Akiya - Diphtheria

8/3/2019 Akiya - Diphtheria

1/52

DIPHTHEDIPHTHE

RIARIA


2/52

An acute, highly

contagious toxin-mediatedinfection caused by

Corynebacteriumdiphtheriae, a gram-

positive, aerobic rod that

usu. infects the respiratorytract; primarily the tonsils,

nasopharynx, & larynx,


3/52


4/52

Infected humans

Weakened

Humans

C. diphtheriae

Discharges from mucous

membranes of

nose and nasopharynx,

skin, & other lesions

Airborne droplets,

direct

contact,

contaminated

fomites, & raw milk

Respiratory

Integumentary

CHAIN

OFINFECTIO

N

INCUBATION

PERIOD: Usu.

2-5 days,

possibly longer


5/52

HUMANANATOMYHUMANANATOMY

& PHYSIOLOGY& PHYSIOLOGY

(UpperRespiratory(UpperRespiratory

Tract)Tract)


6/52


7/52

RISKRISK

FACTORFACTORSS


8/52

PREDISPOSING RISKFACTORS:

Poor sanitation

Crowded living conditions

Limited access to healthcare

Lack of periodic boosterimmunizations


9/52

PRECIPITATING RISKFACTORS:

Direct contact with infected

person, carrier, orcontaminated articles

Use of contaminated objects

from diphtheria-infected people Ingestion of unpasteurizeed

milk


10/52

PATHOGENPATHOGEN

ESISESIS


11/52

Colonizes in the

mucosal surface &

multiply

Bacteria release a toxin

Diphtheria toxin is

absorbed to themucous membranes

Destruction of

epithelium (tissue

necrosis

RISK FACTORS


12/52

Embedded in exuding

fibrin & red & white cells

Psuedomembrane

formation

DIPHTHERIANASAL:

Resembles common cold;serosanguineous

mucopurulent nasal

discharge w/o constitutional

symptoms


13/52

TONSILLAR/PHARYNGEAL:

Thick, patchy, smooth, adherent white/

grayish memrane over the mucous

Low-grade fever

Malaise

Anorexia

Headache Sore throat

Malodorous breath

Dysphagia

Swollen & tender cervical lymph nodes(lymphadenitis) possibly pronounced w/

warm & swollen neck (bulls neck)

Increased weak pulse


14/52

LARYNGEAL:

Fever

Hoarseness

Rasping cough (and other symptoms similar to

croup)

W/ or w/o other sings listed

(potential airway obstruction)

Restlessness

Apprehensive

Dyspneic (suprasternal) retractions

Tachypnea

Cyanosis

Stridor


15/52

CUTANEOUS:

Skin lesions resemble

impetigo


16/52

CLINICALCLINICAL

MANIFESTATIOMANIFESTATIONSNS


17/52

Headache


18/52

Low-

grade

fever


19/52

Anorexia


20/52

Thick, patchy,smooth,

adherent

white/ grayish

memrane

over themucous


21/52


22/52

Swollen & tender cervical lymph nodes

(lymphadenitis) possibly pronounced w/

warm & swollen neck (bulls neck)


23/52

Skin lesions resemble impetigo


24/52

SIMPLE CRITICAL THINKING:

As a nurse caring for a patient

with diphtheria, what should bekept at bedside?


25/52

Suction equipment,Tracheostomy tray andEpinephrine


26/52

DIAGNDIAGN

OSISOSIS


27/52

Examination showing the

characterisic membrane and athroat culture, or culture ofother suspect lesions growing

C. diptheriae in an enzyme-linked immunosorbentasssay( E:LISA) orthe Elek

test (toxigencity test),confirm the diagnosis. Gram-stain or immunofluorescent

antibody stains may also be


28/52

THERAPEUTICTHERAPEUTIC

MANAGEMENTMANAGEMENT


29/52

Diphtheria antitoxin (IM; usu.

IV); preceded by skin orconjunctival test to r/o

sensitivity to horse serum

Antibiotics (penicillin/erythromycin)

CB

R(for prevention ofmyocarditis)

Tracheostomy for airway

obstruction


30/52


31/52


32/52

COMPLICATICOMPLICATI

ONSONS


33/52

o Thrombocytopenia

oNeurologic involvement(primarily affecting motor fibers

but possibly also sensory

neurons)

o Renal involvement

o Pulmonary involvement(bronchopneumonia)

o Myocarditis (2nd wk.)


34/52

NURSINGNURSING

CONSIDERATICONSIDERATIONSONS


35/52

Preventing Spread of

Infection

Maintain and stress the need

for strict isolation in hospital

Teach proper disposal ofnasopharyngeal secretions

Maintain infection precautions


36/52

SIMPLE CRITICAL

THINKING: When can

we say a patient is

free from C.

diphtheriae?


37/52

Maintain infection precautionsuntil after three consecutive

negative cultures at least 24hours apart, with the firstculture being at least 24 hours

after the completion ofantimicrobial therapy.


38/52

SIMPLE CRITICAL

THINKING:How about

those whom the patient

had close contact with?


39/52

Nasopharyngeal and throat cultures are alsoobtained from all close contacts.

Symptomatic clients are isolated andtreated until two negative throat culturesare obtained.

Asymptomatic disease carriers areconfined to home until at least 3 days ofantibiotic therapy have been completed.

Booster shots are given to people who

were immunized 5 or more yearspreviously. Unimmunized contacts aretreated with immunization andantibiotics.

All contacts, including hospital personnel,


40/52

Monitoring and Preventing

Complications

Administer complete care tomaintain bed rest

Observe respiration for signsof obstruction (esp. inlaryngeal diphtheria) and beready to give immediate lifesupport, including intubation &tracheostomy


41/52

Be alert for signs ofmyocarditis, such as

development of heart murmursorECG changes. Ventricularfibrillation is a common causeof sudden death in diphtheriapatients

Watch for signs of shock, w/ccan develop suddenly

If neuritis develops, tell thepatient its usually transient. Beaware that peripheral neuritis

may not develop until 2 to 3


42/52

Patient Comfort

Limit the diet to liquids and soft

foods

Throat irrigation and fluids


43/52

Collaborative Nursing

Considerations Have patient participated insensitivity testing; haveepinephrine (1:1,000) readilyavailable

Give drugs as ordered. Aftergiving antitoxin or penicillin, be

alert for anaphylaxis; keepepinephrine 1: 1,000 andresuscitation handy. In patients

who receive erythromycin,


44/52

Use suctioning as neededAdminister humidified 02 if

prescribed

Serial ECGs should beperformed twice weekly for4to 6 weeks to watch for

myocarditis Obtain cultures as ordered


45/52

Stress the need for childhood

immunizations to all parents.

Report all cases of diphtheriato local public health

authorities.

Prevention


46/52

SIMP

LE

RECALL:What is the

schedulingofdiphtheria

immunization basedfrom EPI?


47/52

At 6 weeks, infants are given 0.5mL ofDPT vaccine IM at upper

outer portion of the thigh.T

hisimmunization has 3 doses with4 weeks interval..


48/52

Diphtheria infection doesntconfer immunity, therefore

diphtheria immunization shouldbe given duringconvalescence.


49/52

RELATEDRELATED

JOURNALJOURNALSS


50/52

Effect of a single tetanusEffect of a single tetanus--diphtheriadiphtheria

vaccine dose on the immunity of elderlyvaccine dose on the immunity of elderly

people in SoP

aulo, Brazilpeople in SoP

aulo, BrazilAbstractEpidemiological data regarding tetanus and diphtheriaimmunity in elderly people in Brazil are scarce. During the FirstNational Immunization Campaign for the Elderly in Brazil inApril 1999, 98 individuals (median age: 84 years) received onetetanus-dyphtheria (Td) vaccine dose (Butantan Institute, lotnumber 9808079/G). Inclusion criteria were elderly individualswithout a history of severe immunosuppressive disease, acuteinfectious disease or use of immunomodulators. Bloodsamples were collected immediately before the vaccine and 30days later. Serum was separated and stored at -20oC untilanalysis. Tetanus and diphtheria antibodies were measured bythe double-antigen ELISA test. Tetanus and diphtheriaantibody concentrations lower than 0.01 IU/mL wereconsidered to indicate the absence of protection, between 0.01and 0.09 IU/mL were considered to indicate basic immunity,and values of 0.1 IU/mL or higher were considered to indicatefull protection. Before vaccination, 18% of the individuals weresusceptible to diphtheria and 94% were susceptible to tetanus.

After oneT

d dose, 78% became fully immune to diphtheria,13% attained basic immunity, and 9% were still susceptible to


51/52

Although one Td dose increases immunity to diphtheria

in many elderly people who live in Brazil, a complete

vaccination series appears to be necessary for the

prevention of tetanus.

Key words:E

lderly,T

etanus,D

iphtheria, Immunization


52/52

Fin.Fin.

Documents

Akiya - Diphtheria