarthralgia, polyarthritis & tenosynovitis, tender papillary skin lesions Diagnostic Examination:
Culture & Sensitivity by mucosal scraping Paps Smear or Vaginal Smear
Medical Management:
Antibiotic: Ceftriaxone (Rocephin) Doxycycline (Tetracycline)
Nursing Care:
Psychological aspect of care-patient has low self esteem because of social stigma Health Education or Patient teaching about prevention measures: Safe Sex
No sex Long term mutual monogamous relationship Mutual masturbation without direct contact
CHLAMYDIAL INFECTION
Twin sister of gonorrhea because if you have gonorrhea, you have also Chlamydia Manifestations: same as gonorrhea except discharges are clear and thinner Diagnostic Examination:
Culture & sensitivity
Management: Antibiotic:
Penicillin: Benzathine Pen G (Penadur) Given per IM Given also to patient with Rheumatic Heart Disease (RHD) Cephalosporin: Ceftriaxone (Rocephin) Doxycycline (Tetracycline): given to patient with both gonorrhea & chlamydial infection
SYPHILIS
also known as Pox, Lues, SY and Bad Blood Disease Causative Agent: Treponema pallidum-a spirochete that passes to the placental barrier during the 16 week of pregnancy (2nd & 3rd trimester) MOT: Sexual contact and vertical transmission Incubation Period: 10-90 days
Tertiary Stage
Gumma described as an infiltrating lesion found on deeper tissues & body organs such as skin, bone and liver It involves the heart= aortitis & aneurysm It involves the CNS= paresthesias, abnormal reflexes, dementia and psychosis
Diagnostic Examinations:
Culture & Sensitivity by mucosal scraping Dark Field Microscope Serologic (Blood Exam) Test Venereal Disease Research Laboratory (VDRL): non specific Flourescent Treponema Antibody Absorption Test (FTA-ABS)confirmatory/definitive test Rapid Plasma Reaction (RPR)
Medical Management:
Antibiotic: Benzathine Penicillin G (Penadur)
MOT:
Blood transfusion Sexual contact Exposure to infected blood, products or tissues Vertical (mother to child) or Perinatal (Pregnancy, Delivery & Breastfeeding) transmission Sharing needles
Normal Immune Response: MO-----detected by ----------Macrophage HIV Antibodies Alert T Cells stimulate B cells
Once HIV enters the body, it directly goes to T-cells. The virus will release reverse transferase that resembles the genetic cells of T-cells. Then T-cells will not destroy the virus leaving it to multiply and damage T-cells. Virus leaves the T-cells then retrovert to its own genetic sequence-not enough T-cells-not enough stimulation of B cell-not enough antigenantibody reaction.
Well Worried Infected with HIV------------------Asymptomatic Window Period (+) HIV Infection------------------- Adult Child---------------------2 Major 2 1 Minor 2 ARC Symptoms AIDS
Well worried person is infected with HIV: he will be asymptomatic because it takes time to produce antibodies. After 6 weeks to 6 months, he will be (+) to HIV infection because it takes about 6 months to produce antibodies known as the Window Period (time interval between infection of an individual to production of antibody) AID Syndrome.
Adults: 2 Major symptoms & 1 Minor symptom Children: 2 Major symptoms & 2 Minor symptoms 3 Major Symptoms:
Fever-1 month & above Diarrhea-1 month & above 10% Weight Loss/Stunted Growth for Pedia
6 Minor Symptoms:
Persistent Cough-1 month & above Persistent Generalized Lymphadenopathy Generalized Pruritic Dermatitis Oropharyngeal Candidiasis Recurrent Herpes Zoster Progressive Disseminated Herpes Zoster
Opportunistic Infections
TB is the most common of the Avium type (from birds) Pneumocystis carinii pneumonia (PCP) Cytomegalovirus (CMV) protozoa CNS Lungs Eyes (Retinal destruction) Cancer: Kaposi Sarcoma malignancy of blood vessel manifested through the skin appearing as pink/purple painless spots on the skin called Leopard Look
Diagnostic Examinations: Enzyme Link Immunosorbent Assay (ELISA) Test-screening test Western Blot-confirmatory test Viral Load Testing CD4 & T-Cell Count
If more than or equal to 200=patient is HIV infected If less than 200=AIDS
Blood Examination/CBC-anemia, thrombocytopenia, leukopenia Blood Culture for pediatrics Immunocomplex dissociation (P24 assay) for pediatrics
Medical Management: Nucleoside Analogs prevent the virus to multiply during the initial phase of cell division: Nucleoside Reverse Transcriptase Inhibitor (NRTI) Azidothymidine (AZT)-Zidovudin, Retrovir Lamivudine-3TC, Epion Stavudine-Cd4T, Zerit Dideoxyinosine (DDI)-Didanosine Dideoxycytidine (DDC)-Zalcitabine, Hivid Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) Delavirdine Nevirapine
Protease Inhibitor (PI) prevents virus to multiply during the last phase of cell division
Indinavir Retonavir Saquinavir Nalfinavir
Preventive Measures:
Practice ABCD of HIV A-bstinence B-e Faithful C-ondom D-ont use drugs Education Counseling Behavior Modification
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