ankCOMMUNICABLE DISEASE NURSING Prepared By: LEONARDO P. DE GUZMAN III, RN, MAN DEFINITIONS OF TERMS 1.

COMMUNICABLE DISEASE an illness due to an infectious agent or its toxic products w/c is transmitted directly or indirectly to a well person or animal or through an agency of an intermediate animal host, vector of the inanimate environment 2. RESERVOIR natural habitat of the organism that is where it resides and multiplies 3. SOURCE site from w/c the organism passes immediately to a host 4. MODE OF TRANSMISSION it indicates the potential of the disease; conveyance of the agent to the host it can be by common source transmission, contact source, air-borne and vector borne 5. HOST a person or animal or plant upon w/c a parasite depends for its survival 6. ISOLATION (vs. REVERSE ISOLATION) the separation of persons suffering from communicable disease or carriers of the infecting organism from other persons and placing them under such conditions that direct or indirect transmission to susceptible person is prevented 7. UNIVERSAL PRECAUTIONS are infectious control measures designed to protect health workers form exposure to diseases 8. INCUBATION PERIOD the time between exposure to a pathogenic organism and the onset of symptoms of a disease 9. ETIOLOGY all factors that may be involved in the development of a disease 10. PROPHYLAXIS prevention of or protection against disease, often involving the use of a biologic chemical or mechanic agent to destroy o prevent entry of infectious disease 11. PERIOD OF COMMUNICABILITY refers to a frame of time that a disease is contagious or transmissible by direct or indirect means 12. SEQUELAE any abnormal conditions that follows and is the result of a disease, treatment or an injury 13. PROGNOSIS a prediction of the provable outcome of a disease based on the condition of the person and the usual course of the disease as observed in similar situation 14. PATHOGENICITY

15. PATHOGENS 16. VIRULENCE

is the ability of a microorganism to produce disease. microorganisms that cause diseases in humans are called. is the degree of pathogenicity of an infections microorganism. is an invasion and multiplication of microorganisms in body tissue that results in cellular injury.

17. INFECTION

these microorganisms are called infectious agents. 18. COLONIZATION

19. FLORA are the vegetation of microorganisms on the human body. Resident flora microorganisms which are always present on skin can be reduced through hand washing, but not totally removed is the multiplication of microorganisms on or within a host that does not result in cellular injury.

Transient flora microorganisms that are picked up by the skin from another person or object attach themselves to the skin and then may be transmitted to a susceptible host CONTAGIOUS vs. INFECTIOUS CONTAGIOUS applied to disease that are easily spread directly transmitted from person-to-person INFECTIOUS are those disease not transmitted by ordinary contact, but require a direct inoculation through a break in the previously intact skin or mucous membrane all contagious diseases are infectious Chain of Infection Infectious Agent Agents that produce infections can consist of bacteria viruses fungi The ability of a microorganism to infect a client is related to: Pathogenicity ability to cause disease Virulence disease severity Invasiveness ability to enter and move through the tissue Infective Dose number of organisms needed to initiate infection Organism Specificity host preference Susceptibility of the Host Source or Reservoir Required for the microorganism to survive while awaiting a host. May allow the organism to multiply, making it more dangerous. The human body is the most common reservoir. Food, plants, animals, and feces are other common reservoirs. Mode of Transmission Route of Transmission Airborne Transmission Contact Transmission Direct contact - person to person

protozoa rickettsia chlamydia

Contact Transmission

Vehicle Route Vectorborne Transmission

Vehicle Route food water drugs

Indirect contact - usually an inanimate object Droplet contact - from coughing, sneezing, or talking by an infected person

salmonellosis shegellosis, legionellosis

 blood

bacteremia resulting from infusion of a contaminated infusion product

hepatitis B, or non-A non-B hepatitis Airborne Transmission Droplet nuclei residue of evaporated

Organisms shed into environment from skin hair

wounds or perineal area

Dust particles air containing the infectious agent Vector Transmission via contaminated or infected arthropods such as; flies mosquitoes ticks, etc. Mode of Escape from Reservoir Respiratory tract GI tract GU tract Open lesion Mechanical escape bites from insects Blood Mode of Entry into Human Body 1. GI tract 2. GU tract 3. Mucous membrane or skin

4. 5.

Placenta Respiratory tract

Susceptible Host A person with a reduced immune response has increased susceptibility. The immune response is the bodys natural defense against infection. Factors Influencing Production of an Infectious Disease: 1. Age 4. Surgery 2. Heredity 5. Nutrition 3. Stress 6. Health Status Factors Influencing Production of an Infectious Disease Age The elderly and children under two years of age are at greatest risk. Heredity Conditions or diseases resulting in the absence of or inability to form immune defenses. Stress Increase in metabolic rate which results in using up stored energy Elevation of blood cortisol, decreasing anti-inflammatory responses Continued stress produces exhaustion, further depleting ability to ward off infection. Surgery Eliminates primary barrier of infection. Predisposes clients to surgical site infections. Localized infection at wound site can progress to a systemic infection. Additional risks include catheters and tubes. Nutrition

 Insufficient protein consumption reduces antibody production and inhibits the bodys ability to ward off infection. Health Status Clients w/ disease of their immune system are at greater risk. Chronic diseases can predispose the client to infection. Four Stages of Infection 1. Incubation - the time between exposure to a pathogenic organism and the onset of symptoms of a disease 2. Prodromal earliest phase of the developing disease condition 3. Illness 4. Convalescence - period of recovery after an illness DEFENSE MECHANISM OF THE BODY *******Normal Defense Mechanisms****** Nonspecific immune defenses Specific immune defenses Work in harmony to defend the host from pathogens. Nonspecific Defense Mechanisms Protect the host from all microorganisms Not dependent on prior exposure to the antigen 1. Skin and Normal Flora 2. Mucous Membranes 3. Sneeze, Cough Reflexes 4. Tearing Reflexes

5. 6. 7.

Elimination Acidic Environment Inflammatory Response

Nonspecific Immune Defenses Mucous Membranes Mucus entraps infectious agents and contains substances that inhibit bacterial growth. Cilia trap and propel mucus and microorganisms away from the lungs. Skin Intact skin is the bodys first line of defense against infection. Sebum is produced by the skin and contains fatty acids that kill some bacteria. Normal Flora Normal flora residing on the skin compete with pathogenic flora for food and inhibit their multiplication. Inappropriate antibiotic use may disrupt the balance of normal flora. Sneeze and Cough Reflexes Physically expel mucus and microorganisms from the respiratory tract and oral cavity with force Elimination Patterns and Acidic Environment Resident flora of the large intestines Flushing action of urination Mechanical process of defecation Acidic environment of urine and vagina Inflammatory Response Tissue injury caused by bacteria, trauma, chemicals, heat, or any other phenomenon Release of substances that produce secondary changes in the tissue Tearing Reflex Protects the eyes by continually flushing away microorganisms Inflammatory Response Tissue injury caused by bacteria, trauma, chemicals, heat, or any other phenomenon Release of substances that produce secondary changes in the tissue

Specific Immune Defense (The Immune Responses)

 Immunity is a specific defense mechanism that creates an immune response to a specific invading antigen.
Immune Responses Active immunity results from the development within the body of antibodies that neutralize the infective agent. Passive immunity is acquired by the introduction of preformed antibodies. Acquired immunity results either from exposure to an antigen or from the passive injection of immunoglobulins. Natural immunity refers to the genetically determined response of protection within a specific species. Artificial immunity is produced following a vaccine. The Humoral Immune Response B lymphocytes recognize the antigen as an enemy. Immunoglobulins are plasma protein cells that produce five different classes of antibodies (IgG, IgA, IgM, IgE, and IgD).GAMED Immunoglobulins circulate throughout the bloodstream for the purpose of destroying antigens. Cell-Mediated Immunity Fights pathogens that survive inside cells. Antigen stimulates the release of activated T cells. T-helper cells T-suppressor cells T-cytotoxic cells Nosocomial Infections Infections acquired in a health care setting that were not present or incubating at the time of the clients admission Common Sites of Nosocomial Infections Urinary tract Surgical sites Respiratory tract

Localized Versus Systemic Infections Infection results from tissue invasion and damage by an infectious agent. Localized infections are limited to a defined area or single organ. Systemic infections affect the entire body and involve multiple organs. Nosocomial Infections Procedures identified as possible sources of infection are: Inadequate hand washing Catheterization technique Improper suctioning technique Improper dressing-change technique Contamination of closed drain system ASEPSIS Asepsis is the absence of microorganisms. Aseptic technique is the infection control practice used to prevent the transmission of pathogens. Medical Asepsis (Clean Technique) Practices to reduce the number, growth, and spread of microorganisms The most common cause of nosocomial infections is contaminated hands of health care providers. Wash hands before and after every client contact. Surgical Asepsis (Sterile Technique) Practices that eliminate all microorganisms and spores from an object or area Surgical scrub Sterile fields Surgical attire Sterile instruments and equipment

Role of Health Care Personnel and Health Agencies in Infection Control Reinforce adherence to isolation. Post signs indicating type of isolation. Provide necessary supplies. Place clients in a private room with adequate ventilation. Use disposable supplies and equipment. Labeling of all articles leaving the room Use of impermeable bags or double bagging Client and family instruction Alert to psychological discomfort

DISEASE 1. PULMONARY TUBERCULOSIS (Kocks, Phthisis, Consumption)

CAUSATIVE AGENT Mycobacterium Tuberculosis

DIAGNOSPATHOGNO-MONIC SIGN TIC TEST A. RESPIRATORY Chest x-ray, HEMOPTYSIS AFB, Afternoon fever, night sweats, body Mantoux malaise, weight loss, cough (dry to test, sputum productive), dyspnea, hoarseness of GS voice, chest pain

NURSING CARE

2. PNEUMONIA

Streptococcus pneumoniae, staphyslococcus aureus, diplococcus pneumoniae Bordetella Pertussis

Chest x-ray, sputum GS, increase WBC

3. PERTUSSIS (Whooping Cough)

Nasopharyn geal swab, sputum culture, CBC

Maintain respiratory isolation until patient responds to treatment, Administer meds, O2 as ordered Check for purulent, or bloody expectoration Semi-fowlers position Give health teaching about PTB, Stop smoking RUSTY SPUTUM Maintain patent airway and Sudden onset of chills with rising adequate oxygenation, rest & fever, stabbing chest pain nutrition aggravated by coughing, choking Control spread of infection, TSB, cough, body malaise, labored CPT respiration, rapid and pounding Monitor danger signs like marked pulse, dyspnea, delirium, cold moist skin, cyanosis and exhaustion WHOOPING COUGH Isolation and medical asepsis CATARRHAL STAGE During paroxysm pt should not be Coryza, sneezing, lacrimation, & dry left alone and suctioning bronchial cough becoming irritating, equipment should be ready at all hacking and nocturnal times to avoid obstruction of PAROXYSMAL STAGE airway Spasmodic, recurrent with excessive Sunshine and fresh air is important explosive outburst of cough in a but should be protected from draft series of 5-10 coughs in one Should be kept quiet as possible

4. DIPTHERIA (Strangling angels disease, Klebbs Loeffler Disease) YPES A. NASAL B. TONSILAR C. NASO PHARYNGEAL D. WOUND/ CUTANEOUS 4. INFLUENZA (La grippe, Flu)

5. BIRDSS FLU (Avian Infuenza)

expiration & ends in a loud crowing inspiratory whoop & chocking on mucuc that causes vomiting CONVALESCENT Gradual dec in paroxysm of coughing both in frequency & severity, vomiting ceases Coryne-bacterium Nose and PSEUDOMEMBRANE Diphteriae, throat swab DOB, Husky voice, Increase HR Klebbs Loeffler Virulence Stridor Bacillus test Nasal drainage/secretion Schicks test Swelling of the palate Molony test Low-grade fever Loefler slant Insidious feeling with fatigue, malaise, slight sore throat and inc temp, cervical adenitis Swollen neck- BULLS NECK SKIN- with yellow spots or sores COMPLICATION- myocarditis, polyneuritis, airway obstruction RNA containing Oropharyng Sudden, chilly sensation, myxoviruses type eal washing hyperpyrexia, malaise, sore throat, A,B,C or swabbing coryza, rhinorrhea, myalgia, for virus headache, severe back ache with culture sweating, vomiting Viral serology WBC Avian Influenza Viral Fever, sore throat, cough Virus (AI 1) Culture Severe case- pneumonia (H5N1)

since activity and excitement precipitate paroxysm Provide warm baths, keep the bed dry and free from soiled linens Intake and output should be closely monitored Absolute bed rest x 2 wks Soft diet, small frequent feedings Fruit juices rich in Vit.C Ice collar applied to the neck Care of the nose and throat SUPPORTIVE CARE -adequate nutrition, fluid and electrolyte balance -O2 inhalation -tracheostomy if required -give Anti-Diptheria Serum -Penicillin may be give as ordered Stay at home Drink plenty of fluids TSB Isolate Limit strenuous activity Give Paracetamol, Aspirin, Ibuprofen as prescribed Same as Flu

1. AMEBIASIS (Amebic Dysentery)

Entameba Hystolitica

Fecalysis, rectal swab

B. GASTRO BLOODY MUCOID STOOL Colicky abdominal pain Watery foul smelling stools

2. CHOLERA (Eltor)

3. SHIGELLOSIS (Bacillary Dysentery)

Vibrio Cholerae - cholerae (classica l - Eltor Vibrio Comma - Ogawa - Inaba - Hirojim a Shigella bacilli Group A S. Dysenterae B.- S. Flexneri C. S. Boydii D. S. Sonnei Hepatitis A (HAV)

Fecalysis, rectal swab

Profuse painless RICE WATERY STOOL without blood or mucus Occasional vomiting Rapid dehydration Acidosis and hypokalemia Oliguria to anuria

Enteric isolation Bed rest BRAT Adequate nutrition and hydration Monitor I & O Rehydrate parenterally/orally Perianal care Deodorize room Prompt fluid therapy with volumes to correct fluid and electrolytes Place in watten bed Keep linen dry and clean Keep place quiet and well ventilated Give oresol Give tetracycline as prescribed Enteric isolation Maintain fluid and electrolyte imbalance to prevent dehydration

Fecalysis, rectal swab CBC- Rise in agglutination titers after the first week

Persistent DIARRHEA WITH BLOOD, MUCUS & PUS (WATERY) WITH TENESMUS Cramping and abdominal pain Profound prostration Nausea and vomiting

1. HEPATITIS *A- Infectious hepatitis, Epidemic Hepatitis, Epidemic

C. HEPATO-ENTERIC PRODROMAL SGOT inc. Fever, malaise, anorexia, abdominal Inc. phosphate discomfort, nausea, headache Leucopenia ACUTE ICTERIC PERIOD

Maintain bedrest until enzyme level begin to normalize Give O2 as needed Provide adequate nutrition

Jaundice, Catarrhal Jaundice, Type A hepatitis, HA *B- Type B hepatitis, serum hepatitis, homologous serum jaundice, Australian Antigen hepatitis, HB *C- Parenterally Non A- Non B hepatitis, Post-transfusion Non A non B, HC *D- Delta agent hepatitis, viral hepatitis D, Delta associated hepatitis, hepatitis delta virus *E- Enterically transmitted non A non B hepatitis Hepatitis B (HBV)

(pre-icteric) Leukocytosis (later)

Hepatitis C, a flavivirus HDV- unable to

replicate a cell by itself, requires coinfection with HBV to undergo replication cycle

Tenesmus, jaundice, scleral icterus, lassitude, enlarged liver DEFERVESCENT -jaundice emerges HbsAgN/V hepatistis B Vague abdominal discomfort surface Arthralgic antigen Rash often progressing to jaundice ELISA N/V SGPT <800IU Vague abdominal discomfort Anorexia Progressing to jaundice less frequently to HB Serologic test Inflammation of the liver maybe for HDV severe and always co-exist with (anti-D-IgG), HBV anti- D-IgM) Same as HA

Diet- high in calories, CHO, limited fats Monitor S/S of dehydration Maintain intact mucus membrane Health teachings to px about disease transmission, isolation and avoidance of blood donation Treat sexual partner, all preganant woman should undergo HbsAg

Coefficient of 183 S Coefficient of 157 S for HAV 2. TYPHOID FEVER Salmonella (Enteric Fever, Typhus Typhosa/Typhi Abdominalis)

Typhi-dot ELISA Widals test Rectal swab

SMALL ROSE SPOTS on chest and abdomen Ladder-like fever Chills, Sweating, Headache, malaise, anorexia, bradycardia, nonproductive cough, constipation, mental dullness, slight deafness, parotitis

Enteric precaution TSB, watch for bladder distention and intestinal bleeding Give high calorie, low residue diet during febrile stage Maintain, restore fluid and electrolytes Maintain good personal hygiene

3. SCHISTOSOMIASIS (Blood Fluke Disease, Snail Fever, Bilharziasis)

Schistosoma Japonicum, Schistosoma Mansoni, Schistosoma Haematobium

1. RABIES (lyssa, Hydrophobia)

Rhabdo virus, Rabies Virus

Fecalysis, BIG BELLY- due to hepatomegally, Kato-katz splenomegally, lymphadenopathy technique Bloody mucoid-stool ELIZA SWIMMERS ITCH- pruritic rash at COPTthe site of penetration Cercum Ova Headache, dizziness, and convulsion Precipetin when parasite reaches the brain Test Becomes icteric, jaundice D. CENTRAL NERVOUS SYSTEM FRAPRODROMAL/INVASIVE Flourescent -fever, anorexia, malaise, sore Rabies throat, copious salivation, Antibody lacrimation, perspiration, irritability, Presence of excitability, apprehensiveness, negri body in depression, melancholia & insomnia dogs brain EXCITEMENT/NEUROLOGICAL Isolation from Marked excitation, apprehension, pts saliva and even terror, delirium with nuchal throat rigidity, involuntary twitching, maniacal behavior, eyes fixed and glossy, skin is cold and clammy, severe painful spasm of muscles of the mouth, larynx and pharynx, AEROPHOBIA, HYDROPHOBIA, PHOTOPHOBIA, profuse drooling of saliva, tonic or clonic contraction of muscles TERMINAL/PARALYTIC Pt becomes quiet, unconscious, loss of bowel and urinary control, progressive paralysis, DEATH

DRUG OF CHOICE PRAZIQUANTEL Proper disposal of excreta Use of rubber boots Treat small breeding places Eradicate snail Improve irrigation system Report endemic case Isolate patient Emotional and spiritual support Provide optimum comfort Darken the room, provide quiet and safe environment IVF should be wrapped and needle should be securely anchored Patient should not be bathed and there should be no running water in the room or within hearing distance of the patient Proper counseling of relative Post-exposure treatment of relative Post-mortem care Concurrent and terminal disinfection

2. ENCEPHALITIS (Brain Fever)

Bacteria, virus, fungi, rikettsia, toxins, chemical substances, or trauma

CSF Analysis, ELISA (IgM) Polymerase chain reaction

3. MENINGITIS (CSF Fever)

Bacteria, virus, fungi

Lumbar Puncture test, urine culture, blood smear and culture, gram stain

4. MENINGOCOCCEMIA

Neisseria Meningitidis

Lumbar Puncture test

Chills, sore throat, arthralgia, myalgia, abdominal pain Nuchal rigidity, ataxia, tremors, mental confusion, speech difficulty, ocular palsy, PTOSIS, DOB, DYSPHAGIA MOTOR DISTURBANCES Persistent convulsions, Parkinsonian syndrome or paralysis agitans, epilepsy MENTAL DISTURBANCES Mental dullness, mental deterioration, lethargy, mental depression, sleep disturbance ENDOCRINE DISTURBANCES Patient may grow fat or thin, lost of sexual interest or activity Headache, hyperpyrexia, convulsion fever, nausea and vomiting, nuchalspinal rigidity, meningeal irritation + BRUDZINSKI SIGN, + KERNIGS SIGN, + OPISTHOTONUS, exaggerated and symmetrical DTR, signs of increase ICP: bulging fontanel for infants, projectile vomiting, severe frontal headache, blurring of vision, alteration in sensorium Nasopharyngitis, high grade fever with chills, N/V, malaise, headache,

Control of convulsions, promote safe environment Sanitary disposal of nose and throat secretions TSB, unless the px is comatose, fluid should be encouraged Oral care should be strictly done Record I &O, provide mouth gag

Check NVS Monitor fluid balance Ensure patients comfort Position the patient carefully to prevent joint stiffness and neck pain Follow strict aseptic technique Provide reassurance and support to px and family Administer mannitol, antibiotics, anticonvulsant with precaution Same as meningitis Prophylactic drug- Rifampicin

5. TETANUS (Lock jaw)

Clostridium Tetani

Serologic test EIA

petechial, purpuric, or echymotic hemorrhages scattered over the entire body and mucous membrane WATERHOUSE FRIEDRICHSEN SYNDROME- Adrenal medullary hemorrhage RISUS SARDONICUS/ SARDONIC GRIN/SARDONIC SMILE, opisthotonus, lock jaw, board-like abdomen, intermittent tonic convulsions, neck facial muscle rigidity (trismus), Tetanolysin destruction of RBC Tetanospasmin- muscle contraction

Give Tetanus toxoid, ATS, TIG O2 inhalation Feed thru NGT Tracheostomy Adequate fluid and electrolytes maintain adequate airway Avoid contractures and pressure sores, avoid stimulation: limit visitors, darkened and quiet room Respiratory isolation x 9 days from onset of swelling Bedrest until swelling subsides Give fluids and soft bland food Provide warm or cold pack for relief of discomfort, light support to scrotum Hot or cold compresses to swollen neck area Kept in mosquito free environment Bedrest Monitor V/S Apply ice pack for nose bleeding,

1. MUMPS (Infectious Parotitis)

Myxovirus parotidis

1. DENGUE FEVER (Breakbone fever, Dandy Fever, Infectious

Flaviviruses (dengue virus 1,2,3,&4) Arboviruses,

E. PAROTID GLAND Virus SWELLING OF SALIVARY isolation in GLANDS leading to dysphagia and saliva, urine earache, enlargement and reddening of Whartons duct and Stensens duct. Fever 1 day prior to grandular swelling, anorexia, headache COMPLICATION Epididymo-orchitis, oophoritis, encephalitis, meningoencephalitis, mastitis, neuritis, thyroiditis F. BLOOD VECTOR BORNE Platelet count GRADE I FEBRILE STAGE <100cubic Fever, headache, +tourniquet test, mm anorexia, N/V, petechial rash, +HERMANS SIGN, generalized

Thrombocytopenic Purpura, Hemorrhagic Fever)

Chikungunya viruses VECTOR: Aedes Egypti

2. MALARIA (Ague, Paludism, Marsh Fever, Periodic Fever)

Plasmodium Ovale Plasmodium Vivax Plasmodium Falciparum Plasmodium Malariae VECTOR: Anopheles Leptospira

Malarial smear, rapid diagnostic test (RDT)

abdominal pain, arthralgia, myalgia GRADE II- HEMORRHAGIC All signs & symptoms of grade I + spontaneous bleeding GRADE III- CIRCULATORY Weak pulse, narrow pulse pressure, hypotension, cold clammy skin and restlessness GRADE IV- SHOCK Undetectable pulse pressure and pulse SHIVERING CHILLS Rapid rising of fever with severe headache, profuse sweating, myalgia, splenomegally, hepatomegally, orthostatic hypotension, CEREBRAL MALARIA Changes in sensorium, severe headache and vomiting, Jacksonian or grand mal seizure SEPTIC STAGE Remittent fever, chills, headache, anorexia, abdominal pain, severe prostration, respiratory distress IMMUNE OR TOXIC STAGE Headache, meningeal manifestation like convulsion, oliguria and anuria with progressive renal failure, shock, coma, CHF

Restore blood volume place on trendelenburg or transfuse blood as ordered. TSB, give Paracetamol, avoid giving Aspirin Use soft bristled toothbrush Avoid dark-color foods Increase fluid intake Give analgesic as prescribed Strict monitoring of I&O, VS TSB Hot application or offering hot drinks during chilling Encourage comfort and psychological support Watch for S/S of bleeding, evaluate degree of anemia, watch out for neuro toxicity Isolate patient proper disposal of urine Keep under close surveillance Eradicate rats, rodents Bed rest, adequate diet Administer fluid, electrolytes and blood as indicated, Tetracycline, Pen G Na, Peritoneal Dialysis as ordered

3. LEPTOSPIROSIS (Weils Disease, Canicola Fever, VECTOR: Hemorrhagic Jaundice, Rats/rodents Mud Fever, Swineherds Disease)

Isolation of Leptospires * 1-7 days (blood) * 4-10 days (CSF) * after 10 days (urine)

4. FILARIASIS (Elephantiasis)

Wuchereria Bancrofti Bruglia Malayi

Circulating Filarial Antigen (CFA)

CONVALESCENCE Relapse may occur during 4th 5th week ELEPHANTIASIS Lymphedema, lymphangitis, lymphadenopathy in arms, breast, scrotum, legs

Sleep under mosquito nets Give DEC as prescribed Surgery may be used to remove surplus tissue and provide a way to drain fluid around the lymphatic vessels. Elevate legs and apply elastic bandages DEC fortified salts Isolation (quiet, well ventilated, subdued light) TSB Skin care Oral and nasal hygiene Care of eyes (sensitive to light) and ears (check for mastoid infection). Change position every 3-4 hours

1. MEASLES (7-day fever, red measles, Rubeola)

2. GERMAN MEASLES (Rubella, 3-day fever)

G. INTEGUMENTARY (ERUPTIVE FEVER DISEASE) Rubeola Virus, WBC, PRODROMAL PERIOD paramyxoWrights stain Low grade fever, headache, malaise, viruses, of sputum or 3 Cs coryza, conjunctivitis, cough Morbilli nasal scraping Presence of enanthem (KOPLIK SPOT, STIMSONS LINE0 ERUPTIVE PERIOD Rashes(erythematous, maculopapular eruption behind ears, face then neck, arms, trunk, legs) high grade fever, anorexia, irritability, abdominal tympanism, pruritus, lethargy CONVALESCENCE PERIOD Rashes fades away, fever subsides, symptoms subside & appetite returns Rubella Virus Virus PRODROMAL PERIOD Family: isolation from Low grade fever, headache, malaise, Togaviridae nasal and mild coryza, conjunctivitis, POST-

Isolation Bedrest until fever subsides Darken room to avoid photophobia

Genus: Rubivirus

throat washing, urine

3. VARICELLA (Chicken Pox)

VZ-Virus

Virus isolation from vesicle fluid, pustule

4. HERPES ZOSTER (Shingles)

VZ- Virus

Tissue culture technique, smear of vesicle fluid

AURICULAR, SUBOCCIPITAL, CERVICAL LYMPHADENOPATHY which occur on the 3rd to 5th day after onset ERUPTIVE PERIOD FORCHEIMERS SPOT Eruption appears after the onset of adenopathy, + testicular pain in young adults, polyarthralgia and polyarthritis PRE-ERUPTIVE PERIOD Mild, fever, malaise ERUPTIVE PERIOD Centrifugal growth of rashes MACULE- lesion that is not elevated above the skin surface PAPULE- lesion that is elevated above the skin 3mm diameter VESICLE- a pop-like eruption filled with fluid PUSTULE- vesicle that is infected or filled with pus CRUST- scab or eschar PRODROMAL PERIOD Malaise, fever ERUPTIVE PERIOD Pustule to vesicles to scab Lesion is unilateral and appears in cluster following a peripheral nerve route Eruption has neural distribution and

Mild liquid diet but nourishing Irrigate eyes with warm saline to relieve irritation Care of the ears Good ventilation Prevent spread of infection

Respiratory isolation until all vesicles have crusted Hygienic measure to prevent complication Proper disposal of nasopharyngeal secretion Disinfection of linen by sunlight or boiling Cut fingernails and wash hands For child- apply mittens Provide diversional activities to avoid scratching of vesicles. Strict isolation precaution Apply cool, wet dressings with NSS to pruritic lesions Avoid cross-infection

1. AIDS (Acquired Immune Deficiency Syndrome)

HIV- Human Immunodeficiency Virus

is painful H. SEXUALLY TRANSMITTED DISEASE ELISA (Initial MINOR SIGNS test x 3) Persistent cough x 1 month WESTERN Generalized pruritic dermatitis BLOT Recurrent herpes zoster (Confirmatory Oropharyngeal candidiasis Chronic disseminated herpes simplex Generalized lymphadenopathy MAJOR SIGNS Weight loss- 10 % BW Chronic diarrhea x > 1 month Prolonged fever x 1 month COMPLICATIONS Pneumocystic Carinii Pneumoniae Oral Candidiasis, Toxoplasmosis of CNS, Wasting syndrome (chronic diarrhea), PTB, EPTB, Cancers (Kaposis Sarcoma, Cervical Dysplasia and Cancer, NonHodgkins Lymphoma Dark-Field Examination of Chancre Fluid chancre or primary sore (painless) Influenza-like Syndrome 5 common lesion -dermatitis -mucous patches -alopecia -Iritis

FOUR CS COMPLIANCE- gives information and counsels the client resulting in client following treatment, prevention, and reccmmendation successfully COUNSELLING/EDUCATION About treatment, disease, guidance on how to avoid STD again Facts about HIV and AIDS CONTACT TRACING- Tracing out and providing treatment on partners CONDOMS- Promoting condom use, instructing about their use and providing them.

2. SYPHILIS

Treponema Pallidum

Case finding Health teaching & guidance along preventive measure Proper direction on how to use community resources and services

3. Gonorrhea

Neisseria Gonorrheae

Identification of the organism -Gramstrained Smear -Culture -Direct Fluorescent Antibody Test

1. ASCARIASIS (Roundworm infection)

Ascaris Lumbricoides

purulent urethral discharge dysuria prostatitis pelvic pain and fever severe scrotal pain urethral sticture spread of infection to posterior urethra, prostate, seminal vesicles and epididymitis inflamed cervix w/ purulent discharge infection spreading to anus and urethra and up to the endometrium vaginal discharge urinary frequency and pain I. PARASITISM Stool for Ova Malnutrition due to damage to the Kato intestinal mucosa imparing techniques, absorption of nutrients abdominal Biliary Tract, Intestinal obstruction xray, CBC Hepatic abscess

Isolation of patient Neonatal prevention silver nitrate aqueous penicillin given IV or IM for positve gonorrhea mothers Control Measures active immunization passive immunization public health control Health Education

Importance of personal hygiene Availability of toilet facility Deworming with Mebendazole 15cc as single dose as ordered Improve nutrition