Gapuz Communicable Disease Nursing

COMMUNICABLE DISEASES
Diseases caused by pathogenic microorganisms, which

can be transmitted from an infected person to a susceptible
person by direct, indirect means or through a break in skin
integrity
Contagious Diseases
Diseases that can easily be transmitted
Concepts:
All communicable diseases are infectious but not
contagious
Because there is the presence of a living microorganism
Because not all of the microorganisms can be easily
transmitted
All contagious diseases are infectious
All contagious diseases are communicable diseases
Diphtheria is a disease, which is
o Contagious
o Communicable
o Infectious
Malaria is a disease, which is
o Communicable
o Infectious
o But not contagious
Tetanus is a disease, which is
o Infectious only
Communicable Diseases are transmitted through:

1. Direct Mode of Transmission
A person to person transmission
Most common is through Droplet transmission
Examples:
o Kissing
o Sexual Contact
Happens in humans
2. Indirect Mode of Transmission
From a source of transmission to a new host with
intermediary object
A bridge connects you to an infected person
Bridges or intermediate objects
Examples:
o Vehicle-borne Transmission
Non-living things
Articles used by patient like catheter,
tubings, linens
Vector-borne Transmission
Living things but are non-human
Insects, arthropods, rodents
3. Break in Skin Transmission
Inoculation
Contaminated sharps or needles
Animal Bites
4. Airborne Transmission
Microorganisms are suspended in air
There is no limitation to the distance traveled by
microorganism
Different from Droplet transmission
Microorganism remains on surface
Travel is limited to a maximum distance of three (3) feet.
Concept:
All these modes are classified under Horizontal
Transmission
Epidemiological Triad
Three (3) factors for a disease to take place
1. HOST
A person
An animal
Concept:
Consider the susceptibility of the host
Susceptibility
o Pertains to degree of resistance
If resistance is low, susceptible person is prone to infection
Types of Hosts:
1.1)
Patient
A person infected manifesting signs and symptoms
1.2) Carrier
Individual who harbors microorganisms but shows no signs
and symptoms
1.3) Suspect
Individual whose medical history and symptoms suggests
that he may be developing a specific infection
Signs and symptoms are suggestive
1.4) Contact
Individuals who come in close association or in contact or
exposed to infected person
Horizontal Transmission
Manner of transfer of microorganisms is in a horizontal
position
Vertical Transmission
Manner in which microorganisms are transferred is in a
vertical manner from up going down
Example:
o Infected mother to newborn child transmission
Concepts:
The PATIENT is the least source of infection
The PATIENT has the least chance to spread
microorganisms
o Because he manifests signs and symptoms of
the disease, he is isolated
o Precautionary measures are now taken
The CARRIER has the highest potential to spread infection
o Because he does not manifest signs and
symptoms of the disease
o However, he has the microorganisms
Infectious Diseases
Diseases wherein there is a presence of a living
microorganism in the body, which may not be transmitted
through ordinary contact
Need not be transferred from one person to another
Concept:
There must be an interplay between the three factors:
Host
Agent
Environment
for infection to set in.
2. AGENT
Microorganisms
They have the highest population among all living things
Not all are susceptible to microorganisms
Not all microorganisms are virulent
CHAIN OF INFECTIOUS PROCESS

A cycle
It is continuous
Concepts:
Virulence
Strength and power of microorganisms to cause infection
Pathogenicity of microorganisms
Capacity of microorganisms to cause infection
Six (6) Factors

1. Causative agent
Microorganisms
Two (2) most common microorganisms causing infections

Bacteria
Viruses
Bacteria
Can multiply in both living and non-living things
Cannot pass through filters in the body because they are
big
Therefore, it is okay to have bacterial infection even during
pregnancy, except for Treponema pallidum, which passes
through the placental barrier after the 16 th week of
pregnancy.
Syphilis is not fatal in the first trimester
Syphilis is fatal in the third trimester
Anti-bacterial medications give only temporary immunity
Viruses
Can only multiply in living things
Reservoir is a living thing
Can pass through the body filters:
o Blood Brain Barrier
o Placental Barrier
It gives rise to self-limiting diseases
Viral infections have own time frame
Example:
o Colds last for 2-3 days with watery secretions as
symptoms
After this, complications would be the
one present with yellowish or mucoid
discharges probably indicative of
sinusitis
o Influenza is present for one week
After one week, pneumonia sets in.
Medical management for viral infections:
o Treated symptomatically not by anti-viral agents
o Antibiotics may be used to treat secondary
bacterial infections
o Purpose is to increase body resistance
2. Reservoir
A place where microorganisms can live and multiply
Examples:
o T. pallidums reservoir is the human genitalia
o Measles virus reservoir is the nasopharynx
o Salmonella typhosas reservoir are the Peyers
patches of the small intestines
3. Portal of Exit
From the reservoir, microorganisms look for a way out
This pertains to the individuals body system
Examples:
o T. pallidums portal of exit is the genitourinary
system
o Measles virus portal of exit is the respiratory
system
o Salmonella typhosas portal of exit is the
gastrointestinal tract
4. Mode of Transmission
When outside of the host, this pertains to the
microorganisms means of transportation
Examples:
o T. pallidums mode of transmission is sexual
contact
o Measles virus mode of transmission is airborne
nuclei
o Salmonella typhosas mode of transmission is
fecal-oral ingestion
5. Portal of Entry
A microorganisms way in to the new host
Also corresponds to the individuals body system
Examples:
o T. pallidums portal of entry is the genitourinary
system
o Measles virus portal of entry is the respiratory
system
o Salmonella typhosas portal of entry is the
gastrointestinal tract
6. Susceptible Host
Concept:
Objective or goal is to limit, prevent or control spread of
communicable diseases by breaking the chain of diseases
Look for the weakest link in the chain
3. ENVIRONMENT
Must be conducive and favorable to growth of
microorganisms
Example:
o Clostridium tetani will not cause infection in the
presence of oxygen because it is an anaerobic
microorganism
Among the six (6) factors, the MODE OF TRANSMISSION

is the weakest link
o It is not the CAUSATIVE AGENT because of its
huge population
o It is not the RESERVOIR (i.e. you cannot remove
the nasopharynx in humans infected by measles
virus)
o It is not the PORTAL OF EXIT nor the PORTAL
OF ENTRY (i.e. you cannot remove the genitals
of humans infected by T. pallidum)
o It is not the SUSCEPTIBLE HOST for you cannot
kill it.
IMPORTANT CONCEPTS!!!
Typhoid mode of transmission is fecal-oral ingestion
First word is the PORTAL OF EXIT
Second word is the PORTAL OF ENTRY
DO NOT INTERCHANGE THIS!!!
IMMUNITY
State of having resistance
State of being free from infection
Two (2) Types of Immunity
Natural Immunity
Acquired Immunity
1. Natural Immunity
Inherent in an individuals body tissues and fluids
A person is born with it
A person dies with it
It is within the genes that you have these antibodies
This is a rare type of immunity
Example:
o Race
Body produces antibodies non-intentionally by

nature that provides immunity
2.1.2) Artificially Acquired Active Immunity

Body produces antibodies because it was intentionally
done
Examples:
o Vaccines
Attenuated
(weakened)
microorganisms
o Toxoids
Attenuated
toxins
(poisonous
substances)
produced
by
microorganisms
Concepts!
When administering vaccines or toxoids, alcohol is NOT
used to clean injection site.
Use instead cotton balls with a clean bowl of water.
When alcohol is used, be sure alcohol HAS DRIED OFF
before administration of the vaccine or toxoid
If the site has not dried off, there will be VACCINE
FAILURE!
Therefore, squeeze off excess alcohol
2.2) Passive Acquired Immunity

Immunity is developed due to presence of antibodies within
the serum, which is not coming from the individual itself
You get it or it is given to you
Two (2) Types of Passive Immunity
2.2.1) Naturally Acquired Passive Immunity
Done by nature
Antibodies given or obtained by nature, in an unintentional
manner
Examples:
o Infants below six (6) months seldom develop
infection
o Maternal transfer of antibodies
o Placental transfer of antibodies
o Infants who are breast-fed
Colostrum intake
Contains antibodies from mother given
unintentionally
2.2.2) Artificially Acquired Passive Immunity
Administration of substances containing antibodies in an
intentional manner
Examples:
o Anti-toxins
o Anti-serum
o Gamma globulin
o Immunoglobulins
If both microorganisms and antibodies are to be given, do
not give both injections on the same site
Artificially Acquired Passive Immunity
o Provides immediate protection
2. Acquired Immunity
This is the more common type of immunity
It is either a person is able to PRODUCE it or a person is
able to GET it
Two (2) Types of Acquired Immunity
2.1) Active Acquired Immunity
An actual participation of the individuals body tissues and
fluid in PRODUCING immunity
You produce the antibodies yourself when microorganisms
are given to you
Two (2) Ways of Producing Antibodies:
2.1.1) Naturally Acquired Active Immunity
Antibodies are produced by nature
Unintentionally
Examples:
o Previous attack of a disease
o Chicken pox attack wherein antibodies are
produced by nature
o Measles attack wherein antibodies are produced
by nature
Sub-clinical immunity
o Developed due to constant exposure to certain
infection
Provides immunity for only a short period as

there are no reserves of it.
o Immunity is lost once exhausted
Active Immunity (i.e. vaccines and toxoids) provide
longer protection
o Because you produced the antibodies yourself,
they would be there anytime they are needed.
Pregnant mother can be given tetanus toxoid
Newborn receives naturally acquired passive immunity
o Natural because it is from mother
o Passive because it is done via placental transfer
Mother receives Artificially Acquired Active Immunity
Three (3) Factors to Know before taking care of Patients with
Communicable Disease
Know the CAUSATIVE AGENT
Know what BODY SECRETION harbors the microorganism
Know the MODE OF TRANSMISSION
o
when
Fever, diarrhea and colds are NOT CONTRAINDICATIONS

to Immunization. Immunization can still be given despite
their presence
In a private setting, the physician can POSTPONE

IMMUNIZATION in the presence of fever, diarrhea, colds
because patient is returned by mother to the physician
once these conditions are resolved.
Current target group of Expanded Program on
Immunization of the Department of Health is composed of
CHILDREN BELOW FIVE (5) YEARS OLD
GENERAL CARE FOR PATIENTS WITH COMMUNICABLE

DISEASES
o (i.e. MMR vaccine)

Recent receipt of blood products
o Wait two (2) to three (3) months
Very severe disease
o Hospital confinement
o Hospital personnel will decide
immunization would be given
Immunocompromised situation
CDT VACCINE
Cholera, Dysentery, Typhoid Vaccine
Given by DOH for free
Adult dose is 0.5 cc
Adult injection site is the deltoid muscle
Child dose is 0.25 cc
Child injection site is the vastus lateralis
Given INTRAMUSCULARLY (I.M.)
Given when there are outbreaks of epidemic
Immunity lasts only for six (6) months.
Anti-Rabies Vaccine
Target group would be the animals
Animals are brought to the Barangay for free immunization
Barangay Captain is responsible for obtaining vaccines
from DOH
Dogs must initially be registered before this vaccine could
be administered
1.3) Environmental Sanitation
Objective:
o No proliferation of arthropods, rodents (both of
which are good vectors)
Presidential Decree 856
Sanitation Code
Also includes submission of sex workers in determination
of sexually transmitted diseases
o For gonorrhea two times a month
o For syphilis once a month
o Physical Examination once a month
Two (2) Aspects

Preventive Aspect
Control Aspect
1. PREVENTIVE ASPECT
You do not have infection yet
1.1) Health Education
Main goal is to effect change in knowledge, skills and
attitude
Change in behavior towards health
1.2) Immunization
Three (3) Laws in Immunization
Presidential Decree 996 Compulsory Immunization for
Children below Eight (8) years old
Proclamation No. 6 United Nations Universal Child
Immunization
Proclamation No.46 of 2000 National Immunization Day
Common Goal is to prevent the seven (7) Childhood Diseases
Tuberculosis (give Bacillus Calmette Guerin or BCG)
Diphtheria
Pertussis
Tetanus
Poliomyelitis (give Oral Polio Vaccine or OPV)
Hepatitis B
Measles (give anti-measles vaccine)
IMPORTANT CONCEPT
There are only two (2) PERMANENT CONTRAINDICATIONS to
Immunization
Allergy
Encephalopathy without known cause or convulsions within
seven (7) days after pertussis vaccine administration
Presidential Decree 825

Anti-Littering Law
Proper disposal of garbage
Anyone caught littering would have a penalty of Php2,000
to Php5,000 and imprisonment for one (1) year.
There are four (4) TEMPORARY CONTRAINDICATIONS for

Immunization
Pregnancy
1.4)
Proper Supervision of Food Handlers
A responsibility of the Department of Health facilitated by

its Sanitary Inspectors
Also a responsibility of the Bureau of Food and Drug
Monitors food and drug sold to public to assure that it is
safe for consumption
Elbow is the cleaner part
For Surgical Asepsis:

Hand is placed up and remains up
Hand is the cleanest portion
Elbow is less clean than the hands
2. CONTROL ASPECT
Done when signs and symptoms are already present
There is already the presence of infection
Goal is to limit the infection
2. Use of Protective Barriers or Use of Personal Protective

Equipment (PPEs)
If you wear them all, the correct sequence for wearing them
would be:
o Mask
o Goggles
o Cap / Bonnet
o Gown
o Gloves
If you are about to remove them, the correct sequence is:
o Gloves
o Do hand washing
o Gown
o Cap / Bonnet
o Goggles
o Mask
2.1) Isolation
Separation of an infected person during period of
communicability
Two (2) ways of Isolation
2.1.1) Strict Isolation
Intended to protect other persons (not the patient) from
infection
It intends to limit the microorganisms to be within the
patient
2.1.2) Reverse Isolation
Also called Protective Isolation
Intended to protect the immunocompromised patient from
infection
Intends to keep microorganisms out of the patient
Concepts:
Quarantine
Limitation of freedom of movement of a well person during
the longest incubation period
It involves the separation of persons who are carriers
These are persons who are not sick
These are persons who do not manifest signs and
symptoms of the disease
3. Avoidance of Needle Stick or Sharps Injury

Do not recap, bend or break needles
There must be puncture-resistant sharps collector
IMPORTANT CONCEPT!!!
If patient is diagnosed as having communicable disease,
practice both Standard Precaution and Transmission-based
Precaution
Transmission Based Precaution
Airborne Precaution
Use of mask
Special ultrafilterable mask
Particulate mask
o For measles, chicken pox, TB
Center for Disease Controls two (2) Revised

Isolation Precautions
1) Standard Precaution
Best strategy to prevent nosocomial infection
Slowly taking place of Universal Precaution
Applies to all patients regardless of their diagnosis
Applies to blood and all body fluids, excretions and
secretions except sweat.
Applies to mucous membrane and non-intact skin
Concept:
Universal Precaution
Has double standards
Used only if patient is diagnosed or suspected of having
blood-borne diseases
Elements included in Standard Precautions
1. Practice hand washing for each patient care
For contact with body fluids of patient
Duration is 10 15 seconds
Length of washing is not important
What is important is the friction that is applied
Concepts:
For Medical Asepsis:
Hand is lower than the elbow
Hand is the dirtiest part
Droplet Precaution
No contact to mucous membrane, nose, mouth
Use mask ordinary mask will do
Use goggles
o For meningitis, mumps, pertussis, German
measles, diphtheria
Contact Precaution
Avoid person to person contact
Use gloves
Use gown
For diarrheal diseases, typhoid, cholera, hepatitis, skin
diseases like ringworm, scabies and pediculosis
Control Measures other than Isolation
1. Disinfection
Killing of pathogenic microorganisms by physical or

chemical means (i.e. boiling, soaking)
Important Concepts:
When inside the human being, the spore transforms into a
VEGETATIVE FORM, which can be destroyed by the
presence of oxygen
Why is Clostridium tetani abundant in soil?
o Normal habitat of C. tetani is in the intestines of
herbivorous animals (i.e. cows, carabaos, goats,
sheep, horses)
o Manure of these animals is used as fertilizer
Mode of Transmission of C. tetani
o Break in skin integrity
Person is at risk for infection when there is any kind of
would (i.e. splinter or salubsob, tooth decay, otitis media)
Types of Disinfection
Concurrent Disinfection
Done when the person is still a source of infection
Example:
o When patient is still in the hospital
Boil all patient gowns
Terminal Disinfection
Done when person is no longer a source of infection
Example:
o Room of patient is cleaned upon discharge of
patient using UV rays or Lysol
Important Concepts!
You need not be wounded by a RUSTY OBJECT to acquire
tetanus
In the newborn, tetanus neonatorum is caused by poor
cord care.
When C. tetani enters the body, it seldom migrates to the
bloodstream where oxygen is present
C. tetani remains in the wound but the effects are systemic
2. Disinfestation
Killing of undesirable small animal forms such as
arthropods, rodents, insects by physical or chemical means
3. Fumigation
Use of gaseous agents to kill arthropods, rodents and
insects.
IMPORTANT CONCEPT!
Toxin is released to the blood and is responsible for the
manifesting signs and symptoms of the disease
4. Medical Asepsis
Hand washing
Gloving
Gowning
Masking
Placarding
o Placing NO SMOKING sign when there is
oxygen inhalation in progress.
Two (2) Types of Toxins in Tetanus

1. Tetanolysin
Dissolves red blood cells
Results to anemia
Thus, patient is pale-looking
COMMUNICABLE DISEASES OF THE CENTRAL NERVOUS

SYSTEM
2. Tetanospasmin
Causes muscle spasm
Acts on MYONEURAL JUNCTION of the muscles and on
the INTERNUNCIAL FIBERS of the spinal cord and the
brain.
Results into multiple muscle spasms
Inhibits the spastic muscle from sending transmissions to
the brain, which would inhibit progression of spasms. Due
to this, adjacent muscles will also undergo spasm similar to
a chain reaction or a domino reaction.
Bacterial infections
Tetanus
Meningitis
Viral Infections
Encephalitis
Poliomyelitis
Rabies
TETANUS
Also called LOCKJAW
With painful muscular spasms
Ten times more painful than leg cramps
Sterilization is needed to kill the microorganism
In the wound, there would be an inflammatory response:

Rubor - rednes
Calor - heat
Tumor - swelling
Dolor - pain
Functiolaesa loss of function
Clostridium tetani
o Causative agent of Tetanus
o Anaerobic microorganism
o Abundant in soil, dust, clothing
o It exists in the form of a SPORE outside the
human body
o That is why it survives outside the human body
even in the presence of oxygen
Signs and Symptoms of Tetanus

The patient manifests:
o Restlessness
o Fever
o Profuse Sweating
Masseter muscle is involved
o It functions for mastication, for opening and
closing of the mouth
o Tetanus affects strong muscles
o Therefore, it affects the closing of the mouth
muscle
o This is called LOCKJAW or TRISMUS
Facial muscle is affected
o Gives rise to risus sardonicus
o Known as the Sardonic Smile
o Also known as Ngiting Aso
o Patient is smiling but his eyebrows are raised.
Spinal muscle is affected
o Resulting into the Ophistotonus position
o This is the arching of the back
o In the vernacular, it is called LIAD
Respiratory muscles are affected
o Results to difficulty of breathing, dyspnea and
chest heaviness
Genitourinary tract muscles are affected
o Results into urinary retention
o Intervention would involve catheterization
Gastrointestinal muscles are affected
o Resulting into constipation
Abdominal muscles are affected
o Results into abdominal rigidity
o Abdomen is hard as a board
o This sign serves as a basis for recovery
o If abdominal rigidity decreases, it means that the
patient is on his way to recovery
Extremity muscles are affected
o Results into stiffness of extremities
o There is difficulty in flexing
o Robot gait is evident
Three (3) Objectives of Medical Management

Neutralize the toxin
This is the top priority
The toxin is responsible for the signs and symptoms of the
disease and the systemic infection
Give anti-tetanus serum or tetanus anti-toxin
o It comes from a horse serum
o Do skin testing first
o If (+) for skin testing, DO NOT GIVE the drug.
Resort to human serum tetanus
immunoglobulin
Concept:
In the Philippine setting, the horse serum is still given
despite a positive skin test.
This is done by giving fractional doses.
Example:
o Initial administration of 0.01 of drug and 0.99
PNSS
o After 30 minutes, 0.05 of the drug and 0.95 of
PNSS
o After another 30 minutes, another increase in the
dose of the drug
When administering tetanus horse serum, always have
ready the following:
o EPINEPHRINE
o CORTICOSTEROID
These would be necessary to counteract any delayed
reaction, which may cause hypersensitivity reactions
leading to anaphylaxis and eventually the death of the
patient.
2. Kill the Microorganism
Give Penicillin
o This is the drug of choice to kill the bacteria
In the fresh wound, do daily cleansing with the use of
hydrogen peroxide
Then apply antiseptic solution like Betadine or Povidone
Then cover wound with THIN DRESSING to allow air to
circulate through the wound.
It may also be good to expose the wound but avoid contact
with flies.
Concept!
Thus, almost all of the muscles are rigid and stiff in
Tetanus!
Diagnostics for Tetanus:
1. Clinical Observation
Assess patient physically
Assess for the presence of lockjaw
If this is positive, a logical question would be Do you
have a wound
3. Prevent and Control Spasm

Give muscle relaxant
o Given during the acute phase of tetanus
o Done via the I.V. route
Give Diazepam / Valium
o Use I.V. push or I.V. drip
Concepts:
I.V. drip regulation is titrated based on the frequency of the
spasm.
o The more frequent the spasm, the faster the rate
of the titration
2. Obtain history of wound

Wound Culture
If there is a fresh wound, microorganism is still present
there
Concept:
The shorter the incubation period, the poorer the prognosis
Shortest incubation period is 2 3 days.
An incubation period of one month has a better prognosis
than an incubation period of 2 3 days.
When the patient is on his way to recovery, muscle

relaxants per orem may be used:
o Methocarbamol or Robaxin
o Lionesal or Baclofen
o Eperison or Myonal
Profuse sweating and draft exposure also leads to

pulmonary infection
Therefore, always keep patient dry; especially at the back.
Physical Injury
For falls:
o Never leave the patient alone
o If you do leave the patient, keep the padded side
rails up
o Keep call light within the reach of the patient
Fractures due to spasm:
o Caused by restraining by relatives
Proceed with other supportive management

For urinary retention, do catheterization
For constipation, administer laxatives as ordered
Nursing Management in tetanus
Muscle spasms are the first concern
Concept:
Stimuli trigger spasms.
Types of Stimuli:
Provide Patient with Comfort Measures

Oral care
o To prevent mouth sores
o Cotton swab used on inner and outer chick
o Do not use toothbrush
1. Exteroceptive
Comes from outside environment of the patient
Examples are bright light and noise
Place the patient in dim and quiet environment
2. Interoceptive
Comes from inside or within the patient
Examples are stress, pain, coughing, passage of flatus
3. Proprioceptive
There is participation of patient and other persons
Examples are touching, turning, jarring the bed of the
patient
Nursing Care in Tetanus
Done to prevent patient from having spasms
Place the patient in a dim and quiet environment
Practice minimal handling of the patient
o Avoid unnecessary disturbance of the patient
Practice Cluster Care
o Do all nursing care activities in one setting
o Do other nursing care activities with vital signs
taking
Gentle handling of the patient
Touching is not contraindicated
Turning is not contraindicated
o However, do these as gently as possible
o Inform the patient before proceeding with any
procedure
Concept:
o Tetanus patients are isolated so as not to be
exposed to stimuli
Attack of tetanus does not give permanent immunity
Vaccine Given:
Diphtheria Pertussis Tetanus Vaccine or DPT vaccine
When given:
o 1st Dose: 6 weeks after birth; 0.5 ml
o 2nd Dose: 10 weeks after birth; 0.5 ml
o 3rd Dose: 14 weeks after birth; 0.5 ml
Number of Doses:
o Three (3)
Interval between Doses:
o Four (4) weeks
Administration Site:
o Vastus lateralis muscle
Route:
o Intramuscular
Expect fever to set in after administration of DPT vaccine
o Give paracetamol
o Apply warm compress for better drug absorption
o Immediately follow up with cold compress to
avoid soreness
If tenderness or swelling on site of injection is present:
o Do cold compress within twenty-four (24) hours
o Then do warm compress
Observe for signs of convulsions within seven (7) days
after DPT immunization
o This indicates that child has reaction with the
pertussis component of the drug
o Therefore, succeeding doses of DPT will NOT BE
GIVEN
o Give ONLY the DT components
o If DPT is given again, this predisposes the child
to neurologic disorders
Observe if child cries uncontrollably
This is an indication of development of
neurologic disorders.
Prevent injury:
Respiratory injury
Airway obstruction
Tongue could be drawn back and cause blockage or
obstruction
Use padded tongue depressor for retaining patency of the
airway
Respiratory Infection
Turning to side is usually not done
o This results to pooling of respiratory secretions in
the lungs
o This leads to pulmonary infection
DPT Immunization for Pregnant Individuals

Dose: 0.5 ml
Route: Intramuscular
Number of Doses given:
o Two (2) doses with three (3) booster doses or;
o Two (2) doses with booster dose given every
pregnancy
When given:
o 1st Dose: Anytime during second trimester of
pregnancy
o 2nd Dose: With one (1) month interval
o Booster Dose: Given with successive
pregnancy/ies
o Pia mater
Cerebrospinal Fluid or
SUBARACHNOID SPACE
CSF
is
found
in
the
Causative Agents in Meningitis

Viral
o CMV Cytomegalovirus
Opportunistic infection for AIDS
Fungal
o Cryptococcal Meningitis
Source is excreta of fowls and
feathered animals
Another form of opportunistic infection
for AIDS
Bacterial
o Tubercle Bacilli
TB meningitis
Staphylococcal meningitis
o Secondary to skin infection
Haemophilus influenzae bacilli
o Common cause of meningitis in the United States
Meningococcemia
o Meningococcemial meningitis
o Spotted Fever Disease
o Most fatal
o The only type of meningitis where the
VASCULAR SYSTEM is affected
o Bleeding is triggered
o Disseminated Intravascular Coagulation occurs
and leads to vascular collapse
o Vascular collapse leads to death in ten percent
(10%) of patients
o This ten percent (10%) has the FULMINANT
TYPE or the Waterhouse-Freiderichen Syndrome
(characterized by vascular collapse)
o Causative agent is Neisseria meningitides
For High-Risk Individual

1st Dose given:
o 03-05-2005
2nd Dose given:
o 04-05-2005
3rd Dose given:
o 10-05-2005 (six months after the LAST dose)
4th Dose given:
o 10-05-2006 (After one (1) year from the LAST
dose)
5th Dose given:
o 10-05-2007 (After one (1) year from the LAST
dose)
Succeeding doses of Tetanus Toxoid are given based on
DATE OF LAST DOSE
If a person is high-risk, give booster dose every five (5)
years
If a person is low risk, give booster dose every ten (10)
years
Effect of Tetanus Toxoid administration on the Mother
Slight soreness or heaviness on site of injection
Important Concept!
In children below four (4) years old, Neisseria meningitidis
is a normal flora in the nasopharynx.
If resistance goes down, these children become prone to
infection
Mode of Transmission
Droplet transmission
In cryptococcal meningitis:
o Inhalation of spores
Portal of Entry
Respiratory system via the nasopharynx
Pathophysiology of Meningitis
From the nasopharynx, the microorganism goes to the
bloodstream
Once in the bloodstream, the microorganism causes
petechiae formation (pin point red spots on the skin)
From the bloodstream, microorganism goes to the
meninges and irritates them
o There is inflammation of the meninges and
accumulation of substances in the meninges
This results into increased Intracranial Pressure (ICP)
Wound Care
Wash wound with soap and running water
Place antiseptic solution on wound
Use thin dressing
Band Aid Plastic Strips are allowable as they have air
ventilation holes
Do not use plaster
Use only those types of plasters with air ventilation holes to
introduce oxygen to the wound
Key Concept!!!
Avoid Wounds
MENINGITIS
Inflammation of the meninges (covering of the brain and
spinal cord)
Concepts!
Meninges are composed of:
o Dura mater
o Arachnoid mater
Increased ICP leads to:

Severe headache
Projectile Vomiting
Two (2) to three (3) feet away from
patient
o Management involves turning patient to side
Position kidney basin about two (2) to
three (3) feet away
Altered Vital Signs
o Increased Temperature
o Decreased Pulse Rate
o Decreased Respiratory Rate
o Increase in Systolic Blood Pressure and Normal
Diastolic Pressure
This results in the widening of the
Pulse Pressure
Convulsions (seizures)
Diplopia
o Due to choking of optic discs
o Double vision but not crossed eyed
o Determined by finger counting
Altered level of consciousness
o
If pain is present, the patient is said to

be positive (+) for Kernigs Sign or
difficulty of extending the leg
Positive for Brudzinskis Sign
o Place the patient in supine position
o Flex the neck
o If there is no reaction, the patient is said to be
negative (-) for Brudzinskis Sign.
o If there is INVOLUNTARY DRAWING UP of the
LEGS / HIP upon flexion of the neck, the patient
is said to be positive (+) for Brudzinskis Sign
Diagnostic Tests for Meningitis

1. Lumbar Puncture
Cerebrospinal Fluid (CSF) is the specimen used
o Assess for the color of the CSF
Bacterial infection is present if:
o CSF is yellowish, turbid, cloudy
Viral infection is present if:
o CSF is clear
No infection is present if:
o CSF is clear
Send CSF for Laboratory Examination
Laboratory findings would show:
o Increased protein levels
o Increased White Blood Cell levels
o Decreased Sugar content
Concepts
If caused by bacteria, do Culture and Sensitivity test
o This is done to know what bacteria caused the
infection
o This is also done to determine what drug will be
used to kill the offending microorganism
Pathophysiology of Meningococcemia
Portal of entry of Neisseria meningitidis is also the
nasopharynx
The bacteria then goes to the bloodstream
Presence of bacteria in the bloodstream causes
ecchymosis
o These ecchymoses are blotchy (pantal-pantal)
purpuric lesions
o They are purplish in color
o Usually found on the wrist and the ankles
From the bloodstream, they go to the meninges and irritate
them.
Same sequence of events follow as mentioned above
If CSF is clear, it is subjected to Counter ImmunoElectrophoresis (CIE)

This is done to determine if causative agent or a protozoa
IMPORTANT
CONCEPT!!!
In patients with HIGHLY INCREASED INTRACRANIAL
PRESSURE due to CNS infection, lumbar puncture or
aspiration of the CSF is CONTRAINDICATED
o This will bring about HERNIATION OF THE
BRAIN and would eventually lead to death
Therefore, it is important that the nurse performs Physical
Assessment before doing a lumbar tap.
2. Blood Culture
Done because microorganism can travel to the
bloodstream
Medical Management of Meningitis
If bacterial
o Give anti-bacterial agent in the form of antibiotics
If viral
o Symptomatic
If fungal
o Give Amphotericin B
If with inflammation
Signs and Symptoms of Meningitis

Once the microorganism is at the nasopharynx:
o Fever
o Headache
o Sore throat
o Cough
o Colds
Other signs and symptoms present as discussed in the
pathophysiology
Pathognomonic Sign of Meningitis
Nuchal Rigidity
Stiffening of the neck
o No flexing of the neck
o No hyperextending of the neck
o No turning from side to side
Abnormal Reflexes
o Positive for Kernigs Sign
Place patient in supine position
Flex both knees toward the abdomen
Then ask the patient to extend the legs
10
Give corticosteroids in the form of

DEXAMETHASONE
o Never give PREDNISONE
Prednisone does not cross the BloodBrain barrier
Prednisone causes sodium retention
Retains CSF
If with excess CSF
o Give osmotic diuretic in the form of MANNITOL
o Check blood pressure before administration as it
causes hypotension
o Monitor the intake and output to evaluate the
effectiveness of Mannitol
o Expect that after two (2) to three (3) hours, the
urine output must increase by thirty (30) to fifty
(50) ml.
o If no changes in urine output occurs, then
Mannitol is not effective
o Refer this to the physician
If there are convulsions due to CNS infection
o Give anti-convulsants
Dilantin
Phenytoin
Routes of Administration of Dilantin
o Per Intravenous
Nursing Care for I.V. administration of
Dilantin
Sandwich Dilantin with NSS
NSS Dilantin NSS
Rationale:
Dilantin would crystallize
o Per Orem
Nursing Care for P.O. administration of
Dilantin
Do frequent oral care
Do gum massage
o Rationale:
Dilantin causes gingival hyperplasia or
overgrowth of the gums
Priority is to relieve headache within thirty (30) minutes

o Provide diversion
o Provide proper positioning
Low-Fowlers position (30 incline)
o Provide comfort measures
o Massage the forehead
o Do petrissage with circular action
3. Potential for injury related to altered level of consciousness
Never leave the patient alone
Place call switch and light within reach of patient
4. Potential for fluid and electrolyte imbalance due to projectile
vomiting
Monitor intake and output
Provide fluids per orem
Important Concept
An attack of meningitis does not provide permanent
immunity
Preventive Measures
1.Proper disposal of nasopharyngeal secretions
Burning
Burying
Proper procedure for disposal of nasopharyngeal
secretions
o Use tissue paper
o Put it in a plastic bag after use
o Knot the plastic bag
o Dispose plastic bag in a trashcan
Important Concepts!
The best and most economic way preventing spread of
infection is through swallowing of nasopharyngeal
secretions
o This brings the secretions to the stomach and to
the intestines and would then be eliminated in the
stool
Children have less chance of spreading infection because
they swallow nasopharyngeal secretions.
This is contraindicated, however, for tuberculosis patients
Thus, for TB patients, they have to spit out nasopharygeal
secretions
Swallowing is allowable for other respiratory infections
Important Concept!
Dilantin is never given Intramuscularly
o This is irritating to the tissues
o This has an erratic effect
2. Cover nose and mouth when sneezing and coughing

Important Concepts!
When you transfer patient
o Make the patient wear a mask so as not to infect
people in the hallway, elevator, etc.
Wear mask when you enter the patients room
3. Vaccine
Hib vaccine for Haemophilus influenza
Nursing Care
Symptomatic
Supportive
Nursing Diagnoses
1. Alteration in body temperature related to infection
Priority is to lower body temperature
o Do TSB
o Provide cold compress
o Provide loose clothing
2. Pain: Alteration in comfort related to increased Intracranial
Pressure
BRAIN FEVER
Arbovirus
Arthropod-borne Virus
Primary cause
St. Louise
11
Japan B
Australian X: Equine (E-W)
Mosquito bites
o Aedes Sollicitans
o Culex tarsalis
Ticks of horse
Migratory birds
Secondary cause
Post racene encephalitis
Toxic
Metal poisoning
o Lead poisoning
o Mercury poisoning
POLIOMYELITIS
Also called:
o Infantile Paralysis
o Heine-Medin Disease
Affects children below ten (10) years of age
Less risk for people above ten (10) years Old
Causative Agent
Virus
o Legio debilitans
Type 1 Brunhilde
Type 2 Lansing
Type 3 Leon
If Brunhilde
o Gives permanent immunity
If Lansing or Leon
o Gives temporary immunity
ENCEPHALITIS
Signs and Symptoms
With altered level of consciousness
With lethargy
o Difficult to awaken
o Patient is abnormally sleepy
With behavioral changes
Brain is immediately affected relative to meningitis
Important Concepts!
When Brunhilde infects you, Leon or Lansing will no longer
affect you!
In the Philippines, the most prominent type is Brunhilde!
Droplet
o In early stage of infection, virus if found at
nasopharyngeal secretions
Fecal-Oral Route
o In late stage of transmission, virus is found at the
mouth
Diagnostic Tests
1. Lumbar Puncture
Specimen is cerebrospinal fluid (CSF)
Laboratory Results would indicate:
o Increased Proteins
o Increased White Blood Cells
o Normal Sugar Content
Portal of Entry
Gastrointestinal Tract
Pathophysiology
Legio debilitans goes to the nasopharynx or the mouth
If in the nasopharynx, it goes to the tonsils and causes:
o Sore throat
o Fever and chills
o Headache with body malaise
If at the mouth, it goes to the Peyers patches and causes:
o Abdominal pain
o Anorexia
o Nausea and Vomiting
o Diarrhea or Constipation
2. Electroencephalogram (EEG)
To assess extent of brain damage
Patient recovers but because he is epileptic, he develops
irreversible brain damage
Medical Management
Symptomatic due to viral cause
Concepts!
No permanent immunity is obtained from attack of
encephalitis, only temporary immunity, due to causation by
various viruses
Source of infection is mosquito
Preventive Management:
CLEAN PROGRAM
o C Chemically Treated Mosquito Net
o L Lavivorous fishes
o E Environmental Sanitation
o A Anti-mosquito Soap (Basic Soap)
o N Neem Trees or Eucalyptus Tree (draws away
mosquitoes)
Concepts!
To kill mosquitoes in canal, pour oil or gas in canal
o This depletes oxygen present in the canal
o There is no need to light it up
STAGES of POLIOMYELITIS
1ST Stage: Invasive Stage or Abortive Stage
All the abovementioned signs and symptoms will appear
Patient recovers
Disease process is aborted
But there will be instances when disease process will not
be aborted
Tonsils
Cervical
12
Peyers Patches
Mesenteric
Lymph
Lymph
Nodes
Nodes
BLOODSTREAM
Central Nervous System
Three (3) Types of Paralysis

1. Bulbar Type
Cranial nerves are affected
9Th cranial nerve (Glossopharyngeal Nerve) and 10 th cranial
nerve (Vagus Nerve) affectations give rise to:
o Respiratory problems
o Vocal cord swelling / paralysis
o Excessive salivation
o Aspiration
o Regurgitation
2. Spinal Type
Most common type of paralysis
Affects ANTERIOR HORN CELLS
Affects MOTOR FUNCTION
o Paralysis of extremities
o Paralysis of intercostal muscles leads to
DIFFICULTY OF BREATHING
2nd Stage: Pre-paralytic Stage of Poliomyelitis

Central Nervous System is already involved but there will
be no paralysis
Signs and Symptoms:
Once in the CNS, microorganism will cause:
o Sever muscle pain
Do not keep on turning or holding
patient
Do not do massage
No positioning will relieve patient
o Instead, what would relieve the patient would be:
Application of warm packs
Analgesics
o Never administer Morphine
It is a narcotic analgesic that would
cause respiratory depression
3. Bulbo-Spinal Type
Combination of Bulbar and Spinal types
Patient has cranial nerve affectations and anterior horn cell
affectations
Once in the CNS, the microorganism will also cause:

o Stiffness of the hamstring
o Patient will be positive for HOYNES Sign and
exhibit a HEAD DROP
o To check for Hoynes Sign
Lift shoulders of patient when lying
supine or extend head of patient
beyond the edge of the bed
If head of patient drops, he is said to be
positive (+) for Hoynes Sign
Important Concepts!!!
Not all patients will develop paralysis
If patient is non-paralytic,
o He has GOOD PROGNOSIS
Diagnostic Tests
1. Lumbar Puncture
Laboratory results would reveal:
o Increased White Blood Cell levels
o Increased Protein levels
o Normal Sugar levels
2. Muscle Testing
To determine what specific muscle is affected
3. Electromyelogram
To determine extent of muscle involvement
4. Stool Examination
Perfomed at the late stage
About ten (10) days after being affected
5. Nasopharyngeal Examination
Performed at the early stage
Medical Management
Symptomatic
Causative agent is viral
If there is respiratory paralysis
Place patient in a MECHANICAL VENTILATOR
Use the IRON LUNG MACHING
o This works on the principle of Negative Pressure
Breathing
o No tracheostomy tube needed (tracheostomy
tube or endotracheal tube work on the principle
of Positive Pressure Breathing)
o Capsular in shape
o With glass windows
Once in the microorganism is in the CNS, the patient would

elicit a POKER SPINE
o Ophistotonus with head retraction
o Sitting position cannot be assumed
o Therefore, patient will assume a TRIPOD
POSITION
Central Nervous System
Paralysis
Concept!
From the CNS, the patient will experience paralysis.
This leads to the third (3rd) stage of the disease
rd
3 Stage: Paralytic Stage
Presence of paralysis
Characteristics of Paralysis:
o Flaccid
Soft
Flabby
Limp
Important Concept!
Flaccid Paralysis is PATHOGNOMONIC SIGN
Poliomyelitis
of
13
With metal plate

Works on electricity
During brownout or power shortages, operate the
machine manually
o It has a steering wheel, which can be
manipulated manually
o Patient stays in the Iron Lung Machine for
months
Nursing Care for Poliomyelitis
Symptomatic and Supportive
Psychological Aspect of Care
o Use empathy
o
o
o
o
o
2. Avoid mode of transmission

Proper disposal of nasopharyngeal secretions
Cover mouth when coughing
Do not put anything through the mouth
Preventive Measures
1. Immunization
Vaccine given:
o Oral Polio Vaccine (OPV) or Sabin
o Dose:
Two (2) to three (3) drops
o Route:
Oral
o Number of Doses:
Three (3)
o Interval:
Four (4) weeks
o When given:
1st Dose at six (6) weeks old
2nd Dose at ten (10) weeks old
3rd Dose at fourteen (14) weeks old
o Important Concepts!!!
Do not feed child for thirty (30) minutes
after administration of OPV
o Rationale:
For better absorption
o If child vomits, REPEAT!!!
o If child has diarrhea
Give OPV
But do not record it
Not all of the vaccine may be absorbed
properly
When OPV 3 is given four weeks after,
record it as OPV 2
Three (3)
Interval:
Four (4) weeks
When given:
1st Dose at six (6) weeks old
2nd Dose at ten (10) weeks old
3rd Dose at fourteen (14) weeks old
Rationale:
Because stool of child may contain the
virus if OPV is given
RABIES
Also called:
o Hydrophobia
o Lyssa
o La Rage
A disease of a low form of animal
o Not a human infection
o Only accidentally transmitted to man
Occurs in canine animals or animals with fangs:
o Fox
o Wolves
o Boar
o Monkeys
o Bats
o Cats
o Dogs
Causative Agent:
Rhabdovirus
o A neurotropic virus
o Has special affinity to neurons and the Central
Nervous System
R H A B D O V I R U S
Peripheral
Efferent
Nerves
Nerves
CNS
Salivary
Pathologic
Gland
Lesions
of Rabid
(negri bodies)
Animal
Integrated Management of Childhood Illnesses (IMCI)

o Tell mother also that she should be very careful
in handling stool of child because this vaccine
eliminates virus to the stool
o If
significant
others
at
home
are
immunocompromised
o Do not administer OPV
o Due to feces of child
o Rather give, IPV or Inactivated Polio Vaccine /
SALK
o Dose:
0.5 cc
o Route:
Intramuscular
o Number of Doses:
Important Concept!
Pathologic lesions that are formed as microorganism
multiplies
If there is no multiplication of the microorganisms at the
Central Nervous System, there will be NO negri bodies.
Contact with saliva of a rabid animal
14
Important Concept!
Therefore, you need not be bitten
Even a scratch could cause rabies as animals lick their
paws
Infection may occur through:
o Corneal transplantation
o Kissing animal
o Dog licking wounds
Important Concept!
When a family member at home is bitten by a rabid animal,
vaccinate all people at home because patient has virus at
saliva
Stage 2 Excitement Stage
Acrophobia
o Fear of Air
Hydrophobia
o Fear of Water
Important Concept!
Air and Water both cause PHARYNGOLARYNGEAL
SPASM
This is characterized by:
o A drowning sensation
o Strangulation to death syndrome
o Like breathing in thick smoke
Other signs and symptoms
o Photosensitivity
o Maniacal behavior
o Resembles attitude of a rabid animal
o Easily agitated
o Runs after people
o Violent
o Club walls
o Jumps out of window
Important Concepts!
Before, THORAZINE and BENADRYL were given for
maniacal behavior but had proven to be ineffective
Now, HALOPERIDOL and BENADRYL are administered
and are very effective against maniacal behavior
Stage 3 Paralytic Sage
Patients spasms will stop
He can be fed, etc.,
Paralysis sets in from toes going upwards
If respiratory system is affected, the patient will die
Manifestation of signs and symptoms sets within 24 hours
and death follows
Important Concept!!!
Rabies is a preventable but not a curable disease
Maximum time before death occurs is seventy-two (72)
hours.
Manifestation:
In Animals
o Incubation Period
Three (3) to eight (8) weeks
Stages of Manifestations in Animals
Stage 1 Dumb Stage
Animal will have complete change in disposition
May show any of the following behaviors:
o Withdrawn
o Stays in one corner
o Depressed
o May be overly affectionate
Can lick wounds
o May be walking to and from
o Hyperactive
o Manic
It is better if the animal is withdrawn as it is easy to note
Stage 2 Furious Stage
Easily agitated
Easily bites
With vicious look
With drooling of the saliva
Expect the animal to die
Dying and biting happens on this stage
Animal can die without biting
Manifestation:
In Humans
o Incubation Period
Ten (10) days to twenty one (21) years
(this is the longest incubation period
recorded in the Philippines)
Stage 1 Invasive Stage
Numbness on the site of the bite
Itchiness on the site of the bite
Flu-like symptoms
o Fever
o Headache
o Sore throat
Marked Insomnia
Restless
Irritable
Apprehensive
Slight photosensitivity
Vague symptoms
Diagnostic Tests Done Before Patient Manifests Signs and

Symptoms
Important Concept!
There is no diagnostic examination done to humans, ONLY
TO ANIMALS
Brain Biopsy of the Animal
Identifies presence of negri bodies
10% of animals have rabies but are negative for negri
bodies
o Because virus may travel through efferent nerves
and may not have reached the CNS before death
Therefore, do the next test
15
Direct Fluorescent Antibody Test (DFA Test)

Confirmatory test for rabies
Observation of the Animal
Done for ten (10) days
Important Concept!
o Submit yourself for treatment if, within ten (10)
days:
Animal dies
Animal shows behavioral changes
Consider the following:
o Site of Bite
If above waist
Submit yourself for treatment
as soon as possible
This is due to the proximity of
the bite to the brain
o Velocity of Virus
Three millimeters per hour (3mm/hr)
o Extent of Bite
Submit yourself for treatment at once if:
You have multiple bites
You have a deep bite
o Reason for the Bite
If bite is provoked
Example:
You stepped on the dogs tail
Do not worry
If unprovoked
Example:
There is no reason
Then, WORRY, because IT
IS A RABID DOG!!!
Medical Management
Post-Exposure Prophylaxis Vaccines
If given intradermally (I.D.)

o No skin testing is done
Site
o Deltoid
o Vastus lateralis
If active form of vaccine
If via I.M.
Schedule is:
Dose
Day
Example Dosage
1st
00
03/05/
2 vials
2005
Purified Duck Embryo Virus

o PDEV
o Lyssavac
o Stock dose is 1.0 cc / vial
Purified Chick Embryo Cell

o PCEC
o Also one of the more common types
o Rabipur
07
3rd
21
3/12/
2005
3/26/
2005
1 vial
1 vial
Counting is ALWAYS BASED on the FIRST DOSE!!!
You can afford not to continue vaccine if dog does not die
after ten (10) days
However, continuance is encouraged because doing so
would give three (3) years of immunity
If you abort vaccination, you will not get three (3) years of
immunity
When you get bitten again, you start all over again
In case the dog:
o Died
o Disappeared
o Was killed within (3) days
Avail of complete doses plus a BOOSTER DOSE
o Booster Dose
Given at DAY 91
In the tabulated example
Schedule would be at
6/05/2005
Dosage is one vial
If via I.D.
Schedule is:
Dose Day
Example
Dosage
Remarks
1st
00
03/05/
0.1 cc if
Given on
2005
Verorab
each site:
or
Right and
0.2 cc if
Left
Lyssavac
Or
Rabipur
2nd
03
3/08/
0.1 cc if
Given on
2005
Verorab
each site:
or
Right and
0.2 cc if
Left
Lyssavac
Or
Rabipur
Active Form of Vaccine

Made up of microorganisms
Purified Vero Cell Vaccine
o PVCV
o One of the more common types
o Verorab
2nd
Remarks
1 cc on
each site;
One on
the left
and one
on the
right
One site
only
One site
only
If given intramuscularly (I.M.)
o Do skin testing first
16
3rd
4th
5th
07
28
to
30
90
3/12/
2005
04/01/
2005
to
04/03/
2005
06/03/
2005
0.1 cc if
Verorab
or
0.2 cc if
Lyssavac
Or
Rabipur
0.1 cc if
Verorab
or
0.2 cc if
Lyssavac
Or
Rabipur
0.1 cc if
Verorab
or
0.2 cc if
Lyssavac
Or
Rabipur
Given on
each site:
Right and
Left
o
o
o
Given on
one site
only
After seven days, patient already has antibodies

Computed Dosage is divided in two
Half is given Intramuscular
On the ventrogluteal muscle or at the
side of the buttocks
Other half is...
Infiltrated around site of bite using four
distinct points or
Given inside the wound of the patient
This is prophylactic and is not considered as a
treatment
Nursing Care
Place patient in a dim and quiet environment
Keep patient away from sub-utility room
Restrain the patient before he exhibits maniacal behavior
Wear all Personal Protective Equipment when you enter
the room because patient continues to spit
Preventive Measures
Be a responsible pet owner
o Have pets immunized
Wash wound with soap, water and antiseptic
Then observe the dog
Virus rabies is destroyed by 60C heat for thirty-five (35)
seconds
Therefore, you will not acquire rabies from eating dog meat
Given on
one site
only
Verorab
o Once reconstituted is only potent for eight (8)
hours
Antibodies are produced in about seven (7) days
Therefore, also give passive form of vaccine.
Passive Forms
Temporary antibodies
COMMUNICABLE DISEASES OF THE CIRCULATORY SYSTEM

DENGUE HEMORRHAGIC FEVER
Important Concept!
Dengue Fever is different from Dengue Hemorrhagic
Fever!
Dengue fever is an affectation of the circulatory system
without bleeding
o It is a mild form of hemorrhagic fever
Causative Agent:
Arbovirus
Carried from one person to another by an Arthropod
Types of Dengue Viruses
Type 1 Onyong-nyong virus
Type 2 Chikungunya
Type 3 West Nile
Type 4 Flavivirus
o Brought epidemics in several areas in the
Philippines
Mosquito Bite
Biological Transmitters
o Aedes aegypti
o Aedes albopectus
Mechanical Transmitter
o Culex fatigans
Biological Transmitter
After this mosquito has bitten an infected person, after
eight (8) to ten (10) days, it can transfer virus to other
people
Animal Serum
Equine Rabies Immunoglobulin (ERIG)
o Anti-rabies serum
o HyperRab
o FaviRab
Important Concepts!
Do skin test first
o If negative for skin test, give drug
Dosage is based on body weight and is
provided in direct proportion
0.2 cc / kg body weight is the standard
Example:
A 50 kg person would receive
10 ml of ERIG
Cost
is
approximately
Php1,800 / 5.0 cc
o If positive for skin test, give HRIG or Human
Rabies Immunolobulin
Imogam
Rabuman
0.133 cc / kg body weight is the
standard dose
Example:
A 50 kg person would receive
6.65 cc of HRIG
Cost is approximately Php4,500 / 2.0
cc
o This is given as a single dose within seven (7)
days from the date of the bite
17
Virus becomes a part of the system of the mosquito as long

as it is alive
Life span of these types of mosquitoes is four (4) months
Mechanical Transmitter
After this mosquito bites an infected person, the very next
person it bites is the only person who gets the virus.
One is to one
Immediate transfer of virus
Aedes aegypti
More common in the Philippines
Day-biting
Low-flying
Low-extremity biting
Breeds on clear, stagnant water usually in urban area
o Old tires
o Flower vases
o Plant cans
In the Philippines, any area is a dengue risk area
Other information:
o When it lands on a surface, body of mosquito is
on a PARALLEL POSITION and two (2) legs are
raised
o It has white stripes on legs
o It has a gray-millennium color
(causes easy
(allows shifting
bleeding;
of fluid from
difficult to stop
one
due to
compartment
thrombocytopenia;
to
poor clotting
another leads
to ascites;
hemoconcentration
Important Concept!
If patient recovers, he only has Dengue Fever (and not
Dengue Hemorrhagic Fever)
Dengue Fever is also called:
o Dandy Fever
o Breakbone Fever
DHF Grade 2
If there is persistence of signs and symptoms of DHF
Grade 1
If there is bleeding from:
o Nose epistaxis
o Gums gum bleeding
o Vomiting of blood Hematamesis (coffee ground
appearance from the stomach)
Upper Gastro-Intestinal Tract Bleeding
o Melena
Passing of black tarry stool
Acted upon by digestive enzymes
Lower Gastro-Intestinal Tract Bleeding
o Hematochezia
Passing of fresh blood in the stool
Then, these signs and symptoms indicate the START OF
HEMORRHAGIC FEVER
Four Classifications of Dengue Hemorrhagic Fever

DHF Grade 1
Increased grade fever (lasts 3 5 days)
o Even if antipyretics are given, fever will persist
o Fever will come down but the patient is still
febrile
o Important Concept!
Therefore, give antipyretic round the
clock
Pain is present
o Headache
o Periorbital pain
o Pain behind the eyes
o Joint and bone pain
o Abdominal Pain
Nausea and Vomiting
Presence of Pathological Vascular Changes
o Petechiae
o Hermans Sign
Generalized redness
Flushing of the skin
DHF Grade 3
Persistence of signs and symptoms of DHF Grade 2
With signs of circulatory collapse or failure
With cold clammy skin
Nursing Alert!
o Check for capillary refill
o How?
Apply pressure on nailbeds
Normal capillary refill time is about one
(1) to two (2) seconds
If capillary refill time is about three (3)
seconds or more, blood flow is sluggish
due to circulatory failure
Check Vital Signs
o Indicators of Circulatory Failure:
Hypotension or decreased blood
pressure
Rapid but weak pulse
Rapid respiration
DHF Grade 4
With signs and symptoms of DHF Grade 3
INFECTED MOSQUITO
BLOODSTREAM (multiplies)
Multiple lesions in the bloodstream
Increased
Increased
Capillary
Capillary
Fragility
Permeability
18
With shock
Hypovolemic shock due to excessive blood loss due to
uncontrolled bleeding
ASA is not given to children below twelve (12)

years old and when cause of disease is
unknown.
Side effect is Reyes Syndrome
A neurologic disorder associated
with viral infection
If there is bleeding
o Give coagulants
Vitamin K
Aquamephyton
Konakion
Vitamin C
To increase capillary
resistance
Provide blood transfusion
Nursing Management
Prioritize bleeding prevention and control
For gum bleeding
o Use cotton swab
o This is softer than any toothbrush
Provide ice chips
Advise patient to gargle
o It will not cause injury
o Use mouthwash
Use soft-bristled toothbrush
o Consider this as the last measure to be taken
compared with the three others above
Keep patient on NPO if patient vomits blood
Apply ice pack over epigastric region of patient
Doctor may order NGT insertion
For gastric lavage, use ice cold NSS or coagulant
Provide adequate nutrition
Avoid dark colored foods
Important Concept!
Attack of Dengue Hemorrhagic Fever does not give
permanent immunity
Prevention:
Practice CLEAN PROGRAM of the DOH
MALARIA
Also called Ague
King of tropical diseases
Manifested by indefinite periods of chills and fever
Important Concepts!
Microorganism is a PROTOZOA
Plasmodium has four species
o Plasmodium malariae
o Plasmodium ovale
o Plasmodium vivax
One of the most common in the
Philippines
o Plasmodium falciparum
Another of the most common in the
Philippines
o The most fatal due to its tendency to multiply
rapidly
Plasmodium is acquired through a mosquito bite
Anopheles mosquito
o
Diagnostic Tests for Dengue Hemorrhagic Fever

1. Tourniquet or Rumpel Leedes Test
Test for capillary fragility
Concept!
o This is only a presumptive test for DHF (not a
confirmatory test)
o Not all patients are subjected to this test
Three (3) criteria that must be present before you perform
the tourniquet test:
o Person must be at least six (6) months old
o Fever should be more than three (3) days
o No other signs of DHF are present
Patient only feels fever
If there are other manifestations (i.e. stomachache), do not
do tourniquet test
How is it done?
o Get the blood pressure of the patient
o Add systolic and diastolic pressures
o Divide the sum by two
o Apply that pressure on the cuff. . .
For five (5) minutes if the patient is
pediatric
For ten (10) minutes if the patient is an
adult
o Deflate the Blood Pressure Cuff
o Check for the presence of petechial formation
o If greater than or equal to petechial formations
per square inch, then patient is positive (+) to
Tourniquet Test
o Therefore, patient is probably suffering from
Dengue Hemorrhagic Fever
To confirm the diagnosis, do the next test. . .
2. Blood Examination
Platelet Count
o Normal value is 150,000 to 400,000 platelets per
cubic millimeter
o Values lower than the normal indicate that patient
is positive (+) for Dengue Hemorrhagic Fever
Hematocrit Determination
o Measures degree of hemoconcentration
o Normal value is 37% to 54%
o Values higher than the normal indicate that
patient is positive (+) for Dengue Hemorrhagic
Fever
Medical Management
Symptomatic
No specific treatment
Important Concepts!
If patient is febrile
o Administer antipyretic
o But never use aspirin
Potentiates clumping of platelets
Results to bleeding
19
Blood is needed by the female Anopheles mosquito for the

fertilization of its eggs
Important Concepts!
Anopheles mosquito is
o A NIGHT biting mosquito
It bites from sunset to sunrise or from
dusk to dawn
o It breeds in CLEAR, SLOW FLOWING WATER
o It is common in
Rural Areas
Mountainous Areas
Forested Areas
Palawan
Dumaguete
Surigao
o It lands on the surface on a forty-five (45) degree
angle or in a slanting position
Shaking, chattering of the lips is present

Nursing Responsibilities
o Provide warmth
o Blankets
o Warm drinks
o Not warm compress
o Hot water bag on soles of the feet
o Expose to heat lamp or droplight
Stage 2 Hot Stage
Last for four (4) to six (6) hours
The patient has:
o Fever
o Headache
o Abdominal Pain
o Vomiting
o Lower the body temperature
o Provide tepid sponge bath
o Provide cold compress
o Increase fluid intake
o Provide light, loose clothing
o Provide antipyretic as ordered
Stage 3 Wet Stage
Patient exhibits:
o Profuse sweating
o Feeling of weakness
Pathophysiology of Malaria
P LAS M O D I U M
BLOODSTREAM
Inside RBC (for

Those that dont
reproduction)
penetrate RBC
go to the LIVER.
They do nothing
and may remain
dormant for
3 5 years.
They wait for the
liver to release
the RBC for
them to
penetrate other
RBC
Inside RBC
o Make patient comfortable
o Keep patient dry and warm
o Provide fluids to prevent dehydration
o Make patient rest comfortably in bed
In other types of sicknesses or disorders, chills occur
before fever
This is due to bodys response to heat loss
In ordinary infections, higher temperatures are seen during
CHILLS because patient is trying to retain heat
In malaria, increased temperature occurs on FEVER or
HOT STAGE
There is no fever during the cold stage
Chills occur due to the release of Plasmodium
Key Concept!
If causative agent is P. falciparum, its rapid multiplication
and RBC destruction would lead to
o Anemia
o Liver then compensates and results to
HEPATOMEGALY
o Splenomegaly
o Mild jaundice sometimes occurs
o Cerebral Hypoxia
Restlessness
Confusion
Delirium
Convulsions
Loss of consciousness
Coma
Once inside the Red Blood Cells (RBC), the microorganism
multiplies and destroys the RBC.
This leads to ANEMIA!
Rupturing of membranes of Plasmodium coincides with the
presence of CHILLS in the patient
Presence of more or new microorganisms in the
bloodstream causes FEVER!
Important Concepts!
If you have malaria and your last attack is more than five
(5) years ago, then you can be a blood donor
If your last attack is less than five (5) years ago, you
CANNOT BE A BLOOD DONOR
Malaria can also be obtained by BLOOD TRANSFUSION
Manifestations of Malaria
Stage 1 Cold Stage
Lasts for ten (10) to fifteen (15) minutes
Chilling sensation is present
20
Black Water Fever

Passing out black urine or dark red
urine due to rapid RBC destruction
This may lead to death
A repeat bite from a malaria mosquito is not needed

because the microorganism may be dormant in the liver
Prevention
Practice the CLEAN PROGRAM of the DOH
COMMUNICABLE
SYSTEM
Diagnostic Tests for Malaria

Blood Smear or Malarial Smear
Best time to collect
o At the HOT STAGE
o At the peak of fever (this is when the
microorganism is in the blood stream)
Concepts!
During the Hot Stage, the microorganism is in the
bloodstream
During the Cold Stage, the microorganism is inside the red
blood cells
Quantitative Buffy Coat (QBC)
This is seldom done
This test is expensive
Specimen used is blood
A rapid test for malaria
You do not have to wait for fever to set in to undergo this
test
You can extract blood earlier
Medical Management of Malaria
Anti-malarial Agents
Drug of Choice
o Chloroquine
Other Drugs used:
o Primaquine
o Atabrine
o Pancidar
o Quinine
A reserve drug for severe type of
malaria
Important Concepts!
Anti-malarial agents are cautiously used in pregnant
women
They are considered as ABOTIFACIENT AGENTS
o They can cause ABORTION
However, this is NOT CONTRAINDICATED because if
mother (infected with malaria) is not treated, the child may
be born with NEONATAL MALARIA
Child with Neonatal Malaria exhibits the following:
o Decreased levels of RBC
o Immature liver
o Severe anemia
Child may die
Key Concepts!
Malaria may be acquired through:
o Blood Transfusion
o Vertical Transfusion
RBC passes through the placenta (not
the microorganism)
DISEASES
OF
THE
INTEGUMENTARY
Viral Communicable Diseases

Measles
German Measles
Chicken Pox
Herpes Zoster
MEASLES
Causative Agent
Morbilli
o Paramyxovirus
Rubeola Virus
Manifestations of Measles
1. Pre-eruptive Stage
Three (3) Cs
o Coryza
o Cough
o Conjunctivitis
Kuplick Spots
o Fine red spots with bluish white spot at the center
o Found at the inner cheeks
o This is the PATHOGNOMONIC SIGN of Measles
Eruptive Stage
Rashes are now present
Maculopapular Rashes
o Flat to elevated
o Reddish in color
o With blotchy appearance
o In the vernacular, pantal-pantal
o Face of the patient looks bloated
o Cephalocaudal distribution
Appears first on the hairline
Head to toe distribution
o Appears on the 3RD DAY of illness
o Within two (2) to three (3) days, the entire body
will be covered with rashes
3. Post-eruptive Stage
Time when rashes start to disappear
Fine, branny desquamation appears
Then the desquamation peels off
Peeling off proceeds in a cephalocaudal manner
It is only the rashes that will be peeling off, NOT THE SKIN
of the patient
Concept!
o Use of Colantro
o Has a burning effect
o Causes skin to likewise peel off
o Use of colantro is now discouraged
Important Concept!
An attack of Malaria does not provide permanent immunity
Diagnostic Tests for Measles
21
Concept!
There is no specific diagnostic test for measles
1.Clinical Observation
Medical Management for Measles
Symptomatic Management
Recovery dependent on Nursing Care
Nursing Care
Maintain and increase body resistance of the patient
Provide the following:
Adequate rest
Adequate nutrition
o No diet restrictions
o Provided that patient is not a hypersentitive
individual (i.e. prone to allergies)
o Seafood or poultry products are contraindicated if
the patient is allergic to these foods
o Increase oral fluid intake
o Especially those rich in Vitamin C
Keep patients back dry and warm
o Rationale
Exposure to draft gives rise to cough
and cold
It gives rise to a good medium for
growth of microorganisms
Leads to pulmonary complications like
pneumonia, which could lead to death
Provide hygienic measures
o Eye care
Measles patients have much MUTA
To prevent eye complications
o Ear care
To prevent otitis media
o Mouth care
o Nasal care
o Skin care
Taking a bath or taking a sponge bath
is not contraindicated
However, do not expose the patient to
draft
Other Nursing Care
Symptomatic nursing care
Patient is photophobic
o Provide dim and quiet environment
Route:
o Subcutaneous
Site:
o Deltoid muscle
Important Instructions to be given to the mother of the
patient!
o Child may experience fever
o Give paracetamol to lower the body temperature
o After three (3) to four (4) days, child will have a
rash formation. This is a NORMAL REACTION
to the vaccine
o In fact, it is a good reaction, indicating that the
patients body has produced anti-bodies to
measles
Important Concepts!
In the private setting, MMR vaccine is given
When:
o Age of fifteen (15) months
Dosage:
o 0.5 cc
Route:
o Subcutaneous
Site:
o Deltoid muscle
Ask mother if the child has allergies to egg and neomycin
o MMR is made up of duck embryo and neomycin
o If patient is allergic to egg
Give vaccine
But observe for signs and symptoms of
allergies
o If patient is allergic to neomycin
Do NOT give MMR vaccine
It may cause anaphylaxis
Important Concept!
DOH Program on Measles
o Ligtas Tigdas Immunization Program in 2004
Airborne
Prevention
Proper disposal of nasopharyngeal secretions
Cover the mouth when coughing or sneezing
Key Concepts!!!
Measles is not fatal by itself
Common complications
o Bronchopneumonia
o Encephalitis
GERMAN MEASLES
Also called:
o Rubella
o Three (3) day disease
o Poteln
Causative Agent
Pseudoparamyxovirus
Important Concept!
Attack of measles gives permanent immunity to the
disease
Key Concept!
When is the patient communicable?
Patient is communicable before rashes appear or during
the pre-eruptive stage.
Preventive Measures
1. Immunization
Anti-measles vaccine (AMV)
When given:
o Age of nine (9) months
Dosage:
o 0.5 cc
22
Rubella Virus
Togavirus
Droplet (not airborne)
o
Manifestations of German Measles

1. Pre-eruptive Stage
Fever may be present or absent
If patient has fever, it lasts only for one (1) to two (2) days
Patient has mild cough and mild cold
NO CONJUNCTIVITIS
o Therefore, he only has two (2) Cs.
Important Concept!
o Enanthem of German Measles are called
FORSCHEIMER SPOTS
Fine red spots
Also called petechial spots
Appears on the soft palate
2nd Stage Eruptive Stage
With maculopapular rashes
o Not reddish but pinkish
o Not blotchy but discreet
o Appearance is fine
o Slightly unnoticeable
o Rashes are smaller compared with those of
measles
o Also has cephalocaudal distribution
o Appears first at the head
Important Concept!
o Once the rashes appear, within twenty-four (24)
hours, the entire body is filled with rashes
o However, head-to-toe distribution is not as
distinct as in measles
Key Concepts!
o Patient is positive for enlargement of lymph
nodes
Suboccipital lymph nodes
Posterior auricular lymph nodes
Posterior cervical lymph nodes
o This is a differentiating factor between German
Measles (positive for enlargement of lymph
nodes) and Measles (negative for enlargement of
lymph nodes).
When is German Measles communicable?

o During the entire course of the disease.
o Until enlarged lymph nodes return to normal
German Measles is NOT FATAL
It can become fatal if patient is on her first trimester of
pregnancy due to chances of giving birth to a child with
congenital anomalies:
o Microcephaly
o Congenital Defect (Tetralogy of Fallot, etc.)
o Cataract leading to blindness
o Deafness and mutism
Mere exposure of pregnant woman to German Measles
MUST BE AVOIDED
o If exposed during the first trimester of pregnancy,
pregnant mother must immediately receive
immunoglobulin or gamma globulin within
seventy-two (72) hours.
After three (3) days, the virus has already passes through
the placenta
o Therefore, once pregnant, women should be
already given gamma globulin
German Measles is more fatal to pregnant women relative
to Measles
All people have been exposed to measles, therefore, antibodies to measles have already been developed.
Not all have been exposed to German Measles, therefore,
not all have developed anti-bodies to German Measles
MMR vaccine
o Measles, Mumps, Rubella vaccine
o If you are an adolescent, you can receive this but
do not be pregnant within the next three (3)
months because you may give birth to a child
with congenital anomalies
CHICKEN POX
Also called Varicella
Causative Agent
Varicella Zoster Virus
o Can be found both on:
Nasopharyngeal Secretions
Secretions of rashes
o But only causes infection if. . .
It enters the nasopharynx
o Does NOT cause infection by skin to skin contact
Airborne
3rd Stage Post-Eruptive Stage

Rashes now start to disappear
But they disappear at the third (3rd) day of illness
Important Concept!
o In measles, rashes just start to manifest
themselves by the third (3rd) day of the illness
o Enlarged lymph nodes will gradually subside
Three (3) Stages of Manifestation

Stage 1 Pre-Eruptive Stage
Presence or absence of low-grade fever
Headache
Body malaise
Muscle pain
Lasts for twenty-four (24) to forty-eight (48) hours
Stage 2 Eruptive Stage
Presence of rashes
o Vesiculopustular rashes
Diagnostic Tests, Medical Management, Nursing Management

and Preventive Measures for German Measles are THE SAME AS
THAT FOR MEASLES
Important Concepts!
An attack of German Measles gives permanent immunity
23
Development of Vesiculopustular Rashes:

o Initially, these rashes are macules FLAT
RASHES
o They will become elevated or become PAPULES
o Then, another set of macules appear
o The original rashes (now papules) will become
vesicles
o Pus then develops
Important Concept!
o It is only during the eruptive fever stage that you
can see all the following:
Macules
Papules
Vesicle
Vesiculopustular Rashes
Additional Concepts!!!
These rashes are itchy
Therefore, it is a MUST that the patient takes a bath DAILY
If the patient does not take a bath. . .
o Patient will perspire
o Patient will accumulate dirt
o Dirt + Wetness + Itchy rashes will lead to greater
itching and would eventually result into
SCRATCHING
Scratching may be avoided while the patient is awake
However, scratching during sleep is common among
Chicken Pox patients
Key Concept!
Do not scratch rashes
Scratching results to infection or pox marks!!!
Period of Communicability
o Until the LAST RASH has crusted!!!
o Easily and highly-contagious upon the
appearance of rashes
Important Concepts!
During the summer season, if you have not had chicken
pox and if you are immunocompromised, DO NOT GO
OUT
Duration of the Disease
o Two (2) weeks
Important Characteristic of Chicken Pox Rashes
Rashes have UNIFOCULAR appearance
They have one focus
Rashes appear one at a time and they NEVER FUSE
TOGETHER
There is always a gap between one rash to another rash
o If rashes get into contact with each other, it is no
longer Chicken Pox.
o It is HERPES ZOSTER
3rd Stage Post-Eruptive Stage

Rashes now start to crust
They start to dry
They start to peel off
If rashes start to dry, let them peel off by themselves
If allowed to dry and peel off, there will be no infection
However, it leaves a pox mark
Diagnostic Test for Chicken Pox
Clinical Observation
Medical Management of Chicken Pox
Symptomatic management as causative agent is a virus
Additional Concepts!
Zovirax or Acyclovir
o Not a treatment for chicken pox
o Virus is not always responsive to this drug
o Some viruses are resistant (drug has no effect)
while some are sensitive to it and patient will heal
within three (3) days
o Dosage is four (4) to five (5) tablets per day for
one week
Zovirax Cream
o Protects skin from infection but does not protect
against pox marks
Zovirax may be effective but it does not allow the patient to
produce antibodies.
Therefore, let the normal course of Chicken Pox occur
SCRATCHING WHILE ASLEEP
RUPTURES THE VESICLES
Permanent
Scar
(Pox mark)
Leads to skin
Infection
Becomes a
Boil,
or a Furuncle
(big Boil),
or a Carbuncle
(several boils
attached to one
another)
Results to cellulitis
or gangrene
Important Concepts:
The distribution of the rashes are:
o Generalized
o Found all over the body
Found first on the trunk
Found on the covered parts of the body
Then found on the scalp
Abundantly found on the covered parts of the body and
then on the exposed parts of the body
Key Concept!
Nursing Care for Chicken Pox

Same as in measles
But more focus should be given on SKIN CARE
o Rationale:
To prevent skin infection
Complication is encephalitis
Important Concepts!
Attack of Chicken Pox gives permanent immunity
Period of Communicability
o Until last rash has crusted
Preventive Measures
24
1. Immunization
Varivax
o Varicella Vaccine
Dosage
o 0.5 cc
Route
o Subcutaneous
For children below thirteen (13) years old
o Single dose is given
o Site of administration is the deltoid muscle
For those thirteen (13) years old and above
o Two doses are given
o With one (1) month interval
Same as in Chicken Pox

Additional Medical Management
Application of Potassium Permanganate (KMnO 4)
compress over the rashes of the patient
Rationale:
o To obtain three-fold effect
Astringent effect
To dry the rashes
Bactericidal effect
To decrease chances of skin
infection
Oxidizing effect
To deodorize the rashes and
remove the fishy odor
Important Concept!
An attack of Herpes Zoster does not give permanent
immunity
Most common complications of Herpes Zoster
o Skin infection
o Encephalitis
Preventive Measures
Same as that of Chicken Pox
Children are mostly affected in:
o German Measles
o Measles
o Chicken Pox
Adults are mostly affected in:
o Herpes Zoster

3.Cover nose and mouth when sneezing or when coughing
Important Concepts!
Not all of the Chicken Pox virus would leave your body.
Some are left behind, travel to the nerve and become
dormant
Therefore, next exposure to it will not give you Chicken Pox
New Varicella Zoster Virus will go to the nerve and activate
dormant virus to give you Herpes Zoster
Herpes Zoster is the dormant or inactive type of Chicken
Pox
You CANNOT have Herpes Zoster until you have obtained
Chicken Pox
Adults usually affected by Herpes Zoster because what is
affected is the ganglion of posterior nerve root
COMMUNICABLE DISEASES OF THE RESPIRATORY SYSTEM

Bacterial
Diphtheria
Pertussis
Tuberculosis
Pneumonia
Viral
Colds
Influenza
Causative Agent
Corynebacterium diphtheriae
(Klebs-Loeffler Bacillus)
This bacteria does not only affect the respiratory tract
o If it affects the mucous membrane, this is called
CUTANEOUS DIPHTHERIA
Types of Cutaneous Diphtheria
o Conjunctival Diphtheria
Conjuctiva is affected
o Vaginal Diphtheria
Vaginal mucosa is affected
o Diphtheria of the Prepuce
Affectation of the uncircumcised
prepuce of the male
o Wound Diphtheria
Affects wounds
Especially of burn patients
HERPES ZOSTER
Also called
o Shingles
o Zone
o Acute Posterior Ganglionitis
Causative Agent
Varicella Zoster Virus
Droplet
Manifestations of Herpes Zoster
Same as those of Chicken Pox
Rashes are also vesiculopustular
However, there are differences in the characteristics of
rashes
Herpes Zoster rashes are:
o Not itchy
o More of painful because nerves are affected
o Even if patient has recovered and rashes are
long gone, pain may be persistent up to two (2)
months. This is NORMAL
o Rashes do not have generalized distribution
o Has a unilateral distribution because it follows the
nerve pathway
o Always vertical or longitudinal (on one side)
o Rashes do not have unifocular appearance but
APPEARS IN CLUSTERS
Diagnostic Test and Medical Management for Herpes Zoster
25
Important Concepts!
Respiratory Diphtheria
o Is the more common type of diphtheria
Wound Diphtheria
o Is the rare type of diphtheria
3. Laryngeal Type
Affects the larynx or the voice box
With hoarseness of voice
With loss of voice
o Aphonia but only temporary
Larynx also serves as airway passage
o Therefore, there is:
Dyspnea
Difficulty of breathing
Body compensates and uses accessory muscles
Important Concepts!
Overuse of accessory muscles results to chest retractions
or chest indrawing
Normally, when a person breathes in, the chest expands
But with over usage of accessory muscles, chest wall does
not expand, rather, it DRAWS IN!!!
In order to detect chest indrawing, look at the subcostal
area (lower area of the chest region). This elevates due to
severe dyspnea
Do not look at the sternum or at the intercostals spaces
Check for chest indrawing when:
o The patient is calm
o The patient is not crying
o The patient is not breast-feeding (chest indrawing
is NORMAL under this condition)
o The patient is bottle-feeding (chest indrawing is
NORMAL under this condition)
Chest indrawing is constant in a patient with diphtheria
Chest indrawing is always present in any position in a
patient with diphtheria
Pseudomembrane is also present
o Present in the larynx
o Laryngoscope is needed to see the
pseudomembranes
Pseudomembranes may trigger cough
Characteristics of cough:
o Barking cough
o Dry
o Metallic
o Croupy
o Husky
Due to hoarseness of voice
Key Concept!
Laryngeal Type of Diphtheria may become severe
Droplet
Manifestations of Diphtheria
Depends upon its classification
Three (3) Types of Respiratory Tract Infections
1. Nasal Type
Nasal passages are affected
With irritating nasal discharge
o Characterized by serosanguinous secretion with
foul mousy odor (whitish, bloody, smells like a
rat)
Due to rubbing of nose, this results to upper lip and nasal
excoriation
Pathognomonic Sign
o Presence of pseudomembrane
o However, not appreciable in the NASAL TYPE
o This is found within the nasal septum
o Speculum is needed
o But is usually covered by irritating nasal
discharge
2. Pharyngeal Type or Faucial Type
Affects the pharynx and the tonsils
Patient complains of:
o Sore Throat
o Dysphagia
Presence of pseudomembrane, which is visible upon
opening of the mouth
Pseudomembrane is present on the following:
o Soft palate,
o Uvula
o Pillars of the tonsils
The pseudomembrane can be described as:
o Grayish-white membrane
o Like cigarette ash
Patient also has a BULL NECK appearance
o Enlargement of the neck
o Specifically of the anterior upper aspect of the
neck
o This is due to inflammation and enlargement of
cervical lymph nodes
o Anterior upper aspect of the neck is:
Reddish
Warm to touch
There is pain
Tenderness
The difference between a person with Pharyngeal Type of
Diphtheria and a person with double chin is that double
chin people have on their necks:
o Normal skin color
o Normal temperature
o No pain
LARNGEAL TYPE OF DIPHTHERIA
Laryngeal Edema
Airway Obstruction
Respiratory Obstruction
Respiratory Distress
Death
26
Waits for opportunities when hearts resistance to

go down:
When the heart is overloaded with work
When the heart is under stressful
activities
Therefore, provide COMPLETE BED REST
o
Therefore,
management
is
EMERGENCY
TRACHEOSTOMY
Among the three types of Diphtheria, Laryngeal Diphtheria
is the most fatal due to the possibility of respiratory
obstruction, which may lead to death.
Diagnostic Tests for Diphtheria
Signs and Symptoms of Myocarditis

Marked facial pallor
Very irregular pulse rate
Hypotension
Chest pain or epigastric pain
Important Concept!
When the above signs and symptoms are observed,
immediately seek consultation
2. Maintenance of Patent Airway
Proper position of patient
o Upright
o Semi-Fowlers
Encourage Deep Breathing Exercises and coughing
exercises with pursed lip
Chest Physiotherapy
Increased oral fluid intake to liquefy the secretions
Frequent turning to sides to prevent pooling of secretions
Do inhalation therapy with doctors order.
o Nebulization
o Steam Inhalation
Perform Postural Drainage with doctors order
If patient cannot expectorate, suction secretions as needed
3.
Provide
adequate
nutritious
diet
Soft diet due to the presence of dysphagia
4. Other nursing managements are symptomatic and supportive
An attack of diphtheria does not provide permanent
immunity since the causative agent is a bacteria
1. Schicks Test
Test for immunity or susceptibility to diphtheria
2. Moloney Test
Test to determine hypersensitivity to diphtheria toxin
Nose and Throat Swab
Most commonly done test
Confirmatory Test
o To identify the microorganism
o To determine if patient is still communicable
Important Concept!
o Patient is still communicable until three (3)
consecutive results of negative (-) nose and
throat culture are obtained
Medical Management for Diphtheria
Three (3) Objectives:
1. Neutralize the toxin
The toxin brings about systemic effects
Therefore, give anti-diphtheria toxin
o Do skin test first
o If positive for the skin test
Give drug
Because there is no Diphtheria Ig
But give in fractional doses
Also have ready and handy the following:
o Epinephrine
o Corticosteroid
2. Kill microorganism
Give anti-biotics
Drug of Choice
o Penicillin
Important Concept!
Scraping the pseudomembrane does not kill the
microorganism
It only causes bleeding
3.Prevent Respiratory Obstruction
Performance of emergency tracheostomy
Preventive Measures
1. Immunization
DPT vaccine
3. Cover the nose and the mouth when sneezing or coughing
4. Never kiss the patient.
Diphtheria affects all ages
Common in children
PERTUSSIS
Also called
o Whoofing cough
o Chin cough
Only affects children below six (6) years old
Causative Agent
Cocobacillus
Both aerobic and anaerobic
o Bordatella pertussis
o Haemophilus pertussis
Droplet
Manifestations of Pertussis
Nursing Management for Diphtheria

1. Place patient on complete bed rest until two (2) weeks after
recovery
Rationale:
o To prevent the number one complication
MYOCARDITIS
o Myocarditis leads to death
o Toxin released by microorganism has special
affinity for heart muscles
o Toxin released travels to the bloodstream
o Goes to the heart
27
Three (3) Stages
1. Catarrhal Stage
Highly contagious
Colds
Nocturnal coughing
o Coughing is present at night
Fever
Tiredness
Listlessness
2. Paroxysmal or Spasmodic Stage
With five (5) to ten (10) successive, forceful coughings,
which ends on a prolonged inspiratory phase or a WHOOF
To loosen mucous plug on airway (this causes the patient
to cough)
To loosen thick and tenacious secretions
Therefore, child coughs for five (5) to ten (10) times
When patient is unsuccessful in expectorating narrow
passageway requires long inhalation
If patient keeps on coughing
o He may choke on his mucous
o This results to vomiting
o Therefore, the patient is positive for vomiting
Due to pressure exerted on vomiting, there could be
o Congested face (bloated face)
o Congested tongue
Purple in color
Due to pressure exerted on the tongue
by the teeth when coughing
o Teary-red eyes with protrusion due to pressure
exerted when coughing
o Distention of face and neck veins
o Involuntary micturition and defecation
o Abdominal hernia due to pressure exerted on
abdominal wall when coughing
If patient is vomiting:
o Metabolic alkalosis occurs
This will trigger convulsions due to electrolyte imbalance
Convalescent Stage
Patient is no longer communicable
Signs and symptoms will now start to subside
Patient is now on the road to recovery
o Give mild sedation

Replace fluids and electrolytes lost due to vomiting
o No expectorant should be given to pertussis
patient
o This stimulates coughing
o Mucolytics are allowable
Nursing Management for Pertussis

1. Complete Bed Rest
To conserve the energy of the patient
Decreases oxygen demand
Decreases oxygen consumption
2. Prevent Aspiration
Proper position of patient
o Upright position in feeding
During spasmodic attacks of cough
o Hold all feedings and keep patient on NPO
(nothing per orem)
For children below six (6) years old:
o If bottle-fed
Inform mother that nipples in bottle
should only have a SMALL BORE to
lessen chances of aspiration
o Feed child with a medicine dropper
3. To manage vomiting:
Monitor Intake and Output
Assess for signs of dehydration
Provide proper I.V. regulation
Provide adequate fluids with extra aspiration precaution
4.Application of Abdominal Binder
To prevent abdominal hernia
Important Concept!
No permanent immunity from an attack of Pertussis is
acquired. However, second attacks are rare. Age
decreases risks
Preventive Measures
Same as for Diphtheria
But you can kiss the patient because you (adults) are
above six (6) years old (in Diphtheria, all ages are affected)
TUBERCULOSIS
Also called
o Kochs infection
o Phthisis
o Galloping Consumption
o Pulmonary Tuberculosis
Causative Agent
Mycobacterium tuberculosis
o Acid-fast bacteria
o Also known as tubercle bacilli
Airborne (most common)
Important Concept!
Therefore, there is no need to separate eating utensils!
Tuberculosis is not acquired through shared utensils.
Diagnostic Tests for Pertussis

1. Nasal Swab
2. Bordet-Gengou Test
Specimen is nasopharyngeal secretion
3. Agar Plates
4. Cough Plate
Medical Management
Anti-biotic Treatment
o Drug of Choice
Erythromycin
Pertussis Immune Globulin
For nocturnal cough
28
Tuberculosis is also acquired through ingestion of

contaminated milk
o Causative agent is Mycobacterium bovis or
Mycobacterium bovine
o Tuberculosis of Cattle
o From improperly pasteurized or improperly boiled
milk
Tuberculosis may also be acquired from birds
o Mycobacterium avium is the causative agent
o Obtained when taking care of infected bird
o Eating of the bird is not necessary to get infected
Mycobacterium avium Complex
o Most common opportunistic infection for AIDS
patients in the United States
Important Concept!
Patients infected with Tuberculosis bacilli are most of the
time asymptomatic
Symptoms are usually seen after four (4) to eight (8)
weeks.
TB2
Manifestations of Tuberculosis
Afternoon low-grade fever with night sweats
Anorexia
Weight loss
Fatigability
Body malaise
Chest pain / back pain
Positive for productive cough
Hemoptysis
Difficulty of Breathing
Anemia
Amenorrhea in females
Three (3) Classifications of Patients
1. According to Extent of Disease

Basis is on the CAVITATIONS IN THE LUNGS as seen
through Chest X-ray
o Minimal Pulmonary Tuberculosis
o Moderately Advanced Pulmonary Tuberculosis
o Far Advanced Pulmonary Tuberculosis
2. According to CLINICAL MANIFESTATIONS
Basis is the presence or absence of clinical manifestations
o Active Pulmonary Tuberculosis
Infected; with signs and symptoms
o Inactive Pulmonary Tuberculosis
Infective; without signs and symptoms;
with medication
3. According to American Pulmonary Society
Positive ( + ) to TB exposure
Positive ( + ) to TB infection
Positive ( + ) to TB testing
Negative ( - ) to TB symptoms
Inactive PTB patients and carriers are under this category
They are given prophylactic management so that they
would not exhibit signs and symptoms
Start on Anti-Tuberculosis drugs
o INH
o Isoniazid
The most effective TB drug
Side Effect
Peripheral Neuritis
Give Vitamin B6 or pyridoxine to counteract INH side effect
Increase Vitamin B6 by intake of:
o Beans
Mongo
Red beans
White beans
Black beans
o Prophylaxis is given for six (6) months
For children
o Prophylaxis is given for nine (9) months
For Immunocompromised patients
o Prophylaxis is given for twelve (12) months
TB3
TB0
Negative ( - ) to TB infection
Negative ( - ) to TB testing
Medical and other healthcare workers are under this
classification
They are given preventive management in the form of
Personal Protective Equipment (PPEs); and increased
body resistance through vitamins, adequate rest and
adequate hand washing
Negative ( - ) to TB exposure
Negative ( - ) to TB infection
Negative ( - ) to TB testing
Newborns are under this classification
They are given preventive management in the form of BCG
vaccine immediately after birth
TB1
29
Positive ( + ) to TB infection
Positive ( + ) to TB testing
Positive ( + ) to TB symptoms
Active PTB patients are under this classification
They are given curative management
Combination of Anti-Tuberculosis drugs to prevent drug
resistance
Short-Course Chemotherapy
o Composed of RIP(E)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
May or may not be given
Standard Regimen
o Composed of SI(E)
Streptomycin
Isoniazid
Ethambutol
May or may not be given
Short-Course Chemotherapy Side Effects
Causes hepatotoxicity
Nursing Management
o Therefore, monitor liver enzyme tests
Advise patient to avoid alcoholic beverages, which
increase hepatotoxic effects
Assess patient for vertigo, which is another sign

indicative of ototoxicity
Key Concept!
The American Pulmonary Society classification is the best
classification!!!
Diagnostic Examinations for Tuberculosis
1. Tubercullin Testing
This is only a screening test for Tuberculosis
If result is positive ( + ), it does not mean that the person is
infected but the person may have an exposure
If result is CONSISTENTLY POSITIVE, it means that the
patient is sensitive to the organism
o This test uses Purified Protein Derivative or PPD
o PPD is administered intradermally
o Tubercullin testing is interpreted after forty-eight
(48) to seventy-two (72) hours
o A positive result would give you an induration of
greater than ten (10) mm.
o If patient is positive for HIV, a positive result
would give the patient an induration of greater
than five (5) mm
Three (3) Ways of Performing Tubercullin Testing
1.1) Mantoux Test
Just like a skin test
Utilizes the same technique as a skin test
Uses PPD
Interpreted after forty-eight (48) to seventy-two (72) hours
Positive result is bigger wheal induration
1.2) Tine Test or Multi-puncture Test
Soak sterile needle in PPD for three (3) to four (4) hours
Get arm
Puncture for six (6) to eight (8) times in a circular manner
This is commercially prepared
This utilizes a special syringe with four (4) small needles
for one simultaneous application
1.3) Vollmer and Pirquet Test
Skin scratch or skin patch test
Get sterile needle
Get gauze containing PPD
Apply this gauze over the scratch or tape this gauze over
the scratch
Keep gauze on for seventy-two (72) to ninety-six (96) hours
Remove after three (3) to four (4) days
Results cannot be interpreted yet
Wait for another forty-eight (48) to seventy-two (72) hours
Therefore, results could be obtained after five (5) to seven
(7) days!!!
Important Concept!
Mantoux Test is the best type of test!!!
o Easier to perform
o Less pain to patient
o Most accurate results
Key Concept!
Rifampicin
Side effects are:
o Orange urine
o Orange tears
o Orange secretions and excretions
o Orange saliva
o Orange sputum
o Orange feces
Nursing Management
o Inform the patient that this normally happens
o Therefore, remove soft contact lenses
These may be permanently stained
with orange color
o Advise the patient to use eyeglasses instead
Isoniazid
Side effect is peripheral neuritis
Nursing Management
o Give Vitamin B6 or pyridoxine
Pyrazinamide
PZA
Side effect is hyperuricemia
Patient is predisposed to stone formation
Therefore, make urine alkaline
Nursing Management
o To alkalinize the urine
o Increase fluid intake
o Increase intake of vegetables
Ethambutol
Side effect is Optic Neuritis
o Causes color blindness or inability to distinguish
red from green
Nursing Management
o IMMEDIATELY STOP the medication because
this side effect is IRREVERSIBLE
Standard Regimen
Streptomycin
o No hepatotoxicity
o But causes RENAL TOXICITY
o Nursing Management
o Monitor the following:
Creatinine levels
Blood Urea Nitrogen (BUN) levels
Monitor Intake and Output
o Also causes OTOTOXICITY
o Nursing Management
o Assess patient for tinnitus or ringing of the ears
2. Sputum Examination
This is the CONFIRMATORY TEST for Tuberculosis
30
Done in the morning upon rising before oral care

Collection of Sputum
o Do deep breathing exercises for three (3) times
o Open mouth widely
o Put tongue at the back of the lower teeth
o As the back of tongue curves upon spitting,
phlegm goes out
Key Concept!!!
o Continuous receipt of anti-Tuberculosis drugs for
two (2) weeks will give the patient a negative ( - )
result
o Therefore, patient is no longer communicable
3. Chest X-Ray
Shows extent of lung involvement
Does not reveal causative agent
Not a confirmatory examination
If after three (3) months, abscess is still present,

this is called an INDOLENT ABSCESS caused
by:
Wrong technique
Given
subcutaneously
instead of intradermally
Childs exposure to a person

with TB (i.e. mother who is asymptomatic)
Nursing Management
o Bring the child to the health center or clinic for
INCISION DRAINAGE
o Then give prophylactic INH for nine (9) months
o
Additional Concepts!!!
At school entrance
Give booster dose of BCG
When given:
o About six (6) to seven (7) years old
Dosage of Booster Dose
o 0.01 cc
Route of Booster Dose:
o Intradermal
Site of Booster Dose
o Left Deltoid muscle
o No abscess formation on site of booster dose
o Site depends on preference of the mother in a
private setting
Preventive Measures (continued)
3. Cover nose and mouth when sneezing or coughing
4. Proper pasteurization of milk
PNEUMONIA
Inflammation of the lung parenchyma
Caused by several organisms
Causative Agents:
Virus
o Cytomegalovirus
Common opportunistic infection in
AIDS
Protozoa
o Pneumocystis carinii Pneumonia
Also a common opportunistic infection
in AIDS
Bacteria
o Most common cause
o Can be caused by primary infection
o Can be secondary to previous infection:
A complication
A debilitating disease
Droplet
Manifestations of Pneumonia
Five (5) Cardinal Signs of Pneumonia
1. Fever
2. Shaking Chills
3. Sputum Production
o Rusty sputum
Medical Management for Tuberculosis

Short-Course Chemotherapy
Standard Regimen
Nursing Care for Pulmonary Tuberculosis
Diet
Drugs
o Most important
Rest
Important Concept!
Do not perform Chest Physiotherapy on PTB patient
This can stimulate or aggravate the following:
o Hemoptysis
o Frank Bleeding
Key Concept!
An attack of PTB only gives temporary immunity
Preventive Measures
1. Immunization
Bacillus Calmette Guerin (BCG) vaccine
Number of Doses:
o Two
When Given:
o 1st Dose At Birth
o 2nd Dose Upon school entrance
Dosage of First Dose
o 0.05 cc
Route of First Dose
o Intradermal
Site of First Dose
o Right deltoid muscle
o Do not massage site of injection
o Rationale:
It will spill the drug
o Child may experience fever
Nursing Management
o Give paracetamol
o On site of injection, there will be an abscess
formation, which will develop into a scar within
two (2) to three (3) months
31
Depends on causative agent

If sputum is creamy yellow
Causative agent is Staphylococcus
o If sputum is currant jelly
Causative agent is Klebsiella
o If sputum is clear
There is no infection
This may also be brought about by
ASPIRATION PNEUMONIA
Important Concept!
o Lipid Pneumonia
Occurs when oil is used in cleaning the
nose
Oil is not absorbed by the lungs
Therefore, do not use oil-based lubricants in nasogastric
tubes.
4, Productive Cough
5. Presence of Chest Pain or Pleuritic Pain
o Aggravated when coughing
o Use of chest binder is encouraged
Presence of fast breathing is common in Pneumonia
In Children:
If two (2) weeks to two (2) months old (1 month and 29
days)
o Cut off is sixty (60) breaths per minute
o If respiratory rate is 61 breaths per minute and
above, this is indicative of Pneumonia
If two (2) months to twelve (12) months
o Cut off is fifty (50) breaths per minute
If twelve (12) months to five (5) years
o Cut off is forty (40) breaths per minute
Therefore, if there is fast breathing, automatically, it is
Pneumonia
Home management involves antibiotic therapy
Important Concept!
Check for the presence of the following:
o Chest Indrawing
o Stridor
Harsh breath sound heard during
inspiration
To check, place ear on nose or mouth
of patient
o Cough
If these three signs are present, then there is SEVERE
PNEUMONIA
Purpose is to know what microorganism brought

pneumonia
3. Auscultation
For crackles
For ronchi
o Decreased vocal fremitus
Ninety-nine verbalized
o Decreased breath sounds
4. Percussion
Dullness upon percussion
Medical Management
Depends on causative agent
If viral
o Symptomatic management
If protozoal (PCP)
o Drug of choice is Pentamidine
If bacterial
o Administer anti-biotics
o In the hospital setting, drug of choice is Penicillin
o In the community setting, drug of choice is
Cotrimoxazole (administered T.I.D.)
o
o
Nursing Care for Pneumonia Patients

Priority
o Ineffective airway clearance
Management
o Maintain patent airway
o Adequate rest
o Adequate nutrition
Preventive Measures
1. Immunization
Pneumovax
For prevention of secondary pneumonia
Given to adults
Given to the elderly with Community-Acquired Pneumonia
(CAP)
2. Proper disposal of nasopharyngeal secretions
3. Cover the nose and mouth while coughing or sneezing
COMMUNICABLE DISEASES OF THE GASTROINTESTINAL
TRACT
Bacterial
Gastroenteritis
Inflammation of the gastric mucosa and the mucosa of the
intestines
Key Concepts!
Main Sign and Symptom of Gastroenteritis is diarrhea
Diarrhea is a general term caused by various
microorganisms
Causative Agents:
Salmonella typhosa
o For typhoid fever
Salmonella Newport
o For food poisoning or salmonellosis
Staphylococcus enterococcus
Diagnostic Tests for Pneumonia

1. Chest X-ray
Expect infiltrations
Lung consolidation
This is the confirmatory examination
2. Sputum Examination
32
o For staphylococcal food poisoning

Clostridium botulinum
o For botulism
Shigella dysenterieae
o For shigellosis
o For bloody flax
o For bacillary dysentery
Vibrio coma or Vibrio cholera
o Coma-shaped
o Cholera or El tor
o Give rise to violent dysentery due to violent
diarrhea (which occurs continuously)
Fecal Oral route
Source of Infection
Food
Water
If food poisoning:
Salmonellosis
o Foods rich in protein
Meat products
Poultry
Eggs
Cheese
Milk
o Incubation Period
Six (6) to eight (8) hours
o Then you manifest the symptoms
Staphylococcal
o Carbohydrate-rich foods
Cereals
Rice
Pastries
Bread
Cakes
Pasta
Noodles
o Incubation Period
Two (2) to six (6) hours
o Then you manifest the symptoms
Botulism
o Caused by canned or preserved foods
o Incubation Period
Eight (8) to twenty-four (24) hours
o General manifestation is diarrhea
o Borborygmi is present
Gurgling sound on the abdomen
Typhoid Fever
o Three (3) Clinical Features
o 1. Rose spots
This is the PATHOGNOMONIC SIGN

for typhoid fever
o 2. Ladder-like fever
o 3. Splenomegaly
Dysentery
o Characteristics of Stool
o If Bacillary Dysentery
Mucoid Stool
Which could become blood streaked if
severe
Microorganisms endotoxin destroys
the intestinal wall
If Cholera
Rice-watery stool, which is one after
the other
The microorganisms do not destroy the
intestinal wall
They only stimulate peristalsis
Rapid dehydration occurs
o Manifested by washer womans hand
Decreased skin integrity
Poor skin turgor
Very dry
Nursing Management
o Patient is placed on a special bed called the
WATEN BED bed with a hole
o Pail is positioned underneath the hole on the bed
o Bed pan is not advised
o Continuous diarrhea makes the bedpan
inadequate in containing all the fecal material
o Vomiting also contributes to dehydration
Number 1 indicator of dehydration in a patient with diarrhea
is LOSS OF WEIGHT
o This occurs within or before forty-eight (48) hours
Other manifestations of dehydration, which are seen after
forty-eight (48) hours are:
o Thirst
o Sunken eyes
o Sunken fontanelles
o Poor skin turgor
o
Diagnostic Tests for Patients with Gastroenteritis

1. Stool Examination
Most common diagnostic examination
For Typhoid Fever
o Stool examination is not a good test
o Blood examinations are done
o Blood culture is also done to identify the
microorganism
o Done during initial manifestation of the disease
In the Philippines, the WIDAL TEST is done for Typhoid
Fever
o The antigen is detected
o Antigen O
Somatic antigen
If present, the patient is positive for
infection
o Antigen H
Flagellar antigen
If present, patient has been previously
exposed to typhoid fever or
immunization
33
In TYPHIDOT, a blood examination is conducted and an

antibody is detected
2. Rectal Swab
If patient is positive for gastroenteritis
Medical Management for Gastroenteritis

1. Fluid and electrolyte replacement
Oresol
I.V. fluid
Gatorade
2. Antibiotics
In typhoid fever, the drug of choice is
CHLORAMPHENICOL
o This drug gives rise to bone marrow depression,
which leads to anemia and even leukemia
In dysentery, particularly bacillary dysentery, the drug of
choice is COTRIMOXAZOLE
In cholera, the drug of choice is TETRACYCLINE
Important Concepts on the Administration of Tetracycline
Tetracycline should not be given with the following:
o Milk or calcium-rich foods
o Antacids
o Iron-preparation medication
For better Tetracycline absorption
o Give Tetracycline with one full glass of water
This drug should not be given to children below eight (8)
years of age because it causes staining of teeth
This drug is not given to pregnant women
o It is TERATOGENIC to bone growth of the fetus
because it binds to calcium
Once Tetracycline is expired, discard it because it will
increase the toxic effect of the drug
It must be kept away from sunlight
It must be placed in an amber bottle
Sunlight destroys component of tetracycline
Important Concept!
Gastroenteritis attack does not give permanent immunity
o
o
o
Fomites
o
o
Environmental Sanitation
Insecticide
Screening
Do not put anything into your mouth
Most common is the ball pen
LEPTOSPIROSIS
Also called
o Mud Fever
o Swamp Fever
o Canicola Fever
o Pre-tibia
o Weils Disease
o Swine Herds Disease
o Ictero-hemorrhagic disease
A disease of a low form of animal found in the farm
RATS
Source of Infection
Excreta of Rats
Urine of Rats
Causative Agent (Spirochetes)

Leptospira canicola
Leptospira interrogans
(most common in the Philippines infects rats)
Leptospira hemorragica
Skin penetration
Important Concept!
No need to have a break in the skin or to have a wound to
have leptospirosis
Individuals who are High-Risk for Leptospirosis:
Sewage Workers
o Those working in drainage systems
Farmers
Miners
Slaughterhouse workers (pigs, cattle are sources of
infection)
Manilenos
o Due to flooding
Incidence of leptospirosis increases during the rainy
season
Preventive Management
1. Immunization
CDT immunization
Given only free during epidemic
Provides six (6) months immunity
2. Avoid the five (5) Fs
Usual source of infection are the Five (5) Fs:
Feces
o Proper excreta disposal
Food
o Proper food preparation
o Proper food handling
o Proper food storage
o Avoid eating in unsanitary places
Fingers
o Hand washing
Flies
o Eradicate
Key Concepts!
When the microorganism enters, it travels along the
bloodstream
It affects other organs
o Striated Muscles
o Liver
o Kidneys
Spirochetes have a special affinity here
They destroy the nephrons
34
Most common complication of Leptospirosis,

which brings about death is Kidney Failure
Preventive Measures
Eradicate rats by environmental sanitation
o Use of rat poison
Avoid walking through flooded areas
o Wash with soap and running water after walking
in floods
MUMPS
Infectious parotitis
Manifestations of Leptospirosis
Fever with chills
Presence of intense itchiness of the conjunctiva
Abdominal Pain
Nausea and Vomiting
Muscle tenderness and pain on the calf muscle
(gastrocnemius)
o Therefore, the patient does not like to walk or
stand
For ictero-hemorrhagic type of leptospirosis:
o Jaundice
o Hemorrhages on skin and mucous membrane
Causative Agent
Paramyxovirus
o Found on the saliva of the infected individual
Droplet
Manifestations of Mumps
High-grade fever
Earache
o Ear pain
Pain upon mastication or chewing
Swelling of the parotid glands
Diagnostic Tests for Mumps
Clinical Observation
Medical Management for Mumps
Symptomatic as the causative organism is viral
Recovery depends on nursing care provided
Important Concept!
Pathognomonic sign of leptospirosis are the orange eyes
or orange sclera of the eyes
Important Concept!
If the kidney is affected, there would be signs and
symptoms of kidney failure:
o Decreased urine output
o Leading to anuria
Diagnostic Tests for Leptospirosis
Blood Examinations
o Leptospira Agglutination Test (LAT)
o Leptospira Antigen-Antibody Test (LAAT)
o Microscopic Agglutination Test (MAT)
Reveals the microorganism
Nursing Care for Mumps Patients

1. Provide Complete Bed Rest (CBR) until swelling subsides
Rationale:
o To prevent glandular complications:
o In Females:
Oophoresis or inflammation of the
ovaries
o In Males:
Orchitis or inflammation of the testes
2. For males, wear well-fitted supporters to prevent pulling of
gravity on the testes and blood vessels.
Rationale:
o This predisposes the patient to orchitis and
atrophy leading to sterility
Important Concepts!
Glandular complications are manifested only by:
o Adolescents
o Adults
In people twelve (12) years old and above, there is
complete descent of the testes into the scrotal sac
Therefore, there is greater pull of gravity on the patient
Glandular complications are absent among Children
If orchitis is positive, its location depends on the location of
the mumps
o If mumps is on the right side, orchitis is also on
the right side
o If mumps is on the left side, orchitis is also on the
left side
o If mumps is bilateral, orchitis is also bilateral
3. Provide adequate nutrition
Medical Management of Leptospirosis

Anti-biotics
Drug of Choice is TETRACYCLINE
If patient does not tolerate Tetracycline, give Penicillin
instead
Important Concepts on Penicillin
If given per orem:
Give one (1) hour before meals or two (2) hours after
meals
o It binds with food and becomes digested
o When this happens, it will be metabolized and
would have no effect
o Therefore, it is best to give Penicillin on an empty
stomach
Do not give with fruit juices or citrus juices
o These juices destroy the component of Penicillin
o Therefore, give with a full glass of water!!!
Nursing Management for Leptospirosis
Symptomatic and supportive
Monitor urine output due to possible kidney failure
Immediately refer to doctor for any signs and symptoms of
kidney failure
35
Provide the following types of diet:

o Soft diet
Because there is pain upon chewing
o Bland diet
Sour and spicy foods are irritating
They increase salivation and increase
pain
Thus, kalamansi is contraindicated for
mumps patients
o Apple juice and water are allowed in mumps
patients
o Hepatitis H
HEPATITIS A
Also called:
o Infectious Hepatitis
o Catarrhal Jaundice Hepatitis
o Epidemic hepatitis
Incidence is in epidemic proportions
Causative Agent
Hepatitis A virus
o RNA-containing virus
Important Concepts!
In Hepatitis A infected individuals:
o The feces
Harbors the microorganism in
abundant amounts
o The blood
Harbors the microorganism in minimal
amounts
Fecal Oral Transmission
Rarely percutaneous or by blood transmission
Individuals AT RISK for Hepatitis A:
Those living in unsanitary conditions
Those who practice anal oral sex
Incubation Period:
Two (2) to six (6) weeks
4. Apply ice cap or ice cooler to relieve pain

Cold application deadens the nerve endings temporarily
This results to numbness
Important Concept!
Aniel (composed of vinegar and dye) has a cold effect that
decreases pain
This is colored blue so that the person with mumps could
be easily identified while he is still far away
Key Concept!
Mumps attack gives permanent immunity
When is the person with Mumps communicable?
o He is communicable until swelling subsides
o Highly-contagious two (2) days after onset of
swelling
Preventive Measures
Immunization
o MMR vaccine
Proper disposal of salivary secretions
Cover nose and mouth while coughing and sneezing
COMMUNICABLE DISEASES OF THE GASTROINTESTINAL
TRACT AND ITS ACCESSORY ORGANS
HEPATITIS B
Also called:
o Serum Hepatitis
o Homologous Hepatitis
o Viral Hepatitis
The most fatal form of hepatitis
The most fulminant form of hepatitis
Causative Agent
Hepatitis B virus
o DNA-containing virus
Important Concept!
In Hepatitis B infected individuals
o The Blood
Harbors the microorganism
o Other body fluids
Tears
Saliva
Sweat
Cerebrospinal Fluid
Milk
Urine
Semen
o In fact, all fluids
Harbor the microorganism
HEPATITIS
Inflammation of the liver
Brought about by several causes:
o Alcoholism
o Drug intoxication
Hepatotoxic Drugs
Anti-Tuberculosis drugs
Tylenol
Acetaminophen
o Chemical Intoxication
Arsenic
o Microorganisms
Viral
Communicable microorganisms
Important Concept!
Current Number of Viruses causing Hepatitis
Capable of Infecting Humans
o Hepatitis A virus
o Hepatitis B virus
o Hepatitis C virus
o Hepatitis D virus
o Hepatitis E virus
o Hepatitis G virus
Non-pathogenic in Man
Percutaneous
o Use of contaminated sharps and needles
o Blood Transfusion
Oral to oral Transmission
36
o In saliva
Sexual Transmission
o Seminal fluid
o Cervical fluid
Swallowing of amniotic fluid by the baby
Individuals AT RISK for Hepatitis B:
Healthcare workers
o All who are in contact with body fluids of patients
Blood recipients
Hemodialyzing patients
Drug addicts
Promiscuous individuals with multiple sex partners
Incubation Period
Six (6) weeks to six (6) months
Sweat
Cerebrospinal Fluid
Milk
Urine
Semen
o In fact, all fluids
Harbor the microorganism
Percutaneous
o Use of contaminated sharps and needles
o Blood Transfusion
Oral to oral Transmission
o In saliva
Sexual Transmission
o Seminal fluid
o Cervical fluid
Swallowing of amniotic fluid by the baby
Individuals AT RISK for Hepatitis D:
Healthcare workers
o All who are in contact with body fluids of patients
Blood recipients
Drug addicts
Promiscuous individuals with multiple sex partners
Incubation Period
Three (3) weeks to twelve (12) weeks
HEPATITIS C
Also called:
o Post-transfusion Hepatitis
Rationale:
o Because people who develop this are those who
have undergone blood transfusion
Causative Agent
Hepatitis C virus
Important Concept!
In Hepatitis C infected individuals
Blood
Percutaneous
Individuals AT RISK for Hepatitis C:
Healthcare workers
Drug addicts
Blood Recipients
Incubation Period
Five (5) to twelve (12) weeks
HEPATITIS D
Also called
Dormant Type of Hepatitis B
Important Concepts!
A person must have Hepatitis B before he could be infected
with Hepatitis D
Hepatitis D cannot multiply by itself
It cannot bring about infection
If Hepatitis B is present in the body, Delta virus activates
Hepatitis B virus to help the Delta virus multiply
HEPATITIS E
Also called
o Enteric Hepatitis
Causative Agent
Hepatitis E virus
Important Concept!
In individuals with Hepatitis E
o The Feces
Fecal Oral route
Individuals AT RISK for Hepatitis E:
Those living in unsanitary conditions
Those who practice anal oral sex
Incubation Period:
Two (2) to six (6) weeks
HEPATITIS G
No synonyms
Causative Agent
Hepatitis G virus
Important Concept!
In individuals with Hepatitis G
o The Blood
Percutaneous
Causative Agent
Hepatitis D virus
Delta virus
Important Concept!
In Hepatitis D infected individuals
o Blood
o Other body fluids
Tears
Saliva
Individuals AT RISK for Hepatitis G:

37
Healthcare workers
Drug addicts
Blood Recipients
Incubation Period
Unknown
Similar Types or Partner Types
Hepatitis A and Hepatitis E
Hepatitis B and Hepatitis D
Hepatitis C and Hepatitis G
Manifestations of Hepatitis
Three (3) Stages
1st Stage Pre-Icteric Stage

This occurs before jaundice arises
The patient experiences:
1. Fever
o Due to infection
2. Right Upper Quadrant pain
o Due to inflammation and infiltration of the liver
3. Fatigability
4. Weight Loss
5. Body Malaise
o The three (3) manifestations above are due to
the inability of the liver to convert glucose to
glycogen
o Body compensates by breaking down protein
o End-product of protein breakdown would be
amino acids
o Amino acids are normally deaminated by the liver
so that they could be eliminated
6. Anorexia
7. Nausea
8. Vomiting
o Above three (3) manifestations are due to
inability of the liver to deaminase proteins
Anemia
Paleness
Pallor
o The above three (3) manifestations are due to
decreased life span of Red Blood Cells (RBC)
o Normal live span of RBCs is one hundred twenty
(120) days
o In hepatitis patients, RBCs live for less than one
hundred twenty (120) days
End-product of RBC breakdown is bilirubin
o Accumulation of bilirubin into the system leads to
the 2nd Stage Icteric Stage
o Due to accumulation of bile salts in the skin

Tea-colored Urine or Brown-colored Urine
o Due to excess bilirubin thrown out by the kidney
in the urine
Acholic Stool or Clay-colored Stool
o Due to absence of bilirubin (conjugated bilirubin)
that normally goes to the duodenum to color the
stool
Hepatomegaly
o Enlargement of the liver
o Due to an overworked liver
Important Concept!
o Viral infections are self-limiting
If no complication arises, this would lead to the 3 rd Stage
Post-Icteric Stage
3rd Stage Post-Icteric Stage

Jaundice disappears
Signs and symptoms subside
Energy level increases
Patient is on the road to recovery
Important Concept!
o It takes three (3) to four (4) months for the liver to
regenerate or recover
o Physician usually advices rest for complete liver
recovery or regeneration
Most important Health Teaching:
o Avoid alcohol for a period of one (1) year
o Avoid over the counter drugs (OTCs) that are
hepatotoxic for one (1) year
o Consult physician prior to use of over the counter
drugs.
Diagnostic Tests for Hepatitis
1. Liver Enzyme Tests
Tests for extent of liver damage
1.1)
ALT
Alanine Aminotransferase
Formerly SGPT
Serum Glutamic-Pyruvic Transaminase
If increased, there is a liver problem
First enzyme to increase in the presence of a liver problem
1.2)
AST
Aspartate Transaminase
Formerly SGOT
Serum Glutamic-Oxaloacetic Transaminase
Increases only upon the onset of jaundice
1.3) ALP
Alkaline Phosphatase
Increase indicates:
o Obstructive Jaundice
o Obstructive Hepatitis
o Obstruction in the Biliary Tract
1.4) GGT
Gamma Glutamyl Transferase
When increased
2nd Stage Icteric Stage

Patient exhibits:
Jaundice
o Due to inability of the liver to eliminate normal
amounts of bilirubin
o Body compensates by eliminating bilirubin
through sweat
Pruritus
38
Patient is experiencing TOXIC HEPATITIS

Due to toxic substances
Alcohol
Hepatotoxic agents
Normal substance produced by the

body when virus enters the human cell
Dosage:
Two (2) to three (3) times a week for
six (6) months
o Action:
Kills the virus
o Cost:
Approximately Php85,000!!!
Nursing Care for Hepatitis
Two (2) Important Aspects
o
1.5) LDH
Lactate Dehydrogenase
When identified, it indicates liver organ damage
2. Serum Antigen-Antibody Test for Hepatitis
2.1) For Hepatitis A
HAsAg
Hepatitis A Surface Antigen
Anti-HAV
Presence of IgG
Presence of IgM
2.2) For Hepatitis B
HBsAg
Hepatitis B Surface Antigen
Anti-HBs
2.3) For Hepatitis E
HBeAg
Protein-independent Antigen
Anti-HBe
2.4) For Hepatitis C
HCsAg
Hepatitis C Surface Antigen
Anti-HCs
Medical Management of Hepatitis
No specific treatment
Treatment is symptomatic as causative agent is a virus
1. Provide Complete Bed Rest (CBR)

To promote liver regeneration and recovery
When rested, there is decreased metabolism
Less metabolism leads to decreased liver load
Liver relaxes and liver recovers
2. Diet
Low fat diet
o Because there is not enough bile released or
produced by the liver
Increased Carbohydrate Intake
o To spare protein metabolism
o To decrease amino acids
o Accumulation of protein breakdown products like
ammonia would lead to hepatic encephalopathy
Butterball Diet
o Produces energy
o These are hard candies
o Chocolates are contraindicated
They contain fat
Protein Intake
o Depends on the situation
o If the patient is infected
Provide moderate protein intake
o If the patient is in the recovery stage
Provide increased protein intake
o If complications arise
Provide decreased protein intake
Key Concept!
The most fatal form of hepatitis is HEPATITIS B!
Even if patient recovers, after twenty (20) or thirty (30)
years, the patient would develop cancer of the liver or
cirrhosis of the liver
Most Common Drugs used in Hepatitis:

Essentiale
Jetipar
Silymarine
o The above three (3) drugs are:
Hepatic protectors
Composed
of
multivitamins,
phospholipids and nutrients needed by
the body so that the liver would not be
overworked and be relaxed, and thus,
recover
Latest Trend in Pharmacological Management of Hepatitis
Utilizes a combination of:
1) Lamivudine
o Anti-viral drug
o Dosage:
Once daily for one year
o Action:
Inhibits multiplication of the virus
o Cost:
Approximately Php200 / tablet
2) BRM
o Biologic Response Modifiers
o An immunomodulating drug
o Interferons
Injectable form of BRM
Preventive Measures for Hepatitis

1. Immunization
Hepatitis B vaccine
Number of Doses:
o Three (3)
Interval between doses:
o Four (4) weeks
When given:
o 1st Dose Six (6) weeks from birth
o 2nd Dose Ten (10) weeks from birth
o 3rd Dose Fourteen (14) weeks from birth
39
Dosage:
o 0.5 cc
Route:
o Intramuscular
Site:
o Vastus lateralis
o Inform the mother that there would be pain and
soreness on the injection site
o A slight elevation on liver enzyme tests is a
NORMAL REACTION to the vaccine
2. Avoid the different modes of transmission
For Hepatitis B, C, and D
o Blood-borne diseases
There is a Needle-exchange Program in the United States
and in Australia
o Every 6:00 PM a healthcare worker is given a
knapsack with needles and sharps
o He then proceed to areas of distribution alleys
o Exchanges new syringes with old syringes used
by drug addicts.
o Abscess formation on the prostate gland

Purulent Discharges
o Mostly abundant in the morning
If gonorrhea is persistent, a scar develops on the
EPIDIDYMIS
o Scar obstructs the flow of the sperm cells
Sterility
o Due to obstruction of sperm cell flow
In females:
Burning sensation upon urination if urinary meatus is
involved
o Urinary meatus is seldom involved in gonorrhea.
o Cervix is usually the one that is affected
Presence or absence of purulent discharges
Important Concept!
o If there is no burning pain and no purulent
discharge, the patient may not know that she is
infected
o Presence of abscess formation on the Bartholins
Gland or the Skeenes Gland
o When this abscess goes up, it gives rise to
ENDOCERVICITIS or ENDOMETRITIS
Hypogastric Pain
o Due to presence of endocervicitis or endometritis
Important Concept!
o Either of Endocervicitis or Endometritis could
give rise to Pelvic Inflammatory Disease
o Pelvic Inflammatory Disease
A systemic disease characterized by:
Fever
Severe abdominal pain
Nausea and Vomiting
This is secondary to
gonococcal infections
Sterility and Ectopic Pregnancy
o If gonorrhea persists, it causes a narrowing of the
Fallopian Tube
Gonococcal Septicemia
o Occurs when gonorrhea is already systemic
o Signs and symptoms would include:
Presence of Gonococcal Rashes
Papular
Elevated Rashes
Pustular
With pus
May be necrotic gonococcal rashes
Polyarthritis develops
Tenosynovitis
o Tendons and synovium are affected
Important Concept!
o Effect of disease to child of mother with
gonorrhea:
Opthalmic neonatorum
o Management:
Give CREEDES PROPHYLAXIS to
prevent blindness in the newborn
COMMUNICABLE DISEASES OF THE GENITOURINARY SYSTEM

SEXUALLY TRANSMITTED DISEASES
Bacterial
Gonorrhea
Syphilis
Viral
HIV Infection
AIDS
GONORRHEA
Also called
Clap
Microorganism resembles hands clapping together
Strain
Gleet
Jack
GC
Morning Drop
Causative Agent
Neisseria gonorrhea
Sexual contact
Important Concepts!
o Most of the time, MALES are infected
Urethra are affected leading to
urethritis
Females can also be infected
o Cervix is affected
o Signs and symptoms develop at a later stage
Manifestations of Gonorrhea
In males:
Burning pain, burning sensation upon urination
o Due to redness and edema of urinary meatus
brought about by acidic urine
Prostatitis
40
Diagnostic Tests for Gonorrhea

2. Health Education and Patient Teaching
To prevent recurrence of infection
1. Culture and Sensitivity

Collect urethral discharges
Done by scraping mucosa of the urethra
2. Papanicolaus Smear or Vaginal Smear
For females
Preventive Measures
Safe Sex
According to the Center for Disease Control, safe sex
means:
o No sex
o Mutual monogamous relationship
o Mutual masturbation without direct contact
Holding of body parts but no sex
Important Concepts!
o Condom is not an example of safe sex
o Condom use is not 100% guaranteed in
preventing infection
o Best way to prevent spread of infection is through
BEHAVIOR MODIFICATION
o Also called LOW-RISK Behavior
SYPHILIS
Also called:
o Pox
o Lues
o Sy
o Bad Blood Disease
Causative Agent
Treponema pallidum
Sexual Contact
May be transmitted vertically
o May pass placental barrier after sixteenth (16 th)
week of pregnancy
Rarely transmitted thorough Blood Transfusion
Medical Management of Gonorrhea

1. Anti-biotics
Drug of Choice
o Penicillin
o Benzathine Pen G (Penadur)
o Given also to Rheumatic Heart Disease patients
o Penicillin G is NEVER GIVEN PER I.V.
o For I.M. use only
o Rationale:
If given per I.V., it will KILL THE
PATIENT!!!!
It is oil based
It forms into an EMBOLUS that would
kill the patient
o When given per I.M.
Use big gauge needle
Gauge 16 18
This drug easily coagulates
This drug easily clots
Therefore, administer this drug
QUICKLY
Dilute with one (1) cc of LIDOCAINE
One cubic centiliter (1cc) of Lidocaine
plus four (4) cubic centiliters of Plain
Normal Saline Solution is used to
provide less pain
o Rationale:
Due to the incorporation of an
anesthetic in the form of Lidocaine
Key Concept!
o If the patient is
Pregnant
Sensitive to Penicillin
o Administer SPECTINOMYCIN instead!!!
Key Concept!
o If patient with gonorrhea has chlamydial infection
or vice versa (Gonorrhea and Chlamydia are
TWIN SISTERS)
Do not give Penicillin
Do not give Spectinomycin
o Administer DOXYCYCLINE instead!!!
Manifestations of Syphilis
Three (3) Stages
Primary Stage of Syphilis
Patient exhibits:
Chancre
o Characteristic lesion
o Painless popular lesions that heal spontaneously
without treatment
o Found on the:
Genitals
Face
Lips
Tongue
Under the breasts
On fingers
o If without treatment, chancre disappears, it will
signal the start of the Secondary Stage
Secondary Stage of Syphilis
Patient exhibits:
Flu-like symptoms
o Sore throat
o Headache
o Fever
Several forms of dermatitis
Nursing Care for Patients with Gonorrhea

Gonorrhea patients are not confined
They are treated on an outpatient basis
1. Psychological Aspect of Care
STD patients have low self-esteem
41
Rashes (Kulugo)
All over the body
o Presence of dry, hard wart-like lesions
Condylomalata
o Infectious lesions that are fused together
o Found under the breast and on the genitals
o Highly infectious lesions
Key Concept!
o Secondary Stage is highly infectious
o Also called Infectious Stage
Changes in hair growth
o Patchy Alopecia all over
o Patient has MOTH-EATEN APPEARANCE
Affects growth of pubic hair
o Thinning of pubic hair
o Management:
Patient uses aloe vera
Patient uses Mane and Tail
Key Concept!!!
o Before the Tertiary Stage of Syphilis occurs, the
patient becomes ASYMPTOMATIC
o This may be called the LATENT PHASE
A transition period of one (1) to two (2)
years.
Tertiary Stage of Syphilis
Patient exhibits:
Gummatous Lesions or Gumma
o Characteristic lesion
o Lesions that are found on deeper tissues and
organs of the body
o Some are in the form of infiltrating tumors
Other organs of the body are also affected
o Most commonly affected is the HEART
o This gives rise to CARDIOVASCULAR SYPHILIS
Neurosyphilis
o Central Nervous System affectation
o Neurologic symptoms are present
Lack of Balance
Dementia
1. Anti-biotics
Drug of Choice
o Penicillin
If patient is sensitive to Penicillin
o Administer a Cephalosporin instead
o Choice of Cephalosporin
Ceptriaxone or Rocephin
Given per I.M. or per I.V.
o Different diluents are used:
o When given I.V.
Diluent used is Sterile Water
o When given I.M.
Diluent used is Xylocaine
o Do NOT INTERCHANGE diluents!
o If I.M. preparation is given via I.V.
Patient dies due to dysrhythmias
o If I.V. preparation is given via I.M.
Viscous medication would give rise to
pain upon administration
Nursing Management in Syphilis

Same as in gonorrhea
Preventive Management of Syphilis
Same as in gonorrhea
Effect of syphilis to child whose mother developed syphilis
during pregnancy:
o Still Birth (baby dies)
o Syphilitic Baby
Placenta is bigger than the baby
Baby resembles the appearance of an
old man
Baby has linear scars at angles of the
mouth
Baby has persistent vesicular eruptions
or blisters
Baby has nasal discharges
Mother may NOT give birth to a child with syphilis but may
give birth to a child with LATE SYPHILIS
o Two (2) years after birth, the child will manifest:
Hutchinsons Teeth
Saw-like teeth
Anterior Bowing of the Tibia
Fractured Tibia
Backward Tibial growth
Saddle nose with high palate
Deafness
Persistence of dactylitis
o If child with Late Syphilis is not given prophylaxis
upon adolescence
Child develops neurosyphilis
Child will eventually die
Mother may NOT give birth to a child with syphilis
o Child may be born NORMAL
o Child may be ALIVE and NORMAL
Diagnostic Tests for Syphilis

1. Culture and Sensitivity
Done by mucosal scraping
2. Dark Field Microscopy
3. Blood Examination
3.1) FTA-ABS
Fluorescent Treponema Antibody Absorption Test
o This is the confirmatory test for syphilis
3.2) VDRL
Venereal Disease Research Laboratory
o This is not a definitive test
3.3) RPR
Reactive Plasma Reagent
o Non-definitive test for syphilis
Medical Management of Syphilis
42
But wait for two (2) years to really declare that

child is normal
o
If you are pregnant, do not be infected with syphilis
Do not get infected with syphilis, particularly in the third
(3rd) trimester of pregnancy.
The nearer you give birth to a child, the greater is the
chance that the child would develop congenital anomalies
sealed in a metal coffin, also within twenty-four

(24) hours from death.
The body of an AIDS victim COULD NOT BE
EMBALMED
The virus will INFECT THE
EMBALMERS
Modes of Transmission
Blood Transfusion per Single Exposure
Single Blood Transfusion
o Provides 90% chance of infection
Sexual Contact
Pandemically, the number one mode of transmission
o Single exposure gives 0.1% to 1.0% chance of
infection
o However, due to repeated sexual encounters,
chance of infection increases
Contaminated Sharps and Needles
Single exposure gives 0.1% to 0.5% chance of infection
From the infected mother to the unborn fetus
o Gives 30% chance of infection
If a child is born to a mother who is HIV positive, the child
would ALWAYS have a POSITIVE RESULT for HIV
TESTING
o HIV testing identifies the presence of antibodies
in the blood
Child possesses maternal antibodies
o Therefore, child is positive for HIV but may this
may not mean the child is infected
Child is given up to eighteen (18) months for HIV testing
o After eighteen (18) months, child must be
negative for HIV testing
o If child is still positive for HIV testing after
eighteen (18) months, then the child is REALLY
INFECTED!!!
NORMAL IMMUNE RESPONSE
ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

Acquired Immune Deficiency Syndrome (AIDS) is
DIFFERENT from HIV Infection
HIV Infection
Means that you are infected with the virus
Initial stage of AIDS
AIDS
Means that you are infected
You manifest a group of signs and symptoms
With decreased or weakened immune system
This is the end-stage of HIV infection
Key Concepts!
All patients with HIV infection will develop into AIDS
All AIDS patients have passed through the HIV stage
Causative Agent
Human Immuno-Deficiency Virus
A Retrovirus
A very fragile virus
Can easily be destroyed by:
o Seventy percent (70%) alcohol
o A temperature of fifty-six degrees Celsius (56C)
o Chlorine
Therefore, AIDS cannot be acquired
through the swimming pool
o By Ordinary House Bleaching Soap with Sodium
Hypochlorite
Zonrox
Chlorox
Purex
Domex
Proportion of bleaching soap to water
is 1:10
Important Concepts!
o If virus leaves the body of an individual infected
with AIDS (i.e. through the semen), the virus will
survive for only four (4) hours
o If it does not penetrate another person, the virus
WILL DIE
o But if the virus goes out with blood, the VIRUS
WILL REMAIN ALIVE, as long as the BLOOD IS
FRESH!!!
o Once a person dies with AIDS, the virus remains
in the body of the individual, as long as, the body
is HUMID
o Therefore, the body of an AIDS victim should be
cremated within twenty-four hours after death or
Microorganism
Detected by the Macrophages
Macrophages will alert T cells
Alerted T cells reproduce and multiply
T cells stimulate the B cells
B cells reproduce and multiply
B cells release the antibody
Antibody produced attacks the invading microorganism
Antigen-Antibody reaction occurs
Manifestation of Disease will be present
43
Important Concept!
In HIV Infection, there is an alteration in the NORMAL
Immune Response
body produces antibodies
( + ) for HIV infection

With AID Related Complex (ARC) Symptoms
Months to years
ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
Months to years
DEATH occurs
HIV (Retrovirus)
Has special affinity for T cells
Retrovirus is NOT DETECTED by the Macrophages
Macrophages will NOT BE ABLE TO ALERT the T cells
Retrovirus ENTERS the T cell
Retrovirus releases the enzyme

REVERSE TRANSCRIPTASE
This resembles the genetic make-up of the T cell
T cell does not destroy the virus
T cell BECOMES a PRO-VIRUS
Virus multiplies within the T cell
T cell is DAMAGED
Virus will retrovert before leaving the T cell
Virus leaves T cell
Virus attacks another T cell
Net effect: No T cells will be present to stimulate the B cells
No B cell stimulation
No antibody production
No antigen-antibody reaction occurs
Person is infected but remains asymptomatic
Important Concepts!
AIDS Related Complex Symptoms include the following:
Fever with night sweats without a cause
o All laboratory works are negative
Enlargement of lymph nodes without a cause
o All laboratory works are negative
Fatigability
Weight Loss
Altered Sleeping Patterns
Temporary Memory Loss
Altered Gait
Manifestations of AIDS
For adults
o Two (2) major symptoms
o One (1) minor symptom
For Children
o Two (2) minor symptoms
Major Symptoms
Fever: One (1) month and above in duration and is
recurrent
Diarrhea: One (1) month and above
Ten percent (10%) weight loss
o Staunted growth in children
Minor Symptoms
Persistent generalized lymphadenopathy
Generalized pruritic dermatitis
Persistent cough: One (1) month and above
Oropharyngeal Candidiasis
Recurrent Herpes Zoster
Progressive Disseminated Herpes Simplex
Continually multiplying and continually growing mouth
sores
Important Concept!
In the course of the HIV infection, the macrophages
CANNOT IDENTIFY the HIV
As the body takes more time to develop antibodies to the
HIV, the person BECOMES INFECTED but REMAINS
ASYMPTOMATIC
A WELL-WORRIED INDIVIDUAL
Infected with HIV but is ASYMPTOMATIC
After six (6) weeks to six (6)

months (called the WINDOW
PERIOD or the time interval
between the infection of the
individual to the production of
the antibodies), where the
Important Concepts!
False-Negative Result for AIDS
o No antibodies are identified but patient is already
infected
44
o This occurs during the WINDOW PERIOD

The person who undergoes HIV testing undergoes
counseling
o This person should not engage in any of the
modes of transmission of AIDS before the
window period ends
The ACTIVE PARTNER
o Considered the GIVER
o Has less chances of becoming infected
The PASSIVE PARTNER
o Considered the RECEIVER
o Has greater chances of being infected
AGAIN, DO NOT ENGAGE in any of the modes of
transmission of AIDS DURING the WINDOW PERIOD!!!
If an adult manifests the following:
o One (1) minor symptom
o Then, that adult is AIDS BONAFIDE
If a child manifests the following:
o Two (2) minor symptoms
o Then, that child is AIDS BONAFIDE
Key Concepts!
When a person has AIDS, all microorganisms entering his
body gives rise to infections
These are called OPPORTUNISTIC INFECTIONS
In the Philippines, the Number One Opportunistic Infection
is TUBERCULOSIS
Cancers Associated with AIDS
o Caposi Sarcoma
A malignancy of blood vessel wall or
the vascular endothelium
Manifested through the skin
With pink or purple, painless spots on
the skin
Gives rise to a LEOPARD-LOOK
o Non-Hodgkins Disease
Cancer of the lymph nodes
Diagnostic Tests for AIDS
3. Western Blot
If a person is diagnosed with HIV
Tests continue
Monitor the following:
o 3.1) Viral Load
o Monitors replicating activity of the virus
o Negative ( - ) Viral Load
Means virus is not actively multiplying
but is still present
o 3.2) CD4 and T cell Count
o Establishes STAGE OF INFECTION, whether it is
HIV or AIDS
Indicates HIV infection
If greater than or equal to
200
Indicates AIDS
If less than 200
Medical Management for AIDS
Symptomatic management as virus is the causative agent
Latest Trend in Pharmacologic Management of AIDS
o COCKTAIL DRUGS
Patient
must
take
medication
composed of at least twenty-one (21)
tablets per day
Patient
spends
approximately
Php1,000 per day on drugs
Prevents multiplication of the virus but
DOES NOT KILL THE VIRUS
1.Nucleoside Reverse Transcriptase Inhibitors
NRTIs
o AZT Azidothymidine
Retrovir
Zidovudine
o ddc
Dideoxycitidine
Zalcitadine
o ddI
Dideoxyinosine
Didanosine
Tastes sour
Give together with fruit juice
o Lamivudine
o Stavudine
1. ELISA
Enzyme-Linked Immunosorbent Assay
o This is only a SCREENING TEST for AIDS
2. PCR Test
Polymerase Chain Reaction Test
o Likewise, a SCREENING TEST for AIDS
o Relatively expensive
o Costs approximately Php5,000 to Php7,000 per
test
o Results are known within two (2) to three (3)
hours
Important Concept!
If a person
o Has been twice positive for ELISA and;
o Has been positive once for PCR
Then confirm the results by doing the next test
2.Non-nucleoside Reverse Transcriptase Inhibitors

Non-NRTIs
o Delavirdine
o Nevirapine
3. Protease Inhibitors
PIs
o Saquinavir
o Indinavir
o Pitonavir
o Delfinavir
Important Concept!
45
All of the abovementioned drugs inhibit multiplication of the

virus but DOES NOT KILL THE VIRUS
Nursing Care for AIDS

Symptomatic as causative agent is a virus
Psychological Care
Promotion of Homeostasis
Important Concept!
Role of the Nurse in AIDS
o A counselor
Preventive Measures
A for Abstinence
B for Be Truthful
C for Condom use
D for Do not use Drugs
Important Concept!
Virus can be found on all body fluids but will not be enough
to cause infections
Example:
o Six (6) to eight (8) gallons of saliva are needed to
transmit HIV
46

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COMMUNICABLE DISEASES

Diseases caused by pathogenic microorganisms, which

Communicable Diseases are transmitted through:

CHAIN OF INFECTIOUS PROCESS

Six (6) Factors

Two (2) most common microorganisms causing infections

Among the six (6) factors, the MODE OF TRANSMISSION

Body produces antibodies non-intentionally by

2.1.2) Artificially Acquired Active Immunity

2.2) Passive Acquired Immunity

Provides immunity for only a short period as

Fever, diarrhea and colds are NOT CONTRAINDICATIONS

In a private setting, the physician can POSTPONE

GENERAL CARE FOR PATIENTS WITH COMMUNICABLE

o (i.e. MMR vaccine)

Two (2) Aspects

Presidential Decree 825

There are four (4) TEMPORARY CONTRAINDICATIONS for

Proper Supervision of Food Handlers

A responsibility of the Department of Health facilitated by

Elbow is the cleaner part

For Surgical Asepsis:

2. Use of Protective Barriers or Use of Personal Protective

3. Avoidance of Needle Stick or Sharps Injury

Center for Disease Controls two (2) Revised

Killing of pathogenic microorganisms by physical or

Two (2) Types of Toxins in Tetanus

COMMUNICABLE DISEASES OF THE CENTRAL NERVOUS

Sterilization is needed to kill the microorganism

In the wound, there would be an inflammatory response:

Signs and Symptoms of Tetanus

Three (3) Objectives of Medical Management

3. Prevent and Control Spasm

2. Obtain history of wound

When the patient is on his way to recovery, muscle

Profuse sweating and draft exposure also leads to

Proceed with other supportive management

Provide Patient with Comfort Measures

DPT Immunization for Pregnant Individuals

Causative Agents in Meningitis

For High-Risk Individual

Increased ICP leads to:

If pain is present, the patient is said to

Diagnostic Tests for Meningitis

If CSF is clear, it is subjected to Counter ImmunoElectrophoresis (CIE)

Signs and Symptoms of Meningitis

Give corticosteroids in the form of

Priority is to relieve headache within thirty (30) minutes

2. Cover nose and mouth when sneezing and coughing

Source of infection is mosquito

Central Nervous System

Three (3) Types of Paralysis

2nd Stage: Pre-paralytic Stage of Poliomyelitis

Once in the CNS, the microorganism will also cause:

Once in the microorganism is in the CNS, the patient would

Central Nervous System

With metal plate

2. Avoid mode of transmission

Integrated Management of Childhood Illnesses (IMCI)

Diagnostic Tests Done Before Patient Manifests Signs and

Direct Fluorescent Antibody Test (DFA Test)

If given intradermally (I.D.)

Purified Duck Embryo Virus