1. INFECTIONS

2. Chain of Infection
Susceptible host
Portal of Entry
Etiologic Agent (microorganism)
Reservoir
Method of transmission from reservoir to
(Source) susceptible host
Portal of exit

3. Pathogens
• Bacteria
– Aerobic
– Anaerobic
• Viruses
- intracellular parasite capable of reproducing outside of a living cell.
• Mycoplasma
– similar to bacteria and have no cell wall
– resistant to antibiotics that inhibit cell wall synthesis
• Rickettsiae & Chlamydia
- rigid cell wall; with some feature of both bacteria and viruses.
– Chlamydia- transmitted by direct contact
– Rickettsiae- infect cells of arthropods and are transmitted by these vectors.
• Fungi
- self-limited, affecting the skin and subcutaneous tissue.
• Parasites

4. Reservoir
-where the pathogen lives and multiplies
– Endogenous
– Exogenous
• Mode of Transmission
– Direct contact
– Indirect contact
• Vector
– Droplet or airborne transmission

5. Host Factors
• Factors that enable a host to resist infections:
• Physical barriers
• Hostile environment created by stomach acid
secretions, urine & vaginal secretions.
• Antimicrobial factors e.g. saliva, tears
• Respiratory defenses
• Specific and nonspecific immune responses to
pathogenic invasion.
• Age
• Nutrition

6. Portal of Entry
• Respiratory Tract
• GI Tract
• Genitourinary Tract
• Skin and mucous membrane
• Bloodstream

7. Stages of Infectious Process
• Incubation period
– period begins with active replication but with no symptoms
• Prodromal stage
– Symptoms first appear
• Acute phase
– proliferation and dissemination of pathogens
• Convalescent stage
- containment of infection and pathogens are eliminated
• Resolution
– total elimination of pathogens without residual manifestation
Nosocomial infection
– Infection acquired in a health care setting.
– Typically manifest after 48 hrs.
– UTI most common type

8. FACTORS AFFECTING RISK
OF INFECTION
• AGE
• HEREDITY
• LEVEL OF STRESS
• NUTRITIONAL STATUS
• CURRENT MEDICAL THERAPY
• PRE-EXISTING DISEASE
• IMMUNIZATION STATUS

9. Standard precautions
• Blood
• All body fluids, secretions, excretions,
• Non-intact skin
• Mucous membranes
• Essential elements:
• Use barrier protection
• Prevent inadvertent percutaneous exposure,
dispose of needles
• Immediate and thorough hand washing

10. Infection Control and Prevention

11. Infection Control in In-Patient Health
Care Agencies
• Hand Hygiene
• Patient Placement
• Protective Equipment
• Proper disposal of Soiled Equipment

12. Infection Control In Community –
Based Setting
• Sanitation
• Proper Disposal of Waste
• Food Preparation
• Report CD Occurrence

13. Pharmacology
• Check for:
– History of hypersensitivity.
– Age and childbearing status of the client.
– Renal function
– Hepatic function
– Site of infection
• Classification of antimicrobial preparations:
– Bacteriostatic
– Bactericidal

14. COMMUNICABLE DISEASE
– Is any disease that can be transmitted directly or
indirectly from one person to another

15. INFECTION
– Is a condition caused by the entry and
multiplication of pathogenic microorganisms
within the host body.
– It is also an invasion of an organisms
(bacteria, helminths, fungi, parasite, ricketsia and
prion)

16. ISOLATION
– It is necessary when a person is known or
suspected to be infected with pathogens that can
be transmitted by direct or indirect contact.
– The principle behind isolation technique is to
create a physical barrier that prevents the transfer
of infectious agents. To do this you have to know
how the organisms are transmitted.

17. Transmission-Based Precautions
–Airborne
–Droplets
–Contact

18. AIRBORNE
– PRIVATE ROOM
– NEGATIVE AIR PRESSURE
– VENTILATION SAFEGUARDS air from room is not
recirculated to other areas
– DOOR SHOULD BE KEPT CLOSED
– BARRIER TO SMALL PARTICLES masks HEPA high
efficiency particulate air
– COVER MOUTH OF PATIENT WITH MASK DURING
TRANSPORT

19. DROPLET
•
– PRIVATE ROOM
– WEAR MASK IF WORKING WITHIN 3 FEET
– WEAR MASKS UPON ENTRY INTO THE ROOM
– COVER MOUTH OF PATIENT WITH MASK DURING
TRANSPORT

20. CONTACT
– PRIVATE ROOM
– WEAR GLOVES
– GLOVES ARE REMOVED BEFORE EXITING FROM
THE ROOM
– HANDS ARE WASHED THOROUGHLY
– NOTHING IS TOUCHED BEFORE EXITING THE
ROOM
– GOWN IS WORN WHEN ENTERING THE ROOM
– REMOVE GOWN CAUTIOUSLY BEFORE LEAVING
THE ROOM
– PATIENT CARE ITEMS SHOULD BE RESTRICTED TO
SINGLE PATIENT

21. AFB ISOLATION
– VISITORS REPORT TO NURSES’ STATION BEFORE
ENTERING ROOM
• MASKS ARE TO BE WORN IN THE PATIENT’S ROOM
• GOWNS ARE INDICATED TO PREVENT CLOTHING
CONTAMINATION
• GLOVES ARE INDICATED FOR BODY FLUIDS AND NON-
INTACTSKIN
• HANDWASHING-after touching the patient or
potentially contaminated articles and after removing
gloves
• articles should be discarded, cleaned or sent for
decontamination and reprocessing
• room is to remain closed
• patient is to wear mask during transport

22. STRICT ISOLATION
– VISITORS-REPORT TO NURSES’ STATION BEFORE
ENTERING ROOM
– PRIVATE ROOM-necessary, door must be kept closed
– GOWNS-must be worn by all persons entering the
room
– MASKS- must be worn by all persons entering the
room
– HANDS-must be washed on entering and leaving room
– GLOVES-must be worn by all persons entering the
room
– ARTICLES-must be discarded, or wrapped before being
sent to CENTRAL SUPPLY for disinfection or
sterilization

23. RESPIRATORY ISOLATION
– VISITORS-REPORT TO NURSES’ STATION BEFORE
ENTERING ROOM
– PRIVATE ROOM-necessary, door must be kept closed
– GOWNS-gowns not necessary
– MASKS- must be worn by all persons entering the
room if susceptible disease
– HANDS-must be washed on entering and leaving room
– GLOVES-not necessary
– ARTICLES-those contaminated with secretions must be
disinfected
– CAUTION-all persons susceptible to the specific
disease should be excluded from the
area, susceptibles must wear masks

24. WOUND AND SKIN PRECAUTIONS
– VISITORS-REPORT TO NURSES’ STATION BEFORE
ENTERING ROOM
– PRIVATE ROOM-desirable
– GOWNS-must be worn by all persons having direct
contact with the patient
– MASKS- during dressing changes
– HANDS-must be washed on entering and leaving
room
– GLOVES-must be worn by all persons having direct
contact with infected area
– ARTICLES-instruments, dressing, linens

25. ENTERIC PRECAUTIONS
– VISITORS-REPORT TO NURSES’ STATION BEFORE
ENTERING ROOM
– PRIVATE ROOM-necessary FOR CHILDREN ONLY
– GOWNS- must be worn by all persons having direct
contact with the patient
– MASKS- not necessary
– HANDS-must be washed on entering and leaving room
– GLOVES-must be worn by all persons having direct
contact with patient or articles contaminated with
fecal material
– ARTICLES-special precautions necessary for articles
contaminated with urine and feces, must be
disinfected or discarded

26. PROTECTIVE ISOLATION
– VISITORS-REPORT TO NURSES’ STATION BEFORE
ENTERING ROOM
– PRIVATE ROOM-necessary, door must be kept
closed
– GOWNS- must be worn by all persons entering
room
– MASKS- - must be worn by all persons entering
room
– HANDS-must be washed on entering and leaving
room
– GLOVES-must be worn by all persons having direct
contact with patient

27. Airborne Diseases

28. Diphtheria
– Corynebacterium diphtheriae
– Klebsloeffler’s bacillus (bacteria)
– MOT = droplets and airborne
• HIGHLY CONTAGIOUS
– IP 2-5 days
– IMMUNITY
• Active = DPT
• Passive = DAT
• Natural = xxx

29. – Dx = throat swab, MOLONEY, SCHICK
– Pseudomembrane, Bullneck
– Penicillin or erythromycin
– Resp Acidosis with hypoxemia
– Cx: myocarditis, septicemia

30. Nursing Considerations:
– OBSERVE CNS, CARDIAC AND KIDNEY COMPLICATIONS
– PSEUDOMEMBRANOUS MAY LEAD TO RESP.
OBSTRUCTION
– ISOLATION UNTIL 2 NEGATIVE CULTURE AT 24 HOUR
INTERVAL
– F&E RESUSCITATION
– PARENTS OR SIBLINGS WHO HAVE NEVER IMMUNIZED
SHOULD RECEIVE A DOSE OF DIPH. ANTI-TOXIN
– ATTENTION TO NASOPHARYNGEAL DISCHARGE
– ANTIBIOTICS-PENICILLIN, ERYTHROMYCIN IF ALLERGIC
TO PENICILLIN

31. Diphtheria KEY POINTS!
– Highly contagious
– Pseudomembrane and bullneck
– Immunization best intervention PREVENTION
– Obstruction and myocarditis
– Isolation technique

32. Measles, Rubeola, 7 Day Fever, Hard
Red Measle
– Paramyxo virus
– MOT = droplets and airborne
• PC 4 days before and 5 days after rash
• HIGHLY CONTAGIOUS
– IP 7-14 days
– IMMUNITY
• Active = measles vaccine, MMR
• Passive = measles Ig
• Natural = lifetime

33. – Rashes:
– Maculopapular
– Cephalocaudal
– With desquamation
– Pruritus

34. • Rashes: maculopapaular, cephalocaudal (hairline and
behind the ears to trunk and
limbs), confluent, desquamation, pruritus

35. – PS koplik’s spot
– Characteristic: stimsons, photophobia (typical
complaint)
– Fever: high fever
– CX pneumonia, meningitis

36. German Measles, Rubella, Rotheln
Disease, 3 Day Measles
– RNA rubella virus
– MOT = droplets and airborne
• PC 5 days before and 5 days after rash
• HIGHLY CONTAGIOUS
– IP = 10-21 days
– IMMUNITY
• Active = MMR
• Passive = rubella Ig
• Natural = lifetime

37. – Rashes:
– Maculopapular
– Diffuse
– No desquamation

38. – Rashes: Maculopapular, Diffuse/not confluent, No
desquamation, spreads from the face downwards
•

39. Chicken Pox, Varicella
– Herpes Zoster Virus
– Varicella Zoster Virus
– MOT = droplets and airborne
• PC one day before rash and 6 days after first crop of vesicles
• HIGHLY CONTAGIOUS
– IP 14-21 days
– IMMUNITY
• Active = varicella vaccine
• Passive = xxx
• Natural = lifetime

40. – Rashes: Maculopapulovesicular (covered areas),
Centrifugal, starts on face and trunk and spreads
to entire body
– Leaves a pitted scar (pockmark)

41. – Dx = Tzanck smear (scraping of ulcer for staining)
– Rashes:
• Maculopapulovesicular (covered areas)
• Centrifugal
• Leaves a pitted scar (pockmark)
– CX furunculosis, erysipelas, meningoencephalitis
– Dormant: remain at the dorsal root ganglion and
may recur as shingles

42. Meningitis Menigococcemia
– Neisseria meningitides (bacteria)
– MOT = droplets
– IP = 1-2 days
– IMMUNITY = xxx

43. – Immunocompetent are susceptible
– Petechiae (volar/palm of hands) EARLY
– Opisthotonus MENIGEAL IRRITATION
– Brudzinski MENINGEAL IRRITATION
– Kernigs MENINGEAL IRRITATION
– Increased ICP BRAIN
– Seizure BRAIN

44. – S/sx:
– Meningococcemia – spiking fever, chills, arthralgia,
petechial rash
– Fulminant Meningococcemia (Waterhouse
Friderichsen) – septic shock; hypotension,
tachycardia, enlarging petecchial rash, adrenal
insufficiency
• Meningitis – most common; nuchal rigidity,
brudzinski, kernigs, Photophobia, confusion

45. – Dx: CT/ MRI, CSF analysis, CSF gram stain, CSF and
blood culture
– Mgmt: antibiotics (Pen G, ceftriaxone), steroids,
anticonvulsants, Rifampin for close contacts of
meningococcemia

46. Amoebiasis
– Entamoeba Hystolitica –protozoan (parasite)
– MOT = 5 F’s, fecal oral route
– IP = 2-4 weeks
– IMMUNITY = xxx

47. – Dx microscopic stool exam or rectal secretions
– (tetra nucleated cyst and trophozoites)
– Diarrhea and constipation (non dysenteric)
– Blood streaked, diarrhea and watery mucoid, abd’l
cramps (dysenteric)
– Extra amoebiasis-
penile, vagina, spleen, liver, anal, lungs and
meninges
– Metronidazole (Flagyl)

48. Typhoid Fever
– Salmonella typhosa (bacteria)
– MOT = same with amoebiasis (5 F’s)
– IP = 1-3 weeks
– IMMUNITY
• Active = vaccine
• Passive = xxx
• Natural = lifetime immunity

49. Pathophysiology
– Oral ingestion
– Bloodstream
– Reticuloendothelial system (lymph node, spleen,
liver)
– Bloodstream
– Gallbladder
– Peyer’s patches of SI
– necrosis and ulceration

50. – 1st week step ladder (BLOOD)
– 2nd week rose spot and fastidial
• typhoid pyschosis (URINE & STOOL)
– 3rd week (complications) intestinal bleeding,
• perforation, peritonitis, encephalitis,
– 4th week (lysis) decreasing S?SX
– 5th week (convalescent)

51. – Blood (typhi dot) 1st week after
– Stool and urine 2nd week after
– Chloramphenicol

52. – Rose spot (abdominal rashes)
– Step ladder fever to fastidial (peak of fever)
typhoid psychosis
– Peyer’s patches of small intestine
– May stay in the gallbladder (hiding area)

53. BLOOD BORNE DISEASES

54. RABIES

55. CONTENTS:

56. What is rabies? (DEFINITION & ETIOLOGY)
• Is an acute infectious disease of warm-blooded animals and
humans characterized by an involvement of the nervous system
resulting in death.
• It is caused by the RABIES VIRUS, a rhabdovirus of the genus
lyssavirus.
Rabies is a serious disease. Each year, it kills more than
50,000 people and millions of animals around the world.
Rabies is a big problem in Asia, Africa, and Central and South
America. In the United States, rabies has been reported in
every state except Hawaii. Any mammal can get rabies.
Raccoons, skunks, foxes, bats, dogs, and cats can get rabies.
Cattle and humans can also get rabies. Only mammals can get
rabies. Animals that are not mammals -- such as
birds, snakes, and fish -- do not get rabies. Rabies is caused
by a virus. An animal gets rabies from saliva, usually from a
bite of an animal that has the disease.

57. The Rabies Virus
RV – a neurotropic filterable virus present in the
saliva of rabid animals. It has a preferrence for Rod-shaped
nerve tissues. rabies viruses
colored for
Virus – minute organism not visible
effect
with ordinary light microscopy. It
is parasitic in that it is entirely
dependent on nutrients inside
cells for its metabolic and
reproductive needs. Can only be
seen by use of eclectron
microscopy. Consists of DNA or
RNA covered with a protein
Parts of the rabies covering called capsid.
A rhabdovirus
virus of the genus lyssavirus. Neurotropic – viruses that
reproduce in nerve tissue
Filterable virus – virus causing
RHABDOVIRUS: any group of rod-shaped
infectious disease, the essential
This is a
RNA viruses with 1 important member,
elements of which are so photograph of
tiny that
rabies virus, pathogenic to man. The
they retain infectivity aftervirus under
the
virus has a predilection for tissue of
RHABDO: from Greek passing through a filter of the
electron
mucus-secreting glands and the Central
rhabdos, "rod" Berkefeld type. microscope
Nervous System. All warm-blooded

58. How do you get rabies? (MODE & MEDIA OF TRANSMISSION, IMMUNITY)
•All warm-blooded mammals are susceptible. Natural immunity in man is
unknown.
•You get rabies through the saliva of an infected animal by an exposure to
an open break in the skin such as bites, open wound or scratch and
inhalation of infectious aerosols such as from bats.
•In some cases, it is transmitted through organ transplants (corneal
transplant), from an infected person.
•The virus gets transmitted through saliva, tears, semen, some liquor
(amniotic fluid, CST) but not blood, urine or stool.
You get rabies from the saliva of a rabid animal, usually
from a bite. The rabies virus is spread through saliva.
You cannot get rabies by petting an animal. You may get
rabies from a scratch if the animal, such as a cat, was
licking its paw before it scratched you. (Remember that
the rabies virus is found in the saliva of an animal).

59. How do you know if an animal has rabies?
• Animals with rabies may act differently from
healthy animals.
• Some signs of rabies in animals are:
 changes in an animal’s behavior
 general sickness (fever, restlessness)
 problems swallowing
 increased drooling
 aggression (biting at inanimate objects, aimless running)
• Wild animals may move slowly or may act as if they are tame. Some wild animals
(foxes, raccoons, skunks) that normally avoid porcupines, may even try to bite
these prickly rodents.
• A pet that is usually friendly may snap at you or may try to bite.

60. How do you know if one has rabies?
(DIAGNOSIS)
•There is yet no way of immediately knowing who had acquired
rabies virus. No tests are available to diagnose rabies in humans
before the onset of clinical disease.
•The most reliable test for rabies in patients who have clinical signs
of the disease is a DIRECT IMMUNOFLUORESCENT STUDY of a
full thickness biopsy of the skin taken from the back of the neck
above the hair line.
•The RAPID FLUORESCENT FOCUS INHIBITION TEST
is used to measure rabies-neutralizing antibodies in
serum. This test has the advantage of providing results
within 24 hours. Other tests of antibodies may take as
long as 14
•days.

61. EPIDEMIOLOGY
RABIES INCIDENCE:
WORLDWIDE:35, 000-
50, 000 cases/ year
(WHO)

62. EPIDEMIOLOGY
PHILIPPINES: 350-450 cases/ year
5-7 per million population
DOG BITE INCIDENCE: 140, 000- 560, 000/ year
200-800 per 100, 000 population/ year
AGE MOST AFFECTED: 5-14 year age group
(53% of cases)
BITING ANIMALS: (SLH STUDY 1982- 2002)
DOGS: 98%
PET: 88%
STRAY: 10%
CATS: 2%

63. • Based on the report from NCDPC (2004), the
six regions with the most number of rabies
cases are Western Visayas, Central Luzon,
Bicol, Central Visayas, Ilocos and Cagayan
Valley
• Data shows that 53.7 percent of animal bite
patients are children
• Dogs remain the principal animal source of
rabies

64. STAGES OF RABIES INFECTION
Rabies virus Entry into the body
INCUBATI0N PERIOD
(20 – 90 days)
INVASION
(0 – 10 days)
EXCITEMENT
(2 – 7 days)
PARALYTIC COMA
(5 – 14 days)
DEATH

65. RABIES CLASSIFICATION
ANIMAL RABIES
• There are two common types of rabies. One type is "furious" rabies.
Animals with this type are hostile, may bite at objects, and have an
increase in saliva. In the movies and in books, rabid animals foam at the
mouth. In real life, rabid animals look like they have foam in their mouth
because they have more saliva.
The second and more common form is known as paralytic or "dumb" rabies.
The dog pictured below has this type. An animal with "dumb" rabies is timid
and shy. It often rejects food and has paralysis of the lower jaw and
muscles.
• Another two types of rabies. One type is “urban” rabies. The type of
rabies in domestic dogs and cats.
The other type is called “ sylvatic” rabies. These type came from wild
animals such as bats, weasels, skunks and moles & voles.

66. HUMAN RABIES
• Humans also have a “furious” type, the
classic foaming of the mouth,
aggression, apprehension & hydrophobia,
and the “dumb” type, progressive
paralysis of the body until they couldn’t
breathe anymore.

67. DIFFERENT STAGES OF RABIES
INFECTION
C B
A A
T T
D S S
O
G
S
VIRUS IN SALIVA INHALED AEROSOLS
VIRUS IN SALIVA
INVASION PHASE
INVASION PHASE
PARALY
SIS
EXCITEMENT
PARALY
SIS
DEATH DEATH

68. INVASION STAGE
• Also called PRODOME PERIOD; Prodrome – symptom indicative of an
approaching disease
• 2-10 DAYS
• Sensory changes on the site of entry.
Pain: dull, constant pain referable to the nervous pathways proximal to
the location of the wound or itching, intermittent, stabbing pains
radiating distally to the region of inoculation. In general, sensitivity is
the early symptom which may be ascribed to the stimulative action of
the virus affecting groups of neurons, esp. sensory system. Though
there is apt to be decreased sensitivity to local pain e.g. needle
introduction, patient may complain bitterly of drafts & bed clothes
which produce a general stimulation
Tick me!

69. • Fever,headache malaise sore throat
anorexia increased sensitivity (bright
lights, loud noises) increased muscle
reflex irritability, tics and muscle tone
• Overactive facial expression

70. EXCITATION STAGE
• Also called ACUTE NEUROLOGICAL PHASE;
hyperactivity
• 2 – 10 DAYS
• Imminent thoraco-lumbar involvement (SNS):
pupillary dilation, lacrimation increased thick
saliva production / foaming of mouth, excessive
perspiration, increased HR
• Anxiety: increased
nervousness, insomnia, apprehension; a strong
desire to be up, wandering aimlessly about, and
Fear: a sense of impending doom
• Hydrophobia (perhaps, SNS stimulation:
depresses GI activity > inhibits
esophageal, gastric & intestinal function) >
violent expulsion of fluids, drooling (in attempt
not to swallow) > dehydration and parched mouth
& tongue
• Pronounced muscular stimulation & general
tremor
• Mania (tearing of clothes & bedding, cases of
biting & fighting rare but may occur) and
Hallucinations with lucid intervals (normal mental
function in which patient is well-oriented &
answers questions intelligently)
• Convulsions( besides r/t pronounced muscular
stimulation, further precipitated by sensory
stimuli – sight, sound, name of water > throat
spasms > choking > apnea, cyanois, gasping
Sympathetic nervous system
• > death, but if patient survive excitement phase…
Tick me Parasympathetic nervous system
Tick me 1st! next!

71. Tick me!

72. PARALYTIC STAGE
-also called DEPRESSION PHASE
• Gradual weakness of muscle groups
– muscle spasms cease
– OCULAR PALSY – strabismus, ocular
incoordination, nystagmus, diplopia, central
type partial blindness > responds poorly to
light, @ times pupil is constricted or unequal
(parasympathetic involvement)
– Oro-facial: FACIAL & MASSETER PALSY >
difficulty closing eyes & mouth, face
expressionless
– Oral: Weakness of muscles of phonation >
hoarsness & loss of voice
• Loss of tendon reflexes, always precedes
weakness of extremity
• Corneal reflex decreased or absent, dry

73. • Ears: VERTIGO . Middle ear disease . Early
symptom, but may develop @ any period
• Neck stiffness
• (+) Babinski [lesions of pyramidal tract], ( - )
Kernig’s ( - ) Brudzinski’s
• Cardiac: shifts from tachycardia (100 –
120bpm) @ bed rest to bradycardia (40 -60
bpm)
• Respi: Cheyne-Stokes > breathing pattern
characterized by a periodic 10 – 6- sec of apnea
followed by gradual increasing depth and
frequency of respiration
• Local sensation (pin prick, heat, cold)
diminished
• Incoordination

74. • Hydrophobia and aerophobia gone, but still has
some difficulty swallowing
• General arousal (PNS stimulation)
• Bladder & intestinal retention and obstipation
(damage to to innervation of the musculature of
intestine & bladder)(SNS damage)
in some cases, patient shows period of recovery, this
apparent remission is followed by progressive
• Ascending, flaccid paralysis of extremities until
it reaches the respiratory muscle
• Apathy, stupor
• Complications: Pneumothorax, thrombosis,
secondary infections

75. MANAGEMENT
NURSING INTERVENTIONS
• HIGH RISK FOR INFECTION TRANSMISSION
» provide patient isolation
» handwashing. Wash hands before and
after each patient contact and following
procedures that offer contamination risk
while caring for an individual patient.
Handwashing technique is important in
reducing transient flora on outer
epidermal layers of skin.
» Wear gloves when handling fluids and
other potential contaminated articles.
Dispose of every after patient care.
Gloves provide effective barrier
protection. Contaminated gloves becomes
a potential vehicle for the transfer of
organisms.

76. • KNOWLEDGE DEFICIT (about the disease,
cause of infection and preventive measures)
»assess patient’s and family’s level
of knowledge on the disease
including concepts, beliefs and
known treatment.
»Provide pertinent data about the
disease:
»organism and route of transmission
»treatment goals and process
»community resources if necessary
»allow opportunities for questions
and discussions

77. • ALTERED BODY TEMPERATURE:
FEVER RELATED TO THE PRESENCE
OF INFECTION. Since fever is
continuous, provide other modes to
reduce discomfort.
»If patient is still well oriented,
Inform the relation of fever to
the disease process. The
presence of virus in the body …
»Monitor temperature at
regular intervals
»Provide a well ventilated
environment free from drafts
and wind.

78. • DEHYDRATION related to refusal to take in
fluids secondary to throat spasms and fear of
spasmodic attacks.
»Assess level of dehydration of
patient.
»Maintain other routes of fluid
introduction as prescribed by the
physician e.g. parenteral routes
»Moisten parched mouth with cotton
or gauze dipped in water but not
dripping.

79. IMMUNIZATION
ACTIVE IMMUNIZATION
- induce antibody and T-cell production in order
to neutralize the rabies virus in the body. It
induces an active immune response in 7-10
days after vaccination, which may persist for
one year or more provided primary
immunization is completed.
TYPES:
a. PVRV (Purified Vero Cell Rabies Vaccine)
b. PCEVC (Purified Chick Embryo Cell Vaccine)

80. PASSIVE IMMUNIZATION
- RIG (Rabies Immune Globulins)
- provide the immediate availability of antibodies
at the site of exposure before it is physiologically
possible for the pt.to begin producing his own
antibodies after vaccination.
- Important for pts. w/ Cat III exposures
Types:
a. HRIG (Human Rabies Immune Globulins)
b. Highly Purified Antibody Antigen Binding
fragments
c. ERIG (Equine Rabies Immune Globulins)

81. VACCINATION
(Intradermal Schedule)
Day of PVRV/PCECV Site
Immunization
DAY 0 0.1 ml L & R deltoids/
anterolateral thighs of
infants
DAY 3 0.1 ml L & R deltoids/
anterolateral thighs of
infants
DAY 7 0.1 ml L & R deltoids /
anterolateral thighs of
infants
DAY 28/30 0.1 ml L & R deltoids/
anterolateral thighs of
infants

82. Intramuscular Schedule
Day of PVRV PCECV Site
Immunization
Day 0 0.5 ml 1.0 ml One deltoid/
anterolateral
thigh of infants
Day 3 0.5 ml 1.0 ml Same
Day 7 0.5 ml 1.0 ml Same
Day 14 0.5 ml 1.0 ml Same
Day 28 0.5 ml 1.0 ml same

83. MANAGEMENT OF RABIES PATIENT
• Once symptoms start, treatment should center
on comfort care, using sedation & avoidance of
intubation & life support measures once
diagnosis is certain
1. MEDICATIONS
a. Diazepam
b. Midazolam
c. Haloperidol + Dipenhydramine

84. 2. SUPPORTIVE CARE
- Pts w/ confirmed rabies should receive adequate
sedation & comfort care in an appropriate
medical facility.
a. Once rabies diagnosis has been confirmed,
invasive procedures must be avoided
b. Provide suitable emotional and physical
support
c. Discuss & provide important info. to relatives
concerning transmission of dse. & indication for
PET of contacts
d. Honest gentle communication concerning
prognosis should be provided to relatives of pt

85. 3. INFECTION CONTROL
a. Patient should be admitted in a quiet, draft-
free, isolation room
b. HLCR workers & relatives in contact w/ pt
should wear proper personal protective
equipment (gown, gloves, mask, goggles)
4. DISPOSAL OF DEAD BODIES

86. Tetanus

87. • Tetanus
– Clostridium tetani
– MOT = wound setting
– IP = 3 -21 days
– IMMUNITY
• Active = TT
• Passive = TAT and TIG
• Natural = active none, passive (+)

88. – Wound Infection
– FATAL INFECTION OF THE CNS
– TOXIN-NEUROTOXIN

89. • PATHOPHYSIOLOGY:
– SETTING OF WOUND ---- ENTRANCE OF C.T. ----
RELEASES TETANUS TOXIN ---- TETANOSPASMIN
(CNS), TETANOLYSIN (BLOOD) ---- ABSORBED BY
MOTOR NERVE ENDINGS ---- SYNAPSE
(CONNECTION BETWEEN NEURONS) ----
MYONEURAL JUNCTION ---- ACETYLCHOLINE
DISTURBANCE IN THE TRANSMISSION OF NERVE
IMPULSE

90. – Trismus – lock jaw
– Risus sardonicus - maskface
– Risorius - grinsmile
– Dx wound and blood extraction (non specific)

91. • Immunization
– DPT (0.5 ml IM) 1 – 1 ½ months old 2 - after 4
weeks 3 – after 4 weeks
– 1 st booster – 18 mos
– 2 nd booster – 4-6 yo
– subsequent booster – every 10 yrs thereafter
– TT (0.5 ml IM) TT1 - 6 months within preg TT2 -
one month after TT1 TT3 to TT5 - every
succeeding preg or every year
– TAT (horse) and TIG (human)

92. • Management
– 1. Anticonvulsant, muscle relaxants,
– antibiotics, wound cleansing and debridement,
hyperbaric chamber
– 2. Active-DPT and tetanus toxoid
– 3. Passive-TIG and TAT, placental immunity

93. VECTOR-BORNE
DISEASES

94. DENGUE HEMORRHAGIC FEVER

95. IINTRODUCTION:
Philippine Hemorrhagic Fever was first reported in 1953. In
1958, hemorrhagic became a notifiable disease in the
country and was later reclassified as Dengue Hemorrhagic
Fever.
What is Dengue
Hemorrhagic Fever?
• A severe mosquito transmitted viral illness endemic
in the tropics.
• It is characterized by increased vascular
permeability, hypovolemia and abnormal blood
clotting mechanisms.

96. WHO case definition for DHF:
• fever or history of recent fever
• thrombocytopenia (platelet count equal to or less than 100 x 10 /
cu mm)
• hemorrhagic manifestations such as petechiae or overt bleeding
phenomena, and
• evidence of plasma leakage due to increase vascular permeability
Infectious Agent / Etiologic Agent:
Flaviviruses; Dengue Virus Types 1, 2, 3, and 4

97. Occurrence:
Dengue occurrence is sporadic throughout the year.
Epidemic usually occurs during the rainy seasons June
– November.
Peak months are September and October.
DHF are observed most exclusively among children of
the indigenous population under 15 years of age.
Occurrence is greatest in the areas of high Aedis
Aegypti prevalence.

98. Notifiable Diseases and Deaths by Cause in
the Philippines (2001 – 2004)
2001 2002 2003 2004
Notifiable
Diseases Reported Reported Reported Reported
Cases Deaths Cases Deaths Cases Deaths Cases Deaths
Dengue
Fever 23,235 13,187 18,039 15,838
Source: National Statistics Office

99. INCIDENCE OF DENGUE HEMORRHAGIC FEVER IN
CEBU CITY (YEAR 2007)
Selected Number of New Cases Number of Deaths Year
Communicable
Disease: total male female total male female
Dengue / DHF 43, 350 … … 416 … … 2007
Source: Department of Health Region VII

100. • The DOH reported 70,204 dengue cases for
week ending September 10, 2011. This was
over 24,000 cases less or 25.87% lower than
for the same period last year. In addition, the
number of cases in July and August (the peak
months for dengue) was 52% lower than last
year. A total of 396 deaths were reported for
this year, which is lower than last year’s
number of 620.

101. Reservoir / Source of Infection:
• Some source is a vector mosquito, the Aedes
Aegypti or the common household mosquito
• The infected person

102. Mode of Transmission: Mosquito bite (Aedis Aegypti)
Incubation Period: Probably 6 days to one week
Period of Presumed to be on the 1st week
of illness – when virus is still
Communicability:
present in the blood
Susceptibility and All persons are susceptible. Both
sexes are equally affected. The age
resistance: groups predominantly affected are
the preschool age and school age.
Adults and infants are not
exempted. Peak age affected 5-9
years. Susceptibility is universal.
Acquired immunity may be
temporary but usually permanent.

103. Diagnostic Test:
1.) Tourniquet Test (Rumpel Leads Tests)
• Inflate the blood pressure cuff on the upper arm to
a point midway between the systolic and diastolic
pressure for 5 minutes
• Release cuff and make an imaginary 2.5 cm
square or 1 inch just below the cuff, at the
antecubital fossa
• Count the number of petechiae inside the box
• A test is (+) when 2 or more petechiae per 2.5 cm
square or 1 inch square are observed
2.) A con firmed diagnosis is established by
culture of the virus, polymerase-chain-reaction
(PCR) tests, or serologic assays.

104. Clinical Manifestations (Public Health Nursing in
the Philippines, 2007):
An acute febrile infection of sudden onset with 3 stages:
• 1st-4th day (febrile or invasive stage)
-high fever, abdominal pain and headache; later flushing which
may be accompanied by vomiting, conjunctiva infection and
epistaxis.
• 4th-7th day (toxic or hemorrhagic stage)
-lowering of temperature, severe abdominal pain, vomiting and
frequent bleeding from gastrointestinal tract in the form of
hematemesis or melena. Unstable blood pressure, narrow pulse
pressure and shock. Death may occur. Tourniquet test which may be
positive may become negative due to low or vasomotor collapse.

105. • 7th-10th day (convalescent or recovery
stage)
-generalized flushing with intervening areas of
blanching, appetite regained and blood
pressure already stable.
• Dengue shock syndrome is defined as dengue
hemorrhagic fever plus:
*Weak rapid pulse,
*Narrow pulse pressure (less than 20 mm Hg) or,
*Cold, clammy skin and restlessness

106. Grading of Dengue Fever:
The severity of DHF is categorized into four grades:
• grade I, without overt bleeding but positive for tourniquet test
• grade II, with clinical bleeding diathesis such as petechiae, epistaxis and
hematemesis
• grade III, circulatory failure manifested by a rapid and weak pulse with
narrowing pulse pressure (20 mmHg) or hypotension, with the presence of
cold clammy skin and restlessness; and
• Grade IV, profound shock in which pulse and blood pressure are not
detectable. It is note-worthy that patients who are in threatened shock or
shock stage, also known as dengue shock syndrome, usually remain
conscious.
* Grade III and IV are considered to be Dengue Shock Syndrome

107. MANAGEMENT

108. • Promote rest
• Medication
–Paracetamol – for
fever and muscle
pains.
–Analgesic – for
headache
–DON’T GIVE ASPIRIN

109. • Rapid replacement of body
fluids is the most important
treatment
– Give ORESOL to replace
fluid as in moderate
dehydration at 75ml/kg in
4-6 hours or up to 2-3L in
adults. Continue ORS
intake until paient’s
condition improves.
– Intravenous fluid

110. • For hemorrhage
– Keep patient at rest during
bleeding periods
– For epistaxis – maintain an
elevated position of trunk
and promote
vasoconstriction in nasal
mucosa membrane through
an ice bag over the
forehead.
– For melena – ice bag over
the abdomen.

111. • Provide support during the
transfusion therapy
• Diet
– Low fat, low fiber, non-
irritating, non-carbonated
– Noodle soup may be given
• Observe signs of
deterioration (shock) such as
low pulse, cold clammy
perspiration, prostration.

112. PREVENTION

113. • Eliminate vector by:
–Changing water and scrubbing sides
of lower vases once a week
–Destroy breeding places of mosquito
by cleaning surroundings
–Proper disposal of rubber tires,
empty bottles and cans
–Keep water containers covered

114. OTHER PRECAUTIONS:
• When outdoors in an area where
dengue fever has been found
–Use a mosquito repellant
–Dress in protective clothing-long-
sleeved shirts, long pants, socks, and
shoes

115. • Keeping unscreened windows and
doors closed
• Keeping window and door screens
repaired
• Use of mosquito nets

116. MALARIA
• Malaria, King of Tropical – P. VIVAX AND OVALE
Disease MAY HAVE RECCURENCE
OF SYMPTOMS
– Protozoan plasmodium
• tertian-febrile paroxysm
• plasmodium ovale - q24H-48H
dormant (liver)
• quartan-febrile paroxysm
• plasmodium vivax - q48H-72H
benign
• plasmodium malariae -
mild but resistant
• plasmodium falciparum -
malignant (cerebral
malaria)

117. – MOT
• Bite from infected anopheles mosquito or minimus
flavire (night biting)
• Blood Transfusion
• Sexual cycle
– sporogony (mosquito)
– gametes is the infective stage
• Asexual cycle
– schizogony (human)
– IP (Incubation Period) 5-6 days

118. – Nursing Considerations
– Dx:
• blood extraction (extract blood at the height of fever)
– Fever, chills, profuse sweating-convulsion
– Anemia and fluid and electrolytes imbalance,
hepatomegaly, splenomegaly, rigor, headache and
diarrhea.
– Chloroquine and Primaquine drug of choice
– Chloroquine for pregnant women
– For resistant plasmodium-use chemo drug
– RBC is being attack

119. – Nursing Considerations
– IV FLUIDS AND ELECTROLYTES
– Blackwater Fever – hemolysis and hemoglobinuria
– Sickle Cell Trait – provides natural resistance
– DECREASE FLUIDS IN CEREBRAL EDEMA
– ASSISTED VENTILATION IN PULMONARY EDEMA
– DIALYSIS IN RENAL FAILURE
– BT IN ANEMIA

120. – TRAVELERS TO MALARIA ENDEMIC area SHOULD FOLLOW
PREVENTIVE MEASURES- (CHEMOPROPHYLAXIS CHLOROQUINE
MAY BE TAKEN 1 WEEK BEFORE ENTERING ENDEMIC AREA)
– SOAKING OF MOSQUITO NET IN AN INSECTICIDE SOLUTION
– BIO PONDS FOR FISH
– ON STREAM CLEARING (TO EXPOSE THE BREEDING STREAM TO
SUNLIGHT)
– VECTORS PEAK BITING AT NIGHT 9PM-3AM
– PLANTING OF NEEM TREE (REPELLENT EFFECT)
– ZOOPROPHYLAXIS (DEVIATE MOSQUITO BITES FROM MAN TO
ANIMALS)
– INFECTED MOTHER CAN STILL CONTINUE BREAST FEEDING

121. Filariasis, Elephantiasis, Human
Lymphatic Filariasis
– CAUSATIVE AGENT-NEMATODE PARASITE
• MICROFILARIAE OR FILARIAL WORMS
• WUCHERERIA BRONCOFTI
• BRUGIA MALAYI
• BRUGIA TIMORI
– MOT
• Bite from aedes poecilius (night biting)
• Invade the lymph vessel, obstructing the lymphatic
channel-leads to edema and may infiltrate the
reproductive organs.
– IP 8-16 months

122. CLINICAL MANIFESTATIONS:
– ASYMPTOMATIC STAGE
• (+) MICROFILARIAE IN THE BLOOD
– NO CLINICAL S/SX
– ACUTE STAGE
• LYMPHADENITIS (LYMPH NODES)
• LYMPHANGITIS (LYMPH VESSELS)
• GENETALIA-FUNICULITIS, EPIDYDIMITIS, ORCHITIS
– CHRONIC STAGE
• HYDROCOELE
• LYMPHEDEMA (UPPER AND LOWER EXTREMITIES)
• ELEPHANTIASIS

123. – INCIDENCE-REGION 5,8,11 AND CARAGA,
MARINDUQUE, SARANGGANI
– Drug: Diethyl Carbamazine Citrate or Hetrazan
6mg/KgBW one dose every year
– Dx:
• NBE nocturnal blood exam (night)
• ICT immunochromatographic test (day)

124. Nursing Considerations
– MASS TREATMENT-DOSE IS 6mg/KBW, SINGLE
DOSE PER YEAR.
– ENVIRONMENTAL SANITATION
– PERSONAL HYGIENE
– MOSQUITO NETS
– LONG SLEEVES, LONG PANTS AND SOCKS
– INSECT REPELLENT
– SCREENING OF HOUSES
– HEALTH EDUCATION

125. Schistosomias, Snail Fever, Takayama
– Blood fluke
– Schistosoma japonicum
– S. hematobium
– S. mansoni
– MOT skin entry (cercaria) travel in to the blood
stream where they will infiltrate the liver, from
liver to intestines

126. – Cycle: Egg-larvae (miracidium)-intermediary host
(oncomelania quadrasi-tiny snail)-cercaria
– Itchiness at the site
– RUQ pain (hepatomegaly)
– Intestine infiltration-abd’l cramps, diarrhea with
blood
– Praziquantel
– Dx COPT (stool exam)

127. – Egg– miracidium– snail– cercaria- human
– Itchiness – liver – intestines
– Praziquantel
– COPT
– PREVENTION
– Samar and Leyte

128. HIV and AIDS
– Retrovirus (HIV1 & HIV2)
– Attacks and kills CD4+ lymphocytes (T-helper)
– Capable of replicating the lymphocytes
undetected by the immune system
– Immunity declines and opportunistic microbes
sets in

129. HIGH RISK GROUP
– Homosexual or bisexual
– Intravenous drug users
– BT recipients before 1985
– Sexual contact with HIV+
– Babies of mothers who are HIV+

130. MOT
– Sexual intercourse (oral, vaginal and anal)
– Exposure to contaminated blood, semen, breast
milk and other body fluids
– placenta

131. HIV TEST
– Elisa
– Western Blot
– Rapid hiv test
• Suds hiv-1
• Results are obtained in less than 10 minutes
• Color indicator similar to pregnancy test
• Positive result needs a confirmatory test

132. How to Diagnose
– HIV+ 2 consecutive positive ELISA and 1 positive
Western Blot Test
– AIDS+ HIV+ CD4+ count below 500/ml Exhibits
one or more of the ff: (next slide)
– Full blown AIDS CD4 is less than 200/ml

133. – Exhibits one or more of – Weight loss
the ff: – Severe diarrhea
– Extreme fatigue – Apathy and depression
– Intermittent fever – PTB
– Night sweats – Kaposis sarcoma
– Chills – Pneumocystis carinii
– Lymphadenopathy – AIDS dementia
– Enlarged spleen
– Anorexia

134. • HIV CLASSIFICATION
– CATEGORY 1 – CD4+ 500 OR MORE
– CATEGORY 2 – CD4+ 200-499
– CATEGORY 3 – CD4+ LESS THAN 200

135. • Management
– Prevention of spread (safe sex)
– Universal precautions
– Health Education
– Symptomatic intervention
– No known cure
– Prevent CD4 reduction