Communicable Diseases

Community Health Nursing
Communicable Disease Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN

COMMUNITY HEALTH NURSING

Communicable Disease

Lecturer: Mark Fredderick R. Abejo RN, MAN

EPI TARGET DISEASES

Disease Causative Agent Mode of Clinical Manifestation Reservoir Diagnostic Exam Treatment Nursing Implication
Transmission

Tuberculosis Mycobacterium Droplet Infection General weakness Man Sputum Exam DOTS Pointers for teaching
Loss of weight, cough and 3 sample are taken on Anti-TB drugs:
“Primary Complex” is Tuberculosis ( inhalation of bacilli wheeze which does not And with 24 hrs: - patient is required
less than 3 years old from patient who respond to antibiotic to take the Ant-Tb
coughs and sneeze) therapy. Diseased Cattle - spot sample (1st drugs in the
- any child who does Fever and night sweat visit) presence of a health Rifampicin: taken
not return to normal Abdominal swelling with a (Bovine TB) befor meals, causes red
care provider to
hard painless mass and free - early morning
health after measles or ensure compliance urine urine
Degree of fluid
whooping cough. specimen to treatment
Hemoptysis and chest pain
Communicability regimen Isoniazide: causes
Painful firm or soft
Most hazardous - spot sample peripheral neuritis,
swelling in a group of
period: first 6-12 Depends upon: superficial lymph nodes. given with Vit.B6
months after Note: (2nd visit)
infection - num.of bacilli Pyrazinamide: cause
Highest in risk of In young children the only Note: at least 2 hyperurucemia
developing: under 3 - virulence of bacilli sample are
sign of pulmonary TB may be Anti-TB drugs:
years old positive Ethambutol: causes
stunted growth or failure to
- environmental


conditions thrive (RIPES) optic neuritis/ blurring
of vision
Chest Xray Rifampicin
Mantoux Test Isoniazid Streptomycin: cause
- .1 cc injection of Pyrazinamide tinnitus, loss of
PDD and 48-72 Ethambutol hearing balance,
hours reading Streptomycin damage to 8th cranial
nerve
* 10 mm +

5 mm + (HIV pt.)
Note: After 2-4 weeks
of treatment, patient is
no longer contagious


The National Tuberculosis Control Program Increase and sustain support and financing for TB control activities

Vision: A country where Tb is no longer a public health problem Strategies:
Mission: Ensure that TB DOTS services are available, accessible and
affordable to the communities in collaboration with the LGU’s Facilitate implementation of TB-DOTS Center certification and accreditation
and other partners Build TB coalitions among different sectors
Goal: To reduce prevalence and mortality from TB by half the year Advocate for counterpart input from local government units
2015 ( Millennium Development Goal ) Mobilize/extend other resources to address program limitations

Targets: Objective D:
1. Cure at least 85% of the sputum smear- positive TB patient discovered.
2. Detect at least 70% of the estimated new sputum smear-positive TB cases. Strengthen management (technical and operational) of TB control services at
all levels
NTP Objectives and Strategies
Strategies:
Objective A:
Enhance managerial capability of all NTP program managers at all levels
Establish an efficient data management system for both public and private sectors.
Improve access to and quality of services provided to TB patients, TB symptomatics and
Implement a standardized recording and reporting system.
communities by health care institutions and providers
Conduct regular monitoring and evaluation at all levels.
Advocate for political support through effective local governance
Strategies:

Enhance quality of TB diagnosis.
KEY POLICIES
Ensure TN patient’s treatment compliance.
Ensure public and private health care providers adherence to the implementation of national Case Finding
standards of care for TB patients.
Improve access to services through innovative service delivery mechanisms for patients living in
1. DSSM ( Direct Sputum Smear Microscopy ) shall be the primary diagnostic
challenging areas.
tool in NTP case finding.
Note: No TB diagnosis shall be made based on Xray result alone likewise result
of PDD skin test (Mantoux Test)
Objective B:
2. All TB symptomatic identified shall undergo DSSM for diagnosis before start of
Enhance the health-seeking behavior on TB by communities, especially the TB treatment
symptomatics Note: Only contraindication for sputum collection is hemoptysis

Strategies: 3. After three sputum specimen yielding negative result X-ray and culture are
necessary
Develop effective, appropriate and culturally-responsive IEC/communication materials. Note: Diagnosis based on Xray shall be made by the TB DiagnosticCommittee.
Organize barangay advocacy groups
4. Only trained medical technologist or microscopist shall perform DSSM.

Objective C:


Patients with the following conditions shall be recommended for hospitalization:

massive hemoptysis RECOMMENDED CATEGORY OF TREATMENT REGIMEN
pleural effusion
military TB ( TB of the Spine “Pot’s Disease”)
TB meningitis
TB pneumonia Category Type of TB Patient Treatment Regimen
and those requiring surgical intervention
Intensive Continuation Total
Phase Phase Period
Anti-TB drugs:
New smear positive
(RIPES) PTB
New smear positive
Rifampicin PTB with extensive
Isoniazid I parenchymal lesion 2 RIPE 4 RI 6 mos.
Pyrazinamide EPTB and Severe
Ethambutol concomitant HIV
Streptomycin disease
Treatment Failure
Relapse
Two Formulation of Anti-TB Drugs II Return after default 2 RIPES /1 5 RIE 8 mos.
RIPE
1. Fixed-Dose Combination ( FDCs) – two or more first line anti-TB drugs are combined in
one tablet. There are 2,3, or 4 drug fixed dose combinations. New smear-
2. Single Drug Formulation (SDF) – each drug is prepared individually. Isoniazid, negative PTB
Pyrazinamide and Ethambuto are in tablet form while Rifampicin is in capsule form and III With minimal 2 RIP 4 RI 6
streptomycin is injectable. parenchymal
lession mos.

Chronic ( still Refer to Specialized facility
smear-positive after
IV supervised re- or DOTS Plus Center refer
treatment )
to City Provincial NTP

Coordinator


Categories II : 2 RIPES / RIPE / 4RIE (FDC)

DOSAGE PER CATEGORY OF TRATMENT REGIMEN

A. Fixed-Dose Combination Formulation Body Intensive Continuation Phase
Weight Phase
The number of tablets of FDCs per patient will depend on the body weight.
First Two (2) Months 3rd Month FDC-B E

( RI ) 400 mg
Categories I and III : 2 RIPE / 4 RI ( FDC)
FDC-A Streptomycin FDC-A

(RIPE) (RIPE)
Body Weight (kg) No.of tablets per day No. of tablets per day
30 – 37 2 0.75 g 2 2 1
Intensive Phase Continuation Phase
38 – 54 3 0.75 g 3 3 2
( 2 months ) ( 4 months )
55 – 70 4 0.75 g 4 4 3
FDC-A ( RIPE) FDC-B (RI)
More 5 0.75 g 5 5 3
30 - 37 2 2
than 70

38 – 54 3 3

55 – 70 4 4 B. Single Dose Formulation ( SDF )

More than 70 5 5 Simply add 1 tablet of Isoniazid ( 100mg) , Pyrazinamide (500mg) and
Ethambutol ( 400mg) each for the patient weighing more than 50kg before treatment
initiation. Modify drug dosage within acceptable limits according to patient’s body weight,
particularly those weighing less than 30 kg at the time of diagnosis.


Categories I and III: 2 RIPE / 4 RI (SDF)

Anti-TB Drugs No. of tablets per day No. of tablets per day Drug Dosage per Kg. Body Weight


( 2 months ) ( 4 months ) Anti-TB Drugs Dose per Kg Body Weight and Maximum Dose

Rifampicin 1 1

Isoniazid 1 1 Rifampicin 5 ( 4 – 6 ) mg/kg and not to exceed 400 mg daily

Pyrazinamide 2 Isoniazid 10 ( 8 – 12 ) mg/kg and not to exceed 600 mg daily

Ethambutol 2 Pyrazinamide 25 ( 20 – 30 ) mg/kg and not to exceed 2 mg daily

Ethambutol 15 ( 15 – 20 ) mg/kg and not to exceed 1.2 g daily

Categories II: 2 RIPES / 1 RIPE / 5 RIE Streptomycin 15 ( 12 – 18 ) mg/kg and not to exceed 1 g daily

Anti-TB Drugs No. of Tablets / Vial per day No.of Tablets per day D.O.T.S ( Directly-Observed Treatment Shortcourse ) “TuTok Gamutan”


(3months ) ( 5 months ) 5 Elements of D.O.T.S

First 2 months 3rd months Sustained political commitment
Access to quality-assured sputum microscopy
Rifampicin 1 1 1 Standardized short-course chemotherapy for all cases of TB
Uninterrupted supply of essential drugs
Isoniazid 1 1 1 Recording and reporting system enabling outcome assessment of all patients and
assessment of overall program performance.
Pyrazinamide 2 2

Ethambutol 2 2 2

Streptomycin 1 vial per day

Note: 56 vials of Streptomycin for two months


MANAGEMENT OF CHILDREN WITH TB Management

Prevention For children with exposure to TB

BCG vaccination shall be given to all infants. Should undergo physical examination and PDD testing (Mantoux Test)
BCG vaccine is moderately effective. It has a protective efficacy of: A child with productive cough shall be referred for DSSM, if found positive, treatment
50 % against any TB disease shall be started immediately. PDD testing shall no longer needed.
Children without sign/symptoms of TB but with positive Mantoux Test and those with
64 % against TB meningitis symptoms of TB but negative Mantoux Test shall referred for chest x-ray examination.

74 % against death from TB
For children with signs and symptoms of TB
Case Finding
A child to have signs and symptoms of TB with either known or unknown exposure
Cases of TB in children are reported and identified in two instances: shall be referred for Mantoux test.
- The patient sought consultation. For children with known contact but with negative Mantoux and those unknown contact
- The patient was reported to have been exposed to an adult with TB but with positive Mantoux shall be referred for chest x-ray examination.
For a negative x-ray report, Mantoux test shall be repeated after 3 months.
All TB symptomatic children 0-9 years old, except sputum positive child shall subject to PDD Chemoprophylaxis of Isoniazid for 3 months shall be given to children less than 5 years
testing old with negative chest x-ray after which Mantoux test shall be repeated
- Only trained nurse and midwife shall do the PDD test and recording
- Testing and reading shall be conducted once a week either on Monday or
Tuesday. Treatment

Note: 10 children shall be gathered for testing to avoid wastage. D.O.T.S will still be followed just like in adult
Short course regimen:
A child shall be suspected as having TB and considered symptomatic if with any three (3) of the - at least 3 anti-TB drugs for 2 months ( intensive phase )
following sign and symptoms: - 2 anti-TB drugs for 4 months ( continuation phase )

cough and wheezing for 2 weeks or more * For Extra Pulmonary TB Cases:
unexplained fever for 2 weeks or more - 4 anti-TB drugs for 2 months ( intensive phase )
loss of appetite, loss of weight, failure to gain weight - 2 anti-TB drugs for 10 months ( continuation phase )
failure to respond to a 2 weeks of appropriate antibiotic therapy
failure to regain state of health 2 weeks after a viral infection or after having measles. Domiciliary treatment shall be the preferred mode of care
No treatment shall be initiated unless the patient and health worker has agreed upon a
caseholding mechanism for treatment compliance.
A child shall be clinically diagnosed or confirmed of having TB if he has any three (3) of the
following condition:

positive history of exposure to an adult/ adolescent TB case
presence of sign and symptoms suggestive of TB
positive Mantoux Test
abnormal chest radiograph suggestive of TB


Treatment Regimen Continuation Phase

A. Pulmonary TB Rifampicin 10-15 mg/kg body weight 10 months
Isoniazid
Drugs Daily Dose (mg/kg per body weight ) Duration 10-15 mg/kg body weight

Intensive Phase

Rifampicin 10-15 mg/kg body weight 2 months
Isoniazid
Pyrazinamide 10-15 mg/kg body weight Public Health Nurse Responsibilities ( Childhood TB )

20-30 mg/kg body weight

Continuation Phase 1. Interview and open treatment cards for identified TB children.
2. Perform Mantoux testing and reading to eligible children
Rifampicin 10-15 mg/kg body weight 4 months 3. Maintain NTP records
Isoniazid 4. Manage requisition and distribution of drugs
10-15 mg/kg body weight 5. Assist the physician in supervising the other health workers of the RHU in the
proper implementation of the policies and guidelines on TB in children.
6. Assist in the training of other health workers on Mantoux testing and reading.

B. Extra Pulmonary TB

Drugs Daily Dose (mg/kg per body weight ) Duration

Intensive Phase

Rifampicin 10-15 mg/kg body weight
Isoniazid
Pyrazinamide 10-15 mg/kg body weight

20-30 mg/kg body weight 2 months
Plus

Ethambutol
OR 15-25 mg/kg body weight

Streptomycin 20-30 mg/kg body weight

Community Health Nursin

EPI TARGET DISEASES
Disease Causative Agent Mode of Clinical Manifestation Reservoir Diagnostic Treatment Nursing Implication
Transmission
Exam

Diphteria it is an Corynebacterium Respiratory Nasal Man Schick’s Test Antibiotics Isolate patient until
acute pharyngitis, acute Droplets 2-3 cultures taken at
nasopharyngitis diphtheriae dryness of the upper - test for the least 24hrs apart are
lip susceptibility to negative
or acute laryngitis with serosanguinous Diptheria Pen G Potassium Small frequent
secretion in the nose Erythromycin feeding
Pseudo membrane –
Promote absolute
grayish white in color
rest
with leathery Use ice collar to
Pharyngeal Moloney Test
consistency in the relieve pain of sore
throat and on the tonsil “Bullneck” throat
- for hyper-
appearance because of May put on soft diet
sensitivity to
the enlarge cervical
Diptheria toxin
lymph nodes.

Laryngeal

sore throat
hoarseness
brassy metallic cough
Pertussis Bordetella Pertussis Airborne – droplet At first, the infected
child may have a
- 100 days cough Primarily by direct common cold with
contact with he runny nose, sneezing
- Whooping cough discharge from and mild cough Bordet-Gengou Erythromycin Place the patient on
Intermittent episode Agar Plate Ampicillin NPO during
respiratory mucous
- “tuspirina” of paroxysmal cough Man paroxysmal stage to
membranes of followed by a whoop - used for culture prevent aspiration
infected person ending vomiting
medium - is given 5-7 days Position prone for
infants and upright
for older


Neonatal Tetanus Clostridium Tetani Unhygienic cutting Assess the NEWBORN
of umbilical cord for a history of all 3 of
the following: Blood Culture Penicillin Prevention
Erythromycin
- which produces the Tetracycline
exotoxins: Improper handling
of cord stump esp. Normal suck and cry CSF analysis Aseptic handling of
Tetanolysin when treated with for the first 2 days of - administered within the neonatal
Tetanospasmin contaminated life 4 hours of injury umbilical cord
Onset of illness Tetanus Toxiod
substance
between 3 and 28 immunization for
days mothers
Inability to suck Active immunization
followed by stiffness of DPT
of the body and
convulsion
Soil
Intestinal
In OLDER CHILDREN, canal of
the following may be animal
observed: Man

Trismus – lockjaw
Opisthotonus –
arching of the neck
and back
Ridus Sardonicus –
sardonic smile


Poliomyelitis 3 Types of Polio Virus Fecal-oral route Abortive - did not Throat swab Strict Isolation
progress to systemic Hot moist compress
“Infantile Paralysis” Type I Brunhilde infection Man to relieve spasm
Type II Lansing
Type III Leon Oral route through Stool exam
pharyngeal Use protective
secretion Non-paralytic – slight devices:
involvement of the CNS - handroll to prevent
Lumbar exam claw hand

Contact with
infected person Poker spine or
stiffness of the spinal Pandy’s test
column
- for CSF analysis

Spasms of the - trochanter roll, to
hamstring prevent outer rotation
With paresis of femur

- footboard
Paralytic – severe
involvement of CNS

Hoyne’s Sign – head
falls back when he is
in supine with
shoulder elevated
Paralysis
Head log/drop
Tripod position –
extend his arm behind
for support when he
sits up
Kernig’s sign
Brudzinski sign


Hepatitis B Prodromal/pre-icteric

- it is liver infection Hepa B Virus 3 P’s Symptoms of URTI Liver Function Increase CHO
caused by the B type of Weight loss Test Moderate fat
hep.virus. Anorexia Man Low CHON
RUQ pain
It attacks livers the Person to person Malaise
liver often resulting in Icteric Observed universal
inflammation Parenteral precaution
Jaundice
Placental Acholic stool
bile-colored urine
3 C’s

Measles Paramyxo Virus Droplet Conjunctivitis Observe respiratory
Coryza isolation
Cough Man Should kept out of
Koplik’s spot – bluish school for at least 4
gray spot on the buccal days after rash
mucosa. appear
For Photophobic,
darkened room,
Generalized blotch rash
sunglasses


DISEASES TRANSMITTED THROUGH FOOD AND WATER

Disease Causative Agent Mode of Transmission Pathognomonic Sign Management and Treatment Prevention

Cholera Vibrio cholera Fecal-oral route Rice watery stool Diagnostic Test:  Proper handwashing
Vibrio coma 5 Fs Stool culture  Proper food and water
Other names: Ogawa and Inaba Period of sanitation
El tor bacteria Incubation Period: Communicability: Treatment:  Immunization of Chole-vac
Few hours to 5 days; 7-14 days after onset, Oral rehydration solution (ORESOL)
Usually 3 days occasionally 2-3 IVF
months Drug-of-Choice: tetracycline (use straw; can
cause staining of teeth).
Oral tetracycline should be
administered with meals or after milk.

Amoebic Entamoeba histolytica Fecal-oral route · Abdominal Metronidazole (Flagyl)  Proper handwashing
Dysentery Protozoan (slipper- cramping * Avoid alcohol because of its Antabuse effect  Proper food and water
shaped · Bloody mucoid stool can cause vomiting sanitation
body) · Tenesmus - feeling
of
incomplete defecation

Shigellosis Shigella bacillus Fecal-oral route · Abdominal Drug-of-Choice: Co-trimoxazole  Proper handwashing
Sh-dysenterae – most cramping  Proper food and water
Other names: infectious 5 Fs: Finger, Foods, · Bloody mucoid stool Diet: Low fiber, plenty of fluids, easily sanitation
Bacillary Sh-flesneri – common Feces, Flies, · Tenesmus - feeling digestible  Fly control
dysentery in Fomites of incomplete foods
the Philippines defecation
Sh-connei Incubation Period:
Sh-boydii 1 day, usually less
than 4 days

Typhoid fever Salmonella typhosa Fecal-oral route · Rose Spots in the Diagnostic Test:  Proper handwashing
(plural, typhi) 5 Fs abdomen – due to  Proper food and water
bleeding caused by Typhi dot – confirmatory test; specimen is feces sanitation
Incubation Period: perforation of the Widal’s test – agglutination of the patient’s
Usual range 1 to 3 Peyer’s patches serum
weeks, average 2 · Ladderlike fever
weeks Drug-of-Choice: Chloramphenicol


Hepatitis A Hepatitis A Virus Fecal-oral route · Fever Prophylaxis: “IM” injection of gamma globulin  Proper handwashing
5 Fs · Anorexia (early sign) Hepatitis A vaccine  Proper food and water
Other names: · Headache Hepatitis immunoglobulin sanitation
Hepatitis / Incubation Period: · Jaundice (late sign) Avoid alcohol  Proper disposal of urine
Epidemic 15-50 days, · Clay-colored stool Complete bed rest – to reduce the breakdown of and feces
Hepatitis / depending on dose, · Lymphadenopathy fats for metabolic needs of liver  Separate and proper
Catarrhal Jaundice average 20-30 days Low-fat diet; increase carbohydrates (high in cleaning of articles used by
sugar) patient
In convalescent period, patient may have
difficulty with maintaining a sense of well-being.

Paralytic Dinoflagellates Ingestion of raw of · Numbness of face Treatment:  Avoid eating shellfish
Shellfish Phytoplankton inadequately cooked especially around the such as tahong, talaba,
Poisoning (PSP I seafood usually mouth 1. No definite treatment halaan, kabiya, abaniko
Red tide bivalve mollusks · Vomiting and 2. Induce vomiting during red tide season
poisoning) during red tide dizziness 3. Drink pure coconut milk – weakens the
season · Headache toxic effect  Don’t mix vinegar to
· Tingling 4. Sodium bicarbonate solution (25 grams in ½ shellfish it will increase
Incubation Period: sensation/paresthesia glass of water) toxic effect 15 times
30 minutes to and Advised only in the early stage of illness greater
several hours after eventful paralysis of because paralysis can lead to aspiration
ingestion hands
· Floating sensation NOTE: Persons who survived the first 12 hours
and after
weakness ingestion have a greater chance of survival.
· Rapid pulse
· Dysphonia
· Dysphagia
· Total muscle
paralysis
leading to respiratory
arrest and death


DISEASES CAUSED BY VIRUS


Chickenpox Human (alpha) herpes Droplet spread Vesiculo-pustular No specific diagnostic exam  Case over 15 years of age
virus 3 (varicella-zoster Direct contact rashes Treatment is supportive. should be investigated to
Other names: virus), a member of the Indirect through articles Centrifugal eliminate possibility of
Varicella Herpesvirus group freshly soiled by appearance of Drug-of-choice: smallpox.
discharges of infected rashes – rashes which Acyclovir / Zovirax ® (orally to reduce the  Report to local authority
Period of persons begin on the trunk and number of lesions; topically to lessen the  Isolation
Communicability: spread peripherally pruritus)  Concurrent disinfection of
From as early as 1 to 2 Incubation Period: and more abundant on throat and nose discharges
days before the rashes 2-3 weeks, commonly covered NEVER give ASPIRIN. Aspirin when given to  Exclusion from school for
appear until the lesions 13 to 17 days body parts children with viral infection may lead to 1 week after eruption first
have crusted. Pruritus development of REYE’S SYNDROME. appears
 Avoid contact with
Nursing Diagnoses: susceptibles
Disturbance in body image
Impairment of skin integrity

German Rubella virus or Droplet Forscheimer spots – Diagnostic Test: MMR vaccine (live
Measles RNAcontaining red pinpoint patches Rubella Titer (Normal value is 1:10); below 1:10 attenuated virus)
Togavirus Incubation Period: on the oral cavity indicates susceptibility to Rubella. - Derived from chick
Other Names: (Pseudoparamyxovirus) Three (3) days Maculopapular rashes embryo
Rubella Headache Instruct the mother to avoid pregnancy for three Contraindication:
Three-day German measles is Low-grade fever months after receiving MMR vaccine. - Allergy to eggs
Measles teratogenic infection, Sore throat - If necessary, given in
can cause congenital Enlargement of MMR is given at 15 months of age and is given divided or fractionated
heart disease and posterior cervical and intramuscularly. doses and epinephrine
congenital postauricular should be at the bedside.
cataract.

Herpes Zoster Herpes zoster virus Droplet Painful vesiculo- Treatment is supportive and symptomatic Avoidance of mode of
(dormant varicella Direct contact from pustular Acyclovir to lessen the pain transmission
Other names: zoster secretion lesions on limited
Shingles virus) portion of the body
Cold sores (trunk and
shoulder)
Low-grade fever


Mumps Mumps virus, a Direct contact Painful swelling in Supportive and symptomatic  MMR vaccine
member front of the ear, angle Sedatives – to relieve pain from orchitis  Isolate mumps cases
Other name: of family Source of infection: of the jaws and down Cortisone – for inflammation
Epidemic Parotitis Paramyxoviridae Secretions of mouth and the neck
nose Diet: Soft or liquid as tolerated
Fever Support the scrotum to avoid orchitis, edema,
Incubation Period: Malaise and atrophy
12 to 26 days, usually Loss of appetite
18 days Dark glasses for photophobia
Swelling of one or
both testicles (orchitis)
in some boys

Influenza Influenza virus Direct contact Sudden onset Supportive and symptomatic  Avoid use of common
A – most common Fever with chills Keep patient warm and free from drafts towels, glasses, and eating
Other name: B – less severe wesDroplet infection or by Headache TSB for fever utensils
La Grippe C – rare articles freshly soiled Myalgia / arthralgia Boil soiled clothing for 30 minutes before  Cover mouth and nose
with nasopharyngeal during cough and sneeze
Period of discharges
Communicability: Immunization:
Probably limited to 3 Airborne Flujob/Flushot – effective
days from clinical onset Incubation Period: for 6 months to 1 year
Short, usually 24 – 72
hours


DISEASES CAUSED BY BACTERIA


Pneumonia Bacteria: Droplet Rusty sputum Diagnosis:  Avoid mode of
Pneumococcus, Fever and chills Based on signs and symptoms transmission
Types: streptococcus Incubation Period: Chest pain Dull percussion on affected lung  Build resistance
a. Community pneumoniae, 2 – 3 days Chest indrawing Sputum examination – confirmatory  Turn to sides
Acquired staphylococcus aureus, Rhinitis/common cold Chest x-ray  Proper care of influenza
Pneumonia (CAP) Klebsiella pneumonia Productive cough cases
b. Hospital / (Friedlander’s bacilli) Fast respiration Management:
Nosocomial Vomiting at times Bedrest
c. Atypical Virus: Convulsions may occur Adequate salt, fluid, calorie, and vitamin intake
Haemophilus Flushed face Tepid sponge bath for fever
influenzae Dilated pupils Frequent turning from side to side
Highly colored urine Antibiotics based on CARI of the DOH
Fungi: Pneumonocystis with reduced chlorides Oxygen inhalation
carinii pneumonia and increased urates Suctioning
Expectorants / mucolytics
Bronchodilators
Oral/IV fluids
CPT

Streptococcal Group A beta hemolytic Droplet Sudden onset Diagnosis:  Avoid mode of
sore throat streptococcus High grade fever with Throat swab and culture transmission
Complication: chills
Other name: Other diseases: Rheumatic Heart Enlarged and tender Treatment: erythromycin
Pharyngitis Scarlet fever Disease cervical lymph nodes
Tonsillitis St. Anthony fire Inflamed tonsils with Care:
Puerperal sepsis mucopurulent exudates Bed rest
Imoetigo Headache Oral hygiene with oral antiseptic or with saline
Acute Dysphagia gargle (1 glass of warm water + 1 tsp rock salt)
glomerulonephritis Ice collar
Rheumatic Heart
Disease


Meningitis Meningococcus Direct (Droplet) A. Sudden Onset Diagnostic Test:  Respiratory Isolation
Neisseria meningitides - high fever Lumbar puncture or Lumbar tap - reveals CSF
Other name: Incubation Period: accompanied WBC and protein, low glucose; contraindicated
Cerebrospinal 2 - 10 days by chills for increased ICP for danger of cranial
fever - sore throat, headache, herniation
prostration (collapse) Hemoculture – to rule out meningococcemia

B. entrance into the Treatment:
bloodstream leading to Osmotic diuretic (Mannitol) – to reduce ICP and
septicemia relieve cerebral edema; Alert: fastdrip to prevent
(meningococcemia) crystallization
a. rash, petchiae, Anti-inflammatory (Dexamethasone) – to
purpura relieve
cerebral edema
C. Symptoms of Antimicrobial (Penicillin)
menigeal Anticonvulsany (Diazepam / Valium)
irritation
- nuchal rigidity (stiff Complications:
neck) – earliest sign Hydrocephalus
- Kernig’s sign – when Deafness (Refer the child for audiology testing)
knees are flexed, it and mutism
cannot Blindness
be extended
- Brudzinski signs –
pain on neck flexion
withautomatoc flexion
of the knees
- convulsion
- poker soine (poker
face /
flat affect)
- Increased ICP
(Cushing’s triad:
hypertension,
bradycardia,
bradypnea)
and widening pulse
pressure


VECTOR-BORNE DISEASES

Malaria Plasmodium Parasites: Bite of infected Cold Stage: severe, Early diagnosis – identification of a patient *CLEAN Technique
Vivax anopheles mosquito recurrent chills (30 with malaria as soon as he is seen through *Insecticide – treatment of
Falciparum (most fatal; Night time biting minutes to 2 hours) clinical and/or microscopic method mosquito net
most common in the High-flying Clinical method – based on signs and *House Spraying (night
Philippines) Rural areas Hot Stage: fever (4-6 symptoms of the patient and the history of his time fumigation)
Ovale Clear running water hours) having visited a malaria-endemic area *On Stream Seeding –
Malariae Microscopic method – based on the construction of bio-ponds
Wet Stage: Profuse examination of the blood smear of patient for fish propagation (2-4
sweating through microscope fishes/m2 for immediate
Episodes of chills, (done by the medical technologist) impact; 200-400/ha. for a
fevers, and profuse QBC/quantitative Buffy Coat – fastest delayed effect)
sweating are Malarial Smear – best time to get the *On Stream Clearing –
associated with rupture specimen is at height of fever because the cutting of vegetation
of the red blood cells. microorganisms are very active and easily overhanging along stream
identified banks
- intermittent chills *Avoid outdoor night
and Chemoprophylaxis activities (9pm – 3am)
sweating Only chloroquine should be given (taken at *Wearing of clothing that
- anemia / pallor weekly intervals starting from 1-2 weeks before covers arms and legs in the
- tea-colored urine entering the endemic area). In pregnant women, evening
- malaise it is given throughout the duration of *Use mosquito repellents
- hepatomegaly pregnancy. *Zooprophylaxis – typing
- splenomegaly of domestic animals like
- abdominal pain and Treatment: the carabao, cow, etc near
enlargement Blood Schizonticides - drugs acting on sexual human dwellings to
- easy fatigability blood stages of the parasites which are deviate mosquito bites
responsible from man to these animals
for clinical manifestations Intensive IEC campaign
1. QUININE – oldest drug used to treat
malaria; from the bark of Cinchona tree; NURSING CARE:
ALERT: Cinchonism – quinine toxicity 1. TSB (Hot Stage)
2. CHLOROQUINE 2. Keep patent warm
3. PRIMAQUINE – sometimes can also be (Cold Stage)
given as chemoprophylaxis 3. Change wet clothing
4. FANSIDAR – combination of (Wet Stage)
pyrimethamine and sulfadoxine 4. Encourage fluid intake
5. Avoid drafts


Filariasis Wuchereria bancrofti Bite of Aedes poecillus Asymptomatic Stage: Diagnosis  CLEAN Technique
Brugia malayi (primarily) Presence of Physical examination, history taking,  Use of mosquito repellents
Other names: Brugia timori Aedes flavivostris microfilariae observation of major and minor signs and  Anytime fumigation
Elephantiasis – nematode parasites (secondary) in the blood but no symptoms  Wear a long sleeves, pants
Endemic in 45 out clinical signs and and socks
of 78 provinces Incubation period: symptoms of disease Laboratory examinations
Highest 8 – 16 months Nocturnal Blood Examination (NBE) – blood
prevalence rates: Acute Stage: are taken from the patient at his residence or in
Regions 5, 8, 11 Lymphadenitis hospital after 8:00 pm
and CARAGA Lymphangitis Immunochromatographic Test (ICT) – rapid
Affectation of male assessment method; an antigen test that can be
Genitalia. done at daytime

Chronic Stage: (10-15 Treatment:
years from onset of Drug-of-Choice: Diethylcarbamazine Citrate
first (DEC) or Hetrazan
attack)
Hydrocele
Lymphedema
Elephantiasis

Shistosomiasis Schistosoma mansoni Contact with the Diarrhea Diagnostic Test: Dispose the feces properly
S. haematobium infected freshwater with Bloody stools (on and COPT or cercum ova precipitin test (stool not reaching body of water
Other Names: S. japonicum (endemic cercaria and penetrates off dysentery) exam) Use molluscides
Snail Fever in the Philippines) the skin Enlargement of Prevent exposure to
Bilharziasis abdomen Treatment: contaminated water (e.g.
Endemic in 10 Vector: Oncomelania Splenomegaly Drug-of-Choice: PRAZIQUANTEL use rubber boots)
regions and 24 Quadrasi Hepatomegaly (Biltracide) Apply 70% alcohol
provinces Anemia / pallor Oxamniquine for S. mansoni immediately to skin to kill
High prevalence: weakness Metrifonate for S. haematobium surface cercariae
Regions 5, 8, 11 *Death is often due to hepatic complication Allow water to stand 48-72
hours before use

Dengue Dengue virus 1, 2, 3, Bite of infected Classification (WHO): Diagnostic Test: 4 o’clock habit
Hemorrhagic and 4 and Chikungunya mosquito (Aedes Torniquet test (Rumpel Leads Test / capillary Chemically treated
Fever virus Aegypti) - characterized Grade I: fragility test) – PRESUMPTIVE; positive when mosquito net
Types 1 and 2 are by black and white a. flu-like symptoms 20 or more oetechiae per 2.5 cm square or 1 Larva eating fish
Other names: common in the stripes b. Herman’s sign inch square are observed Environmental sanitation
H-fever Philippines Daytime biting c. (+) tourniquet sign Platelet count – CONFIRMATORY; (Normal Antimosquito soap
Low flying is Neem tree (eucalyptus)
Stagnant clear water 150 - 400 x 103 / mL)
Urban


Period of Incubation Period: Grade II: Treatment:  Eliminate vector
communicability: Uncertain. Probably 6 a. manifestations of Supportive and symptomatic  Avoid too many hanging
Unknown. Presumed to days to 1 week Grade Paracetamol for fever clothes inside the house
be on the 1st week of Manifestations: I plus spontaneous Analgesic for pain  Residual spraying with
illness up to when the First 4 days: bleeding Rapid replacement of body fluids – most insecticide
virus is still present in Febrile/Invasive Stage b. e.g. petechiae, important  Daytime fumigation
the - starts abruptly as fever ecchymosis purpura, treatment  Use of mosquito repellants
blood - abdominal pain gum ORESOL  Wear long sleeves, pants,
Occurrence is sporadic - headache bleeding, Blood tansfusion and socks
throughout the year - vomiting hematemesis, Diet: low-fat, low-fiber, non-irritating,  For the control of H-fever,
Epidemic usually occur - conjunctival infection melena noncarbonated. knowledge of the natural
during the rainy seasons -epistaxis Grade III: Noodle soup may be given. ADCF history of the disease is
(June to November) 4th – 7th days: a. manifestations of (Avoid Dark-Colored Foods) important.
Peak months: Toxic/Hemorrhagic Grade ALERT! No Aspirin  Environmental control is
September Stage II plus beginning of the most appropriate
and October - decrease in circulatory failure primary prevention
temperature b. hypotension, approach and control of
- severe abdominal pain tachycardia, tachypnea Hfever.
- GIT bleeding Grade IV:
- unstable BP (narrowed a. manifestations of
pulse pressure) Grade
- shock III plus shock (Dengue
- death may occur Shock Syndome)
7th – 10th days:
Recovery/Convalescent
Stage
- appetite regained
- BP stable


DISEASES TRANSMITTED BY ANIMALS
Leptospirosis Leptospira interrogans Through contact of the Leptospiremic Phase Diagnosis  Protective clothing,
bacterial spirochete skin, especially open - leptospires are present Clinical manifestations boots and gloves
Other Names: RAT is the main host. wounds with water, in blood and CSF Culture of organism  Eradication of rats
- Weil’s Disease moist soil or vegetation - onset of symptoms is Examination of blood and CSF during the first  Segregation of domestic
- Mud Fever Although pig, cattle, infected with urine of abrupt week of illness and urine after the 10th day animals
- Trench Fever rabbits, hare, skunk, the infected host - fever Leptospira agglutination test  Awareness and early
- Flood Fever and other wild animals - headache diagnosis
- Spirochetal can also serve as Incubation Period: - myalgia Treatment:  Improved education of
Jaundice reservoir 7-19 days, average of - nausea Penicillins and other related B-lactam antibiotics people
- Japanese 10 days - vomiting Tetracycline (Doxycycline)  Avoid wading or
Seven Days Occupational disease - cough Erythromycin swimming in water
fever affecting veterinarians, - chest pain contaminated with urine
miners, farmers, sewer Most common complication: kidney failure of infected animals.
workers, abattoir Immune Phase  Concurrent disinfection
workers, - correlates with the of articles soiled with
etc appearance of circulating urine.
IgM

Rabies Rhabdovirus of the Bite or scratch (very Sense of apprehension Diagnosis:  Have pet immunized at 3
genus rare) of rabid animal Headache history of bite of animal months of age and every
Other Names: lyssavirus Non-bite means: Fever culture of brain of rabid animal year thereafter
Lyssa Degeneration and leaking, scratch, organ Sensory change near site demonstration of negri bodies  Never allow pets to roam
Hydrophobia necrosis transplant (cornea), of animal bite the streets
Le Rage of brain – formation of inhalation/airborne Spasms of muscles of Management:  Take care of your pet
negri bodies (bats) deglutition on attempts to *Wash wound with soap immediately.
swallow Antiseptics National Rabies
Two kinds of Rabies: Source of infection: Fear of e.g. povidone iodine or alcohol may be applied Prevention and Control
a. Urban or canine – saliva of infected water/hydrophobia *Antibiotics and anti-tetanus immunization Program
transmitted by dogs animal or human Paralysis *Post exposure treatment: local wound  Goal: Human rabies is
b. Sylvatic – disease of Delirium treatment, active immunization (vaccination) and liminated in the
wild animals and bats Incubation period: Convulsions passive immunization (administration of rabies Philippines and the
which sometimes 2 – 8 weeks, can be “FATAL once signs and immunoglobulin) country is declared
spread years depending on symptoms appear” *Consult a veterinarian or trained personnel to rabiesfree
to dogs, cats, and severity of wounds, site observe the pet for 14 days
livestock of wound as distance *Without medical intervention, the rabies victim
from brain, amount of would usually last only for 2 to 6 days. Death is
virus introduced, and often due to respiratory paralysis.
protection provided by
clothing

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