CD Handouts

8/11/2019 CD Handouts

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COMMUNICABLE DISEASESCommunicable Diseases are Primary Cause ofMortality Gap between Rich and Poor CountriesNon-communicable diseases account for 59% of alldeaths worldwide estimated to rise from !"m in#99$ to 5$m in !$!$

bout &$% of deaths caused by communicablediseases can be attributed to'

()*+)D,

Malaria uberculosis

Measles

Diarrheal disease

cute respiratory infectionPhilippines top 10 leading causes of o!"idit#$ o!talit# in the #ea! %00&'Dia!!heaB!onchitisPneuoniaInfluen(a

)#pe!tension*u"e!culosisMala!ia)ea!t diseasesCance!AccidentsCh!onic o"st!ucti+e pulona!# disease andothe! !espi!ato!# diseasesDia"etes and ,idne# diseases-

Goal of .(/#0 Pre1ention of disease

!0 Pre1ention of disability and death from infection20Pre1ention throu3h immuni4ation

Chain of )nfectionPathogen o! causati+e agentbiolo3ic a3ent or3anism6 capable of causin3disease7liminate or3anism by'

,terili4in3 sur3ical instruments and anythin3that touches sterile spaces of the body

8sin3 3ood food safety methods

Pro1idin3 safe drinin3 water

*accinatin3 people so they do not becomereser1oirs of illness

reatin3 people who are ill.ese!+oi!

ny person: animal: arthropod: plant: soil: orsubstance or combination of these6 in which ancausati1e a3ent normally li1es and multiplies: onwhich it depends primarily for sur1i1al: and where itreproduces in such numbers that it can betransmitted to a susceptible host7liminate reser1oirs by'

reatin3 people who are ill

*accinatin3 people

(andlin3 and disposin3 of body fluidsresponsibly

(andlin3 food safely

Monitorin3 soil and contaminated water insensiti1e areas of the hospital and washin3hands carefully after contact with either

Po!tal of e/it

the way the causati1e a3ent 3ets out of thereser1oir body fluid or sin6Reduce ris from portals of e;it by'

Co1erin3 cou3hs and snee4es with a tissue

(andlin3 body fluids with 3lo1es: then doin3hand hy3iene


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a specific 3roup of si3ns and symptoms thataccompany a particular disease

Incidence the number of people in a population who de1elop a disease durin3 a particular timeperiodP!e+alence

the number of people in a population whode1elop a disease: re3ardless of when it appeared

refers to both old and new casesClassification of Infectious DiseaseBased on Beha+io! ithin hostInfectious Disease- ny disease caused by in1asion andmultiplication of microor3anismsContagious Disease disease that easily spreads from one personto anotherBased on Occu!!ence of DiseaseSpo!adic Disease

disease occurs only occasionally i0e0 botulism: tetanusEndeic Disease constantly present in a population: countryor community i0e0 Pulmonary uberculosisEpideic Disease ac=uire disease in a relati1ely short period 3reater than normal number of cases in anarea

within a short period of time

Pandeic Diseaseepidemic disease that occurs worldwide

i0e0 ()* infectionBased on Se+e!it# o! Du!ation of Disease Acute Disease de1elops rapidly rapid onset6 but lasts onlya short time

i0e0 measles: mumps: influen4aCh!onic Disease

De1elops slowly: milder but lon3er lastin3clinical manifestationBased on State of )ost .esistance

P!ia!# Infection acute infection that causes the initial illnessSeconda!# Infection one caused by an opportunistic patho3en afterprimary infection has weaened the body@sdefensesStages of DiseaseIncu"ation Pe!iod time inter1al between the initial infection andthe

#stappearance of any s+s;

P!od!oal Pe!iod early: mild symptoms of diseasePe!iod of Illness o1ert s+s; of disease .AC may increase or decrease can result to death if immune response ormedical inter1ention failsPe!iod of Decline s+s; subside 1ulnerable to secondary infection

Pe!iod of Con+alescence re3ains stren3th and the body returns to its

pre diseased state reco1ery has occurredMode of ransmissionhe process of the infectious a3ent mo1in3 fromthe reser1oir to the susceptible hostContact ransmission- the most important and fre=uent mode of

transmission*#pe of Contact *!ansissionDi!ect Contact *!ansission

Person to person transmission of an a3entby

physical contact between its source and

susceptible host

No intermediate ob>ect in1ol1ed

i0e0 issin3: touchin3: se;ual contact

,ource B ,usceptible (ostIndi!ect Contact *!ansission

reser1oir to a susceptible host by means ofa

non li1in3 ob>ect fomites6

,ource B Non i1in3 /b>ect B ,usceptible(ost

,usceptible (ostReco3nition of hi3h ris patients

)mmunocompromised

DM

,ur3ery

Aurns

7lderlyPe!centage Nosocoial Infection

#% Su!gical

2E% U*I

#2% L.I

#E% Bacte!eia

!!% Othe! incldng s2inInf/n3

4acto!s fo! Nosocoial InfectionMic!oo!ganis5)ospital En+i!onentMost common cause

,taph aureus: Coa3 Ne3 ,taph 7nterococci 70 coli: Pseudomonas: 7nterobacter:


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?unctions of )mmune ,ystem#0 Protects the body from internal threats!0 Maintains the internal en1ironment by remo1in3dead or dama3ed cells020 Pro1ides protection a3ainst in1asion from outsidethe body0

he immune systemhe ma>or components of the immune system

includes the bone marrow which produces thewhite blood cells .AC6: the lymphoid tissueswhich includes the thymus: spleen: lymphnodes:tonsils and adenoids0Natu!al Iunit# INNA*E3Non-specific immunity present at birth0 hisincludes

a0 Pha3ocytosis of bacteria and otherin1aders by white blood cells and cells of the tissuemacropha3e system

b0 Destruction by the acid secretions of thestomach and by the di3esti1e en4ymes on

or3anisms swallowed into the stomach0c0 Resistance of the sin in1asion by

or3anismsd0 Presence in the blood of certain chemical

compounds that attach to forei3n or3anism orto;ins and destroy them lie lyso4yme: natural illercells and complement comple;0Ac6ui!ed Iunit#

he human body has the ability to de1elope;tremely powerful specific immunity a3ainstindi1idual in1adin3 a3ents0 )t usually de1elops as aresult of prior e;posure to an anti3en throu3h

immuni4ation or by contractin3 a disease0cti1e c=uired )mmunity - immune defense arede1eloped by the person@s own body0 his immunitylast many years or a lifetime0Passi1e c=uired )mmunity - temporary immunityfrom another source that has de1eloped immunitythrou3h pre1ious disease or immuni4ation0 )t isused in emer3encies to pro1ide immediate: shortactin3 immunity when the ris is hi3h0

N)A/D)7,Agglutination - clumpin3 effect of antibodiesbetween two anti3en0 )t helps to clear the body of

in1adin3 or3anisms by facilitatin3 pha3ocytosis0Opsoni(ation in this process: the anti3en-antibody molecule is coated with a sticy substancethat facilitates pha3ocytosis01- Ig7 &893

ppears in serum and tissues

ssumes a ma>or role in bloodborne andtissue infections

cti1ates the complement system

7nhances pha3ocytosis

Crosses placenta

%- IgA 1893 ppears in body fluids blood:sali1a: tears:

breat mil6 Protects a3ainst respiratory: G) and G8

Pre1ents absorption of anti3ens from food

Passes to neonate in breast mil forprotection

:- IgM 1093

ppears mostly in intra1ascular serum

?irst immuno3lobulin produced in responseto bacterial or 1iral infection

cti1ates complement systems;- IgD -%93

ppears in small amount in serum8- IgE -00;93

ller3ic and hypersensiti1ity reactionsCombats parasitic infections

)MM8N)H)/NND *CC)N7,)MM8N)H)/NProcess inducin3 immunity artificially by either1accination acti1e6 or administration of antibodypassi1e6

cti1e ' stimulates the immune system to produceantibodies: cellular immune responses to protecta3ainst infectious a3entPassi1e ' pro1ides temporary protection throu3hadministration of e;o3enous antibody)MM8N)H)NG G7N,*accines ' a preparation of proteins:polysaccharides or nucleic acids of patho3ens thatare administered inducin3 specific responses thatinacti1ate or destroy or suppress the patho3eno;oid ' a modified bacterial to;in that has beenmade nonto;ic but retains the capacity to stimulatethe formation of antito;in)MM8N)H)NG G7N,)mmune 3lobulin ' an antibody containin3 solutionderi1ed from human blood obtained by cold ethanolfractionation of lar3e pools of plasma and usedprimarily for immunodeficient persons or for passi1eimmuni4ation

ntito;in ' an antibody deri1ed from serum ofhuman or animals after stimulation with specificanti3ens used for passi1e immunity

7;panded Pro3ram of )mmuni4ationlaunched in Iuly #9& by D/( with cooperationwith .(/ and 8N)C7?0/b>ecti1e was to reduce the mortality and morbidityamon3 infants and children caused by the si;childhood immuni4able diseases0P


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be resumed usin3 minimal inter1als between dosesto catch up as =uicly as possible0

first e;piry and first out ?7?/6 1accine systemis practiced to assure that all 1accines are utili4edbefore its e;piry date0 *accine temperature ismonitored twice a day in all health facilities andplotted to monitor brea in the cold chain0Most sensiti1e to (eat /ral polio 1accine:

Measleseast ,ensiti1e to (eat DP 1accine: (epa A:ACG: tetanus o;oidIN4EC*ION CON*.OL P.OCEDU.EMedical Asepsis

- CLEANechni=ue- )n1ol1es procedures and practices that

reduce the number and transfer ofpatho3ens

- .ill e;clude patho3ens /NFAttain "#'

- ?re=uent and thorou3h hand washin3- Personal 3roomin3- Proper cleanin3 of supplies and e=uipment- Disinfection- Proper disposal of needles: contaminated

materials and infectious waste- ,terili4ation

Su!gical AsepsisS*E.ILEtechni=ue

- Practices used to render and eep ob>ectsand areas sterile

- 7;clude ALLmicroor3anismAttain "#'

- 8se strict aseptic precautions for in1asi1eprocedures

- ,crub hands and fin3ernails before enterin3/0R0

- 8se sterile 3lo1es: mass: 3owns and shoeco1ers

- 8se sterile solutions and dressin3s- 8se sterile drapes and create an sterile field- (eat sterili4ed sur3ical instruments

Uni+e!sal P!ecautions8ni1ersal Precautions

- )nfection control 3uidelines desi3ned to

protect worers from e;posure to diseasesspread by blood and certain body fluids0

- ?or pre1ention of transmission of blood-borne patho3ens in health care settin3s topre1ent contact with patient blood and bodyfluids

- ,tress that all patients should be assumedto be infectious for blood-borne diseasessuch as )D, and hepatitis A0

- 8ni1ersal Precautions?ollowed when worers are e;posed to blood andcertain other body fluids: includin3'

- semen- 1a3inal secretions- syno1ial fluid- cerebrospinal fluid- pleural fluid- peritoneal fluid- pericardial fluid- amniotic fluid- 8ni1ersal Precautions

do not appl# to'- feces

- nasal secretions- sputum- sweat- tears- urine- 1omitus- sali1a e;cept in the dental settin3: where

sali1a is liely to be contaminated withblood6

Standa!d P!ecautions,tandard PrecautionsReplaced uni1ersal precautions

pply to all patients,tipulate that 3lo1es should be worn to touch any ofthe followin3'

- blood- all body fluids- secretions and e;cretions: e;cept sweat:

re3ardless of whether they are 1isibly bloody- non-intact sin- mucous membranes

,tandard PrecautionsGlo1es

- Pre1ent contamination of the hands withmicroor3anisms

- Pre1ent e;posure of the (C. to blood-borne patho3ens

- Reduce the ris of transmission ofmicroor3anisms from the hands of (C.s tothe patient

- Do not replace the need for hand hy3iene,tandard Precautions(ands washed immediately after 3lo1es are

remo1ed and between patient contacts- ?or procedures that are liely to 3enerate

splashes or sprays of body fluid: a maswith eye protection or a face shield and a3own should be worn

- Disposable 3owns should be constructed ofan imper1ious material to pre1entpenetration and subse=uent contaminationof the sin or clothin3

,tandard Precautions- Needles should not be recapped: bent: or

broen but should be disposed of in

puncture-resistant containers,tandard Precautions(and (y3iene

- ,in3le most important means to pre1enttransmission of nosocomial patho3ens

- Remo1es the transient flora recentlyac=uired by contact with patients oren1ironmental surfaces

- lcohol-based hand rubs are recommendedif hands are 1isibly soiled: washin3 withsoap and water is recommended6

- Rin3 remo1al prior to patient care

*!ansissionunction with standardprecautions2 types'

- irborne- Droplet


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- ContactAi!"o!ne P!ecautionsD!oplet P!ecautionsContact P!ecautions

irborne Precautions- Pre1ent transmission of diseases by droplet

nuclei particles smaller than 5 Om6 or dustparticles containin3 the infectious a3ent

- irborne Precautions- ll persons enterin3 the room of these

patients must wear a personal respiratorthat filters # Om particles with a n efficiencyof at least 95% N95 mas6

- Gowns and 3lo1es are used as dictated bystandard precautions

#0 Disseminated 4oster!0 Measles20 ,mallpo;E0 ,R,50 uberculosis pulmonary or laryn3eal6&0 *aricella

0

- Patient placed in a pri1ate room withmonitored ne3ati1e air pressure in relationto surroundin3 areas: and the room air must

under3o at least & e;chan3es per hour- Door to the isolation room must remain

closed- ir from the isolation room should be

e;hausted directly to the outside: away fromair intaes: and not recirculated hi3hefficiency filters may be used also6

- Cou3h eti=uette- Patients should be instructed to co1er

his+her mouth and nose with tissue whencou3hin3 or snee4in3

Droplet PrecautionsPre1ent transmission by lar3e-particle droplet6aerosols unlie droplet nuclei: droplets are lar3er: do notremain suspended in the air: and do not tra1el lon3distances6Droplets are produced when the infected patienttals: cou3hs: or snee4es and durin3 someprocedures e030: suctionin3: bronchoscopy6

susceptible host may become infected if theinfectious droplets land on the mucosal surfaces ofthe nose: mouth: or eye0

- Re=uire patients to be placed in a pri1ateroom: but no special air handlin3 isnecessary patients with same disease canbe placed in the same room if pri1ate roomsare not a1ailable6

- Droplets do not tra1el lon3 distances3enerally no more than 2 feet6: the door tothe room may remain open

- (C. should wear a standard sur3ical maswhen worin3 within 2 feet of the patient

- Gowns and 3lo1es should be worn by(C.s when dictated by standardprecautions

#0 Diphtheria: pharyn3eal!0 (0 influen4ae menin3itis: epi3lottitis:

pneumonia20 )nfluen4aE0 Menin3ococcal infections50 Multi-dru3 resistant pneumococcal disease

&0 Mumps0 Mycoplasmapneumonia"0 Par1o1irus A#9 infections90 Pertussis#$0 Pla3ue: pneumonic##0 Rubella#!0 ,treptococcal pharyn3itis

Contact Precautions- Pre1ent the transmission of

epidemiolo3ically important or3anisms froman infected or coloni4ed patient throu3h

direct contact touchin3 the patient6 orindirect contact touchin3 contaminatedob>ects or surfaces in the patient@sen1ironment6

- Patients are placed in a pri1ate room orpatients infected with same or3anism maybe placed in the same roo

- Aarrier precautions to pre1entcontamination should be employed

- Glo1es and (and hy3iene- Gowns worn if the (C. anticipates

substantial contact of his or her clothin3 with

the patient or surfaces in the patient@sen1ironment or there is an increased ris ofcontact with potentially infecti1e material

- Noncritical patient care e=uipment shouldremain in the room and not used for otherpatients: if items must be shared: theyshould be cleaned and disinfected beforereuse

-

#0 cute diarrheal illnesses liely to beinfectious in ori3in

!0 cute 1iral con>uncti1itis

20 Clostridium difficile diarrheaE0 7ctoparasistic infections lies and scabies650 (,*+*aricella+Disseminated 4oster&0 MDR bacteria MR,: *R7: *),: *R,6

infection or coloni4ation0 ,R,"0 ,mallpo;90 ,treptococcal 3roup 6 ma>or sin: burn or

wound infection#$0 *iral hemorrha3ic fe1ers

ISOLA*ION O4 PA*IEN*S

Sou!ce Isolation.e+e!se Isolation

- Protecti1e or neutropenic isolation- 8sed for patients with se1ere burns:

leuemia: transplant: immuno deficientpersons: recei1in3 radiation treatment:leuopenic patients

- hose that enter the room must wear massand sterile 3owns to pre1ent fromintroducin3 microor3anisms to the room


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?A ),/)/N

- *),)/R, - report to nurses@ stationbefore enterin3 the room

- M,


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- .uchereria bancrofti and Aul3aria malayi- ransmitted to the bite of infected female

mos=uito edes: nopheles: Mansonia6- he lar1ae are carried in the blood stream

and lod3ed in lymphatic 1essels and lymph3lands where they mature in adult form

wo biolo3ical typeNocturnalmicrofilaria circulate in peripheral blood at ni3ht#$pm !am6Diurnalmicrofilaria circulate in 3reater concentration atdaytime

Clinical Manifestationcute sta3e- filarial fe1er and lymphatic inflammation thaoccurs fre=uently as #$ times per year and usuallyabates spontaneously after days- ymphadenitis )nflammation of the lymphnodes6

- ymphan3itis )nflammation of the lymph 1essels6Chronic ,ta3e #$-#5 years from the onset of thefirst attac6- (ydrocele ,wellin3 of the scotum6- ymphedema emporary swellin3 of the upperand lower e;tremities6- 7lephantiasis enlar3ement and thicenin3 of thesin of the lower or upper e;tremities6

aboratory Dia3nosis- Alood smear presence of microfilaria- )mmunochromato3raphic est )C6- 7osinophil count

Mana3ement Guidelines- ,pecific herapy- Dietylcarbama4ine D7C6 &m3+aundice6manifested by fe1er: con>uncti1al in>ectionsi3ns of menin3eal irritation

)cteric ype .eil ,yndrome6(epatic and renal manifestationIaundice: hepatome3ally/li3uris: anuria which pri3ress to renal failure,hoc: coma: C(?Con1alescent Period

Dia3nosis

Clinical history and manifestationCultureAlood' durin3 the #st weeC,?' from the 5th to the #!th day8rine' after the #st wee until con1alescent period eptospira 33lutination est6other laboratoryA8N:CR7: li1er en4ymes

reatment,pecificPenicillin 5$$$$ units+3+day

etracycline !$-E$m3+3+dayNon-specific,upporti1e and symptomatic

dministration of fluidsPeritoneal dialysis for renal failure7ducate public re3ardin3 the mode of transmission:a1oid swimmin3 or waddin3 in potentiallycontaminated waters and use proper protecti1ee=uipment0

Nu!sing .esponsi"ilities#0 Dispose and isolate urine of patient0

!0 7n1ironmental sanitation lie cleanin3 theesteros or dirty places with sta3nant water:eradication of rats and a1oidance of wadin3 orbathin3 in contaminated pools of water020 Gi1e supporti1e and asymptomatic therapyE0 dministration of fluids and electrolytes050 ssist in peritoneal dialysis for renal failurepatient he most important si3n of renal failure ispresence of oliguria06

MALA.IA

- Malaria- ected into humans- se;ual cycle+schi4o3ony human6- 3ametes is the infecti1e sta3e taen up by

bitin3 mos=uito


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Plasmodium *i1a;- more widely distributed- causes beni3n tertian malaria- chills and fe1er e1ery E" hours in 2 days

Plasmodium ?alciparum- common in the Philippines- Causes the most serious type of malaria

because of hi3h parasitic densities in blood0- Causes mali3nant tertian malaria

Plasmodium malaria- much less fre=uent- causes =uartan malaria: fe1er and chills

e1ery ! hrs in E days- Plasmodium /1ale- rarely seen0

Patholo3y- the most characteristic patholo3y of malaria

is destruction of red blood cells: hypertrophyof the spleen and li1er and pi3mentation ofor3ans0

- he pi3mentation is due to the pha3ocytocis

of malarial pi3ments released into the bloodstream upon rupture of red cells

Clinical Manifestationuncomplicated

- fe1er: chills: sweatin3 e1ery !E 2& hrsComplicated

- sporulation or se3mentation and rupture oferythrocytes occurs in the brain and 1isceralor3ans0

- Cerebral malaria- chan3es of sensorium: se1ere headache

and 1omitin3- sei4ures

clinical anifestation#0 Cold sta3e #$-#5 mins: chills: shaes!0 hot sta3e E-& hours: recurrin3 hi3h 3rade

fe1er: se1ere headache: 1omittin3:abdominal pain: face is blue

20 Diaphoretic ,ta3e e;cessi1e sweatin3

Dia3nosis- Malarial smear- Luantitati1e Auffy Coat LAC6

ra1el in endemic areasreatment'Determine the species of parasite/b>ecti1es of treatment

#0 Destroy all se;ual forms of parasite to curethe clinical attac

!0 Destroy the e;cerythrocytes 776 to pre1entrelapse

20 Destroy 3ametocytes to pre1ent mos=uitoinfections

reatment for P0 ?alciparum

#0 chloro=uine tablet #5$m3+base+tab6 Day#:!:2 E:E:!6

!0 ,ulfado;ine+Pyrimethamine5$$m3+!5m3+tab: 2tab sin3le dose

20 Prima=uine #5m3+tab6 2 tabs sin3le dosereatment for P0 *i1a;

#0 Choloro=uine: Day #:!:2 E:E:!6!0 Prima=uine # tab /D for #E days

reatment for mi;ed- chloro=uine E:E:!6

- ,ulfado;ine+Pyrimethamine 2 tabs once- Prima=uine # tab for #E days

Multi-dru3 resistant P0 ?alciparum=uinine plus do;ycycline: or tetracycline andprima=uineComplications

- se1ere anemia- cerebral malaria- hypo3lycemia

Pre1ention and Control- 7liminate anopheles mos=uito 1ectors- d1ise tra1elers- limit dus to dawn outdoor e;posure- insect repellant: nets

Nursin3 Care#0 Consider a patient with cerebral malaria to be anemer3ency

- dminister )* =uinine as )* infusion

- .atch for neurolo3ic to;icity from =uininetransfusion lie delirium: confusion: con1ulsion andcoma!0 .atch for >aundice this is related to the densityof the falciparum parasitemia:20 71aluate de3ree of anemiaE0 .atch for abnormal bleedin3 that are may bedue to decrease production of clottin3 factors bydama3e li1er0Chemoprophyla;is

- do;ycycline #$$m3+tab: !-2 days prior totra1el: continue up to E wees upon lea1in3

the area- Meflo=uine !5$m3+tab: # wee before

tra1el: continue up to four wees uponlea1in3 the area

- Pre3nant: #st trimester: chloro=uine: ! tabsweely: ! wees before tra1el: durin3 stayand until E wees after lea1in3

- !nd and 2rd trimester: Pyrimethamine-sulfado;ine

Cate3ory of pro1incesCatego!# A no si3nificant impro1ement in

malaria for the past #$ years0 K#$$$- Mindoro: isabela: Ri4al: Hamboan3a: Ca3ayan:

payao: alin3aCatego!# B- #$$$+year- )fu3ao: abra: mt0 pro1ince: ilocos: nue1a eci>a:bulacan: 4ambales: bataan: la3unaCatego!# C si3nificant reduction-pampan3a: la union: batan3as: ca1ite: albay

CEN*.AL NE.?OUS S@S*EM DISEASES)nflammation of the meni3esCaused by bacterial patho3en: N0 meni3itidis: (0

)nfluen4a: ,trep0 Pneumoniae: MycobacteriumuberculosisPA*)OLO7@Primary spread of bacteria from the bloodstreamto the meni3es,econdary results from direct spread of infectionfrom other sources or focus of infection0

he disease usually be3ins as an infection bynormal body flora: of'


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#0 he ear otitis media6 - Haemophilusinfluenzae!0 he lun3 lobar pneumoniae6 - Streptococcus

pneumoniae20 he upper respiratory tract rhinopharyn3itis6 -Neisseria meningitidis, Haemophilus

influenzae, Streptococcus: Group AE he sin and subcutaneous tissuefurunculosis6 S. aureus

50 he bone osteomyelitis6 - S. aureus&0 he intestine - E. coliClinical anifestation

- ?e1er- Rapid pulse: respiratory arrythmia- ,oreness of sin and muscles- Con1ulsion+sei4ures- headache- irritability- fe1er- nec stiffness- patholo3ic refle;es' erni3@s: Aabinsi:

Arud4insi

Dia3nosis- umbar puncture- Alood C+,- other laboratories

umbar Puncture- o obtain specimen of C,?- o reduce )CP- o )ntroduce medication- o in>ect anesthetic

C,? 7;amination- ?luid is turbid+purulent K#$$$cc+mm cells- .AC count increase- ,u3ar content maredly reduced- C(/N increased- Presence of microor3anism

- reatmentAacterial menin3itis

- A menin3itis- )ntensi1e Phase- Maintainance Phase- ?un3al menin3itis- cryptococcal menin3itis flucona4ole or

amphotericin A!0 ,upporti1e+,ymptomatic a0 ntipyretic b0 treat si3ns of increased )CP c0 Control of sei4ures d0 ade=uate nutritionNu!sing Inte!+entionPre1ent occurrence of further complication

- Maintain strict aseptic techni=ue when doin3

dressin3 or lumbar puncture0- 7arly symptom should be reco3ni4e- *ital si3ns monitorin3- /bser1e si3ns of increase )CP- Protect eyes from li3ht and noises

Maintain normal amount of fluid and electrolytebalance

- Note and record the amount of 1omitus- Chec si3ns of dehydration

Pre1ent ,pread of the disease- (a1in3 proper disposal of secretions

- 7mphasi4e the importance of masin3- 7;plain the importance of isolation

7nsure patient@s full reco1ery- Maintain side rails up in episodes of

sie4ures- Pre1ent sudden >ar of bed-


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- fear of water- fear of air

E ,G7, #0 prodrome - fe1er: headache: paresthesia:

!0 encephalitic e;cessi1e motor acti1ity:hypersensiti1ity to bri3ht li3ht: loud noise:

hypersali1ation: dilated pupils 20 brainstem dysfunction dyspha3ia:

hydrophobia: apneaE0 death

Dia3nosis- ? fluorescent antibody test6- Clinical history and si3ns and symptoms

Mana3ement- No treatment for clinical rabies- Prophyla;is

Poste/posu!e p!oph#la/is

0 cti1e 1accine PD7*:PC7C:P*R*6 )ntradermal $:2::2$:9$6 )ntramuscular $:2::#E:!"6

$::!#6A0 Passi1e *accine a0 7R)G wt in 3 ; 0! S cc to be in>ected imN,6 b0 (R)G wt in


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- ,edati1es- ran=uili4ersE0 racheostomy

reatment'anti-to;inetanus nti-o;in 6

- dult:children:infant E$:$$$ )8 T)M:#+! )*

- Neonatal etanus !$$$$)8: #+!)M: T )*

)G- Neonates #$$$ )8: )*

drip or )M- dult: infant: children 2$$$ )8: )* drip

or )Mntimicrobial herapy Penicillin U-2 mil units = Ehours Pedia 5$$$$$ !mil units = E hrs

Neonatal !$$$$$ units )*P = #!hrs or="hrs

Control of spasms- dia4epam- chlorproma4ine

Nursin3 care- Patient should be in a =uiet: darened room:

well 1entilated0- Minimal+3entle handlin3 of patient- i=uid diet 1ia NG- Pre1ent )n>ury- Pre1enti1e Measures- reatment of wounds- etanus to;oid $:#:&:#:#6

)EPA*Oaponicum- ,0 >aponicum is endemic in the Philippines

leyte: ,amar: ,orso3on: Mindoro:Aohol6- )ntermediate host: /ncomelania Luadrasi

D)GN/,),- ,chistosoma e33s in stool- Rectal bipsy-


13/27

- )nfluen4a- Malaise and easy fati3ability- nore;ia and abdominal discomfort- Nausea and 1omitin3- ?e1er: CD- >aundice

D;' Anti )A? IgM acti+e infection Anti )A? Ig7 old infection no acti+ediseaseManageent'

- Prophyla;is- Complete bed rest- ow fat diet but hi3h su3ar- 7nsure safe water for drinin3- ,anitary method in preparin3 handlin3 and

ser1in3 of food0- Proper disposal of feces and urine0- .ashin3 hands before eatin3 and after toilet

use0- ,eparate and proper cleanin3 of articles

used by patient

(epatitis A- DN: (epa A 1irus- ,erum hepa- .orldwide distribution- Main cause of li1er cirrhosis and li1er

cancer

)P' !-5 monthsMode of ransmission

- ?rom person to person throu3h- contact with infected blood throu3h broen

sin and mucous membrane- se;ual contact- sharin3 of personal items- Parenteral transmission throu3h- blood and blood products- use of contaminated materials- Perinatal transmission

(i3h Ris 3roup- Newborns and infants of infected mothers- (ealth worers e;posed to handlin3 blood- Persons re=uirin3 fre=uent transfusions- ,e;ually promiscuous indi1iduals- Commercial se; worers- Dru3 addicts

Possible /utcome- Most 3et well completely and de1elop life

lon3 immunity0- ,ome become carriers of the 1irus and

transmit disease to others0- lmost 9$% of infected newborns become

carriers

(epatitis C- Post transfusion (epatitis- Mode of transmission percutaneous: A- Predisposin3 factors paramedical teams

and blood recepients- )ncubation period !wees & months

(epatitis D- Dormant type- Can be ac=uired only if with hepatitis A

(epatitis 7- )f hepatitis 7 recurs at a3e !$-2$: it can lead

to cancer of the li1er- 7nteric hepatitis- ?ecal-oral route

DJ'- 7le1ated , or ,GP specific6 and or

,G/- )ncreased )3M durin3 acute phase- X6 or R7C)*7 (As3 S )N?7C7D:

may be acute: chronic or carrier- X6 (Ae3 S hi3hly infectious- #stto increase in li1er dama3e

o (Ac3 S found only in the li1er cells- X6 nti-(Ac S acute infection- X6 nti-(Ae S reduced infectiousness- X6 nti-(As S with antibodies ?R/M

1accine or disease6- Alood Chem0 nalysis to monitor

pro3ression6- i1er biopsy to detect pro3ression to C6

M3mt'- Pre1ention of spread )mmuni4ation and

(ealth 7ducation- 7nteric and 8ni1ersal precautions- ssess /C- Aed rest- D7< deficiency inter1ention- (i3h C(/: Moderate C(/N: ow fat- ?*7 pre1ention

C;'#0 ?ulminant (epatitis s+s; of encephalopathy!0 Chronic (epatitis - lac of complete resolution ofclinical s; and persistence of hepatome3aly20 (As3 carrierE.UP*I?E 4E?E.MEASLES

- 7;tremely conta3ious- Areastfed babies of mothers ha1e 2 months

immunity for measles- he most common complication is otitis

media- he most serious complications are

bronchopneumonia and encephalitis

Measles= .u"eola= & Da# 4e+e!= )a!d .edMeasles

- RN: Paramy;o1iridae- cti1e MMR and Measles 1accine- Passi1e Measles immune 3lobulin- ifetime )mmunity- )P' -#E days

M/' droplets: airborne- YConta3ious E days before rash and E days

after rash

Clinical ManifestationPre erupti1e sta3e

- Patient is hi3hly communicable- E characteristic features

0 Cory4aA0 Con>uncti1itisC0 PhotophobiaD0 Cou3h


14/27

-


15/27

o sub acute phase: thrombocytosis:des=uamation and resolution offe1er0

o Con1alescent sta3e

Manifestations- bilateral: non purulent con>ucti1itis- con3ested oropharyn;: strawberry ton3ue:

erythematous lymphs- erythematous palms+soles: edematous

hands+feet- periun3al des=uamation: truncal rash- CDP #node K#05cm6

Dia3nosis- CAC' leuocytosis- Platelet count KE$$$$$- !D echo if coronary artery in1ol1ement is

hi3hly su33esti1e- 7,R and CRP ele1ated

Mana3ement- )* Gamma 3lobulin !3+3 as sin3le dose

for #$-#! hours0 7ffecti1e to pre1entcoronary 1ascular dama3e if 3i1en within #$days of onset0

- ,alicylates' "$-#$$m3+3+!E hours in Edi1ided doses

- ,ymptomatic and supporti1e therapy

.espi!ato!# S#steMups

- RN: Mumps 1irus- Mumps 1accine - K #yo- MMR #5 mos- ifetime )mmunity- )P' #!-#& days- M/' Droplet: sali1a: fomites

,+s;' 8nilateral or bilateral- parotitis: /rchitis - sterility if bilateral:- /ophoritis: ,timulatin3 food cause se1ere

pain: aseptic menin3itis- D;' serolo3ic testin3: 7),

M3mt' supporti1e

Nursin3 care- Respiratory precautions- Aed rest until the parotid 3land swellin3

subsides- 1oid foods that re=uire Chewin3- pply hot or cold compress- o relie1e orchitis: apply warmth and local

support with ti3ht fittin3 underpants

Dipthe!ia- cute conta3ious disease- Characteri4ed by 3enerali4ed systemic

to;emia from a locali4ed inflammatory focus- )nfants immune for & months of life- Produces e;oto;in- Capable of dama3in3 muscles especially

cardiac: ner1e: idney and li1er- )ncrease incidence pre1alence durin3 cooler

months- Mainly a disease of childhood with pea at

!-5 years: uncommon in K&months

Co!#ne"acte!iu diphthe!iae= g!a 3= slende!=cu!+ed clu""ed o!ganis F,le"s


16/27

a sudden noisy inspiration with a lon3 hi3hpitched whoopQ

- Durin3 attac the child becomes cyanoticand the eyes appear to bul3e or poppin3 outof the eyeball and ton3ue protrudes

Dia3nosis- .AC count !$$$$-5$$$$- Culture with Aordet Gen3ou 3ar

reatment- 7rythromycin shorten the period of

communicability- mpicillin if with aller3y to erythromycin- (eperimmune pertusis 3amma 3lobulin in

! years old #0!5ml )M6- Control of cou3h with sedati1es

D/' >)O < H%1 da#s cough close contact 5

pe!tussis p/ 3 cultu!e O. !ise in A" to 4)Ao! pe!tussis to/in th!oat cultu!e 5 Bo!det gengou aga!Mana3ement

- CAR to conser1e ener3y- Pre1ent aspiration- (i3h calorie: bland diet- /mit mil and mil product because it

increases the mucous- Refeedin3 of infants !$ min after 1omittin3- Mil should be 3i1en at room temperature

complications- Aronchopneumonia- bdominal hernia- ,e1ere malnutrition- A: asthma- encephalitis

P!e e/posu!e p!oph#la/is fo! Diphthe!ia=Pe!tussis= *etanusDP- $05 ml )M

- # - # T months old! - after E wees

2 - after E wees- #stbooster #" mos- !ndbooster E-& yo- subse=uent booster e1ery #$ yrs

thereafter

Infectious Mononucleosis- 7pstein Aarr 1irus- )nc0 period' E-& wees- Communication period' 8nnown: 1irus is

shed before the onset of the dse until &months or lon3er after reco1ery

- ,ource' oral secretions- ransmission' Direct intimate contact:

infected blood

ssessment- ?e1er: sorethroat: malaise: headache:

fati3ue: nausea: abdominal pain- CDP: hepatosplenome3ally

Nursin3 care- ,upporti1e

- Monitor si3ns of splenic rupture: whichinclude abdominal pain: left upper =uadrantpain or left shoulder pain

PULMONA.@ *UBE.CULOSIS- he world@s deadliest disease and remains

as a ma>or public health problem0- Aadly nourished: ne3lected and fati3ued

indi1iduals are more prone- ,usceptibility is hi3hest in children under 2

years-


17/27

ACG 1accination

7ducate the public in mode of transmissionand importance of early dia3nosid

)mpro1e social condition

Pneuonia#0 Community ac=uiredypical ,trep0 Pneumoniae: (0 )nfluen4ae type A

typical Pneumonia ,0 ureus: M0 Pneumoniae:0 Pneumophila: P0 Cariini!0 Nosocomial Pseudomonas: ,0 ureusM/' aspiration: inhalation: hemato3enous: directinoculation: conti3uous spreadC()D(//D PN78M/N)#0 No pneuonia- infant: &$+min and no chest indrawin3%- Pneuonia< youn3 infant K&$+min: fast breathin3 withoutchest indrawin320 ,e1ere pneumonia

- fast breathin3: se1ere chest indrawin3: with oneof dan3er si3nsE0 *ery se1ere pneumonia- below ! mos old: fast breathin3: chest indrawin3:with dan3er si3nsE Dan3er ,i3ns

#0 *omits!0 Con1ulsion20 Drowsiness+lethar3yE0 Difficulty of swallowin3 or feedin3

,+s;'#0 ypical sudden onset ?e1er of K 2" ; -#$

days: producti1e cou3h: pleuritic chestpain: dullness: inc fremitus: rales!0 typical 3radual onset: dry cou3h:

headache: myal3ia: sore throat.atch out for complications )n !E hours death willoccur from respiratory failureNursin3 Dia3nosis

)neffecti1e airway clearance

)neffecti1e breathin3 pattern

)mpaired 3as e;chan3e

Ris for acti1ity intolerance

M3mt' ntibiotics: hydration: nutrition: nebuli4ation

CR)-health teachin3

Nursin3 )nter1entions

Respiratory support- o;y3en supplementation- mechanical 1entilation Positionin3

Rest

,uctionin3 of secretions

ntipyretic and ,A

Nutrition

Sca!let fe+e!- Group beta hemolytic streptococcus- Respiratory- )ncubation !-5 days- ?e1er: red sandpaper rash: white strawberry

ton3ue: flushed chees: red strawberryton3ue

- Dia3nostics is throat culture- Penicillin for #$ days

7I*Aoe"iasis

- 7ntamoeba (ystolitica: proto4oa- )P' few days to months to years:- usually !- E wees- M/' )n3estion of cysts from fecally

contaminated sources /ral fecal route6oral and anal se;ual practices

- 7;traintestinal amoebiasis- 3enitalia:spleen: li1er: anal: lun3s and menin3es

s5s/'- Alood streaed: watery mucoid diarrhea:

foul smellin3:- abdominal cramps- Pain on defecation tenesmus6- (yperacti1e bowel sounds

Diagnostic test- ,tool culture of 2 stool specimens- ,i3moidoscopy- Recto-si3moidoscopy and coloscopy for

intestinal amoebiasis

Medical treatment- Metronida4ole trichomonocide and

amoebicide for intestinal and e;tra intestinalsites monitor li1er function test6

- Dilo;anide furoate luminal amoebicide- Paromomycin eradicate cyst of histolytica- inida4ole hepatic amebic abscess

Bacilla!# D#sente!#

Shigellosis- ,hi3a bacillus' dysenteriae fatal6: fle;neri

Philippines6: boydii: sonnei 3ram -6- ,hi3a to;in destroys intestinal mucosa- (umans are the only hosts- Not part of normal intestinal flora- )P' #- days- M/ ' oral fecal route

S5s/' fe+e!= se+e!e a"doinal pain= dia!!hea isate!# to "lood# ith pus= tenesusD;' stool cultureM3mt' /resol: mpicillin: rimethoprim-

,ulfametho;a4ole: Chloramphenicol: etracycline:Ciproflo;acin

Chole!a- *ibrio coma inaba: o3awa: hio>ima6: 1ibrio

cholerae: 1ibrio el tor 3ram -6- Cholera3en to;in induces acti1e secretion of

NaCl- cti1e )mmuni4ation- )P' few hours to 5 days- M/' oral fecal route

S5s/' .ice ate!# stool ith flec2s of ucus=

s5s/ of se+e!e deh#d!ation ie >ashe!oanss2in= poo! s2in tu!go!D;' stool culturegt' I? fluids= *et!ac#cline= Do/#c#cline=E!#th!o#cin= Juinolones= 4u!a(olidone andSulfonaides child!en3

*ia the sin)oo2o! .oundo!3

- Necator mericanus: ncylostomaDuodenale


18/27

- eads to iron deficiency and hypochromicmicrocytic anemia

- Gain entry 1ia the sin- D;' microscopic e;am stool e;am6- M3mt' Pyrantel Pamoate and Mebenda4ole- don@t 3i1e dru3 without X6 stool e;am- members of the family must be e;amined

and treated also

Pa!agoniiasis- Chronic parasitic infection- Closely resembles PA- 7ndemic areas' mindoro: camarines sur:

norte: samar: sorso3on: leyte: albay: basilan- Para3onimiasis-


19/27

MNG7M7N ND C/NR/ M7,8R7,'- NO DE4INI*E MEDICA*IONS- INDUCE ?OMI*IN7 EA.L@

IN*E.?EN*ION3- D.IN,IN7 PU.E COCONU* MIL,

>EA,ENS *OIC E44EC*3 DON* 7I?EDU.IN7 LA*E S*A7E I* MA@ >O.SEN*)E CONDI*ION-

- Na)CO: SOLU*ION %8 7.AMS IN 7LASS O4 >A*E.3

- .ESPI.A*O.@ SUPPO.*- A?OID USIN7 ?INE7A. IN COO,IN7

S)ELL4IS) A44EC*ED B@ .ED *IDE18 +i!ulence3

- *OIN O4 .ED *IDE IS NO* *O*ALL@DES*.O@ED IN COO,IN7-

- A?OID *A)ON7= *ALABA= )ALAAN=,ABI@A= ABANI,O- >)EN .ED *IDE ISON *)E .ISE-

BO*ULISM- rue poison nown to be one of the

deadliest substance and usually releasedinto the food shortly after it has beencanned

- Botulis- Clostridium Aotulinum: 3ram X6: spore

formin3- )n3estion of contaminated foods canned

foods6: wound contamination: infantbotulism most common in3estion of honey6

- Neuroto;ins bloc c(- )P' #!-2&( canned food6- )P' E-#E days wound6- cti1e and passi1e immuni4ation

,+s;' Diplopia: dyspha3ia: symmetric descendin3flaccid paralysis: ptosis: depressed 3a3 refle;:nausea: 1omitin3: dry mouth: respiratory paralysisD;' 3astric siphonin3: wound culture: serumbioassay food borne6M3mt' respiratory support: antito;in

CON*AC*Pediculosis

Alood sucin3 lice+Pediculus humanusp0 capitis-scalpp0 palpebrarum-eyelids and eyelashesp0 pubis-pubic hairp0 corporis-body

M/' sin contact: sharin3 of 3roomin3 implementss+s;' nits in hair+clothin3: irritatin3 maculopapular orurticarial rashM3mt' disinfect implements: indane


20/27

Paucibacillary - &-9 months#0 Dapsone

!0 RifampicinMultibacillary- #!-!E months

#0 Dapsone mainstay hemolysis:a3ranulocytosis

!0 Clofa4imine reddish sin pimentation:intestinal to;icity

20 Rifampicin bactericidal renal and li1er

to;icity

Nursin3 )nter1ention- (ealth teachin3s- Counselin3 in1ol1in3 the family members

and e1en the community- Pre1ention of transmission use of mas 6

Anth!a/- Aacillus anthracis: 3ram X6- Releases e;oto;in- Cattle: sheep: 3oat and pi3- )P' #-2 days- D;' 3ram stain: culture: b testin3- M3mt' parenteral Penicillin G: cutaneous

lesions should be cleaned

M/- )nhalation .oolsorter@s disease6

8R) fe1er ; 2-5 days6 lower infectional1eoli6 metabolic acidosis hypo;ia

- ,in most common6 itchiness papule-1esicle depressed

blac eschars painless6 septicemiaSpect!u of Acti+it# of Antiection site to minimi4e tissue in>ury

Penicillin interfere with bacterial cell wallsynthesis broad spectruma0 mo;icillin: ampicilin: methicillin: PenicillinCephalosporina0 #st 3eneration cefa4olin: cephale;in:

cephalothinb0 !nd3eneration Cefaclor: Cefamandolec0 2rd3eneration Ceftria;one: cefota;ime

)nhibits cell wall synthesis- 7rythromycin- etracycline- mino3lycosides- Chloramphenicol,ide 7ffectsetracycline hepatoto;ic: phototo;icity:hyperurecemia: enamel hypoplasia

mino3lycosides ototo;icity: leuopenia:thrombocytopenia: neuroto;icityChloramphenicol bone marrow depression:hypersensiti1ity

Infective endocarditisInfection of the hea!t +al+es and the endothelialsu!face of the hea!tCan "e acute o! ch!onicEtiologic facto!s1- Bacte!ia< O!ganis depends on se+e!alfacto!s%- 4ungi

.is2 facto!s


21/27

1- P!osthetic +al+es%- Congenital alfo!ation:- Ca!dio#opath#;- I? d!ug use!s8- ?al+ula! d#sfunctions

Du2es c!ite!ia)0 Criteria for )7

- wo ma>or criteria or- /ne ma>or and three minor- ?i1e ma>or criteria

Ma>or criteria- Positi1e blood culture typical for )7- Positi1e echocardio3ram study

Minor criteria- Predisposin3 heart condition- ?ebrile syndrome- *ascular phenomena' con>ucti1al

hemorrha3e: >aneway lesions- )mmunolo3ic phenomena- /sler nodes and roth spots- 7chocardio3ram su33esti1e of )7 but not

classified as ma>or

cute- nafcillin or o;acillin- 3entamycin,ubacute- penicillin- 3entamycinAssessent findings1- Inte!ittent fe+e!%- ano!e/ia= eight loss

:- cough= "ac2 pain and oint pain;- splinte! heo!!hages unde! nails8- Osle!s nodes< painful nodules on finge!pads- .oths spots< pale heo!!hages in the !etina&- )ea!t u!u!s- )ea!t failu!e

P!e+entionAnti"iotic p!oph#la/is if patient is unde!goingp!ocedu!es li2e dental e/t!actions="!onchoscop#= su!ge!#= etc-LABO.A*O.@ EAM

Blood Cultu!es to dete!ine the e/act o!ganisNu!sing anageent1- !egula! onito!ing of tepe!atu!e= hea!tsounds%- anage infection:- long


22/27

b0 )ncreased ris of urinary stasisc0 )mpaired immune response!0 ?emales' short urethra: ha1in3 se;ualintercourse: use of contracepti1es that alter normalbacteria flora of 1a3ina and perineal tissues witha3e increased incidence of cystocele: rectoceleincomplete emptyin3620 Males' prostatic hypertrophy: bacterialprostatitis: anal intercourse

E0 8rinary tract obstruction' tumor or calculi:strictures50 )mpaired bladder inner1ation&0 Aowel incontinence0 Diabetes mellitus"0 )nstrumentation of urinary tract

Cystitiso Most common 8)o Remains superficial: in1ol1in3

bladder mucosa: which becomeshyperemic and may hemorrha3e

o General manifestations of cystitiso Dysuriao ?re=uency and ur3encyo Nocturiao flan or low bac paino ,uprapubic pain and tenderness

ssessment and laboratorieso 8rinalysis bactereriuria K#$@5 colonies of

bacteria+mlo 70coli 55%

o Pseudomonas and enterrococcus catheterassociated 8)

o 8rine culture- 3old standardCriteria

o ll meno ll childreno .omen with commpromised ),o DM pto Recent documentationo Prolon3ed or persistent utio K2 8)+yearo Pre3nant womeno .omen se;ually acti1e or ha1e new

partners

50 Readily responds to treatment&0 8ntreated: may in1ol1e idneys0 ,e1ere or prolon3ed may cause slou3hin3of bladder mucosa with ulcer formation"0 Chronic cystitis may lead to bladder stoneformation

P#eloneph!itis

#0 )nflammation of renal pel1is andparenchyma functional idney tissue6!0 cute pyelonephritisa0 Results from an infection that ascends toidney from lower urinary tractRis factors#0 Pre3nancy!0 8rinary tract obstruction and con3enitalmalformation20 8rinary tract trauma: scarrin3E0 Renal calculi

50 Polycystic or hypertensi1e renal disease&0 Chronic diseases: i0e0 diabetes mellitus0 *esicourethral reflu;

Manifestations#0 Rapid onset with chills and fe1er!0 Malaise20 *omitin3E0 ?lan pain

50 Costo1ertebral tenderness&0 8rinary fre=uency: dysuriaAssessent findings' Uppe! U*I

o 4e+e! and C)IILS

o 4lan2 pain

o Costo+e!te"!al angle tende!ness

La"o!ato!# E/ainationU!inal#sis' assess p#u!ia= "acte!ia= "lood cellsin u!ine Bacte!ial count H100=000 5l indicati+eof infection"- .apid tests fo! "acte!ia in u!ine1- Nit!ite dipstic2 tu!ning pin2 K p!esenceof "acte!ia3%- Leu2oc#te este!ase test identifies >BCin u!ine3c- 7!a stain of u!ine' identif# "# shapeand cha!acte!istic g!a positi+e o! negati+e3o"tain "# clean catch u!ine o! cathete!i(ationU!ina!# *!act Infection U*I3Nu!sing inte!+entions

o Adiniste! anti"iotics as o!de!ed

o P!o+ide a! "aths and allo client to

+oid in ate! to alle+iate painful +oiding-o 4o!ce fluids- Nu!ses a# gi+e : lite!s of

fluid pe! da#o Encou!age easu!es to acidify urine

c!an"e!!# uice= acid


23/27

o brupt onset: #$ days after streptococcalinfection

o May be mild or se1ere presentin3 with R?with oli3uria

o Proteinuria due to increased permeability ofthe 3lomerular membrane

o 7dema and hypertension in 5%o (eadache: malaise and flan pain

Dia3nostic findin3so ,erial nti-streptolysin /o ,erum )3 and complement le1elo 7lectron microscopy and

immunofluorescent identify the nature of thelesion

o


24/27

Ris ?actorso Malnutritiono )ncontinenceo )mmobilityo ,in shearin3o Decreased sensory perception

Nursin3 careo )nstitute measures to pre1ent decubitus

ulcero ssess the nutritional statuso Pro1ide ade=uate nutritional intae to

promote sin inte3rityo Monitor for alteration in sin inte3rityo Relie1e or remo1e pressure on sino urn e1ery ! hourso mbulate the patiento Pro1ide acti1e and passi1e e;ercise = "hrso


25/27

S#philis*!eponea pallidu= spi!ocheteF BeautifulG fast o+ing "ut delicate spi!alth!eadIP' 10a!ts=Cond#loa Acuinatu

(P* type & W ##: papilloma 1irus

,+s;' ,in3le or multiple soft: fleshy painless3rowth of the 1ul1a: 1a3ina: cer1i;: urethra:or anal area: *a3inal bleedin3: dischar3e:odor and dyspareunia

DJ' Pap smear-shows cellular chan3es

oilocytosis6 cetic acid swabbin3 will whiten lesion6

Cauliflower or hypereratotic papularlesions

reatment- li=uid nitro3en- podophylin resinM3mt'

aser treatment is more effecti1eCJ'

Neoplasia

Neonatal laryn3eal papillomatosis 1a3inalbirth6

Candidiasis= Moniliasis

Candida lbicans: Feast or fun3us

,+s;' Cheesy white dischar3e:

V7;treme itchinessDJ'


26/27

)n ,ub-,aharan frica: 5"% of ()*+)D,infected adults are women0 More than two-thirds of newly infected teena3ers arefemale0

ife e;pectancy has declined by more than#$ years in ,outh frica and Aotswana ,wa4iland faces the ris of e;tinction

Most ()*+)D, )nfected i1e in frica and

,outh sia)ealth(ealth care worers often ha1e rates of infection ashi3h or hi3her than adults in 3eneral)llness and death of silled personnel furtherweaens the sectorEducation7ducation faces decimation of silled teachersChildren of families struc by )D, often ha1e tolea1e school to help 3enerate income or undertaebasic household tassM/'

,e;ual intercourse oral: 1a3inal and anal6 7;posure to contaminated blood: semen:

breast mil and other body fluids Alood ransfusion

)* dru3 use

ransplacental

Needlestic in>uries()G( R),< GR/8P

(omose;ual or bise;ual

)ntra1enous dru3 users

A recipients before #9"5

,e;ual contact with ()*X Aabies of mothers who are ()*X

s+s;'#0 cute 1iral illness # mo after initial

e;posure6 fe1er: malaise:lymphadenopathy

!0 Clinical latency " yrs w+ no s; towardsend: bacterial and sin infections andconstitutonal s; )D, related comple;CDE counts E$$-!$$

20 )D, ! yrs CDE lymphocyte !$$ w+X6 7), or .estern Alot and opportunistic

infections()* C,,)?)C)/NCA*E7O.@ 1 CD; 800 O. MO.ECA*E7O.@ % CD; %00este!n Blot

.apid hi+ test

(ow to Dia3nose)I?

% consecuti+e positi+e ELISA and1 positi+e >este!n Blot *estAIDS)I?CD; count "elo 8005lE/hi"its one o! o!e of the ff' ne/t slide34ull "lon AIDSCD; is less than %005l7;hibits one or more of the ff'

o 7;treme fati3ue

o )ntermittent fe1ero Ni3ht sweatso Chillso ymphadenopathyo 7nlar3ed spleeno nore;iao .ei3ht losso ,e1ere diarrhea

o pathy and depressiono PAo


27/27

*omitin3

Con1ulsions

bnormally sleepy

Parameters for assessin3 dehydration 7yes sunen: absent of tears: lac of

laster ?ontanelles

,in tur3or Mouth

bnormally sleepy

e1el of thirst END

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