Comhealth Nursing

THE COMMUNITY HEALTH NURSING AND
COMMUNICABLE DISEASES
Community Health Nursin
COMMUNITY HEALTH NURSING
I ! De"inition o" Terms Community- derived from a latin word comunicas which means a group of people.
a group of people with common characteristics or interests living together within a territory or geographical boundary
place where people under usual conditions are found
Health - is the OLOF (Optimum Level of Functioning)
Community Health - part of paramedical and medical intervention/approach which is concerned on the health of the whole population
Aims# 1. health promotion 2. disease prevention 3. management of factors affecting health
Nursin - both profession & a vocation. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
II ! Community Health Nursin
The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities,
concerned with the promotion of health, prevention of disease and disability and rehabilitation.
Goal# To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as
to maximize their potential for high-level wellness
MISSION O$ CHN
% Health &romotion ' a(ti)ities relate* to enhan(ement o" health
% Health &rote(tion ' a(ti)ities *esine* to +rote(t the +eo+le
% Health Balan(e ' a(ti)ities *esine* to maintain ,ell -ein
% Disease +re)ention ' a(ti)ities relate to a)oi* (om+li(ation
% So(ial .usti(e ' a(ti)ities relate* to +ra(ti(e e/uity amon (lients
&HILOSO&HY O$ CHN ACCORDING TO DR0 MARGARET SHETLAND
The philosophy of CHN is based on the worth and dignity on the worth and dignity of man.
&rin(i+les o" Community Health#
1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group
(those who share common characteristics, developmental stages and common exposure to health problems e.g. children, elderly), and the
community.
2. n CHN, the client is considered as an ACTVE partner NOT PASSVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.
Role o" CH Nurse#
Clinician - who is a health care provider, taking care of the sick people at home or in the RHU
Health Advocator speaks on behalf of the client
Advocator act on behalf of the client
Supervisor - who monitors and supervises the performance of midwives
Facilitator - who establishes multi-sectoral linkages by referral system
Collaborator working with other health team member
COMMON &ROCEDURE IN CHN#
% HOME 1ISIT
% BAG TECHNI2UE
% STERILI3ATION
% S&ECIMEN COLLECTION
! URINE ' sterile -ottle4 mi*stream (olle(tion
! $ECES ! (lean (ontainer4 small amount o" "e(es only
! S&UTUM ! N&O mi*niht 5st (olle(tion early AM then su-mit at the health (enter imme*iately then 6n* (olle(tion "ollo,in *ay early
in the Am then su-mit at the health (enter then (olle(t the 7r* s+utum4 instru(t +atient to ta8e a *ee+ -reath 9 times then
(ouh out
Le)els o" Client in CHN#
1. Application of Nursing Process to:
50a $amily
50a05 $amily Co+in In*e:
&hysi(al In*e+en*en(e ! ability of the family to move in & out of bed & performed activities of daily living
Thera+euti( In*e+en*en(e ! ability of the family to comply with the therapeutic regimen (diet, medication & usage of appliances)
;no,le*e o" Health Con*ition! wisdom of the family to understand the disease process
A++li(ation o" General <&ersonal Hyiene! ability of the family to perform hygiene & maintain environment conducive for living
Emotional Com+eten(e ' ability of the family to make decision maturely & appropriately (facing the reality of life)
$amily Li)in &attern! the relationship of the family towards each other with love, respect & trust
Utili=ation o" Community Resour(es ' ability of the family to know the function & existence of resources within the vicinity
Health Care Attitu*e ' relationship of the family with the health care provider
&hysi(al En)ironment ' ability of the family to maintain environment conducive for living
>>>>50a06 $amily Li"e Cy(le
Stae I ' Beginning Family (newly wed couples)
TAS;# compliance with the PD 965 & acceptance of the new member of the family
Stae II ' Early Child Bearing Family(0-30 months old)
TAS;# emphasize the importance of pregnancy & immunization & learn the concept of parenting
Stae III 'Family with Pre- school Children (3-6yrs old)
TAS;# learn the concept of responsible parenthood
Stae I1 ' Family with School age Children (6-12yrs old)
TAS;# Reinforce the concept of responsible parenthood
Stae 1 ! Family with Teen Agers (13-25yrs old)
TAS;# Parents to learn the concept of let go system and understands the generation gap
Stae 1I ' Launching Center (1st child will get married up to the last child)
TAS;# compliance with the PD 965 & acceptance of the new member of the family
Stae 1II !Family with Middle Adult parents (36-60yrs old)
TAS;# provide a healthy environment, adjust with a new lifestyle and adjust with the financial aspect
Stae 1III ' Aging Family (61yrs old up to death)
TAS;# learn the concept of death positively
50- Community
COMMUNITY ASSESSMENT# Status information about morbidity, mortality & life expectancy Structure information about age, gender and
socio economic Process information about how the community function
TY&ES O$ COMMUNITY ASSESSMENT#
50 COMMUNITY DIAGNOSIS
A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the
population, to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and
strategies.
6 Ty+es#
Com+rehensi)e Community Dianosis &ro-lem!Oriente* Community Dianosis
! aims to obtain general information about the community - type of assessment responds to a particular need
STE&S#
&re+aratory &hase
1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data collection
6. finalize sampling design and methods
7. make a timetable
Im+lementation &hase
1. data utilization
2. data collection
3. data organization/collation
4. data presentation
5. data analysis
E)aluation &hase
60 BIOSTATISTICS
2.1 DEMOGRA&HY ! study of population size, composition and spatial distribution as affected by births, deaths and migration.
Sour(es # Census complete enumeration of the population
6 ?ays o" Assinin &eo+le#
50 De Jure ! People were assigned to the place where assigned to the place they usually live regardless of where they are at the time of census.
60De Facto ! People were assigned to the place where they are physically present at are at the time of census regardless, of their usual place of
residence.
Com+onents#
50 &o+ulation si=e
60 &o+ulation (om+osition
* Age Distribution
* Sex Ratio
* Population Pyramid
* Median age - age below which 50% of the population fall and above which 50% of the population fall. The lower the median age, the younger
the population (high fertility, high death rates).
* Age Dependency Ratio - used as an index of age-induced economic drain on human resources
* Other characteristics: - occupational groups - economic groups - educational attainment - ethnic group
3. Population Distribution
* Urban-Rural - shows the proportion of people living in urban compared to the rural areas
* Crowding ndex - indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host.
* Population Density - determines congestion of the place
3. 1ITAL STATISTICS
the application of statistical measures to vital events (births, deaths and common illnesses) that is utilized to gauge the levels of health,
illness and health services of a community.
TY&ES#
A. Fertility Rate
A0 CRUDE BIRTH RATE
total # of livebirths in a given calendar year X 1000
estimated population as of July 1 of the same given year
B0 GENERAL $ERTILITY RATE
total # of livebirths in a given calendar year X 1000
Total number of reproductive age
B. Mortality Rate
A0 CRUDE DEATH RATE
Total @ o" *eath in a i)en (alen*ar year A 5BBB
Estimate* +o+ulation as o" .uly 5 o" the same (alen*ar year
B0 IN$ANT MORTALITY RATE
Total @ o" *eath -elo, 5 yr in a i)en (alen*ar year A 5BBB
C0 MATERNAL MORTALITY RATE
Total @ o" *eath amon all maternal (ases in a i)en (alen*ar year A 5BBB
C. Morbidity Rate
A0 &RE1ALENCE RATE
Total @ o" ne, < ol* (ases in a i)en (alen*ar year A 5BB
Total @ o" +ersons e:amine* at same i)en time
B0 INCIDENCE RATE
Total @ o" ne, (ases in a i)en (alen*ar year A 5BB
Estimate* +o+ulation as o" .uly 5 o" the same year
C0 ATTAC; RATE
Total @ o" +erson ,ho are e:+ose* to the *isease A 5BB
@ o" +ersons e:+ose* to the same *isease in same i)en year
III ! E+i*emioloy
the study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution
the study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations
A0 Patterns of disease occurrence:
E+i*emi( - a situation when there is a high incidence of new cases of a specific disease in excess of the expected.
- when the proportion of the susceptibles are high compared to the proportion of the immunes
En*emi( - habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibles e.g.
Malaria is a disease endemic at Palawan.
- the causative factor of the disease is constantly available or present to the area.
S+ora*i( - disease occurs every now and then affecting only a small number of people relative to the total population
- intermittent
&an*emi( - global occurrence of a disease
Steps in EPDEMOLOGCAL VESTGATON:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained
B0 Role of the Nurse
Case Finding
Health Teaching
Counseling
Follow up visit
I10 Health Situation o" the &hili++ines
&hili++ine S(enario#
% In the +ast 6B years some in"e(tious *eenerati)e *iseases are on the rise0
% Many $ili+inos are still li)in in remote an* har* to rea(h areas ,here it is *i""i(ult to *eli)er the health ser)i(es they nee*
% The s(ar(ity o" *o(torsC nurses an* mi*,i)es a** to the +oor health *eli)ery system to the +oor
1ITAL HEALTH STATISTICS 6BBD
E &RO.ECTED &O&ULATION #
MALE ! 96CFG9CGHH
$EMALE ! 96C7H6C59G
BOTH SEAES ! FDC67HCI57
E LI$E EA&ECTANCY
$EMALE ! GB yrs0 ol*
MALE ! H9 yrs0 Ol*
LEADING CAUSES O$ MORBIDITY
% Most o" the to+ ten lea*in (auses o" mor-i*ity are (ommuni(a-le *isease
% These in(lu*e the *iarrheaC +neumoniaC -ron(hitisC in"luen=aC TBC malaria an* )ari(ella
% Lea*in non CD are heart +ro-lemC H&NC a((i*ents an* malinant neo+lasms
LEADING CAUSES O$ MORTALITY
% The to+ 5B lea*in (auses o" mortality are *ue to non CD
% Diseases o" the heart an* )as(ular system are the 6 most (ommon (auses o" *eaths0
% &neumoniaC &TB an* *iarrheal *iseases (onsistently remain the 5B lea*in (auses o" *eaths0
10 Health Care Deli)ery System the totality of all policies, facilities, equipments, products, human resources and services which address the
health needs, problems and concerns of the people. t is large, complex, multi-level and multi-disciplinary.
HEALTH SECTORS
% GO1ERNMENT SECTORS
De+artment o" Health 1ision# Health for all by year 2000 ands Health in the Hands of the People by 2020
Mission# n partnership with the people, provide equity, quality and access to health care esp. the marginalized
D MaJor $un(tions#
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency
jurisdictions
3. Ensure a minimum level of implementation nationwide of services regarded as public health goods
4. Plan and establish arrangements for the public health systems to achieve economies of scale
5. maintain a medium of regulations and standards to protect consumers and guide providers
% NON GO1ERNMENT SECTORS ' +ro)i*es man+o,er in the e:e(ution o" the +roram
% &RI1ATE SECTORS ' +ro)i*es "inan(ial as+e(t in the e:e(ution o" +rorams
&RIMARY STRATEGIES TO ACHIE1E HEALTH GOALS
Support for health goal
Assurance of health care
Increasing investment for PHC
Development of National Standard
MILESTONE IN HEALTH CARE DELI1RY SYSTEM
% RA 5BF6 ! RHU Act
% RA 5FI5 ! Strengthen Health Services
% &D DHF ! Restructuring HCDS
% RA G5HB ! LGU Code
1I ' National Health &lan
National Health Plan is a long-term directional plan for health; the blueprint defining the country's health
PROBLEMS, POLCY THRUSTS STRATEGES, THRUSTS
GOAL # to enable the Filipino population to achieve a level of health which will allow Filipino to lead a socially and economically-productive life,
with longer life expectancy, low infant mortality, low maternal mortality and less disability through measures that will guarantee access of
everyone to essential health care
OB.ECTI1ES#
promote equity in health status among all segments of society
address specific health problems of the population
upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient, and effective one in the provision of solutions to
changing the health needs of the population
promote active and sustained people's participation in health care
MA.OR HEALTH &LANS TO?ARDS KHEALTH IN THE HANDS O$ THE &EO&LE IN THE YEAR 6B6BL
A0 MA.OR HEALTH &LAN
23 N 93
Health for more in 94
Think health.. Health Link
5 in 95
B0 &RIORITY &ROGRAM IN YEAR 6BBB
Plan 50 (Pharmaceutical Plan)
Plan 500 ( Phil Health nsurance Plan)
Women's health
Children's health
Healthy Lifestyle
Prevention & Control of nfectious Disease
C0 &RIORITY &ROGRAM IN THE YEAR 6BBD
Ligtas Buntis Campaign
Mag healthy Lifestlye tayo
TB Network
Blood Donation Program (RA 7719)
DTOMS
Ligtas Tigdas Campaign
Murang Gamot
Anti Tobacco Signature Campaign
Doctors to the Barrios Program
Food Fortification Program
Sentrong Sigla Movement
D0 NATIONAL HEALTH E1ENTS $OR 6BBH
.ANUARY
National Cancer Consciousness Week - (16-22)
$EBRUARY
Heart Month
Dental Health Month
Responsible Parenthood Campaign National Health nsurance Program
MARCH
Women's Health Month
Rabies Awareness Month
Burn njury Prevention Month
Responsible Parenthood Campaign
Colon and Rectal Cancer Awareness Month
World TB Day - (24)
A&RIL
Cancer in Children Awareness Month
World Health Day - (7)
Bright Child Week Phase -
Garantisa*on &am-ata (11-17)
MAY
Natural Family Planning Month
Cervical Cancer Awareness Month
ADS Candlelight Memorial Day - (21)
World No Tobacco Day - (31)
.UNE
Dengue Awareness Month
No Smoking Month
National Kidney Month
Prostate Cancer Awareness Month
.ULY
Nutrition Month
National Blood Donation Month
National Disaster Consciousness Month
AUGUST
National Lung Month
National Tuberculosis Awareness Month
Sight-Saving Month
Family Planning Month
Lung Cancer Awareness Month
SE&TEMBER
Generics Awareness Month
Liver Cancer Awareness Month
OCTOBER
National Children's Month
Breast Cancer Awareness Month
National Ne,-orn S(reenin ?ee8 M7!IN
Bright Child Week Phase Garantisa*on &am-ata (10-16)
NO1EMBER
Filariasis Awareness Month
Cancer Pain Management Awareness Month
Traditional and Alternative Health Care Month
Campaign on Violence Against Women and Children
DECEMBER
Firecracker njury Prevention Campaign:
OPLAN WAS PAPUTOK
1II ! INTEGRATED MANAGEMENT O$ CHILDHOOD ILLNESSES MIMCIN
INTEGRATED MANAGEMENT O$ CHILDHOOD ILLNESSES MIMCIN
MC is an integrated approach to child health that focuses on the well-being of the whole child.
MC strategy is the main intervention proposed to achieve a significant reduction in the number of deaths from communicable diseases in
children under five
Goal#
By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal of reducing it by two thirds by 2015.
AIM#
to reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age.
MC includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.
IMCI OB.ECTI1ES#
To reduce significantly global mortality and morbidity associated with the major causes of disease in children
To contribute to the healthy growth & development of children
IMCI COM&ONENTS O$ STRATEGY#
mproving case management skills of health workers
mproving the health systems to deliver MC
mproving family and community practices
**For many sick children a single diagnosis may not be apparent or appropriate
&resentin (om+laint#
Cough and/or fast breathing
Lethargy/Unconsciousness
Measles rash
Very sick young infant
&ossi-le (ourseO asso(iate* (on*ition#
Pneumonia, Severe anemia, P. falciparum malaria
Cerebral malaria, meningitis, severe dehydration
Pneumonia, Diarrhea, Ear infection
Pneumonia, Meningitis, Sepsis
$i)e Disease $o(us o" IMCI#
Acute Respiratory nfection
Diarrhea
Fever
Malaria
Measles
Dengue Fever
Ear nfection
Malnutrition
THE IMCI CASE MANAGEMENT &ROCESS
Assess and classify
dentify appropriate treatment
Treat/refer
Counsel
Follow-up
THE INTEGRATED CASE MANAGEMENT &ROCESS
Check for General Danger Signs:
% A eneral *aner sin is +resent i"#
! the (hil* is not a-le to *rin8 or -reast"ee*
! the (hil* )omits e)erythin
! the (hil* has ha* (on)ulsions
! the (hil* is lethari( or un(ons(ious
ASSESS MAIN SYM&TOMS
% CouhODOB
% Diarrhea
% $e)er
% Ear +ro-lems
IMCI COLOR CODING
&IN; MURGENT RE$ERRALN YELLO? MTreatment at out+atient GREEN MHome manaementN
health "a(ilityN
OUTPATENT HEALTH FACLTY
Pre-referral treatments
Advise parents
Refer child
OUTPATENT HEALTH FACLTY
Treat local infection
Give oral drugs
Advise and teach caretaker Follow-up
HOME Caretaker is counseled on:
Home treatment/s
Feeding and fluids
When to return immediately Follow-up
REFERRAL FACLTY
Emergency Triage and Treatment
( ETAT)
Diagnosis, Treatment
Monitoring, follow-up
Treat oral infection
Give oral drugs
Advise & teach caretaker
Follow up
Caretaker is counseled on:
Home treatments
Feeding & fluids
When to return immediately
Follow up
ASSESS AND CLASSI$Y COUGH OR DI$$ICULTY O$ BREATHING
- Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx, trachea, air passages or lungs. Assess an*
(lassi"y &NEUMONIA
% (ouh or *i""i(ult -reathin
% an in"e(tion o" the luns
% Both -a(teria an* )iruses (an (ause +neumonia
% Chil*ren ,ith -a(terial +neumonia may *ie "rom hy+o:ia Mtoo little o:yenN or se+sis Menerali=e* in"e(tionN0
>> A (hil* ,ith (ouh or *i""i(ult -reathin is assesse* "or#
% Ho, lon the (hil* has ha* (ouh or *i""i(ult -reathin
% $ast -reathin ' in(rease in RR
% Chest in*ra,in ' 1isi-le mar8 o" ICS u+on inhalation
% Stri*or in a (alm (hil* ' a*)entitious soun*s hear* e)en ,ithout the ai* o" stethos(o+e0
REMEMBER#
** If the child is 0 months up to 2 months the child has fast breathing if you count 60 breaths per minute or more
** If the child is 2 months up to 1 year old the child has fast breathing if you count 50 breaths per minute or more.
** If the child is 12 months up to 5 years the child has fast breathing if you count 0 breaths per minute or more.
PNEUMONA TREATMENT SCHEME
Any general danger sign or
Chest indrawing or
Stridor in calm child
SEVERE PNEUMONA OR VERY
SEVERE DSEASE
Give first dose of an appropriate
antobiotic
Give Vitamin A
Treat the child to prevent low blood
sugar
Refer urgently to the hospital
Give paracetamol for fever > 38.5oC
Fast breathing PNEUMONA
Give an appropriate antibiotic for 5 days
Soothe the throat and relieve cough with
a safe remedy
Advise mother when to return
immediately
Follow up in 2 days
Give Paracetamol for fever > 38.5oC
No signs of pneumonia or very severe
disease
NO PNEUMONA : COUGH OR COLD
f coughing more than more than 30
days, refer for assessment
Soothe the throat and relieve the cough
with a safe remedy
immediately Follow up in 5 days if not
improving
Assess an* (lassi"y DIARRHEA
A (hil* ,ith *iarrhea is assesse* "or#
% ho, lon the (hil* has ha* *iarrhea
% -loo* in the stool to *etermine i" the (hil* has *ysentery
% sins o" *ehy*ration0
Classi"y DYSENTERY
% (hil* ,ith *iarrhea an* -loo* in the stool
Two of the following signs ?
Abnormally sleepy or difficult to awaken
Sunken eyes
Not able to drink or drinking poorly Skin pinch
goes back very slowly
SEVERE DEHYDRATON f child has no other severe classification: -
Give fluid for severe dehydration ( Plan C ) OR
f child has another severe classification : -
Refer URGENTLY to hospital with mother
giving frequent sips of ORS on the way -
Advise the mother to continue breastfeeding
f child is 2 years or older and there is
cholera in your area, give antibiotic for cholera
Two of the following signs :
Restless, irritable
Sunken eyes
Drinks eagerly, thirsty Skin pinch goes back
slowly
SOME DEHYDRATON
Give fluid and food for some dehydration
( Plan B )
f child also has a severe classification : -
Refer URGENTLY to hospital with mother
giving frequent sips of ORS on the way -
Advise mother when to return immediately
Follow up in 5 days if not improving
Not enough signs to classify as some or severe
dehydration
NO DEHYDRATON Home Care
Give fluid and food to treat diarrhea at home
( Plan A )
Follow up in 5 days if not improving
Ty+es o" Diarrhea
Dehydration present
SEVERE PERSSTENT
DARRHEA
Treat dehydration before referral unless the
child has another severe classification
Give Vitamin a
Refer to hospital
No dehydration PERSSTENT DARRHEA
Advise the mother on feeding a child who has
persistent diarrhea
Give Vitamin A
Follow up in 5 days
Blood in the stool DYSENTERY
Treat for 5 days with an oral antibiotic
recommended for Shigella in your area
Follow up in 2 days Give also referral
treatment
Does the (hil* ha)e "e)erP **Decide ! ! Malaria Risk - No Malaria Risk - Measles - Dengue
Malaria Ris8
Stiff neck
VERY SEVERE FEBRLE DSEASE /
MALARA
Give first dose of quinine ( under
medical supervision or if a hospital is not
accessible within 4hrs )
antibiotic
sugar
Give one dose of paracetamol in health
center for high fever (38.5oC) or above
Send a blood smear with the patient
Refer URGENTLY to hospital
Blood smear ( + ) f blood smear not
done:
NO runny nose, and
NO measles, and NO other causes of
fever
MALARA
Treat the child with an oral antimalarial
immediately
Follow up in 2 days if fever persists
f fever is present everyday for more
than 7 days, refer for assessment
Blood smear ( - ), or
Runny nose, or
Measles, or Other causes of fever
FEVER : MALARA UNLKELY
immediately
f fever is present everyday for more
than 7 days, refer for assessment
No Malaria Ris8
Stiff neck
1ERY SE1ERE $EBRILE
DISEASE
Give first dose of an appropriate antibiotic
Treat the child to prevent low blood sugar
Give one dose of paracetamol in health center
for high fever (38.5oC) or above
No signs of very severe febrile disease FEVER : NO MALARA Give one dose of paracetamol in health center
for high fever (38.5oC) or above
f fever is present everyday for more than 7
days, refer for assessment
Measles
Clouding of cornea or
Deep or extensive mouth ulcers
SEVERE COMPLCATED MEASLES
Give Vitamin A
antibiotic
f clouding of the cornea or pus draining
from the eye, apply tetracycline eye
ointment
Pus draining from the eye or
Mouth ulcers
MEASLES WTH EYE OR MOUTH
COMPLCATONS
Give Vitamin A
f pus draining from the eye, apply
tetracycline eye ointment f mouth ulcers,
teach the mother to treat with gentian
violet
Measles now or within the last 3 months MEASLES Give Vitamin A
Denue $e)er
Bleeding from nose or gums or
Bleeding in stools or vomitus or
Black stools or vomitus or
Skin petechiae or
Cold clammy extremities or
Capillary refill more than 3 seconds or
Abdominal pain or
Vomiting
Tourniquet test ( + )
SE1ERE DENGUE HEMORRHAGIC
$E1ER
f skin petechiae or Tourniquet test,are
the only positive signs give ORS
f any other signs are positive, give
fluids rapidly as in Plan C
sugar
DO NOT GVE ASPRN
Refer all children Urgently to hospital
No signs of severe dengue hemorrhagic
fever
FEVER: DENGUE HEMORRHAGC
UNLKELY
DO NOT GVE ASPRN
Follow up in 2 days if fever persists or
child shows signs of bleeding
immediately
Does the (hil* ha)e an ear +ro-lemP
Tender swelling behind the ear MASTODTS
Give first dose of appropriate antibiotic
Give paracetamol for pain
Refer URGENTLY
Pus seen draining from the ear and
discharge is reported for less than 14
days or
Ear pain
ACUTE EAR NFECTON
Give antibiotic for 5 days
Give paracetamol for pain
Dry the ear by wicking
Follow up in 5 days
Pus seen draining from the ear and
discharge is reported for less than 14
days
CHRONC EAR NFECTON
Dry the ear by wicking
Follow up in 5 days
No ear pain and no pus seen draining
from the ear
NO EAR NFECTON No additional treatment
Che(8 "or Malnutrition an* Anemia
Gi)e an A++ro+riate Anti-ioti(#
A0 $or &neumoniaC A(ute ear in"e(tion or 1ery Se)ere *isease
COTRIMOAA3OLE
BD FOR 5 DAYS
AMOAYCILLIN
BD FOR 5 DAYS
Ae or ?eiht A*ult ta-let Syru+ Ta-let Syru+
2 months up to 12 months ( 4 - <
9 kg )
1 / 2 5 ml 1 / 2 5 ml
12 months up to 5 years ( 10
19kg )
1 7.5 ml 1 10 ml
B0 $or Dysentery
COTRIMOAA3OLE BD FOR 5 DAYS AMOAYCILLIN BD FOR 5 DAYS
AGE OR ?EIGHT TABLET SYRU& SYRU& 6DBMGODML
2 4 months ( 4 - < 6kg ) 5 ml 1.25 ml ( tsp )
4 12 months ( 6 - < 10
kg )
5 ml 2.5 ml ( tsp )
1 5 years old ( 10 19
kg )
1 7.5 ml ( 1 tsp )
C0 $or Cholera
TETRACYCLINE QD FOR 3
DAYS
COTRIMOAA3OLE BD FOR 3 DAYS
AGE OR ?EIGHT Ca+sule 6DBm Ta-let Syru+
2 4 months ( 4 - < 6kg ) Q 1 / 2 5ml
4 12 months ( 6 - < 10 kg ) R 1 / 2 5 ml
1 5 years old ( 10 19 kg 1 1 7.5ml
Gi)e an Oral Antimalarial
CHOLOROQUNE Give for
3 days
Primaquine Give single
dose in health center for
P. Falciparum
Primaquine Give daily for 14
days for P. Vivax
Sulfadoxine + Pyrimethamine
Give single dose
AGE
TABLET ( 150MG ) TABLET ( 15MG) TABLET ( 15MG) TABLET ( 15MG)
DAY1 DAY2 DAY3
2months 5months Q
5 months 12
months
5O6
12months 3 years
old
1 1 R Q S
3 years old - 5
years old
1 1 1 1/2 1
GI1E 1ITAMIN A
AGE VTAMN A CAPSULES 200,000 U
6 months 12 months 1//2 ( 100,000 U) red capsules
12 months 5 years old 1 ( 200,000 U) blue capsules
GI1E IRON
AGE or WEGHT
ron/Folate Tablet FeSo4 200mg + 250mcg Folate
(60mg elemental iron)
ron Syrup FeSo4 150 mg/5ml ( 6mg
elemental iron per ml )
2months-4months ( 4 - <6kg ) 2.5 ml
4months 12months ( 6 - <10kg ) 4 ml
12months 3 years ( 10 - <14kg ) 1/2 5 ml
3years 5 years ( 14 19kg ) 1/2 7.5 ml
GI1E &ARACETAMOL $OR HIGH $E1ER M 7F0DoC OR MORE N OR EAR &AIN
AGE OR WEGHT TABLET ( 500MG ) SYRUP ( 120MG / 5ML )
2 months 3 years ( 4 - <14kg ) 5 ml
3 years up to 5 years ( 14 19 kg ) 10 ml
GI1E MEBENDA3OLE Give 500mg Mebendazole as a single dose in health center if : > hookworm / whipworm are a problem in children in
your area, and > the child is 2 years of age or older, and > the child has not had a dose in the previous 6 months
1III ! DOH &ROGRAMS DENTAL HEALTH &ROGRAM
E To im+ro)e the /uality o" li"e o" the +eo+le throuh the attainment o" the hihest +ossi-le oral health0
E O-Je(ti)e# To +re)ent an* (ontrol *ental *iseases an* (on*itions li8e *ental (aries an* +erio*ontal *iseases thus re*u(in their
+re)alen(e0
OSTEO&OROSIS &ROGRAM
E It is (hara(teri=e* -y a *e(rease in -one mass an* *ensity that +roresses ,ithout a sym+tom or +ain until a "ra(ture o((urs
enerally in the hi+C s+ine or ,rist0
E O-Je(ti)es#
E To in(rease a,areness on the +re)ention an* (ontrol o" osteo+orosis as a (hroni( *e-ilitatin (on*ition4
E To in(rease a,areness -y +hysi(ians an* other health +ro"essionals on the s(reeninC treatment an* reha-ilitation o" osteo+orosis4
E To em+o,er +eo+le ,ith 8no,le*e an* s8ills to a*o+t healthy li"estyle in +re)entin the o((urren(e o" osteo+orosis0
HEALTH EDUCATION < CO
% A((e+te* a(ti)ity at all le)els o" +u-li( health use* as a means o" im+ro)in the health o" the +eo+le throuh te(hni/ues ,hi(h may
in"luen(e +eo+les thouht moti)ationC Ju*ment an* a(tion0
Three as+e(ts o" health e*u(ation#
nformation Communication Education
Se/uen(e o" ste+s in health e*u(ation#
Creating awareness Creating motivation Decision making action
RE&RODUCTI1E HEALTH
50 $amily &lannin
60 MCH < Nutrition
70 &re)ention O treatment o" Re+ro*u(ti)e Tra(t In"e(tion < STD
90 &re)ention o" a-ortion < its (om+li(ation
D0 E*u(ation < (ounselin on se:uality < se:ual health
H0 A*oles(ent se:ual re+ro*u(ti)e health
G0 1iolen(e aainst ,omen
F0 MenTs re+ro*u(ti)e health M Male se:ual *isor*er N
I0 Breast CA < other yne +ro-lem
5B0 &re)ention O treatment o" in"ertility
OLDER &ERSONS HEALTH SER1ICES
% &arti(i+ation in the (ele-ration o" Healthy National El*erly ?ee8 M O(t 5!GN
! Le(ture on healthy li"estyle "or the el*erly
% &ro)ision o" *rus "or the el*erly M6BU *is(ountN
GUIDELINES $OR GOOD NUTRITION
% Nutritional Gui*elines are +rimary re(ommen*ations to +romote oo* health throuh +ro+er nutrition0
ACTI1ITIES#
50Malnutrition Reha-ilitation &roram
E Tarete* $oo* Tas8 $or(e Assistan(e &roram MT$A&N
E Nutrition Reha-ilitation ?ar*
E A8-ayan sa ;alusuan sa ;a-ataan MAS; &roJe(tN
60Mi(ronutrient Su++lementation &roram
% K67 in VI7L
% $orti"ie* 1itamin Ri(e
% KHealth "or More in VI9L
% K"u#an ng $abataan% &ag'asa ng "ayanL
% National $o(us# National Mi(ronutrient Day or K(ra# ng )ang*ap &inoyL
&ROTEIN ENERGY MALNUTRITION
1. Marasmus looks like an old worried man - less subcutaneous fats
2. Kwashiorkor - a moon face child - with flag sign (hair changes) VTAMN A DEFCENCY
Early symptoms:
Xeropthalmia (Nigtblindess)
Bitot's spot (silvery foamy spot located @ lateral sclera)
Corneal Xerosis (eye lesion)
Conjunctival Xerosis (scar in the eyes)
Keratomalacia ( whitish to grayish sclera)
BLNDNESS
RES&IRATORY IN$ECTION CONTROL
E &ro)ision o" me*i(ines
E Consultati)e meetins ,ith CARI (oor*inators
E Monitorin o" health "a(ilities on the im+lementation o" the +roram
ALTERNATI1E MEDICINE
% RA F967
% 67 IN I7
A0 The 5B Her-al Me*i(ineMLUBBY SANTAN

Her-al Me*i(ine USES
Laun*i M 1ite: Neun*oN SHARED
Skin diseases Headache, Asthma, fever, cough&colds, Rheumatism, Eczema,
Dysentery
Ulasiman Bato M&e+eronia &ellu(i*aN RA
Lowers uric acid Rheumatism Arthritis
Ba,an M Allium Sati)umN HAT
Headache and toothache
Baya-as M &si*ium GuaJa)aN
Anti septic, Anti-diarrheal
Yer-a Buena MMentha Cor*i"oliaN S&ITMAND
Swollen gums, Pain, nsect bites, Toothache, Menstrual & gas pain, Arthritis &
rheumatism, Nausea & vomiting & Diarrhea
Sam-on MBlumea Balsami"eraN ADA
Anti - edema, Diuretics, Anti uro-lithiasis
A8a+ul8o
Fungal infection, skin diseases
Nio Nioan M2uis/ualis In*i(aN
Anti-helminthic
Tsaan Gu-at MCarmona RetusaNSAD
Stomachache & Diarrhea
Am+alaya MMomor*i(a CharantiaN DM
MATERNAL! CHILD CARE
I ! Maternal Care
A0 $AMILY &LANNING
I0 S+a(in O Arti"i(ial Metho*
A. Hormonal
B. Mechanical & Barrier
C. Biologic
D. Natural
II0 &ermanent Msuri(alOirre)ersi-leN
A. Tubal Ligation
B. Vasectomy
III0 Beha)ioral Metho*
B. BREASTFEEDNG
II ! CHILD CARE
A0 UNDER $I1E CARE &ROGRAM
A package of child health-related services focused to the 0-59 months old children to assure their wellness and survival
Growth Monitoring Chart (GMC)
A standard tool used in health centers to record vital information related to child growth and development, to assess signs of malnutrition.
B0 EA&ANDED &ROGRAM ON IMMUNI3ATION
% LEGAL BASIS
% &D @IIH ' Compulsory basic
% && @59G ' National mmunization Day
% && @GG7 ' Knock out Polio Days
% && @ 5BH9 ' polio eradication campaign
% && @9 ! Ligtas Tigdas month
MENTAL HEALTH a state of well-being where a person can realize his or her own abilities, to cope with the normal stresses of life and work
productively
Com+onents o" Mental Health &roram Stress Management and Crisis ntervention Drugs and Alcohol Abuse Rehabilitation Treatment
and Rehabilitation of Mentally-ll Patients Special Project for Vulnerable Groups
SENTRONG SIGLA MO1EMENT AIM# to promote availability of quality health services
9 +illars#
Quality assurance
Grants & technical assistance
Health promotion
Award
COMMUNITY ORGANI3ING &ARTICI&ATORY ACTION RESEARCH
Community Orani=in
a continuous and sustained process of
% EDUCATING THE &EO&LEC
% CRITICAL A?ARENESS
% MOBILI3ING
&arti(i+atory A(tion Resear(h
A combination of education, research and action.
The purpose is the EMPOWERMENT of people
9 &hases#
% &re entry
% Entry
% Orani=ational Buil*in
% Sustenan(e an* Strenthenin
La,s A""e(tin CHN Im+lementation#
RA FG9I - Clean Air Act (2000)
RA H96D Dangerous Drug Act: sale, administration and distribution of prohibited drugs is punishable by law
RA I5G7 ' Philippine Nursing act of 2002
RA 67F6 Philippines Medical Act: define the practice of medicine in the Philippines
RA 5BF6 Rural Health Act: employment of more physicians, nurses, midwives who will live in the rural areas to help raise the health condition.
RA 7DG7 ! Reporting of Communicable Disease
RA HHGD ' Generic Act: promotes, requires and ensures the production of an adequate supply, distribution, use of drugs identified by their
generic names.
RA H7HD
RA HGDF
RA 9GB7 Advocates Home Treatment for all Leprae Patient
RA G7BD Magna Carta for Public Health Workers (approved by Pres. Corazon C. Aquino): aims to promote and improve the social and
economic well being of health workers, their living and conditions.
RA G5HB Local Government Code: responsibility for the delivery of basic services of the national government
IA ! CHRONIC COMMUNICABLE DISEASES
I ! TUBERCULOSIS TB is a highly infectious chronic disease that usually affects the lungs.
Causati)e Aent# Mycobacterium Tuberculosis
SOS# cough afternoon fever weight loss night sweat blood stain sputum
&re)alen(eOIn(i*en(e# ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines sixth leading cause of mortality
(with 28507 cases) in the Philippines.
Nursin an* Me*i(al Manaement Ventilation systems Ultraviolet lighting Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine
drug therapy
&re)entin Tu-er(ulosis BCG vaccination Adequate rest Balanced diet Fresh air Adequate exercise Good personal Hygiene
DOTS MDire(t O-ser)e* Treatment Short CourseN
Reimen Ty+e o" TB &atient
Reimen I 2RPE / 4R
New pulmonary smear (+) cases New seriously ill pulmonary
smear (-) cases w/ extensive lung lesions New severely ill
extra-pulmo TB
Reimen II 2RPES/ 1RPE / 5RE
New pulmonary smear (+) case New seriously ill pulmonary
smear (-) cases w/ extensive lung lesions New severely ill
extra-pulmo TB
Reimen III 2RP / 4R
New smear(-) but with minimal pulmonary TB on radiography
as confirmed by a medical officer New extra-pulmo TB (not
serious)
II ! LE&ROSY Sometimes known as HansenWs *isease
is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium
Gerhard Armauer Hansen - discovered the microbes
Historically, leprosy was an incurable and disfiguring disease
Today, leprosy is easily curable by multi-drug antibiotic therapy
Sins < Sym+toms
Early staeMCLUM&N
Change in skin color
Loss in sensation
Ulcers that do not heal
Muscle weakness
&ainful nerves
Late StaeMGMISCN
Gynocomastia
Madarosis(loss of eyebrows)
Inability to close eyelids (Lagopthalmos)
Sinking nosebridge
Clawing/contractures of fingers & nose
&re)alen(e Rate Metro Manila, the prevalence rate ranged from 0.40 3.01 per one thousand population.
MANAGEMENT# Dapsone, Lamprene clofazimine and rifampin Multi-Drug-Therapy (MDT) six month course of tablets for the milder form of
leprosy and two years for the more severe form
A ! 1e(tor Borne Communi(a-le Disease
I ' LE&TOS&IROSIS an infectious disease that affects humans and animals, is considered the most common zoonosis in the world
Causati)e Aent# Leptospira interrogans
SOS# -high fever -severe headache -chills -muscle aches -vomiting -may include jaundice (yellow skin and eyes) -red eyes -abdominal pain
-diarrhea
TREATMENT# PET - > &enicillins , Erythromycin, Tetracycline
II ! MALARIA Malaria (from Medieval talian: mala aria - "bad air"; formerly called ague or marsh fever) is an infectious disease that is
widespread in many tropical and subtropical regions.
Causati)e Aent# Anopheles female mosquito
Sins < Sym+toms# Chills to convulsion Hepatomegaly Anemia Sweats profusely Elevated temperature
Treatment# Chemoprophylaxis chloroquine taken at weekly interval, starting from 1-2 weeks before entering the endemic area.
&re)enti)e Measures# MCLEANN
Chemically treated mosquito nets
Larvae eating fish
Environmental clean up
Anti mosquito soap/lotion
Neem trees/eucalyptus tree
III ! $ILIARIASIS name for a group of tropical diseases caused by various thread-like parasitic round worms (nematodes) and their larvae
larvae transmit the disease to humans through a mosquito bite
can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis
SOS#
Asym+tomati( Stae
Characterized by the presence of microfilariae in the peripheral blood
No clinical signs and symptoms of the disease
Some remain asymptomatic for years and in some instances for life
A(ute Stae
Lymphadenitis (inflammation of lymph nodes)
Lymphangitis (inflammation of lymph vessels)
n some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum)
Chroni( Stae
Hydrocoele (swelling of the scrotum)
Lyphedema (temporary swelling of the upper and lower extremities
Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum, breast)
MANAGEMENT# Diethylcarbamazine vermectin, Albendazolethe
No treatment can reverse elephantiasis
1I ' SCHISTOSOMIASIS parasitic disease caused by a larvae
Causati)e Aent# Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni
Sins < Sym+toms# MBALLI&SN
Bulging abdomen
Abdominal pain
Loose bowel movement
Low grade fever
Inflammation of liver & spleen
&allor
Seizure
Treatment# Diethylcarbamazepine citrate (DEC) or Hetrazan (drug of choice)
1II ' DENGUE DENGUE is a mosquito-borne infection which in recent years has become a major international public health concern..
t is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.
SOS# M1LINOS&ARDN
1omiting
Low platelet
Increase Platelet count
Nausea
Onset of fever
Severe headache
&ain of the muscle and joint
Abdominal pain
Rashes
Diarhhea
+,-(+.-/+!
The mainstay of treatment is supportive therapy.
- intravenous fluids
- A platelet transfusion
- No aspirin
Communi(a-le Disease
Mo*ule on Communi(a-le Diseases
Community Health Nursing is faced with problems regarding communicable diseases. t is important therefore that the nurse poses basic
knowledge on how to deal with related problems and more so prevent its occurrence, since this is like wise the focus of community health
nursing.
INTRODUCTION
This module focuses on the basic communicable diseases affecting the patterns of mortality and morbidity in the Philippine community. t will give
you the basic information regarding the description, etiology, mode of transmission, incubation period, signs and symptoms, diagnostic
procedures and management of these diseases. As an added bonus each topic is carefully selected to prepare you both in the practical
application in the community setting and the board exam most especially. Due to this you are advised to be familiarized with the following
phrases:
ON THE BOARD refers to common question that comes out in the board exam.
CLINICAL $OCUS refers to the important reminders that are crucial in the actual practice.
GROU& ALERT refers to age group variation that also demand different approaches. A post test is prepared for your satisfaction so that you will
be able to measure your knowledge. t is recommended that you supplement your studies with text books which focus on the said topic. This is
just a guide and although careful review has been made the author waive any responsibility that may negatively occur due to application of the
concepts learned here in.
OB.ECTI1E GENERAL To study the different communicable diseases affecting man and the family as a component of the community
S&ECI$IC By the end of the module in 7 days you should be able to;
1. Understand the basic concepts of CD
2. Familiarize with the basic control and method of prevention to the said diseases.
3. be able to apply to practice the concepts learned by effectively giving health education all these is expected to be attained by you none the
less, by passing at least 65% of the final assessment questions.
?hat is in"e(tionP nfection is the successful entry and multiplication of micro-organism in the human body. Usually their entrance results in the
appearance of the disease. But it doesn't always follow the same. Some organism may enter the body but no obvious illness is apparent.
?hat are the ty+es o" in"e(tionP There are two types of infection it could be nosocomial or opportunistic.
/osocomial ' refers to hospital acquired infection with sets in within the premises of the hospital during confinement.
Remember an infection is considered nosocomial if it sets in after 72 hours upon admission.
Most of the time the responsible organism are hospital pathogens such as pseudomonas, klebsiella etc.
0pportunistic ' refers to the type infection acquired due to the failure of the immune defenses.
Usually this is caused by the normal microflora.
?hat are (ommuni(a-le *iseases an* (ontaious *iseasesP
1ommunicable diseases are any disease that are caused by microorganism and can be transferred from one body to another, hence it is
communicable.
1ontagious diseases are any communicable infection that are easily transmissible.
ON THE BOARD! Keep in mind that every contagious disease is communicable and all communicable diseases are infection but never the other
way around.
?hat is +athoeni(ityP t is the over all ability of the organism to cause pathogenic changes in the body. Which is further described by the
following terms:
.ode of action ' manner by which organism damages the host. Example clostridium tetani releases toxin while plasmodium falciparum kills the
RBC.
2irulence ' it is the over all strength of the microorganism
Dose ' the number of the organism required to cause infection for example as little as 4 tubercle bacilli inhaled is sufficient to cause
Tuberculosis among high risk patient. Invasiveness the ability of the organism to penetrate an intact barrier
+o3igenicity ' the ability of the organism to produce toxins
)pecificity ' is the ability of the organism to attach on specific cellular surface receptors. Viability the ability to sustain life outside the body of
the host
(ntigenicity ' the ability of the organism to stimulate and or resist antibody response
THE 7 LE1ELS O$ &RE1ENTION
&RIMARY focuses on health promotion and disease prevention
&romoti4e ' there is no risk of having the disease. Activity is directed in promoting healthy lifestyle, proper nutrition, adequate exercise and
environmental sanitation.
&re4enti4e ' risk of having the disease is already existing and activity is directed in avoiding the risk ergo the disease it self. E:am+le are EP,
Pap smear, BSE and STE.
SECONDARY focuses on the Curative aspect of care.
1urati4e ' effort is directed for early treatment. Move is also undertaken to avoid possible complications
TERTIARY focuses on the rehabilitative aspect
,ehabilitati4e ' effort of helping the patient adjust with the limitations and disability brought about by the previous disease.
ELEMENTS O$ DISEASE CAUSATION Refers to the relationship of the Aent (microorganism), !"st (Human) and the Envir"nment (reservoir).
f balance between the three is present disease is absent but if one of the three gain advantage over the other it may compromise one element
and cause disease.
STAGES O$ IN$ECTION
aN E:+osure ' the stage of contact with the infectious agent
-N In(u-ation or latent ' the organism successfully entered the body. No apparent illness is present. The organism is still multiplying so as to
manifest an actual illness.
(N &ro*romal ' the manifestation of vague signs and symptoms start to appear. Example fever, cough, pain etc.
*N A(ute *isease ' an acute disruption in the physiologic mechanism. Disease due to the infecting organism is already present.
eN Con)ales(en(e ' the stage of resolution. The body is able to maintain homeostasis. The infectious organism is under control
"N Rela+se ' a stage of reactivation of a previous infection which may be due to re-exposure or waning immunity.
CHAIN O$ IN$ECTION
The series of events that takes place in order for infection to occur.
The following subtopics describe each component of the chain.
ON THE BOARDX Remember infection will never occur unless the six chain are completed.
aN Causati)e aent ' refers to the microorganism such as fungi, protozoa, parasite, viruses, bacteria etc.
-N Reser)oir ' the medium or body which the microorganism thrive and survive.
(N &ortal o" Entry ' opening in the body where in the microorganism could use as passageway to reach the internal physiological structures. For
example mouth, nose, wound etc.
*N &ortal o" e:it ' any opening to which the organism uses to exit from the body. Example are anus, nose, vagina, penis, etc.
eN Mo*e o" transmission ' the method on how the organism travels from one infected host to another.
i0 Dire(t ' requires physical contact from the point source of infection. Such as kissing and unprotected sexual intercourse.
ii0 In*ire(t ' transmitted through fomites and other non living organism. Contaminated surgical instruments.
iii0 1e(tor -orne ' relies greatly on the presence of the secondary host to cause infection. e.g. mosquitos, flies and rats
i)0 Dro+let ' organism travels through droplet nuclei that comes out during coughing, sneezing etc.
)0 Air-orne ' the organism can uniquely suspend in the air and carried on air current and the like method.
"N Sus(e+ti-le host ' any person whose immune defenses are weak or those who are healthy but do not posses adequate specific immunity
ON THE BOARD! Remember that the mode of transmission is the chain that is easiest to break!
THE DE$ENSE MECHANISM O$ THE BODY The defensive mode is divided into three, namely:
i. 1st line of defense
ii. 2nd line of defense
iii. 3rd line of defense
#st $INE %& DE&ENSE Non specific defense mechanism this is the first to come in contact with harmful organism. E00 s8inC sali)aC0 TearsC
stoma(h a(i*sC urine et(0
'ND $INE %& DE&ENSE Non specific phagocytic response. E00 +hao(ytosis -y neutro+hils0
()D $INE %& DE&ENSE Specific immune response dependent upon the presence of specific anti bodies. E00 immunity aainst (hi(8en+o:
IMMUNITY Ability of the body to effectively mount an immune response to prevent infection. it is usually dependent on the presence of
antibodies.
a0 Natural a(ti)e ' contact with infectious organism and the immunity that follows after that.
-0 Natural +assi)e ' immunity received from the mother through the placenta
(0 Arti"i(ial a(ti)e ' immunity gained after the administration of vaccines
*0 Arti"i(ial +assi)e ' immunity gained after receiving immune serum or immune globulin.
E&IDEMIOLOGY Refers to study of the pattern and distribution of diseases among the identified population.
a0 En*emi( ' the disease is always present in a community the rise and fall remains steadily predictable.
-0 E+i*emi( ' there is a sharp increase in the number of disease as it affects the population over a period of time and specific locality.
(0 &an*emi( ' nations are affected by a disease. t is commonly referred to as international epidemic.
*0 S+ora*i( ' patches in appearance. The disease does not manifest it self as a dominant entity. Most often the disease affects only a small
portion of the community.
e0 Out -rea8 ' the disease has affected the population but the number of the people afflicted is above the endemic proportion but lower than
epidemic levels. An outbreak is an indicator of impending epidemic.
GENERAL MEASURES TO CONTROL COMMUNICABLE DISEASES
5and #ashing 6 the most basic of infection control practices. t is the use of soap and water to remove contaminant from our hands.
Disinfection ' the use of chemicals like alcohol or other physical means to destroy disease causing organism outside the body.
a0 Terminal *isin"e(tion ' disinfecting the surroundings of the patient
-0 Con(urrent *isin"e(tion ' disinfection of substances and materials discharged from the body.
)terili7ation 6 all forms of microbial life are eliminated.
Isolation 6 the act of separating an infected patient to prevent cross infection. The following are the types of isolation precaution.
i0 $irst Tier ' Standard precaution ; applied to all patient regardless of their clinical diagnosis. t is desired that the application of this tie will
protect the nurse and the patient from body fluids including blood as well as wounds or any break in the skin and mucous membrane. Use of
gloves.
ii0 Se(on* Tier ' Transmission based precaution refers to any patient who require more stringent control that necessitates deeper method than
those identified above. These includes contact, airborne and droplet precaution.
a0 Conta(t +re(aution ' to protect against direct and indirect transmission. Mask and gown are added.
-0 Air-orne +re(aution ' the use of air filters to prevent infection due to organism suspended in the air.
(0 Dro+let +re(aution ' maintaining a distance of 3 feet from the point source of infection to avoid droplet nuclei. The use of high particulate
mask and goggles are added.
8uarantine 6 the act of limiting the movement and freedom of travel of any patient who have been exposed from an infectious organism. The
length of time is dependent to the maximum incubation period of the suspected disease.
)ur4eillance ! monitoring of patients, high risk groups or families to predict, identify and control infection.
CHEMICAL DISIN$ECTANTS THAT ARE COMMONLY USED
9ermicide ' also known as disinfectant this can kill disease causing organism.
"actericidal ' refers to its ability to kill bacteria only.
"acteriostatic ' the ability of a chemical agent to halt bacterial reproduction
(ntiseptic 6 chemicals that can kill or control the growth of microorganism. This are usually applied on the skin to prevent wound infection.
Soa+s an* *eterents ' effective against bacteria found in clothes.
&henols :;ysol< ' effective against gram negative bacteria.
(lcohol ' ideally isopropyl alcohol in 70% solution. Effective in killing broad range of microbes.
1hlorine ' one of the most effective water disinfectants I"dine equally effective with chlorine in antimicrobial activity. This is also used in skin
*isin"e(tion MBeta*ineN Hy*roen &ero:i*e ' wound cleanser and disinfectant for surgical devices.
COMMUNICABLE DISEASES /-=,0;09I1(; )>)+-.
TETANUS ALSO KNOWN AS LOCK JAW
Description:
An acute infection associated with painful muscular spasm
Etiology:
Caused by Clostridium tetani which are found on soils and human feces
Mode of transmission:
Contamination of wound
ncubation period:
5 10 days
Signs and symptoms
Fever, lock jaw, the most important sign is trismus and risus sardonicus. While laryngospasm is the most life
threatening condition.
Diagnostic procedure
None. History of wound and possible contamination are usually enough to arouse suspicion and take necessary
management.
Management
Wash wound, apply wound antiseptic.
Assess for history of immunization
Give tetanus toxoid for negative history of immunization
Administer Antitoxin after negative skin test
Penicillin is the drug of choice
Prepare for intubation. NGT feeding may become necessary.
Avoid over stimulation to prevent painful muscle contraction.
Diazepam is the drug of choice for muscle spasm
MENNGTS
Description:
An acute inflammation of the meninges
Etiology:
Caused by Neisseria meningitides this is usually a normal inhabitant of the nasopharynx.
Droplet infection
ncubation period: 2 10 days
Pathophysiology:
The organism enters the bloodstream after invading the respiratory tissues. Reaches the spinal cord and of course
the meninges. t stimulates chemotaxis that leads to leukocyte infiltration of the meninges. As a result inflammation
follows. This build up pressure, pus and compresses sensitive nervous tissues, that may decrease the level of
consciousness and in more severe cases pus could impede blood flow and brain infarct my ensue.
Signs and symptoms
The most significant finding indicating meningeal irritation: brudzinski and kernigs sign. Other sign observable are
headache, opisthotonus, fever and petechiae
Lumbar puncture (CSF analysis)
Management
nstitute droplet precaution
Rifampicin or Ciprofloxacin for prophylaxis
Ampicillin is the drug of choice
Ceftriaxone for systemic and CNS infection given in combination with Ampicillin to combat resistant organism.
Mass prophylaxis is not needed provided that all children in day care centers who have been exposed are exempted
hence they need prophylaxis, this also includes all other children who are close to the infected patient such as when
they share eating utensils.
Nurses and Doctors are not at risk of having the disease except when close contact occurred like in mouth to mouth
resuscitation.
ENCEPHALTS
Description:
nflammation of the tissues of the Brain
Etiology:
Mosquito borne Japanese enceph, West Nile enceph etc Viral borne Complication of chicken pox or measles
Amebic Acanthamoeba hystolytica
Mosquito borne bite of the infected mosquito Viral may be droplet or airborne Amebic accidental entry in the
naso - pharynx due to swimming in infested waters.
ncubation period:
Mosquito borne varied Viral 5 15 days Amebic 3 7 days
Pathophysiology:
The infectious organism regardless of the type penetrate the brain and causes inflammation of the brain tissues it self.
the inflammatory response compresses the brain structure which explains the rapid deterioration of the LOC.
Encephalitis is more severe than meningitis.
Signs and symptoms
Marked decrease in LOC. Brudzinski and kernigs may also be present if meningeal irritation result. The most
significant though is the appearance of decorticate and decerebate rigidity.
Lumbar Tap (CSF analysis) EEG
Management
Primarily supportive. The body can neutralize the organism thru the presence of antibody. Amebic encephalitis may
benefit from metronidazole. Anti inflammatory may be given Mannitol could decrease CP
POLOMYELTS
Description:
An acute paralytic infection that destroys the affected nerves.

Etiology:
Caused by polio virus 1 (Brunhilde), 2 (Lansing), 3 (Leon)
Fecal oral route. Particularly rampant among those in the squatters area who have no access to sanitary toilet
facilities
ncubation period:
7 14 days
Pathophysiology:
The virus enters the oral cavity and reproduces in the intestines which later penetrate the intestinal wall causing
viremia and reaching the motor nerves and the spinal cord. The virus reproduces inside the nerve and as they are
released, the infected cell die, hence paralysis results.

Signs and symptoms
Pokers sign, Haynes sign, tonsillitis, abdominal pain and flaccid paralysis
Stool exam, pandys test, EMG
Management Prevention OPV
No anti viral therapy.
Toilet hygiene must be reinforced Watch out for respiratory paralysis Assist in rehabilitation (physical therapy and
comfort measures OPV is preferred over PV because the latter can only provide
RABES
Description:
Another acute viral infection which have a zoonotic origin
Etiology:
Primarily carried by mammals specially land and aerial mammals. n the Philippines Dogs and Cats are among the
most important reservoir. The causative organism is Rhabdo Virus
Bite of infected animal. Scratch wound from cats can also cause infection since cats usually lick their paws.
ncubation period:
10 days for man 14 days for animals
Pathophysiology:
The virus replicates at sight of infection which later proceeds to infect the nearby axons and then reaches the nerve
itself. From that point onwards the virus travels along the nerve pathway to reach the brain. n the brain the virus
insights inflammatory reaction that give rise to the appearance of encephalitis like symptoms later the organism
descends from the brain and exit to affect other nerves in he body. The affectation of trigeminal nerve causes throat
spasms which gives rise to its classic finding hydrophobia
Signs and symptoms
Hydrophobia, aerophobia, laryngeal, Pharyngeal spasm excessive salivation.
Fluorescent antibody Staining, Negri bodies found in brain biopsy of the infected animal
Management
Human Diploid Cell Vaccine, Rabies mmunoglobulin, Rabies Anti serum. tetanus anti serum is also given if with
negative or inadequate immunization history Wash wound with soap and water, may apply wound antiseptic Once
sign and symptoms are present passive immunization is already useless. Supportive therapy comes next. Protect
from glare and sunlight, protect from water and air current. Cover V bottle and tubing with carbon paper or any other
else that can effectively hide the iv fluids. Secure consent and restrain the patient. Observed contact and droplet
precaution.
LEPROSY
Description:
A chronic infection that usually affects the peripheral nerves and leads to paresthesias
Etiology:
A possible zoonotic infection which is rarely cultured in laboratory but seen to be growing freely among armadillo.
Causative organism is Mycobacterium leprae
Droplet infection is the most important transmission. Skin contact may cause infection only if there is an open lesion
with prolonged contact.
ncubation period:
6 months to 8 years
Pathophysiology:
The organism enters the body via droplet infection. t is ingested by macrophages but can't be killed, as this
circulating macrophage reaches the skin the bacteria penetrate the nerves. Later due to immune recognition WBC
attacks the infected cell which results to the destruction of the affected cell hence the appearance of paresthesias and
consumption of the involved extremity becomes apparent due to immune response it self.
Signs and symptoms
Painless wound, paresthesias, ulcer that does not heal, leonine appearance, maderosis. Nerve involvement with acid
fast bacilli is the pathognomic sign of leprosy
Scraped incision method.
Management
nstitute concurrent disinfection specially of nasal discharge.
Prevention is achieved by BCG immunization Rifampin, Dapsone and lampreme are effective treatment against this
infection
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DENGUE HEMORRHAGC SHOCK SYNDROME
Description:
An acute arthropod borne infection which causes massive bleeding.
Etiology:
Causative organism is Dengue virus 1, 2, 3 and 4 the primary vector is Aedes egypti other wise known as tiger
mosquito because of the black stripes present at the dorsal legs of the insect. The mosquito prefers to thrive
on clean stagnant water.
Bite of the infected vector mosquito
ncubation period:
6 7 days
Pathophysiology:
The virus is carried by the infected mosquito and transferred through bites in the victim. Once the proboscis
pierced the capillaries it also leaves the viral organism. The virus mixes in the bloodstream survive and
reproduce causing viremia which explains the appearance of generalized flushing. The virus will then
successfully enters the bone marrow and arrest the maturation of megakaryocyte. Since the precursor of
platelets can not take full course it will result to massive drop in the patient's platelet count which significantly
raises the risk for hemorrhage.
Signs and symptoms
Petechiae, bleeding, epitaxis, Herman's sign and fever
Tourniquet test, platelet count.

Management
Watch out for bleeding.
Minimize injections and other parenteral procedures if possible.
Apply pressure for 10 minutes on injection site.
Avoid aspirin use acetaminophen provide TSB as an adjunct to anti pyretics.
Monitor platelet closely.
Prepare for platelet concentrate or fresh whole blood as the need may call for it.
Hydrate with PNSS Preventive measure focuses on 4 o clock habit Use DEET as an effective mosquito
repellant Use mosquito nets
MALARA
Description:
Another type of mosquito borne infection most common in the tropics
Etiology:
The causative organisms are Plasmodium Vivax, Falciparum, Ovale, and Malariae. The primary vectors are
anopheles mosquitoes.
Bite of the infected mosquito
ncubation period:
For Falciparum 12 days, for Vivax and Ovale 14 days and for Malariae 30 days
Pathophysiology:
From the bite of the infected mosquito the organism enters the body via bloodstream and immediately proceed
to the liver in the form of sporozoites. nside the hepatocytes reproduction continues until the host burst
releasing the parasite in the form trophozoites that enters the RBC, inside it the organism divides and form
schizont. This will later produce merozoites that enters RBC the process causes drop in the number of
circulating RBC leading to anemia and cachexia.
Signs and symptoms
A cycle of hot stage (high fever) followed by diaphoretic stage (sweating) and then cold stage (chilling). The
cycle repeats leading to malarial cachexia
Malarial smear or peripheral blood smear
Management
Chloroquine is the drug of choice.
Primaquine must be given to prevent relapse.
Prevent by using mosquito repellant and mosquito net
Chloroquine is the drug of choice for prophylaxis.
FLRASS
Description:
A chronic lymphatic disorder that is related to elephantiasis
Etiology:
Causative organism is Wuchereria bancrofti primary vector Culex spp.
Bite of the infected mosquito
ncubation period:
6 12 months
Pathophysiology:
The organism enters the body after the vectors' bite, it then matures and migrate on the lymphatic vessels but it
usually affects those in the lower extremity. The protozoal parasite crowds and destroy the filtering ability of the lymph
nodes which then leads to the accumulation of lymph or body fluids causing edema and at worst cases gross
deformity hence it could lead to elephantiasis.
Signs and symptoms
Recurrent low grade fever, lymphangitis, nocturnal asthma and in worst cases elephantiasis
Microscopic examination of peripheral blood.
Management
Use of mosquito repellant and nets Hetrazan is effective against Filiriasis adverse reaction though are seen in a
number of patients, if such may be present may use vermectin
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DPHTHERA
Description:
An acute infection of the upper respiratory system whose complication may include the lower respiratory tract.
Etiology:
The organism, Corynebacterium diphtheriae is ubiquitous.
Droplet infection is the means of spread
ncubation period:
1 7 days
Pathophysiology:
The organism infects the oral cavity which later due to its ability of releasing toxins causes the death of the involved
tissues. This gives rise to the appearance of psudomembarne which may be dislodge and block the airway. As toxins
are secreted the heart, kidney and the nerves absorb it, this toxins halt protein synthesis of the infected cell which
later on causes its death.

Signs and symptoms
Pathognomonic Sign is pseudo membrane. Tonsillitis may also be present. Fever and malaise. f complication arises
paralysis, endocarditis and kidney failure may be seen.
Throat swab
Management
Gather specimen for culture Prepare for epinephrine and possible intubation Be ready for antitoxin therapy after
checking for allergy Administer penicillin or erythromycin
PERTUSS
Description:
A widespread organism that threaten any one who have no immunity against it.
Etiology:
Causative organism is Bordetella pertussis
Droplet infection
ncubation period:
7 21 days
Pathophysiology:
The organism enters the upper respiratory tract attaches to the respiratory epithelium and causes an increased
production of cyclic amino phosphate that essentially leads to hyperactivity of the mucous secreting cells. Thick
tenacious secretions blocks the airway. The organism also halts the mucociliary escalator leaving coughing reflex the
last effective protective mechanism of expelling sputum. Due to its relative tenaciousness the body experiences
difficulty in coughing out phlegm thus we observe patient to manifest violent cough.
Signs and symptoms
Pathognomonic of this infection is violent cough w/out intervening inhalation followed by an inspiratory whoop.
Vomiting may be present, ncreased in CP and OP are also seen. Hernia is also a high risk incident.
Throat swab
Management
Penicillin, Erythromycin ; Mucolytic may be ordered. Nebulization may also be indicated; Provide small feedings Apply
abdominal binder ; Avoid dust and drafts
TUBERCULOSS
Description:
A chronic lung infection that leads to consumption of alveolar tissues
Etiology:
Causative organism is acid fast bacillus mycobacterium tuberculosis.
Droplet infection as well as airborne
ncubation period:
2 4 weeks
Pathophysiology: The bacilli is inhaled and taken in the alveoli where macrophage will ingest but fail to kill the organism. As these
macrophages migrate to nearby lymph nodes it will die and leave the capsulated bacteria undigested. Once the
body's immune system dropped, the bacteria will be activated and stimulate immune response which likewise damage
the alveolar tissues leading to casseation necrosis and could eventually consume the entire lungs if the process is
repeated frequently
Signs and symptoms
Afternoon fever, night sweats, cough for 2 weeks, anorexia weight loss.
Sputum microscopy, CXR, Mantoux test
Management
nstitute DOTS Give as ordered;
Pyrazinamide, zoniazid, Rifampicin, Ethambutol and Streptomycin.
Check for sensitivity to any of the drug mentioned
Provide B6 if receiving zoniazid
Watch out for visual problem if receiving Ethambutol
=Ethambutol is contra indicated for children who cant verbalize visual problems yet.
PNEUMONA
Description:
an acute usually bacterial in nature
Etiology:
the most common causative organism is strptococcus pneumoniae ubiquitous, orgainsm and may be transferred
among population that has poor ventilation and impaired respiratory cilliary function. certain disease like measles may
promote the development of pneumonia
Droplet infection
ncubation period:
24 to 72 hrs usually 48 hrs
Pathophysiology:
the organism enters the respiratory tract and if the cilliary mechanism fails to prevent its further entry the organism
then infects the lower respiratory centers where it stimulate an inflammatory reaction. this response leads to migration
of WBC in particular with neutrophil hence leukocyte infiltration is seen in chest x-rays as consolidation. the build up
puss increases the alveolar presure causing in atelectasis once collapsed alveoli cant participate in gas exchange
anymore leading to impaired DOB.
Signs and symptoms
Rusty colored sputum is the pathognomonic sign this is caused by WBC infiltrates, RBC and sputum. DOB, increased
RR, coughing and in late cases lethargy, cyanosis and death.
sputum exam
Management
Co-Trimoxazole and gentamycin are the drug of choice.
although Co-tri is used more widely than gentamycin because of its oral preparation which are allowed to be
administered by midwives for patient in far flung areas. instruct the mothers to continue the administration of antibiotic
for 5 straight days
TSB if in case fever may arise
Promote proper room ventilation avoid crowding as much as possible Use Pneumococcal vaccine as indicated
COLDS (CORYZA)
Description:
The causative agent comes from adenovirus and rhino virus.
Droplet infection, direct contact.
ncubation period:
1 3 days
Pathophysiology:
As the virus enters the respiratory tract, it attaches itself to the mucous membrane and causes local irritation and
inflammation. n response, the mucous membrane releases mucous to flush out the virus. Since there is an increased
in the production of the mucous it usually flows back and causes rhino rhea and because of the naso-lacrymal duct,
increased mucous production impedes the drainage of tears thus watery eyes is present. Complications: Children
otitis media and bronchopneumonia Adult sinusitis
Signs and symptoms
General malaise
Fever, chills
Sneezing, dry and scratchy throat
Teary eyes, headache
Continues water discharge from nares
Management
a. Provide adequate rest and sleep b.
ncrease fluid intake c.
Provide adequate and nutritious diet d.
Encourage vitamins specially vitamin C
NFLUENZA (LA GRPPE OF FLU)
Description:
A highly contagious disease characterized by sudden onset of aches and pains.
Etiology:
nfluenza virus A, B, C
Droplet infection, contact with nasopharyngeal secretions
ncubation period:
24 48 hrs.
Pathophysiology:
Upon entry in the upper respiratory tract, it is deposited in the same site and penetrates the mucosal cells. Causing
lysis and destruction of the ciliated epithelium the virus releases neuramidase that decreases the viscosity of the
mucosa. Facilitating the spread of the infected exudates to the lower respiratory tract, this causes intestinal
inflammation, and necrosis of the alveolar and bronchiolar epithelium. Thus, the alveoli are filled with exudates
containing WBC, RBC and hyaline cartilage. This places the patient to increased possibility of acquiring bacterial
pneumonia usually caused by S. Aureus.
Signs and symptoms
Respiratory most common
fever
anorexia
chills
muscle pain and aches
coryza
sore throat
bitter taste
orbital pain
ntestinal
vomiting
severe abdominal pain
fever
obstinate constipation
severe diarrhea
Nervous
headache
Management
a. provide adequate rest and ventilation
b. tepid sponge bath to reduce the temperature
c. monitor the vital signs
d. provide adequate nutrition
e. assist the patient in conserving strength when she is very weak
f. drug of choice:
antibiotics sulfonamides
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SCARLET FEVER (SCARLATNA)
Description:
s an acute, febrile, contagious condition characterized by sudden onset usually with vomiting and by punctuate
erythematous skin eruption followed by characteristic exfoliation of the skin during convalescence, rapid pulse and
sore throat.
Etiology:
Group A hemolytic streptococcus group
Direct contact, droplet infection and indirect contact
ncubation period:
1 7 days
Pathophysiology:
The bacterium releases erythrogenic toxins, which causes sensitivity reaction in the body. The toxin can cause toxic
injury to the small capillaries of vascular epithelium found in the body. The skin is the site where the manifestations
are most visible where one will observed strawberry like tongue, rashes, etc.
Complications: sinusitis nephritis otitis media myocarditis/endocarditis mastoiditis
Signs and symptoms
. Prodomal stage
fever
tachycardia
sore throat
vomiting
headache
abdominal pain
body malaise
. Eruptive stage
rashes: appears at the end of 24 hours on the chest spread gradually upward and downward
enanthem: macular eruption on the hard palate
pastia's line: due to the grouping of macules found around the folds of the skin particularly on the elbow
tiny subcuticular vesicles: found in the cuticles of the nails
strawberry tongue: tongue becomes red at the edges and enlarged papillae show
raspberry tongue: circumoral pallor
. Desquamation (8 10 days) skin begins to peel shedding of the hair and nails
Scultz-Charlton rash extinction or blanching test for sensitivity to scarlet fever antitoxin
Dick test determines whether or not a person is naturally immune to scarlatine
nasal swab
Laboratory:
positive throat culture for strep
elevated ASO titer
white and differentiated count high as 50,000 increase in eosinophils
Management
1. isolation medical aseptic technique
2. bed rest
3. keep the patient warm at all times and avoid drafts
4. apply ice cap/packs for high fever
5. give TSB for high temperature
6. increase oral fluid intake
7. take vital signs q 3 4 hrs
8. daily bath should be given: sodium bicarbonate or starch is used in excessive itching and oil rub
after bath is useful
9. use of mouthwashes and gargles for good oral hygiene
10. prevent exoriations by wiping nasal discharges with soft tissues and application of cold creams
11. encourage daily elimination
12. diet should be of high calorie foods and fruit juices, milk cream and soups
Medical management:
a. antitoxins
b. convalescent serum
c. gamma globin administered M
d. sulfonamides e. antibiotics penicillin (for cleaning the throat of streptococcus)
LEPROSY (HANSEN'S DSEASE, HANSENOSS, LEPRAE, LEONTHASS)
Description:
A chronic infectious disease characterized by the appearance of modules in the skin or mucous membranes or by
changes in the nerves leading to anesthesia, paralysis or other changes
Etiology:
Mycobacterium leprae (acid fast bacillus), sporadic/endemic cases, occurs in tropical and semitropical countries
throughout the world. t can be contracted in childhood (manifested at age 15 and diagnosed by the age of 20 years).
Prognosis: > the longer the time of active disease, severe lesions, the more rapidly they have advanced without ability
to produce the lepromin reaction the poorer the prognosis > case under 21 years old high relapse rate
Prolonged intimate skin to skin contact, nasal secretions
ncubation period:
Prolonged, undetermined and varies from one to many years
Pathophysiology:
The bacterium, which is an acid-fast bacillus, attacks the skin tissues and peripheral nerve, which causes skin lesions,
anesthesia, infection and deformities
Signs and symptoms
Assessment:
1. Tu-er(uloi* ty+e ' shows high resistance to Hansen's bacilli. Clinical manifestations are mainly in the skin
and nerves and usually are used or non-infectious.
2. Le+romatous ty+e ' minimal resistance to the multiplication, existence of the bacillus, constant presence
of large numbers in the lesions and form globi (characteristic manifestations in the skin and mucus
membranes) and peripheral nerves.
70 O+en or in"e(tious (ases
4. In*erterminate ty+e ' clinical manifestations are located chiefly in skin and nerves; lesions are flat
macules.
D0 Bor*erline
Clini(al Mani"estations#
50 Early stae
loss of sensation
paralysis of extremities
absence of sweating (anhydrosis)
nasal obstruction
loss of hair (eyebrows)
eye redness
change in the skin color
ulcers that does not heal
muscle weakness
60 Late sym+toms
contractures
leonine appearance (due to nodular and thickened skin of the forehead and face)
madarosis (falling of eyebrows)
gynecomastia sinking of bridge of nose
70 Car*inal sins
presence of Hansen's bacilli
presence of localized areas of anesrhesia
peripheral nerve enlargement
1. Lepromin reaction a positive test develops a nodule at the site of inoculation (first and third week)
2. Wassermann reaction
Management
Planning and implementation
1. Prevention
o separate infants from lepromatous parents at birth
o segregate and treat open cases of leprosy
o require public health supervision and control of cases of Hansen's disease
2. Medical management
1. Multiple drug therapy
paucibacillary treatment six months or until negative (-) results occur
refampicin once a month
dapsone - once a day
2. Multibacillary treatment for 2 consecutive years or until negative (-) for leprosy test
rifampicin once a month
lamprene once a day
dapsone once a day
3. full, wholesome generous diet
4. alcohol or TSB may be used for high fever
5. patient should have a daily cleansing bath and change of clothing
6. good oral hygiene
7. normal elimination should be maintained
h. meticulous skin care for ulcers
MEASLES (RUBEOLA, MORBLL, 7 DAY MEASLES)
Description:
An extremely contagious exanthematous disease of acute onset which most often affects children and the chief
symptoms of which are referable to the upper respiratory passages.
Etiology:
The causative agent is the paramyxo virus
Mode of transmission: Nasal throat secretions, droplet infection, indirect contact with articles

ncubation period:
8 20 days
Pathophysiology:
As the virus enters the body it immediately multiplies in the respiratory epiyhelium. t disseminate by way of the
lymphatic system causing hyperplasia of the infected lymphoid tissue. As a result there is a primary viremia which
infects the leukocyte and involves the whole reticuloendothelial system. As the infected cells die it necrose and
release more viruses to infect other leukocytes leading to secondary viremia, which also causes edema of upper
respiratory tract producing its symptoms and it may predispose to pneumonia.
Complications:
otitis media
bronchopnuemonia
severe bronchitis Prognosis:
death rate is highest in the first two years of life (20%)
after 4 years uncommon
over all mortality less than
Signs and symptoms
Assessment:
1. Stages
1. incubation period (average of 10 days)
2. Pre-eruptive stage or stage of invasion (3-6 days)
from the appearance of the first signs and symptoms to the earliest evidence of the eruption.
fever, severe cold
frequent sneezing
profuse nasal discharge
eyes are red and swollen with mucopurulent discharge (lids stick together)
Stimson's sign (puffiness of lower eyelids with definite line of congestion on the conjunctivae)
redness of both eardrums
vomiting, drowsiness
hard, dry cough
Koplik's spot (appears on second day): small bright, red macules or papules with a tiny or bluish-white specks on the
center and can be found on the buccal cavity
macupapular rashes (seen late in 4th day): appears first on the cheeks or at the hairline
true measles rash: slightly elevated sensation to touch, appears first on the face and spreads downward over neck,
chest trunk, limbs and appearing last on the wrist and back of the hand
3. Eruptive stage
characterized by a general intensification of all local constitutional symptoms of the pre-eruptive stage with the
appearance of bronchitis and loose bowels
irritability and restlessness
red and swollen throat
enlargement of cervical glands fever subsides
4. Desquamation stage follows after the rash fades follows the order of distribution seen in the formation of eruption
Diagnostic procedure No specific diagnostic exam except only for the presence of leucopenia.
Management
a. prevention
education of parents regarding the disease
passive immunization of infants and children (gammaglobulin)
active immunization (1st year of life)
b. management
drugs
antibiotics
sulfodiazine isolation
meticulous skin care warm alcohol rub to prevent pressure sores good oral and nasal hygiene increase oral fluid
intake
proper care of the eyes eye screen to avoid direct light; wear dark glasses ears should be cleaned after bath if
there is discharges patient should lie the affected ear down or towards the bed

give ample of fluids during febrile stage
GERMAN MEASLES (RUBELLA, ROTHEN, ROSEOLA, 3-DAY MEASLES)
Description: An acute infectious disease characterized by mild constitutional symptoms, rose colored macular eruption which may
resembles measles and enlargement and tenderness
Etiology:
Caused by myxovirus. Occurs mostly in spring and seen mostly in children over 5 years of age
Direct contact
ncubation period:
14 21 days Period of communicability 7 days before to 5 days after the rash appears
Pathophysiology:
As the virus gains entrance to the nasopharynx, it immediately invades the nearest lymph gland causing
lymphadenopathy. Later on, the virus enters the blood stream that stimulates the immune response, which is the
cause of rashes found in the body of infected individual. f rashes has appeared it means that viremia has subsided.
Since the disease is generally mild and serious complication has ha been very rare, what should be watched out
rather are its congenital effects because it can cross the placental barrier, which may kill the fetus or cause congenital
rubella syndrome.
Complications: otitis media encephalitis transient albuminuria arthritis congenital defects for babies who's
mother were exposed in early pregnancy
Prognosis: very favorable
Signs and symptoms
fever, cough loss of appetite enlargement of lymph nodes sweating leucopenia vomiting (in some cases)
headache, mild sore throat desquamation follows the rash enanthem of uvula with tiny red spots rash (cardinal
symptom) accompanied with cervical adenitis: begins on the face including the area around the mouth; oval, pale,
rose-red papules about the size of a pinhead; covers the body within 24 hours and gone by the end of the 4th day
Management
Planning and implementation
a. Prevention: vaccination gamma globulin given to pregnant women with negative history and who have been
exposed in the first trimester of pregnancy include in MMR given at 15months to the baby
b. management isolation (catarrhal stage to prevent infection to others) bed rest for first few days meticulous
skin care especially after the rash fades good oral and nasal hygiene (use of petroleum jelly if lips become dry) no
special diet is necessary, increase oral fluid intake
VARCELLA (CHCKEN POX)
Description:
A very contagious acute disease usually occurring in small children, characterized by the appearance of vesicles
frequently preceded by papules, occasionally followed by postules but ending in crusting
Etiology:
Varicella zoster virus (airborne)
Droplet infection, direct contact
ncubation period:
2 -3 weeks
Pathophysiology:
The virus gain entrance via the upper respiratory tract it crosses the mucous membrane and cause systemic infection
followed by appearance of numerous macupapular rash. The rash are fluid filled that contain polymorphonuclear
leukocytes.
Period of communicability: highly contagious from 2 days prior to rash to 6 days after rash erupt. Full blown case
imports permanent immunity.
Complications: pneumonia nephritis encephalitis impetigo pitting or scarring of the skin
Signs and symptoms
slight fever: first to appear body malaise, muscle pain eruption (maculopapular) then progresses to vesicle (3-4
days); begins on trunk and spreads to extremities and face (even on the scalp, throat and mucus membranes)
intense pruritus vesicles ended as a granular scab irritability
Management
1. Drugs penicillin can be used when the crusts are severe or infected to prevent scarring or secondary invasion
alkalinizing agent to prevent nephritis and to stop vomiting acyclovir, immunosin antiviral hydrocortisone lotion 1%
for itching
2. isolation in a room by itself
3. provide a well ventilated, warm room to the patient
4. warm bath should be given daily to relieve itching; use a calamine lotion
5. avoid injuring the lesions by using soft absorbent towel and the patient should be patted dry instead of rubbed dry
6. maintain good oral hygiene, if lesions are found in the mouth or nasal passages, antiseptic prep may be used 7.
diet should be regular
HERPES ZOSTER (SHNGLES)
Description: Acute viral infection of the peripheral nervous system due to reactivation of varicella zoster virus. The virus causes an
inflammatory reaction in isolated spinal and cranial sensory ganglia and the posterior gray matter of the spinal cord.
Contagious to anyone who has not had varicella or who immunosupressed.
Signs and symptoms
neuralgic pain malaise burning fever cluster of skin vesicles along course of peripheral sensory nerves
(unilateral and found in trunk, thorax or face); appears 3-4 days
Management
1. drugs
o analgesics
o corticosteroids
o acetic acid compresses or white petrolatum
o anti-viral (acyclovir)
2. isolate client
3. apply drying lotion
4. administer medications as ordered
5. instruct client to preventive measures
SCABES
Description:
An infection of the skin produced by burrowing action of a parasite mite resulting in irritation and the formation of
vesicles or postules.
Etiology:
tchmite, sarcoptes scabei, occurs in individual living in area of poverty where cleanliness is lacking.
Direct contact with infected persons, indirect contact through soiled bed linens, clothing and others.
ncubation period:
-
Pathophysiology:
Both female and male parasites live on the skin. A female parasite burrows into the superficial skin to deposit eggs.
Pruritus occurs and scratching of skin may produce secondary infection. Scattered follicular. Eruption contains
immature mites. nflammation may produce postules and crust. Eggs is hatched in 4 days. Larvae undergo a series of
matts before becoming adult. Life cycle is complete in 1-2 weeks.
Signs and symptoms
intense itching especially at night sites between fingers or flexor surfaces of wrists and palms, around nipples,
umbilicus, in axillary folds, near groin or gluteal folds, penis, scrotum.
Presence on skin of female mite, ova and feces upon skin scrapping.
Management
1. Take a warm soapy shower bath or bath to remove scaling debris from crusts.
2. Apply prescribed scabicide such as:
o lindane lotion (kwell) 1%
o crotamiton (Eurax) cream or lotion
o 6-10% precipitate of sulfur in petrolatum
3. encourage to change clothing frequently
RNGWORM (TRCHOPHYTOSS)
Description:
A group of diseases caused by a number of vegetable fungi and affecting various portion of the body in different ways
(skin, hair, nails)
Etiology:
TNEA PEDS (Athlete's foot) a superficial fungal infection due to trichophyton Rubrum, mentagrophytes, or
epidermophyton floccosum which may manifest itself as an acute, inflammatory, vesicular process or as chronic rash
involving the soles of the feet and the inter-digital web spaces. particularly common in summer, contracted swimming
area and locker rooms.
TNEA CORPORS or TNEA CRCNATA ringworm of the body.
TNEA CRURS (Jock itch) superficial fungal infection of the groin which may extend to the inner thigh and buttocks
areas and commonly associated with tinea pedis.
TNEA CAPTS (ringworm of the scalp) caused by microsporum canis, trichophyton tonsurans. usually spread
through child to child contact, use of towels, combs, brushes and hats kitten and puppies may be the source of the
infection primarily seen in children before puberty
Signs and symptoms
TNEA PEDS scaly fissures between toes, vesicles on sides of feet pruritus burning and erethema lymphangitis
and cellulites may occur
TNEA CORPORS or TNEA CRCNATA intense itching appearance: begins as scaling erythematous lesions
advancing to rings of vesicles with central clearing and appears on exposed areas of body.
TNEA CRURS dull red brown eruption of the upper thighs and extends to form circular plaques with elevated scaly
or vesicular borders. itching seen most in joggers, obese individuals and those wearing tight undercoating.
TNEA CAPTS reddened, oval or round areas of alopecia presence of kerion: an acute inflammation that produces
edema, postules and granulomatous swelling
TNEA PEDS direct examination of scrapings (skin, nails, hair) isolation of the organisms in culture TNEA CAPTS
wood's lamp microscopic evaluation
Management
TNEA PEDS
1. Prevention: instruct client to keep feet dry such as by using talcum powder.
2. Management:
o Drugs: topical agent, clotrimazole, miconazole, tolnaftate
o Systemic anti-fungal therapy: griseofulvin, ketoconazole
o Elevate feet for vesicular type o pain infection.
TNEA CORPORS or TNEA CRCNATA
1. Prevention: infected pet is a common source and should be inspected and treated by a veterinarian.
2. Management
o see treatment for tinea pedis
o wear clean cotton clothing next to skin
o use clean towel daily
o dry all areas and skin folds thoroughly
o use self monitoring for signs of re-infection after a course of therapy.
TNEA CRURS
1. Prevention: avoid nylon underclothing, tight-fitting underwear and prolonged wearing of wet bathing suit.
2. Management:
o Drugs topical therapy (miconazole cream); griseofulvin (oral)
o avoid excessive washing or scrubbing; wear cotton underwear.
TNEA CAPTS same with other fungal infection
9()+,0I/+-)+I/(; DI)0,D-,)
TYPHOD FEVER (ENTERC FEVER)
Description:
A general infection characterized by the hyperplasia of the lymphoid tissues, especially enlargement and ulcerations
of the Peyer's patches and enlargement of the spleen, by parechymatous changes in various organs and liberation of
an endotoxin in the blood.
Etiology:
Salmonella typhosa, prevalent in temperate climates, high incidence in fall, and mostly affected are the males and in
youth and infant.
nfected urine and feces and intake of contaminated food and water
Pathophysiology:
The organism enters the body via the G tract and invades the walls of the G tract leading to bacteremia that localizes
in mesenteric lymph nodes, in the masses of lymphatic tissue, in the mucus membrane of the intestinal wall (Peyer's
patches) and in small, solitary lymph follicles in the ileum and colon thus ulceration of the intestines may result.
Com+li(ation#
perforation of the intestine from erosion of one of the ulcers
intestinal hemorrhage from erosion of blood vessels
relapse
thrombophlebitis
urinary infection
meningitis
Signs and symptoms
50 Gra*ual onset
o severe headache, malaise, muscle pains, non-productive cough
o chills and fever, temperature rises slowly
o pulse is full and slow
o skin eruption irregularly spaced small rose spots on the abdomen, chest and back; fades 3-4
days
o splenomegally
60 Se(on* ,ee8
fever remains consistently high
abdominal distention and tenderness, constipation or diarrhea
delirium in severe infection
coma-vigil look; pupils dilate and patient appears to stare without seeing
sultus tendium twitching of the tendon sets
70 Thir* ,ee8
gradual decline in fever and symptoms subsides
white blood cell counts blood or bone marrow culture positive urine and stool cultures in later stage blood serum
agglutination (+) at the end of scond week
Management
1. Prevention: decontamination of water sources, milk pasteurization, individual vaccination of high risk
persons, control carriers.
2. Drugs
o chloramphenicol
o ampicillin
o sulfamethoxazole
o trimethoprim
o furazolidone
3. intravenous infusion to treat dehydration and diarrhea
4. Nursing care
o give supportive care
o position the patient to prevent aspiration
o use of enteric precautions
o TSB for high fever
o encourage high fluid intake
o monitor for complications
5. intestinal decompression procedure, V fluids and surgical intervention for perforation
6. withhold food, blood transfusions and bowel resection for intestinal hemorrhage
LEPTOSPROSS (WEL'S DSEASE, CANCOLA FEVER, HEMMORHAGC JAUNDCE, CTEROHEMORRHAGC SPROCHETOSS, SWNEHERD'S
DSEASE, MUD FEVER)
Description:
Worldwide in its distribution and especially in areas where sanitation is poorest; common in Japan. Usually those who
are affected are the sewer workers, miners and swimmers in polluted water
.
Etiology:
Leptospira icterohaemorrhagiae carried by wild rat
ncubation period: 5 6 days
Signs and symptoms
sudden onset with chills, vomiting and headache by severe fever and pains in the extremities
intense itching of the conjunctivae
severe jaundice with hemorrhage in the skin and mucus membranes
hematemesis, hematuria and hepatomegaly for severe cases
convalescence occurs in the third week unless there is a complication

Diagnostic procedure Positive agglutination test
Management
Prevention eradication of rats and environmental sanitation Drugs antiserum or convalescent serum; penicillin
Nursing care supportive and symptomatic
DYSENTERY
Etiology:
BACLLARY DYSENTERY (shigellosis, bloody flux) caused by shigella dyseteriae and shigella paradysenteriae
coming from bowel discharges of infected persons and carriers.
VOLENT DYSENTERY (Cholera) caused by vibrio cholera, vibrio comma (ogawa and inaba) from infected feces or
vomitus.
BACLLARY DYSENTERY eating of contaminated foods, hand to mouth transfer of contaminated material, flies,
objects soiled with discharges of infected person, contaminated water.
VOLENT DYSENTERY direct or indirect fecal contamination of water or food supplies by soiled hands, utensils or
mechanical carriers such as flies.
ncubation period:
BACLLARY DYSENTERY 1-7 days (average of 4 days)
period of communicability during acute phase and until (-) stool exam VOLENT DYSENTERY from a few hours
to five days (average 3 days)
period of communicability until the infectious organism is absent from the bowel discharges (7-14 days)
Signs and symptoms
BACLLARY DYSENTERY
chills
fever
nausea and vomiting
tenesmus
severe fiarrhea accompanied by blood and mucus
alternating episodes of diarrhea and constipation (chronic)
VOLENT DYSENTERY
1. Onset
o acute colicky pain in the abdomen
o mild diarrhea (yellowish)
o marked mental depression
o headache, vomiting
o fever, may or may not be present
2. Collapse stage after 1 or 2 days
profuse watery stools (grayish white or rice water)
thirst
severe/violent cramps in the legs and feet
thickly furred tongue
sunken eyeballs
ash-gray colored skin
3. Reaction stage after 3 days
increased consistency of stools
skin becomes warm and cyanosis disappear
peripheral circulation improves
urine formation increases
BACLLARY DYSENTERY
stool exam
serologic test
VOLENT DYSENTERY
(+) stool exam/vomitus
Management
BACLLARY DYSENTERY
1. Methods of control and prevention
o recognition of disease and reporting
o concurrent disinfection from bowel discharges
o investigation of source of infection (food, water and milk supplies, general sanitation and search
for carriers)
o prevention of flybreeding, screening
o sanitary disposal of human excreta
o protection and purification of public water supplies and prevention of subsequent contamination
2. Drugs
kaolin
bismuth and paregoric (combination of sulfonamide)
chloramphenicol
3. Nursing care
isolation by medical aseptic technique
daily cleansing bath
increase oral fluids in acute stage
TSB for fever
record and the character of stools passed, amount and frequency of vomiting
VOLENT DYSENTERY
1. Prevention
immunization
screen the sickroom from flies
protect the food supplies for contamination
b. Drugs tetracycline
c. Replacement of fluids and electrolytes
d. solation
e. Patient should be spared all unnecessary efforts during the acute stage
f. Buttocks should be kept clean with warm water and soap and rubbed dry
g. antiseptic mouthwash in case of vomiting
h. fluids is given as soon as they can be tolerated
MUMPS (NFECTOUS OR EPDEMC PAROTTS)
Description:
An acute contagious disease the characteristic feature of which is the swelling of one or both of the parotid glands
usually occurring in epidemic form.
Etiology:
Filterable virus, member of myxovirus family, infected oral and nasal secretions is the source of infection
Complication: orchitis or epididymp-orchitis Prognosis: favorable in most cases of mumps, complete recovery
ordinarily takes place even complications take place.
Mode of transmission: Direct contact with a person who has the disease or by contact with articles which is contaminated.
ncubation period:
14 21 days
period of communicability: before the glands is swollen to the time present of localized swelling
Signs and symptoms
pain in the parotid region
headache
earache
fever
difficulty to open the mouth wide
general malaise
sore throat
moderate leukocytosis
complement fixation test
skin test for susceptibility to mumps
Management
a. Prevention: immunization (MMR given at 15 months)
b. Drugs aspirin for fever, cortisone
c. isolation
d. absolute bed rest to prevent complications (at least 4 days)
e. daily bath should be given
f. soft bland diet for sore jaw
g. advise male to wear well fitting support to relieve the pull of gravity on the testes and blood vessels
h. TSB for fever
i. ice pack/collar application
PARASTSM
Description:
Etiology:
PNWORM (Enteropiasis) oxyuris vermicularis, occurs from fomites, autoinfection, fecal contamination, affects one
in family and invariably infects entire family.
GANT NTESTNAL ROUNDWORMS (Ascariasis) ascaris lumbricoides, from sputum and ova in soil.
THREADWORM strongyloides stercoralis, from fecal soil contamination
WHPWORM (trichuriasis) from fecal soil contamination
HOOKWORM (ancylostomiasis) from larvae in fecal soil contamination
TAPEWORM (taeniasis)
Types:
hymenolepis nana from fecal contamination
taenia saginata (beef) from insufficiently cooked meat
taenia solium (pork) contaminated meat
diphyllobothrium latun poorly cooked infested fish
PNWORM mouth
GANT NTESTNAL ROUNDWORMS mouth
THREADWORM enter usually through the skin or feet
WHPWORM mouth
HOOKWORM through skin of the feet
TAPEWORM - mouth
Signs and symptoms
PNWORM
eosinophilia, itching around the anus, convulsions in children.
GANT NTESTNAL ROUNDWORMS
chest pain, cough after two months, malnutrition, indigestion, diarrhea, colicky abdominal pain.
THREADWORM
intermittent diarrhea
WHPWORM nausea and vomiting, diarrhea, anemia, stunted growth; may cause prolapse of rectum in children and
occasionally appendicitis.
HOOKWORM anemia, diarrhea, stunted growth, bronchial symptoms, obstruction of the biliary and pancreatic duct.
PNWORM adults and ova in stool
GANT NTESTNAL ROUNDWORMS adults and ova in stool
THREADWORM larvae WHPWORM ova in stool
HOOKWORM ova in stool
TAPEWORM ova and segments of the worm in the stool
Management
THREADWORM Prevention: wear shoes and use sanitary toilets
use of sanitary toilets
provide hygiene education of the family
dispose of the infected stools carefully
meticulous cleansing of skin especially anal region, hands and nails
drugs antihelminthic drugs, piperazine citrate, pyrantel pamoate, mebendazole
HEPATTS
Description:
Widespread inflammation of the liver tissue with liver cell damage due to hepatic cell degeneration and necrosis;
proliferation and enlargement of the Kuffer cells and inflammation of the periportal areas thus may cause interruption
of bile flow.
Etiology:
TYPE A (infectious hepatitis) occurs in crowded living conditions; with poor personal hygiene or from contaminated
food, milk, water or shellfish. Common occurrence during fall and winter months usually affecting children and young
adults.
TYPE B (serum hepatitis, SH virus, viral hepatitis, transfusion hepatitis, homologous serum jaundice)
TYPE C (non-A, non-B hepatitis)
TYPE A fecal/oral route
TYPE B blood and body fluids (saliva, semen, vaginal secretions), often from contaminated needles among V drug
abusers, intimate/sexual contact.
TYPE C by parenteral route, through blood and blood products, needles and syringes

ncubation period:
TYPE A 15-45 days
period of communicability 3 weeks prior and one week after developing jaundice
TYPE B 50-180 days
TYPE C 7-50 days
Pathophysiology: -
Signs and symptoms
a0 &re!i(teri( stae
anorexia
nausea and vomiting
fatigue constipation or diarrhea
weight loss
right upper quadrant discomfort
hepatomegaly
spleenomegaly
lymphadenopathy
-0 I(teri( stae
fatigue
weight loss
light colored stools
dark urine
jaundice
pruritus
continued hepatomegaly with tenderness
(0 &ost!i(teri( stae
fatigue but increased sense of well being
hepatomegaly: gradually decreasing
a. All 3 types
SGPT, SGOT, alkaline phospatase, bilirubin, ER all increased in pre-icteric
leukocytes, lymphocytes, neutrophils all decreased
prolonged PT
b. HEPA A: Hepa A (HAV) in stool before onset
Anti-HAV (gG) appears soon after onset of jaundice, peaks in 1-2 months and persist indefinitely
Anti-HA (gM) positive in acute infection lasts 4-6 weeks
c. HEPA B
HbsAG (surface antigen) positive, develops 4-12 weeks after infection
Anti-HbsAg negative in 80% cases
Anti-HBC associated with infectivity, develops 2-16 weeks after infection
ABeAG associated with ineffectively and disappears before jaundice
Anti-Hbe present in carriers, represents low in effectivity
Management
a. Prevention
. Type A
good hand washing
good personal hygiene
control and screening of food handlers
passive immunization SG, to exposed individuals and prophylaxis for travelers to developing countries

. Type B
screen blood donors HB3Ag
use disposable needles and syringes
registration of all carriers
passive immunization SG
active immunization hepatavax B vaccine and formalin treated hepatitis B vaccine given in 3 doses
b. Nursing management
promote adequate nutrition small frequent meals of high CHO, moderate to high CHON, high vitamin, high caloric
diet, avoid very hot or cold foods.
ensure rest and relaxation
monitor/relive pruritus cool, moist compresses, emollient lotion
administer corticosteroid as ordered
isolation procedures as required
provide client teaching and discharge planning with regards to:
importance of avoiding alcohol
importance of not donating blood
recognition/reporting of signs of inadequate convalescence
avoidance of persons with known infections
Drugs liver protector (essentiale, jectofer, interferon drug)
FOOD POSONNG
Description:
A gastroenteritis often produced by the presence of a disease organism or its toxins.
Etiology:
SALMONELLA GASTROENTERTS salmonella typhimurium, salmonella paratyphi A, B, and C;
salmonella new port
STAPHYLOCOCCUS GASTROENTERTS coagulase positive, gram positive: grows rapidly on food containing
carbohydrates
Recovery: within 24 36 hours BOTLSM clostridium botulinum
ncubation period:
SALMONELLA GASTROENTERTS 6 to 48 hours after the ingestion of contaminated food STAPHYLOCOCCUS
GASTROENTERTS 2 to 6 hours after ingestion BOTLSM 24 hours after the ingestion
Signs and symptoms
SALMONELLA GASTROENTERTS
headache
nausea and vomiting
diarrhea (stools are usually fluid and contain mucus; bloody if in severe infection)
STAPHYLOCOCCUS GASTROENTERTS
sudden abdominal pain
excessive perspiration
vomiting
diarrhea
pallor weakness
BOTLSM
peripheral nervous system
vomiting
ataxia
constipation
ocular paralysis
aphonia
other neufromascular signs
paralysis of the respiratory system which may lead to death
Diagnostic procedure SALMONELLA GASTROENTERTS history of illness after ingestion of certain foods
Management
SALMONELLA GASTROENTERTS/STAPHYLOCOCCUS GASTROENTERTS
replacement of fluids and salts
sedatives and anticholinergic to reduce hypermobility of the intestine
good oral hygiene
application of heat to abdomen to relieve cramps
BOTLSM
prevention
regulation of commercial processing of canned foods
education of housewives concerning proper processing of home canned foods
canned foods should be boiled first to destroy the toxins
polyvalent antitoxins (botulinum antitoxin)
patient with botulinum should be placed on quiet room and avoidance of unnecessary activity
symptomatic
intubation for feeding
tracheostomy in respiratory failure
oxygen by PPB
)-?=(;;> +,(/).I++-D DI)-()-
GONORRHEA (STRAN, CLAP, JACK, MORNNG DROP, G.C. GLEET)
Description:
An infectious disease, which causes inflammation of the mucous membranes of the genitourinary tract.
Complications:
MALE bilateral epididymitis, sterility
FEMALE pelvic inflammatory disease, sterility
NEWBORN opthalmia neonatorum mother to child
Etiology:
Neisseria gonorrhea
Sexual contact

ncubation period:
2 5 days
Signs and symptoms
MALE
burning sensation in the urethra upon urination
passage of purulent (yellowish) discharge
pelvic pain
fever
painful urination
FEMALE
burning sensation upon urination
presence or absence of vaginal discharge
pelvic pain
abdominal distention
nausea and vomiting
urinary frequency
culture and sensitivity
female: pap smear or cervical smear; male: urethral smear
blood exam VDRL
Management
educate men and women to recognize signs of gonorrhea and to seek immediate treatment
monitor urinary and vowel elimination
important to treat sexual partner, as client may become re-infected
make arrangements for follow-up culture 2 weeks after therapy is initiated
Drugs penicillin: drug of choice
tetracyclines
ceftriaxone sodium (rocephin)
amoxicillin (augmentin)
SYPHLS (LEUS, POX, BAD BLOOD DSEASE)
Description:
A contagious disease that leads to many structural and cutaneous lesions
Complications: a. still birth b. child born with syphilis placenta is bigger than the baby persistent vesicular eruptions
and nasal discharges old man feature mucus patches on mouth and anus c. child born with late syphilis (signs and
symptoms after 2 years)
hutchinson's teeth deafness saddle nose high palate
Etiology:
Treponema pallidum
Sexual contact

ncubation period:
3 6 weeks
Signs and symptoms
a. Primary syphilis
chancre on genitalia, mouth or anus
serous drainage from chancre
enlarge lymph nodes
maybe painful or painless
highly infectious
b. Secondary syphilis
skin rash on palms and soles of feet
reddish copper colored lesions on palms of hands and soles of feet
condylomas: lesions/sores that fused together
erosions of oral mucus membranes
alopecia
enlarged lymph nodes
fever, headache, sore throat and general malaise
c. Tertiary syphilis
gumma the characteristic lesions
cardiovascular changes
ataxia
stroke, blindness
a. positive test for syphilis
venereal disease research laboratory (VDRL)
rapid plasma reagin circle card test (CRPR-CT)
automate reagin test (ART)
fluorescent treponemal antibody absorption test (FTA-ABS)
wessermann test
khan precipitation test
kline, hinton and mazzin tests
b. darkfield examination
c. culture and sensitivity
d.
Management
strict personal hygiene is an absolute requirement
assist in case finding
instruct client to avoid sexual contact until clearance is given by physician
encourage monogamous relationship
explain need to complete course of antibiotic therapy
Drugs penicillin, tetracyclins/kithramycin
ACQURED MMUNE DEFCENCY SYNDROME (ADS)
Description:
An acquired immune deficiency characterized by a defect in natural immunity
Etiology:
Retrovirus, human immunodeficiency virus (HV-1 and HV-2) previously referred to as human T-lymphotropic virus
type (HTLV-)
Blood transfusion, sexual contact, contaminated needles, perinatal transmission
ncubation period:
6 months to 9 years
Pathophysiology:
Signs and symptoms
anorexia
fatigue
dyspnea
night sweats
fever
diarrhea
enlarged lymph nodes
HV encephalopathy: memory loss, lack of coordination, partial paralysis, mental deterioration
HV wasting syndrome, emaciation
positive test for HV antibody
positive test for presence of HV itself
opportunistic infection: neumocystic carinii, cystomegalovirus, kaposi's sarcoma
ELSA test (enzyme-linked immunosorbent assay) a screening test
western blot a confirmatory test
Management
provide frequent rest periods
provide skin care
provide high-calorie, high protein diet to prevent weight loss
provide good oral hygiene
provide oxygen and maintain pulmonary function
provide measures to reduce pain
protect the client from secondary infection; carefully assess for early signs
encourage verbalization of feelings
teach client the importance of:
informing sexual contacts of diagnosis
not sharing needle with other individuals
continuing medical supervision
CHLAMYDAL NFECTON
Description:
A sexually transmitted disease that is highly contagious caused by chlamydial organism
Etiology:
Chlamydia trachomatis
2 -3 weeks for males
ncubation period:
Sexual intercourse
Pathophysiology:
-
Signs and symptoms
pruritus in vagina
burning sensation in vagina
painful intercourse
pruritus of urethral meatus in men
burning sensation during urination
Diagnostic procedure Culture of aspirated material from vaginal, anal or penile discharges
Management
doxycycline or azithromycin (recommended for pregnant woman)
universal precaution should be practiced
TRCHOMONASS
Description:
Another type of sexually transmitted disease that may also be transmitted by other means such as handling of
infected fomites. t is caused by a protozoan parasites.
Etiology:
Trichomonas vaginalis
Sexual intercourse, contact with wet towels and wash clothes infected by the organism
ncubation period: 4 20 days, usually 7 days
Signs and symptoms
vaginal discharge
burning and pruritus of vagina
redness of the introitus
usually asymptomatic in men
Diagnostic procedure culture of obtained specimen
Management
metronidazole
sitz bath may relieve symptom
acid douches
tetracyclines may be given on male who are also infected
*I%+E))%)ISM AND PANDEMI,S
n the recent course of international conflicts, which has lead to war, has used weapon that are quite different from the conventional ones used
before. The medical science is being used not to prolong life but to cause immediate death by infection of various biological organisms. The
following gives an insight of these dangerous biological terrorism leading to pandemics.
SMALL POX
Description:
For about two decades the WHO has declared that the world is already small pox free. Although eliminated in the
world over, the specimen is still kept in two laboratory facility in the United States.
Etiology:
Variola virus (DNA virus)
Direct contact or by droplet from person to person
ncubation period:
12 days
Signs and symptoms
high fever
malaise
headache
back ache
maculopapular rash in the face, mouth and pharynx (the patients are contagious after the appearance of the
rash)
Management
generally supportive care
before rendering care transmission precaution should be specifically indicated
autoclaving of soiled linens is needed
isolation is necessary until no longer contagious
ANTHRAX
Description:
Also known as whoolsorters disease, the capsulated form of this organism is found in soil worldwide. The organism
needs to take about 8,000 to 50,000 to put a person at risk of contracting the disease.
Etiology:
Bacillus anthracis
inhalation of spores
ingestion of spores
entrance through skin lesions
ncubation period:
For inhalation anthrax 60 days,
for cutaneous anthrax 1-6 days
Signs and symptoms
a. nhalation anthrax cough headache fever vomiting chills weakness dyspnea syncope
b. Cutaneous anthrax nausea and vomiting abdominal pain hematochexia ascites massive diarrhea
Management
a. standard precaution is already sufficient to control the spread of the infection
b. ciprofloxacin/doxycycline is prescribed for mass exposure/casualty with infecting organism
c. important pharmacologic interventions are penicillin, erythromycin, chlorampenicol and gentamycin
SEVERE ACUTE RESPRATORY SYNDROME (SARS)
Description:
Latest among all the rest of pandemics which has its origin from China and has spread to USA, Canada, Philippines
and other South East Asian Country
Etiology:
Corona virus
Airborne

ncubation period:
7 10 days
Signs and symptoms
fever
cough
rapid respiratory compromise
dyspnea
atelectasis
Management
supportive treatment
provide ventilatory assistance
use N95 mask to avoid infection

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