Disease Dengue Hemorrhagic Fever (Break Bone Fever )

Etiology Flaviviridae

Classification Vector borne infection

Drug of Choice Paracetamol Sucrafaltate 1gm q 6hrs Ranitidine 50mg IVP q 8hrs

Sign and Symptoms Positive Tourniquet Test

Diagnostic Procedure Platelet Count (Thrombocyto penia )

Treatment

Management Continuously assess the pt. for signs and complication. Monitor the pt. vital signs esp. the blood pressure and pulse rate.

Incubation Period If is an acute febrile infection of sudden onset characterized by 2-7 days.

Supportive and Symptomatic Therapy. Paracetamol High Grade Hematocrit Sucralfate Fever Level Ranitidine (Hemoconcentr Gastric Lavage Headache ation) using Cold Saline Body Malaise Bleeding Parameters (Partial Conjuctival Thromboplasti Infection n Time- PTT, Prothombin Vomiting Time- PT) Epistaxis/g um bleeding Melena Unstable BP

Hydration Therapy for fluid collection with hemoconcentration. Use D5LRS alternate with D5IMB. Platelet Concentrate. It is given if the platelet count is 50000 or below if with signs of bleeding and if platelet count is less than 20000 even if there is no significant bleeding.

Cryoprecipitate. It is given if with prolonged PTT. Fresh Frozen Plasma. It is given in pt. with impending Shock (Stage III) and unresponsive to isotonic and colloid solution and in pt. with prolonged Prothombin time 2x the control. Fresh Whole Blood. It is given with significant active bleeding with or without prolonged bleeding parameters. Packed RBC. It is given if there is no significant active bleeding but with low hemoglobin.

Disease Malaria

Etiology Plasmodium

Classification Vector borne infection

Drug of Choice Quinine in full stomach Primaquine Sulfadoxine (given in resistant P. Falciparum strain) Doxycyclin e 100mg/tab, 2-3days prior to travel

Sign and Symptoms Chills Shakes

Diagnostic Procedure Blood Smear (Thick or thin smear)

Treatment Destroy all sexual forms of parasite to cure the clinical attack. Destroy all excerythrocyte to prevent relapse. Destroy gametocyte to prevent mosquito infection.

Management Advise the community regarding: Wearing of clothing that covers the arms and legs in the evening. Avoiding outdoor night activities, esp. the vectors peak biting hous from 9pm to 3am.

High Grade CBC Fever BUN Severe headache Creatinine Vomiting Abdominal Pain Cyanotic Face SGOT SGPT

Using mosquito repellents such as mosquito coils, using chemically treated mosquito net and placing of neem tree. Using chemophylatic antimalarial drugs before traveling in an endemic area. Give supporting Nursing Care Consider pt. with cerebral malaria an emergency. Administer IV Quinine as IV infusion.

Mefloquine Excessive 250mg/tab, Sweating 1 week before travel For pregnant-

Chloroquine Watch for neurologic toxicity from Quinine transfusion like delirium, confusion, convulsion and coma.

Watch for jaundice- this is related to the density of the falciparum parasetimia. Evaluate degree of anemia. Watch for abdominal bleeding.

Disease Filariasis

Etiology Caused by nematode

Classification Vector borne infection

Drug of Choice Diethylcaba mazine or

Sign and Symptoms Filarial fever

Diagnostic Procedure

Treatment

Management Health workers must emphasize the importance of

Physical Diethylcarbamazine examination Citrate or hetrazan

Incubation Period 8-16 months

parasite known as Wuchereria bancrofti, Brugia Malayi, and Brugia Timori.

hetrazan form 12 days.

Lymphatic inflammation Inflammation of lymph vessels Hydrocele (swelling of the scrotum) Lymphedema Elenphantiasis

of the 6mg/KBW affected part or Chronic cases of extremities. elephantiasis or hydrocele can be Nocturnal referred to surgery Blood for management. Examination Immunochro matographic Test Eosinophils increase

compliance to the treatment. Advised infected individuals to observe personal hygiene.

Teach the community to prevent and control the spread of filariasis through environmental sanitation and use of mosquito nets, screening of houses and use of insect repellants. Advise community leaving in areas where filariasis is endemic to have blood examination once or twice a year to diagnose filariasis early.

Disease

Etiology

Classification

Drug of Choice

Sign and Symptoms

Diagnostic Procedure

Treatment

Management

Leptospirosis Leptospira Pyrogenes Leptospira Manilae

Vector borne infection

Penicillin G, Conjuctival 50000 suffusion units/kg/24h rs Calf muscle tenderness Tetracycline 20-40 Decrease urine mg/kg/24hrs output is used as a (Oliguria to second drug Anuria) of choice

History of Pen G 50000 wading to units/kg/24hrs flooded waters Tretracycline 20Physical 40 mg/kg/24 hrs Examination Blood culture during first week, CSF from the 5th12th day and urine after the 1st week until convalescence. LAAT (leptospira Antigen Antibody Test) BUN CREA Liver enzymes.

Dispose and isolate urine of the pt. Environmental Sanitation like cleaning the esteros or dirty places stagnant water, eradication of rats and avoidance of wading or bathing in contaminated pools of water.

Give supportive and asymptomatic therapy. Administrations of fluid and electrolytes

Assist in peritoneal dialysis for renal failure pt. Advise people living in areas where flood is common to take doxycycline 200 mg/week as prophylaxis to prevent leptospirosis infection.

Disease

Etiology

Classification

Drug of

Sign and

Diagnostic

Treatment

Management

Choice Mannitol Meningitis Incubation Period 1-10 days (average 3-6 days) after a primary respirator infection It is caused by Central nervous an untreated system infection infection that spread to the central nervous system through following different organisms: Haemophil us influenza (common in children) Strep. Pneumonia (common in adults) Neisseria meningitide s Staph. Aureus E.coli

Symptoms Fever Restlessness Headache Vomiting

Procedure Ct scan Blood Culture Lumbar Puncture Antibiotic Therapy Hyperosmotic therapy Monitor the pts temperature.

Administer antipyretic drug as prescribe. Avoid elevation of temperature, since fever increase cerebral metabolism and the rate of cerebral edema formation. Monitor cardiac output with SwanGanz catheter if measure are taken to reduce the pts temperature. Provide continuing assessment of the pts level of responsiveness. Glascow coma Scale Know the pts baseline condition; all observations should be compared with and evaluated accordingly. Watch pt carefully when changing his position.

Disease

Etiology

Classification

Drug of Choice Benzyl penicillin

Sign and Symptoms High grade fever

Diagnostic Procedure Blood, CSF, Skin lesion culture

Treatment Antibiotic of choise: penicillin

Management Watch out for complications like deterioration of sensorium, signs of shock and bleeding

Meningococcemia Incubation Period 1-3 days

Caused by Neisseria meningitis transmitte d through droplet

Central nervous system infection

Olfloxacin 400mg 1 tab single dose

Rifampicin 300mg 1 tab bid x 2 days

Pathognomo nic rash Gram stain of peripheral smear CSF, Skin lesion Vasomotor collapse and culture shock

Manage shock and vascular collapse

Practice strict respiratory isolation of patient to prevent exposure of hospital staff and other patients

Manage convulsive seizures

Monitor the respiratory function of the patient and check for the signs of secondary bacterial infection

Ceftriaxone 125mg IM single dose

Watch out for signs and symptoms of complication like DIC

Use Proper personal Protective Equipment, wear gloves, gowns and mask especially when doing suctioning or endotracheal intubation. Give Health Education to the family and the community regarding

Chemoprophylaxis

the mode of transmission.

Monitor the level of consciousness of the patient and assess for the signs of intracranial pressure like vomiting, headache and difficulty in awakening the patient.

Monitor the intake and output and check for fluid balance.

Avoid activities that can cause increase in intracranial pressure.

Watch for signs of complication like pneumonia, endocarditis and DIC.

Disease

Etiology

Classification

Drug of Choice

Sign and Symptoms Fever Excitation Agitation Combativeness

Diagnostic Procedure A history of bite or non bite exposure with hydrophobia and aerophobia.

Treatment There is no treatment for clinical rabies. The only treatment is prevention through vaccination.

Management Immediately wash the wound with running water and soap. Administer tetanus toxoid. Give appropriate antibiotics as prescribed by the physician. Remember that suturing of wound or any primary closure should be avoided as much as possible. Assist in the isolation of the patient to prevent exposure of the hospital personnel, watchers and visitors to the patients body fluids like saliva, tears. Hospital personnel should wear complete personal protective equipment, mask, gown, gloves and goggles.

Rabies Incubation Period

acute viral encephalomyel itis

Central Nervous Post system exposure infection. prophyla xis

10days to 1year but there are causes reported that incubation period may be as short as 4days and as long as 19years.

Muscle spasm Meningsmus Excessive salivation Difficulty of swallowing Hydrophobia Aerophobia

Post-exposure to Fluorescent prophylaxis (most antibody test. common form of vaccination used Microscopic after the patient examination was bitten by a of negri suspected rapid bodies in animal. samples of brain tissues of the infected animal. FAT (fluorescent antibody test)

 Give health teachings on the family and the public the risk of rabies after exposure to rabies patient with emphasis that not all contacts of patients need post exposure prophylaxis. Provide the community adequate information regarding the treatment of animal bite. No to apply any substance like garlic, papaya on the wound site or not to consult to albularyo or tawaks.

Disease Tetanus

Etiology

Classification

Drug of Choice

Sign and Symptoms Trismus or lack jaw Risus sardonicus Opisthatonus Rigid board like abdomen Paroxysmal, violent,

Diagnostic Procedure Wound culture CBC

Treatment Antibiotic therapy Control of muscle spasm Tetanus antitoxin Tetanus immunoglobin

Management All therapeutic and other manipulations should be well coordinated and carefully scheduled, so that the risk of tetanospasms is reduced to a minimum. Watch out the signs of respiratory and cardiovascular complication. Maintain an adequate and patent airway. Administer medications as ordered.

Tetanus occurs sporadically Incubation and almost affects non Period immunized or partially 4-21 days or immunized an average of individuals who failed to 10 days. maintain adequate immunity with booster dose of

Central Nervous penicillin System infection

vaccine. It cause tetanospasm Clostridium tetani

painful generalized muscles spasm that cause cyanosis and threaten ventilation.

Watch out for respiratory depression when giving diazepam or drugs to control the muscle spasm. Place the patient in a quite, semi darkened room to avoid trigger of muscle spasm. Wound management: all wounds must be thoroughly cleansed, debride all necrotic tissue and foreign materials. Apply povidone iodine for wound disinfection. Give health teachings to the community regarding the prevention of tetanus which includes maternal vaccination even during pregnancy to prevent tetanus neonatorum.

Disease

Etiology

Classification Urinary tract infection

Drug of Choice Trimenthoprim sulfamethaxaz ole

Sign and Symptoms Acute onset of dysuria(pain , buring or tingling sensation)

Diagnostic Procedure WBC

Treatment Antimicrobials

Management For women, teach the family on proper cleaning of the perineum. Teach the pt. to carefully wipe the perineum from front to back and to clean thoroughly with soap and water.

Urinary Tract It exist when Infection pathogenic microorganism are present in the urine, urethra,

bladder and prostate. Cystitis and urethritis are the most common form of lower urinary tract infection and are 10 times more common in women than men.

Urinary frequency Urgency Suprapubic pain

Advise young sexually active women to void immediately after sexual interactions. Teach the pt. not to delay or postpone urinations and stress the need to empty the bladder completely. Advise the importance of drinking plenty of fluids. Advise pt. to take cranberry juice which can inhibit the growth of some bacteria because of its acidic effect on the urine. Teach the community about the common manifestations of urinary tract infections and to consult the health center frequently. Provide client teaching and discharge planning concerning: a. Avoidance of tub baths b. Avoidance of bubble baths that might irritate urethra. c. Importance for girls to wipe perineum from front to back. d. Increase in foods/fluids that acidify urine. e. Recommended frequent comfort stops during long car trips and stress the importance

of the need to empty the bladder completely.

Disease

Etiology

Classification Eyes and ears infections

Sign and Symptoms Redness and swelling of the external canal. Moderate to severe ear pain. Fever Foul smelling ear discharge Asteatosis

Diagnostic Procedure Clinical history and physical examinations confirms the diagnosis. A history of the risk factors and manifestations like red, swollen external ear canal would help in the diagnosis. The manipulation of the tragus and auricle would help distinguish acute otitis externa from otitis media.

Treatment

Management

Otitis externa Caused by bacterial infections like pseudomonas aeroginosa, proteus vulgaris, streptococci or staphylococcus aureus.

It will depend on For the application of ear drops in the complain of the adults, pull the pinna upward and client backward to straighten the ear canal. For children, pull the pinna downward Antibiotic and backward. management like instillation of otic Cleaning the ear canal with mild antibiotic like burrows solution. polymycin after cleaning the ear Monitor for possible complication of alcohol acetic otitis extena like tympanic membrane. mixture and removal of ear Advise pt. to wear ear plugs or keep canal debris is the head above the water. effective. Warn the pt. about cleaning the ears Pain using cotton swabs. manangement. If the pt. is a diabetic, evaluate for signs of malignant otitis media.

Disease Otitis Media

Etiology Obstruction of the Eustachian tube is a basic causative factor in the development of otitis media.

Classification Eyes and ears infection

Sign and Symptoms Pain A sense of fullness Purulent otorrhea Hearing loss Vertigo or tinnitus Fever

Diagnostic Procedure Otoscopic examination

Treatment Antibiotics like trimethoprimsulfamethoxane (cotrimoxazole) Ampicillin or ampicillin for 10 consecutive days. Pain magement like acetaminophen

Management Explain to the pt. and the family the importance of proper compliance to the antibiotic therapy Advise the pt. and the family to report immediately signs of fever and severe ear pain because it may indicate secondary infection After myringotomy, check and maintain the flow of the ear drainage. Do not put cotton or plugs deep in the ear canal.

If there is not improvement Pt. should be instructed to apply heat within 72hours the to the affected ear to relieve the pain. pt. should switched to cefuroxime or amoxicillinclavulanate (coamoxiclav)

Disease Mastoiditis

Etiology Haemophilus influenza, Moraxella catarrhalis, and staphylococcus and gram negative bacteria.

Classification Eyes and ears infections

Drug of Choice Penicillin at least 2weeks

Sign and Symptoms Swelling; redness and tenderness behind the ear in the area of the mastoid bone are seen. Low grade fever Headache thick purulent discharges tenderness over the mastoid bone area.

Diagnostic Procedure

Treatment

Management Explain to the family the importance of the compliance to the treatment regimen and to report any signs of mastoiditis and its complications. If the client is diabetic, check for signs of malignant otitis media. After mastectomy, give pain medications as needed and keep the side rails up and assist the pt. with ambulation. Check the client for possible complication after surgery, like changes in hearing acuity, facial nerve paralysis, bleeding, vertigo and infection. Advised the pt. to keep water out of th ear.

Concentional- Parental antibiotic X-ray or Ct Therapeutic scan (Confirmatory Mastoidectomy Diagnosis) it shows mucosal thickening in the middle ear space and in the mastoid cavity. Audiometry test shows conductive hearing loss.

Disease Botulism Incubation Period 12-36 hours after ingestion of contaminated food. Shorter incubation period and early onset of manifestation of botulism would warrant immediate

Etiology Human botulism occurs worldwide and it affects adults more often than children.

Classification Gastrointestinal infections

Drug of Choice Administra tion of IV or IM botulinum antitoxin.

Sign and Symptoms Acute symmetrical cranial nerve paralysis Ptosis Dysarthia Diplopia Progressive weakness or paralysis of the muscle Dyspnea Weakness progresses rapidly from

Diagnostic Procedure

Treatment

Management Extract a good history of the pt. food intake for the past several days. Check if other members of the family exhibit same signs and symptoms and a history of shared common food. Monitor closely for sign of the disease like diplopia, dysarthia and signs of respiratory weakness or distress. If the pt. ingestion of the contaminated food occurred only within several hours, induce vomiting or begin gastic lavage and enema to purge any unabsorbed toxin from the bowel. If sign of respiratory distress are noted, immediately bring the pt. to the hospital for proper monitoring and treatment. Administer the botulinum antitoxin as

Electromyography Pt. with bolutism should be monitored closely for signs of respiratory distress or failure, intubation and mechanical ventilation should be considered when the paralysis is progressing rapidly and with hypoxemia resulting in a vital capacity of less than 30% of predicted.

attention and treatment because it is a signal of a potentially fatal case.

the head, neck, thorax and legs.

orderd by the physian.

Disease Leproxy Incubation Period

Etiology

Classification

Drug of Choice

Sign and Symptoms Hypopigmented or hyperpigmented macules or plaques Skin dryness Anhydrosis anesthesia

Diagnostic Procedure It can be identified on a typical manifestation of leprosy like the skin lesions, muscular and neulogic deficits tru physical examination.

Treatment Rifampin Dapsone It depends on the type whether the pt. has paucibacillary leprosy or multibacillery.

Management Give health teachings about the importance of early detection. Instruct the pt. and caretaker how to give the drug regimen. Health teaching about the mode of transmission. Children who are susceptible in the disease should not be exposed in pts with untreated leprosy Encourage the importance of BCG vaccination in infants. Counsel the family and community that leprosy is treatable disease and there is no need to isolate the pt. if the

6months to 8 years

Caused by Skin and soft Rifampin mycobacterium tissue infection leprae, an acid Dapsone fast bacillus that attacks cutaneous tissue and peripheral nerves, producing the typical skin lesions of leprosy, local areas of anesthesia and deformities.

pt. is taking the medications regularly. Advocate healthy living through proper nutrition, adequate rest, sleep and good personal hygiene. Teach pt. and family to prevent and protect the pt.from secondary injury burns and sharp objects. Tell the pt. and the family to treat injuries to the hands, feet, and eyes early to prevent deformities. Give emotional support to the family.

Disease

Incubation Etiology Classification s/sx period Pulmonary 2 -10 weeks Myobacterium Pulmonary Cough tuberculosis tuberculosis infection Unexplained weight loss Fever Night sweats Chills Loss of appetite

Drug of choice Nsg. Treatment Diagnostic procedure Intervention Rifampicin *maintain resp. CATEGOR *Sputum analysis for Isoniazid isolation Y 1 - NEW AFB *confirmatory Pyrazinamide *administer PTB, (+) Chest xray Ethambutol meds. As order SPUTUM *Tuberculin testing streptomycin *always check GIVE RIPE *PPD sputum for 2 blood or MONTHS, purulent MAINTEN expectoration ANCE OF *teach or RI 4 educate client MONTHS about PTB CATEGOR *encourage pt. Y2to stop PREVIOU smoking SLY *teach how to TREATED dispose WITH secretion RELAPSE properly S *be alert of GIVE drug reaction RIPES 1ST 2

MONTHS, REPS 1 MONTH, MAINTEN ANCE RIE 5 MONTHS

CATEGOR Y 3 - NEW PTB (-) SPUTUM FOR 3X

Disease

Incubation Etiology Classification period diphtheria 2-5 days Corynebacterium Pulmonary diphtheriae infection

s/sx

Drug of Nsg. Intervention Treatment Diagnostic choice procedure Penicillin * Strict isolation of DPT- 0.5 ml the hospitalized IM *Administer antitoxin child 1 - 1 months old *Maintenance of 2 - after 4 weeks adequate nutrition 3 - after 4 weeks st * Ice collar must be 1 booster 18 applied to the neck mos 2nd booster 4-6 yo subsequent booster every 10 yrs thereafter

Household contacts

(+) primary immunizatio n and (-) culture booster dose (+) culture and (-) immunization treated as a case of Diptheria

Disease Mumps

Incubation period 14-25 days

Etiology

Classification

s/sx Unilateral or bilateral parotitis, Orchitis sterility if bilateral, Oophoritis, Stimulating food cause severe pain, aseptic meningitis

Drug of choice Nsg. InterventionTreatment

paramyxovirus Pulmonary infection

Respirato supportive ry pain relief : precautio application of ns hot or cold Bed rest until the parotid gland swelling subsides Avoid foods that require swelling Apply hot or cold compress

Diagnostic procedure serologic testing, ELISA

To relieve orchitis, apply warmth and local support with tight fitting underpant s

Disease

Incubation Etiology period Amoebiasis 3 days Entamoeba several months histolytica

Classification Gastro intestinal disease

Drug of choice Nsg. Treatment Intervention Blood diloxanide Observe streaked, furoate isolation & watery mucoid Metronidazole enteric diarrhea, (Flagyl precaution abdominal Provide health cramps education and instruct patient to : Boil water for drinking and

s/sx

Diagnostic procedure Culture and sensitivity

use purified water Avoid washing food from open drum of pail Cover left over food Wash hand after defecation , before eating Avoid ground vegetables ( lettuce, carrots)

Disease Peritonitis

Incubation period 2-3 days

Etiology Bacteria

Classification Gastro intestinal disease

Drug of choice Nsg. Treatment Intervention *abdominal Pen G *monitor v/s pain *maintain pt. in *nausea and semi fowlers vomiting position *constipation *encourage to *pallor deep breath *excessive *maintain sweating parenteral fluid and electrolyte administration

s/sx

Diagnostic procedure *chest x-ray *blod studies *parasentesis *laparotomy

Disease Typoid fever

Incubation period

Etiology

Drug of choice Nsg. Intervention Salmonellaenterica Hepato enteric profuse sweatingciprofloxacin disease and gastroenteritis. Less commonly, a rash of flat, rose-colored spots may appear

Classification

s/sx

Treatment The rediscovery of oral rehydration therapy in the 1960s provided a simple way to prevent many of the deaths of diarrheal diseases in general. Where resistance is uncommon, the treatment of choice is a

Diagnostic procedure

fluoroquinolone such as ciprofloxacin otherwise, a thirdgeneration cephalosporin such as ceftriaxone or cefotaxime is the first choice.

Disease Croup

Incubation period

Etiology

Drug of choice Nsg. Intervention Parainfluenza Respiratory *stridor Antibiotic *monitor viruses tract infection *muffled vocal cough and sound breath sound *barking *control fever cough with TSB *relieve sore throat by soothing

Classification

s/sx

Treatment

Diagnostic procedure *home care with *throat culture rest,cool *ghest x-ray humidification *laryngoscopy during sleep,and anti pyretics such as acetamenophen relieve symptoms

Disease Pneumonia

Incubation period

Etiology Viral, bacterial, fungal, protozoal

Classification Respiratory infection

Drug of choice Nsg. Treatment Diagnostic Intervention procedure *coughing Antibiotic *maintain Anti microbial *chest x-ray *sputum Analgesic adequate therapy *sputum smear production oxygenation *pleuric chest *teach pt. how pain to cough, deep *shaking chills breathing *fever exercise *obtain sputum as needed *administer antibiotics as necessary

s/sx