COMMUNICABLE DISEASE NURSING (Part II: Diseases)

5 Communicable Disease Nursing

I. EPI DISEASES

DISEASE CAUSATIVE AGENTMODE OF

TRANSMISSIONPATHOGNOMONIC

SIGNMANAGEMENT/TREATMENT PREVENTION

1. Tuberculosis

Other names:Koch’s Disease ConsumptionPhthisisWeak lungs

Mycobacterium tuberculosis

TB bacillusKoch’s bacillusMycobacterium bovis

(rod-shaped)

Airborne-droplet

Direct invasion through mucous membranes and breaks in the skin (very rare)

Incubation period : 4 – 6 weeks

1. Usually asymptomatic 2. Low-grade afternoon

fever3. Night sweating4. Loss of appetite5. Weight loss6. Easy fatigability – due

to increased oxygen demand

7. Temporary amenorrhea8. Productive dry cough9. Hemoptysis

Diagnostic test: Sputum examination or the Acid-fast bacilli

(AFB) / sputum microscopy1. Confirmatory test2. Early morning sputum about 3-5 cc3. Maintain NPO before collecting sputum4. Give oral care after the procedure5. Label and immediately send to laboratory6. If the time of the collection of the sputum is

unknown, discard Chest X-ray is used to:

1. Determine the clinical activity of TB, whether it is inactive (in control) or active (ongoing)

2. To determine the size of the lesion:a. Minimal – very smallb. Moderately advance – lesion is < 4 cmc. Far advance – lesion is > 4 cm

Tuberculin Test – purpose is to determine the history of exposure to tuberculosisOther names:Mantoux Test – used for single screening, result interpreted after 72 hoursTine test – used for mass screening read after 48 hoursInterpretation:0 - 4 mm induration – not significant5 mm or more – significant in individuals who are considered at risk; positive for patients who are HIV-positive or have HIV risk factors and are of unknown HIV status, those who are close contacts with an active case, and those who have chest x-ray results consistent with tuberculosis.10 mm or greater – significant in individuals who have normal or mildly impaired immunity

Respiratory precautions Cover the mouth and

nose when sneezing to avoid mode of transmission

Give BCGBCG is ideally given at birth, then at school entrance. If given at 12 months, perform tuberculin testing (PPD), give BCG if negative.

Improve social conditions

TREATMENT: SCC/Short Course Chemotherapy, Direct –observed treatment short course/DOTS; Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E), Streptomycin (S)

CATEGORY 1: 6 months SCCIndications:> new (+) smear> (-) smear PTB with extensive parenchymal lesions on CXR> Extrapulmonary TB> severe concominant HIV diseaseIntensive Phase: 2 monthsR&I : 1 tab each; P&E 2 tabs eachContinuation Phase: 4 monthsR&I : 1 tab each

CATEGORY 2: 8 months SCCIndications:> treatment failure> relapse> return after default

Intensive Phase:3 mosR&I 1 tab each; P&E 2 tabs eachStreptomycin – 1 vial/day IM for first 2 months = 56 vials (if given for > 2mos can cause nephrotoxicity

Continuation Phase: 5 monthsR&I : 1 tab eachE : 2 tabs

CATEGORY 3: 6 months SCCIndications:> new (-) smear PTB with minimal lesions on CXRSame meds with Category 1Intensive Phase: 2 monthsR&I 1 tab each; P&E 2 tabs eachContinuation Phase: 4 monthsR&I 1 tab each

CATEGORY 4: Chronic (*Referral needed)

SIDE EFFECTS:Rifampicin body fluid

discoloration hepatotoxic permanent

discoloration of contact lenses

Isoniazid Peripheral neuropathy(Give Vit B6/Pyridoxine)

Pyrazinamide hyperuricemia /gouty arthritis (increase fluid intake)

SIDE EFFECTS:Ethambutol Optic neuritis Blurring of vision(Not to be givento children below 6 y.o. due to inability to complain blurring of vision) Inability to recognize

green from blueStreptomycin Damage to 8th CN Ototoxic Tinnitus nephrotoxic

Most hazardous period for development of clinical disease is the first 6-12 months after infectionHighest risk of developing disease is children under 3years old


NATIONAL TB CONTROL PROGRAM:Vision: A country where TB is no longer a public health problemMission: Ensure that TB DOTS Services are available, accessible, and affordable to the communities in collaboration with LGUs and othersGoal: To reduce prevalence and mortality from TB by half by the year 2015 (Millennium Development Goal)Targets: 1. Cure at least 85% of the sputum smear (+) patients discovered 2. Detect at least 70% new sputum smear (+) TB casesObjectives: 1. Improve access to and quality of services 2. Enhance stakeholder’s health-seeking behavior 3. Increase and sustain support for TB control activities 4. Strengthen management of TB control activities at all levelsKEY POLICIES:*Case finding:- DSSM shall be the primary diagnostic tool in NTP case finding- No TB Dx shall be made based on CXR results alone- All TB symptomatic shall be asked to undergo DSSM before treatment- Only contraindication for sputum collection is hemoptysis- PTB symptomatic shall be asked to undergo other tests (CXR and culture), only after three sputum specimens yield negative results in DSSM- Only trained med techs / microscopists shall perform DSSM- Passive case finding shall be implemented in all health stations

*Treatment: Domiciliary treatment – preferred mode of care DSSM – basis for treatment of all TB cases*Hospitalization is recommended: massive hemoptysis, pleural effusion, military TB, TB meningitis, TB pneumonia, & surgery is needed or with complications*All patients undergoing treatment shall be supervised*National & LGUs shall ensure provision of drugs to all smear (+) TB cases*Quality of fixed-dose combination (FDC) must be ensured*Treatment shall be based on recommended category of treatment regimen

DOTS Strategy – internationally-recommended TB control strategyFive Elements of DOTS: (RUSAS)Recording & reporting system enabling outcome assessment of all patientsUninterrupted supply of quality-assured drugsStandardized SCC for all TB casesAccess to quality-assured sputum microscopySustained political commitment

sMANAGEMENT OF CHILDREN WITH TUBERCULOSIS

Prevention: BCG immunization to all infants (EPI)

Casefinding: - cases of TB in children are reported and identified in 2 instances: (a) patient was screened and was found symptomatic of TB after consultaion (b) patient was reported to have been exposed to an adult TB patient - ALL TB symptomatic children 0-9 y.o, EXCEPT sputum positive child shall be subjected to Tuberculin testing (Note: Only a trained PHN or main health center midwife shall do tuberculin testing and reading which shall be conducted once a week either on a Monday or Tuesday. Ten children shall be gathered for testing to avoid wastage.

- Criteria to be TB symptomatic (any three of the following:) * cough/wheezing of 2 weeks or more * unexplained fever of 2 weeks or more * loss of appetite/loss of weight/failure to gain weight/weight faltering * failure to respond to 2 weeks of appropriate antibiotic therapy for lower respiratory tract infection * failure to regain previous state of health 2 weeks after a viral infection or exanthem (e.g. measles)

-Conditions confirming TB diagnosis (any 3 of the following:) * (+) history of exposure to an adult/adolescent TB case * (+) signs and symptoms suggestive of TB * (+) tuberculin test * abnormal CXR suggestive of TB * Lab findings suggestive or indicative of TB

- for children with exposure to TB* a child w/ exposure to a TB registered adult patient shall undergo physical exam and tuberculin testing* a child with productive cough shall be referred for sputum exam, for (+) sputum smear child, start treatment immediately* TB asymptomatic but (+) tuberculin test and TB symptomatic but (-) tuberculin test shall be referred for CXR examination

- for TB symptomatic children*a TB symptomatic child with either known or unknown exposure to a TB case shall be referred for tuberculin testing* (+) contact but (-) tuberculin test and unknown contact but (+) tuberculin test shall be referred for CXR examination*(-) CXR, repeat tuberculin test after 3 months* INH chemoprophylaxis for three months shall be given to children less than 5y.o. with (-) CXR; after which tuberculin test shall be repeated

Treatment (Child with TB):Short course regimenPULMONARY TBIntensive: 3 anti-TB drugs (R.I.P.) for 2 monthsContinuation: 2 anti-TB drugs (R&I) for 4 months

EXTRA-PULMONARY TBIntensive: 4 anti-TB drugs (RIP&E/S) for 2 monthsContinuation: 2 anti-TB drugs (R&I) for 10 months

PERIOD OF COMMUNICABILITY OF TUBERCULOSIS:

as long as bacillus is contained in the sputum

Primary complex in children is NOT contagious

Good compliance to regimen renders person not contagious 2-4 weeks after initiation of treatment


2. Diphtheria

Types:> nasal> pharyngeal – most common> laryngeal – most fatal due to proximity to epiglottis

Corynebacterium diphtheria

Klebbs-loffler

***Diphtheria transmission is increased in hospitals, households, schools, and other crowded areas.

Droplet especially secretions from mucous membranes of the nose and nasopharynx and from skin and other lesions

Milk has served as a vehicle

Incubation Period:2 – 5 days

Pseudomembrane – mycelia of the oral mucosa causing formation of white membrane on the oropharynx

Bull neckDysphagiaDyspnea

Diagnostic test: Nose/throat swab Moloney’s test – a test for hypersensitivity to

diphtheria toxin Schick’s test – determines susceptibility to

bacteriaDrug-of-Choice:Erythromycin 20,000 - 100,000 units IM once only

Complication: MYOCARDITIS (Encourage bed rest)

Plan nursing care to improve respiration.

DPT immunizationPasteurization of milkEducation of parents

***Infants born to immune mothers maybe protected up to 6-9 months. Recovery from clinical attack is always followed by a lasting immunity to the disease.

3. Pertussis

Whooping coughTusperinaNo day cough

Bordetella pertussisHemophilus pertussisBordet-gengou bacillusPertussis bacillus

Droplet especially from laryngeal and bronchial secretions

Incubation Period: 7 – 10 days but not exceeding 21 days

Catarrhal period: 7 days paroxysmal cough followed by continuous nonstop accompanied by vomiting

Complication: abdominal hernia

Diagnostic:

Bordet-gengou agar test

Management:1. DOC: Erythromycin or Penicillin 20,000 -

100,000 units2. Complete bed rest3. Avoid pollutants4. Abdominal binder to prevent abdominal hernia

DPT immunizationBooster: 2 years and 4-5 yearsPatient should be segregated until after 3 weeks from the appearance of paroxysmal cough

4. Tetanus

Other names:Lock jaw

Clostridium tetani – anaerobic spore-forming heat-resistant and lives in soil or intestine

Neonate: umbilical cordChildren: dental cariesAdult: punctured wound; after septic abortion

Indirect contact – inanimate objects, soil, street dust, animal and human feces, punctured wound

Incubation Period:Varies from 3 days to 1 month, falling between 7 – 14 days

Risus sardonicus (Latin: “devil smile”) – facial spasm; sardonic grin

Opisthotonus – arching of back

For newborn:1. Difficulty of sucking2. Excessive crying3. Stiffness of jaw4. Body malaise

No specific test, only a history of punctured wound

Treatment:Antitoxin antitetanus serum (ATS)tetanus immunoglobulin (TIG) (if the patient has allergy, should be administered in fractional doses)Pen GDiazepam – for muscle spasms

Note: The nurse can give fluid provided that the patient is able to swallow. There is risk of aspiration. Check first for the gag reflex

DPT immunizationTetanus toxoid (artificial

active) immunization among pregnant women

Training and Licensing of midwives/”hilots”

Health education of mothers

Puncture wounds are best cleaned by thorough washing with soap and water.

Incidence: highest under 7 years of ageMortality: highest among infants (<6 months)One attack confers definite and prolonged immunity. Second attack occasionally occurs


5. Poliomyelitis

Other name:Infantile paralysis

Legio debilitansPolio virusEnterovirus

Attacks the anterior horn of the neuron, motor is affectedMan is the only reservoir

Fecal – oral route

Incubation period: 7 – 21 days

ParalysisMuscular weaknessUncoordinated body movementHoyne’s sign – head lag after 4 months

(!Safety)

Diagnostic test:

CSF analysis / lumbar tap Pandy’s test

Management:Rehabilitation involves ROM exercises

OPV vaccinationFrequent hand washing

6. Measles Other names:MorbilliRubeola

RNA containing paramyxovirus

Period of Communicability:4 days before and 5 days after the appearance of rash

Droplet secretions from nose and throat

Incubation period: 10 days – fever14 days – rashes appear(8-13 days)

1. Koplik’s spots – whitish/bluish pinpoint patches on the buccal cavity2. cephalocaudal appearance of maculopapular rashes3. Stimson’s line – bilateral red line on the lower conjunctiva

No specific diagnostic test

Management:Supportive and symptomatic

Measles vaccineDisinfection of soiled articlesIsolation of cased from diagnosis until about 5-7 days after onset of rash

7. Hepatitis B

Other names:Serum Hepatitis

Hepatitis B virus Blood and body fluidsPlacenta

Incubation period: 45 – 100 days

1. Right-sided Abdominal pain

2. Jaundice3. Yellow-colored sclera4. Anorexia5. Nausea and vomiting6. Joint and Muscle pain7. Steatorrhea8. Dark-colored urine9. Low grade fever

Diagnostic test:

Hepatitis B surface agglutination (HBSAg) test

Management:> Hepatitis B Immunoglobulin

Diet: high in carbohydrates

-Hepatitis B immunization-Wear protected clothing-Hand washing-Observe safe-sex-Sterilize instruments used in minor surgical-dental procedures-Screening of blood products for transfusion

Hepatitis A – infectious hepatitis; oral-fecalHepatitis B – serum hepatitis; blood and body fluidsHepatitis C – non-A non-B, post-transfusion hepatitis; blood and body fluidsHepatitis D – Delta hepatitis or dormant hepatitis; blood and body fluids; needs past history of infection to Hepatitis BHepatitis E – oral-fecal


II. DISEASES TRANSMITTED THROUGH FOOD AND WATER




1. Cholera

Other names:El tor

Vibrio choleraVibrio comaOgawa and Inaba bacteria

Fecal-oral route

5 Fs

Incubation Period:Few hours to 5 days; usually 3 days

Rice watery stool

Period of Communicability:7-14 days after onset, occasionally 2-3 months

Diagnostic Test:Stool cultureTreatment:Oral rehydration solution (ORESOL)IVFDrug-of-Choice: tetracycline (use straw; can cause staining of teeth). Oral tetracycline should be administered with meals or after milk.

Proper handwashingProper food and water sanitationImmunization of Chole-vac

2. Amoebic Dysentery

Entamoeba histolytica

Protozoan (slipper-shaped body)

Fecal-oral route Abdominal cramping Bloody mucoid stool Tenesmus - feeling of

incomplete defecation (Wikipedia)

Treatment:

Metronidazole (Flagyl)* Avoid alcohol because of its Antabuse effect can cause vomiting

Proper handwashingProper food and water sanitation

3. Shigellosis

Other names:Bacillary dysentery

Shigella bacillus

Sh-dysenterae – most infectious Sh-flesneri – common in the PhilippinesSh-conneiSh-boydii

Fecal-oral route

5 Fs: Finger, Foods, Feces, Flies, Fomites

Incubation Period:1 day, usually less than 4 days

Abdominal cramping Bloody mucoid stool Tenesmus - feeling of

incomplete defecation (Wikipedia)

Drug-of-Choice: Co-trimoxazole

Diet: Low fiber, plenty of fluids, easily digestible foods

Proper handwashingProper food and water sanitationFly control

4. Typhoid fever Salmonella typhosa (plural, typhi)

Fecal-oral route

5 Fs

Incubation Period:Usual range 1 to 3 weeks, average 2 weeks

Rose Spots in the abdomen – due to bleeding caused by perforation of the Peyer’s patches

Ladderlike fever

Diagnostic Test:Typhi dot – confirmatory test; specimen is fecesWidal’s test – agglutination of the patient’s serum

Drug-of-Choice: Chloramphenicol

Proper handwashingProper food and water sanitation

5. Hepatitis A

Other names:Infectious Hepatitis /

Hepatitis A Virus Fecal-oral route

5 Fs

Incubation Period:

Fever Anorexia (early sign) Headache Jaundice (late sign) Clay-colored stool

Prophylaxis: “IM” injection of gamma globulinHepatitis A vaccineHepatitis immunoglobulinAvoid alcoholComplete bed rest – to reduce the breakdown of fats

Proper handwashingProper food and water sanitationProper disposal of urine and feces

http://en.wikipedia.org/wiki/Defecation

http://en.wikipedia.org/wiki/Defecation


Epidemic Hepatitis /Catarrhal Jaundice

15-50 days, depending on dose, average 20-30 days

Lymphadenopathy for metabolic needs of liverLow-fat diet; increase carbohydrates (high in sugar)

In convalescent period, patient may have difficulty with maintaining a sense of well-being.

Separate and proper cleaning of articles used by patient

6. Paralytic Shellfish Poisoning (PSP I Red tide poisoning)

Dinoflagellates

Phytoplankton

Ingestion of raw of inadequately cooked seafood usually bivalve mollusks during red tide season

Incubation Period:30 minutes to several hours after ingestion

Numbness of face especially around the mouth

Vomiting and dizziness Headache Tingling

sensation/paresthesia and eventful paralysis of hands

Floating sensation and weakness

Rapid pulse Dysphonia Dysphagia Total muscle paralysis

leading to respiratory arrest and death

Treatment:1. No definite treatment2. Induce vomiting3. Drink pure coconut milk – weakens the

toxic effect4. Sodium bicarbonate solution (25 grams in ½

glass of water)Advised only in the early stage of illness because paralysis can lead to aspiration

NOTE: Persons who survived the first 12 hours after ingestion have a greater chance of survival.

1. Avoid eating shellfish such as tahong, talaba, halaan, kabiya, abaniko during red tide season

2. Don’t mix vinegar to shellfish it will increase toxic effect 15 times greater

ROBERT C. REÑA, BSN

Death from diarrhea is usually due to dehydration.

Food recall is the basis for the diagnosis of food poisoning.

III. SEXUALLY TRANSMITTED DISEASES





1. Syphilis

Other names:SyBad BloodThe poxLues venerealMorbus gallicus

Treponema pallidum(a spirochete)

Incubation Period:10 to 90 days (3 months); average of 21 days

Direct contactTransplacental (after 16th week AOG)Through blood transfusionIndirect contact with contaminated articles

Primary stage (4-6 weeks): painless chancre at site of entry of germ with serous exudates

Tertiary stage (one to 35 years) : Gumma, syphilitic endocarditis and meningitis

Diagnostic test:Dark field illumination testFluorescent treponemal antibody absorption test – most reliable and sensitive diagnostic test for Syphilis; serologic test for syphilis which involves antibody detection by microscopic flocculation of the antigen suspensionVDRL slide test, CSF analysis, Kalm test, Wasseman test

Treatment:Drug of Choice: Penicillin (Tetracycline if resistant to Penicillin)

AbstinenceBe faithfulCondom

2. Gonorrhea

Other names:GC, Clap, Drip,Stain, Gleet,Flores Blancas

Neiserria gonorrheae Direct contact – genitals, anus, mouth


Thick purulent yellowish dischargeBurning sensation upon urination / dysuria

Diagnostic test:Culture of urethral and cervical smearGram staining

Treatment:Drug of Choice: Penicillin

Abstinence, Be faithfulCondom

Prevention of gonococcal ophthalmia is done through the prophylactic use of ophthalmic preparations with erythromycin or tetracycline

3. Trichomoniasis

Other names:VaginitisTrich

Trichomonas vaginalis Direct contact

Incubation Period:4 – 20 days; average of 7 days

Females:white or greenish-yellow odorous dischargevaginal itching and sorenesspainful urinationMales:Slight itching of penisPainful urinationClear discharge from penis

Diagnostic Test:Culture

Treatment:Drug of Choice: Metronidazole (Flagyl)


Personal Hygiene

4. Chlamydia Chlamydia trachomatis(a rickettsia)

Direct contact

Incubation Period:

Females:AsymptomaticDyspareunia

Diagnostic Test:Culture


Primary and secondary sores will go even without treatment but the germs continue to spread throughout the body. Latent syphilis may continue 5 to 20+ years with NO symptoms, but the person is NO longer infectious to other people. A pregnant mother can transmit the disease to her unborn child (congenital syphilis).

Secondary syphilis (6-8 weeks: generalized rashes, generalized tender discrete lymphadenopathy, mucus patches, flu-like symptoms, condylomata, patchy alopecia

Latent stage (one to two to 50 years): non-infectious


2 to 3 weeks for males; usually no symptoms for females

Fishy vaginal discharge

Males:Burning sensation during urinationBurning and itching of urethral opening (urethritis)

Treatment:Drug of Choice: Tetracycline

5. Candidiasis

Other names:MoniliasisCandidosis

Candida albicans Direct contact White, cheese-like vaginal dischargesCurd like secretions

Diagnostic Test:CultureGram staining

Treatment:Nystatin for oral thrushCotrimazole, fluconazole for mucous membrane and vaginal infectionFluconazole or amphotericin for systemic infection


6. Acquired immune deficiency syndrome (AIDS)

Retrovirus (Human T-cell lymphotrophic virus 3 or HTLV 3)

Attacks the T4 cells: T-helper cells; T-lymphocytes, and CD4 lymphocytes

The major route of HIV transmission to adolescent is SEXUAL TRANSMISSION.

French kissing brings low risk of HIV transmission.

Direct contactBlood and body fluidsTransplacental

Incubation period:3-6 months to 8-10 years

Variable. Although the time from infection to the development of detectable antibodies is generally 1-3 months, the time from HIV infection to diagnosis of AIDS has an observed range of less than 1 year to 15 years or longer.

1. Window Phasea. initial infectionb. lasts 4 weeks to 6 monthsc. not observed by present laboratory test (test should be repeated after 6 months)

2. Acute Primary HIV Infectiona. short, symptomatic periodb. flu-like symptomsc. ideal time to undergo screening test (ELISA)

3. Asymptomatic HIV Infectiona. with antibodies against HIV but not protectiveb. lasts for 1-20 years

Diagnostic tests:Enzyme-Linked Immuno-Sorbent Assay (ELISA)

- presumptive testWestern Blot – confirmatory

Treatment:1. Treatment of opportunistic infection2. Nutritional rehabilitation3. AZT (Zidovudine) – retards the replication

of retrovirus; must be taken exactly as ordered

4. PK 1614 – mutagen

Major signs of Pediatric AIDS: Chronic diarrhea > 1 month Prolonged fever > 1 month Weight loss or abnormally slow growth

Breastmilk is important in preventing intercurrent infection in HIV infected infants and children.

The care of HIV patients is similar to the routine


Sterilize needles, syringes, and instruments used for cutting operations

Proper screening of blood donors

Rigid examination of blood and other blood products

Avoid oral, anal contact and swallowing of semen

Avoid promiscuous sexual contact

Avoid sharing of toothbrushes.


(PHN Book) depending upon factors

4. ARC (AIDS Related Complex)a. a group of symptoms indicating the disease is likely to progress to AIDSb. fever of unknown originc. night sweatsd. chronic intermittent diarrheae. lymphadenopathyf. 10% body weight loss

5. AIDSa. manifestation of severe immunosuppressionb. CD4 Count: <200/dLc. presence of variety of infections at one time:

oral candidiasisleukoplakiaAIDS dementia complexAcute encephalopathyDiarrhea, hepatitisAnorectal diseaseCytomegalovirusPneumonocystis carinii pneumonia (fungal)TBKaposi’s sarcoma (skin cancer; bilateral purplish patches)Herpes simplexPseudomonas infectionBlindnessDeafness

care given to cases of other diseases.

Not everybody is in danger of becoming infected with HIV through sex.

Never give live attenuated (weakened) vaccines e.g. oral polio vaccine.

HIV positive pregnant women and their partner must be informed of the potential risk to the fetus.

HIV/AIDS Prevention and Control Program:

Goal: Contain the transmission of HIV /AIDS and other reproductive tract infections and mitigate their impact

LECTURE DISCUSSION – best method to use in teaching about safe sex

Priority intervention when caring for AIDS patient:Use disposable gloves when in contact with non-intact skin.

IV. ERUPTIVE DISEASES





1. Chickenpox

Other names:Varicella

Human (alpha) herpes virus 3 (varicella-zoster virus), a member of the Herpesvirus group

Period of Communicability:From as early as 1 to 2 days before the rashes appear until the lesions have crusted.

Droplet spread

Direct contact

Indirect through articles freshly soiled by discharges of infected persons

Incubation Period:2-3 weeks, commonly 13 to 17 days

Vesiculo-pustular rashes

Centrifugal appearance of rashes – rashes which begin on the trunk and spread peripherally and more abundant on covered body parts

Pruritus

No specific diagnostic examTreatment is supportive.

Drug-of-choice:Acyclovir / Zovirax ® (orally to reduce the number of lesions; topically to lessen the pruritus)

NEVER give ASPIRIN. Aspirin when given to children with viral infection may lead to development of REYE’S SYNDROME.

Nursing Diagnoses:Disturbance in body imageImpairment of skin integrity

Case over 15 years of age should be investigated to eliminate possibility of smallpox. Report to local authorityIsolationConcurrent disinfection of throat and nose dischargesExclusion from school for 1 week after eruption first appearsAvoid contact with susceptibles

2. German Measles

Other Names:RubellaThree-day Measles

Rubella virus or RNA-containing Togavirus (Pseudoparamyxovirus)

German measles is teratogenic infection, can cause congenital heart disease and congenital cataract.

Droplet

Incubation Period:Three (3) days

Forscheimer spots – red pinpoint patches on the oral cavity

Maculopapular rashesHeadacheLow-grade feverSore throatEnlargement of posterior cervical and postauricular lymph nodes

Diagnostic Test:Rubella Titer (Normal value is 1:10); below 1:10 indicates susceptibility to Rubella.

Instruct the mother to avoid pregnancy for three months after receiving MMR vaccine.

MMR is given at 15 months of age and is given intramuscularly.

MMR vaccine (live attenuated virus)- Derived from chick

embryoContraindication:- Allergy to eggs- If necessary, given in

divided or fractionated doses and epinephrine should be at the bedside.

3. Herpes Zoster

Other names:ShinglesCold sores

Herpes zoster virus(dormant varicella zoster virus)

DropletDirect contact from secretion

Painful vesiculo-pustular lesions on limited portion of the body (trunk and shoulder)

Low-grade fever

Treatment is supportive and symptomatic

Acyclovir to lessen the pain

Avoidance of mode of transmission

4. Dengue Hemorrhagic Fever

Other names:

Dengue virus 1, 2, 3, and 4 and Chikungunya virus

Types 1 and 2 are common in the

Bite of infected mosquito (Aedes Aegypti) - characterized by black and white stripes

Classification (WHO):

Grade I:a. flu-like symptomsb. Herman’s sign

Diagnostic Test:

Torniquet test (Rumpel Leads Test / capillary fragility test) – PRESUMPTIVE; positive when 20 or more oetechiae per 2.5 cm square or 1 inch

4 o’clock habit

Chemically treated mosquito netLarva eating fish


H-fever Philippines

Period of communicability: Unknown. Presumed to be on the 1st week of illness up to when the virus is still present in the blood

Occurrence is sporadic throughout the year

Epidemic usually occur during the rainy seasons (June to November)

Peak months: September and October

Daytime bitingLow flyingStagnant clear waterUrban

Incubation Period:Uncertain. Probably 6 days to 1 week

Manifestations:

First 4 days: Febrile/Invasive Stage- starts abruptly as fever- abdominal pain- headache- vomiting- conjunctival infection-epistaxis

4th – 7th days: Toxic/Hemorrhagic Stage- decrease in temperature- severe abdominal pain- GIT bleeding- unstable BP (narrowed pulse pressure)- shock- death may occur

7th – 10th days:Recovery/Convalescent Stage- appetite regained- BP stable

c. (+) tourniquet sign

Grade II:a. manifestations of Grade I plus spontaneous bleedingb. e.g. petechiae, ecchymosis purpura, gum bleeding, hematemesis, melena

Grade III:a. manifestations of Grade II plus beginning of circulatory failureb. hypotension, tachycardia, tachypnea

Grade IV:a. manifestations of Grade III plus shock (Dengue Shock Syndome)

square are observed

Platelet count – CONFIRMATORY; (Normal is 150 - 400 x 103 / mL)

Treatment:Supportive and symptomaticParacetamol for feverAnalgesic for pain

Rapid replacement of body fluids – most important treatment

ORESOL

Blood tansfusion

Diet: low-fat, low-fiber, non-irritating, non-carbonated. Noodle soup may be given. ADCF (Avoid Dark-Colored Foods)

ALERT! No Aspirin

Environmental sanitationAntimosquito soapNeem tree (eucalyptus)

Eliminate vector

Avoid too many hanging clothes inside the house

Residual spraying with insecticide

Daytime fumigation

Use of mosquito repellants

Wear long sleeves, pants, and socks

For the control of H-fever, knowledge of the natural history of the disease is important.

Environmental control is the most appropriate primary prevention approach and control of H-fever.

V. VECTOR-BORNE DISEASES





1. Malaria Plasmodium Parasites:VivaxFalciparum (most fatal; most common in the Philippines)OvaleMalariae

-attacks the red blood cells

Bite of infected anopheles mosquito

Night time bitingHigh-flyingRural areasClear running water

Cold Stage: severe, recurrent chills (30 minutes to 2 hours)

Hot Stage: fever (4-6 hours)

Wet Stage: Profuse sweating

Episodes of chills, fevers, and profuse sweating are associated with rupture of the red blood cells. - intermittent chills and sweating- anemia / pallor- tea-colored urine- malaise- hepatomegaly- splenomegaly- abdominal pain and enlargement- easy fatigability

NURSING CARE:1. TSB (Hot Stage)2. Keep patent warm (Cold Stage)3. Change wet clothing (Wet Stage)4. Encourage fluid intake5. Avoid drafts

Early Diagnosis and Prompt TreatmentEarly diagnosis – identification of a patient with malaria as soon as he is seen through clinical and/or microscopic methodClinical method – based on signs and symptoms of the patient and the history of his having visited a malaria-endemic areaMicroscopic method – based on the examination of the blood smear of patient through microscope (done by the medical technologist)

QBC/quantitative Buffy Coat – fastestMalarial Smear – best time to get the specimen is at height of fever because the microorganisms are very active and easily identified

ChemoprophylaxisOnly chloroquine should be given (taken at weekly intervals starting from 1-2 weeks before entering the endemic area). In pregnant women, it is given throughout the duration of pregnancy.

Treatment:Blood Schizonticides - drugs acting on sexual blood stages of the parasites which are responsible for clinical manifestations

1. QUININE – oldest drug used to treat malaria; from the bark of Cinchona tree; ALERT: Cinchonism – quinine toxicity

2. CHLOROQUINE3. PRIMAQUINE – sometimes can also be

given as chemoprophylaxis4. FANSIDAR – combination of

pyrimethamine and sulfadoxine

*CLEAN Technique *Insecticide – treatment of mosquito net*House Spraying (night time fumigation)*On Stream Seeding – construction of bio-ponds for fish propagation (2-4 fishes/m2 for immediate impact; 200-400/ha. for a delayed effect)*On Stream Clearing – cutting of vegetation overhanging along stream banks

*Avoid outdoor night activities (9pm – 3am)*Wearing of clothing that covers arms and legs in the evening*Use mosquito repellents*Zooprophylaxis – typing of domestic animals like the carabao, cow, etc near human dwellings to deviate mosquito bites from man to these animals

Intensive IEC campaign

2. Filariasis Wuchereria bancrofti Brugia malayi

Bite of Aedes poecillus (primarily)

Asymptomatic Stage:Presence of microfilariae

DiagnosisPhysical examination, history taking, observation

CLEAN Technique


Other names:Elephantiasis

Endemic in 45 out of 78 provinces

Highest prevalence rates: Regions 5, 8, 11 and CARAGA

Brugia timori

– nematode parasites

Aedes flavivostris (secondary)

Incubation period:8 – 16 months

in the blood but no clinical signs and symptoms of disease

Acute Stage:LymphadenitisLymphangitisAffectation of male genitalia

Chronic Stage: (10-15 years from onset of first attack)HydroceleLymphedemaElephantiasis

of major and minor signs and symptoms

Laboratory examinationsNocturnal Blood Examination (NBE) – blood are taken from the patient at his residence or in hospital after 8:00 pmImmunochromatographic Test (ICT) – rapid assessment method; an antigen test that can be done at daytime

Treatment:Drug-of-Choice: Diethylcarbamazine Citrate (DEC) or Hetrazan

Use of mosquito repellentsAnytime fumigationWear a long sleeves, pants and socks

3. Shistosomiasis

Other Names:Snail FeverBilharziasis

Endemic in 10 regions and 24 provinces

High prevalence: Regions 5, 8, 11

Schistosoma mansoniS. haematobiumS. japonicum (endemic in the Philippines)

Contact with the infected freshwater with cercaria and penetrates the skin

Vector: Oncomelania Quadrasi

DiarrheaBloody stools (on and off dysentery)Enlargement of abdomenSplenomegalyHepatomegalyAnemia / pallorweakness

Diagnostic Test:COPT or cercum ova precipitin test (stool exam)

Treatment:Drug-of-Choice: PRAZIQUANTEL (Biltracide)

Oxamniquine for S. mansoniMetrifonate for S. haematobium

*Death is often due to hepatic complication

Dispose the feces properly not reaching body of waterUse molluscidesPrevent exposure to contaminated water (e.g. use rubber boots)Apply 70% alcohol immediately to skin to kill surface cercariaeAllow water to stand 48-72 hours before use

ROBERT C. REÑA, BSNREFERENCES:

THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10th EDITION

DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov

VI. DISEASES TRANSMITTED BY ANIMALS





1. Leptospirosis

Other Names:- Weil’s Disease- Mud Fever- Trench Fever- Flood Fever- Spirochetal Jaundice- Japanese Seven Days fever

Leptospira interrogans – bacterial spirochete

RAT is the main host. Although pig, cattle, rabbits, hare, skunk, and other wild animals can also serve as reservoir

Occupational disease affecting veterinarians, miners, farmers, sewer workers, abattoir workers, etc

Through contact of the skin, especially open wounds with water, moist soil or vegetation infected with urine of the infected host

Incubation Period:7-19 days, average of 10 days

Leptospiremic Phase- leptospires are present in blood and CSF- onset of symptoms is abrupt- fever- headache- myalgia- nausea- vomiting- cough- chest pain

Immune Phase- correlates with the appearance of circulating IgM

DiagnosisClinical manifestationsCulture of organismExamination of blood and CSF during the first week of illness and urine after the 10th dayLeptospira agglutination test

Treatment:Penicillins and other related B-lactam antibioticsTetracycline (Doxycycline)Erythromycin

Most common complication: kidney failure

Protective clothing, boots and gloves

Eradication of ratsSegregation of

domestic animalsAwareness and early

diagnosisImproved education of

peopleAvoid wading or

swimming in water contaminated with urine of infected animals.

Concurrent disinfection of articles soiled with urine.

2. Rabies

Other Names:LyssaHydrophobiaLe Rage

Rhabdovirus of the genus lyssavirus

Degeneration and necrosis of brain – formation of negri bodies

Two kinds of Rabies:a. Urban or canine – transmitted by dogs

b. Sylvatic – disease of wild animals and bats which sometimes spread to dogs, cats, and livestock

Bite or scratch (very rare) of rabid animal

Non-bite means: leaking, scratch, organ transplant (cornea), inhalation/airborne (bats)Source of infection: saliva of infected animal or human

Incubation period:2 – 8 weeks, can be years depending on severity of wounds, site of wound as distance from brain, amount of virus introduced, and protection provided by

Sense of apprehensionHeadacheFeverSensory change near site of animal biteSpasms of muscles of deglutition on attempts to swallowFear of water/hydrophobiaParalysisDeliriumConvulsions

“FATAL once signs and symptoms appear”

Diagnosis: history of bite of animalculture of brain of rabid animaldemonstration of negri bodies

Management:*Wash wound with soap immediately. Antiseptics e.g. povidone iodine or alcohol may be applied*Antibiotics and anti-tetanus immunization*Post exposure treatment: local wound treatment, active immunization (vaccination) and passive immunization (administration of rabies immunoglobulin)*Consult a veterinarian or trained personnel to observe the pet for 14 days

*Without medical intervention, the rabies victim would usually last only for 2 to 6 days. Death is often due to respiratory paralysis.

Have pet immunized at 3 months of age and every year thereafter

Never allow pets to roam the streets

Take care of your pet

National Rabies Prevention and Control ProgramGoal: Human rabies is eliminated in the Philippines and the country is declared rabies-free


clothing3. Bubonic Plague

Bacteria (Yersinia pestis)

Vector: rat flea

Direct contact with the infected tissues of rodents

Fever and lyphadenitis Streptomycin, tetracycline, chloramphenicol Environmental Sanitation

VII. DISEASES OF THE SKIN


TRANSMISSIONPATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION


1. Leprosy

Other names:HansenosisHansen’s disease

-an ancient disease and is a leading cause of permanent physical disability among the communicable diseases

Mycobacterium leprae Airborne-droplet

Prolonged skin-to-skin contact

Early signs:Change in skin color – either reddish or whiteLoss of sensation on the skin lesionLoss of sweating and hair growthThickened and painful nervesMuscle weakness or paralysis or extremitiesPin and redness of the eyesNasal obstruction or bleedingUlcers that do not heal

Late Signs:MadarosisLoss of eyebrowsInability to close eyelids (lagophthalmos)Clawing of fingers and toesContracturesChronic ulcersSinking of the nosebridgeEnlargement of the breast (gynecomastia)

Diagnostic Test:Slit Skin Smear - determines the presence of M. leprae; optional and done only if clinical diagnosis is doubtful to prevent misclassification and wrong treatmentLepromin Test – determines susceptibility to leprosy

Treatment:Ambulatory chemotherapy through use of MDTDomiciliary treatment as embodied in RA 4073 which advocates home treatment

PAUCIBACILLARY (tuberculoid and indeterminate); noninfectious typeDuration of treatment: 6 to 9 monthsProcedure: Supervised: Rifampicin and Dapsone once a month on the health center supervised by the rural health midwifeSelf-administered: Dapsone (side effect: itchiness of the skin) everyday at the client’s house

MULTIBACILLARY (lepromatous and borderline); infectious typeDuration of treatment: 24-30 monthsProcedure: Supervised: Rifampicin, Dapsone, and Lamprene (Clofazimine; side effect: dryness or flaking of the skin) once a month on the health center supervised by the rural health midwifeSelf-administered: Dapsone and Lamprene everyday at the client’s house

Avoid prolonged skin-to-skin contact

BCG vaccination – practical and effective preventive measure against leprosy

Good personal hygiene

Adequate nutrition

Health education

Major activity of leprosy control program: casefinding and treatment with effective drugs

Prevent deformities by self-care, exercise, and physical therapy.

2. Anthrax

Other names:Malignant pustuleMalignant edemaWoolsorter

Bacillus anthracis

Incubation period: few hours to 7 days

Contact witha. tissues of animals (cattle, sheep, goats, horses, pigs, etc.) dying of the disease

1. Cutaneous form – most common- itchiness on exposed part - papule on inoculation site- papule to vesicle to eschar- painless lesion

Treatment: Penicillin Proper handwahing

Immunize with cell-free vaccine prepared from culture filtrate containing the protection antigen

MDT Facts:It reduces communicability period of leprosy in 4-6 weeks time.It prevents development of resistance to drugs.It shortens the duration of treatment.


diseaseRagpicker diseaseCharbon

most cases occur within 48 hours of exposure

b. biting flies that had partially fed on such animalsc. contaminated hair, wool, hides or products made from them e.g. drums and brushesd. soil associated with infected animals or contaminated bone meal used in gardening

2. Pulmonary form – contracted from inhalation of B. anthracis spores- at onset, resembles common URTI- after 3-5 days, symptoms become acute, with fever, shock, and death

3. Gastrointestinal anthrax – contracted from ingestion of meat from infected animal- violent gastroenteritis- vomiting- bloody stools

Control dust and proper ventilation

3. Scabies Sarcoptes scabiei- An itch mite

parasite

Direct contact with infected individuals

Incubation Period:24 hours

Itching

When secondarily infected:Skin feels hot and burning

When large and severe: fever, headache, and malaise

Diagnosis:Appearance of the lesionIntense itchingFinding of causative mite

Treatment: (limited entirely to the skin)Examine the whole family before undertaking treatmentBenzyl benzoate emulsion (Burroughs, Welcome) – cleaner to use and has more rapid effectKwell ointment

Personal hygieneAvoid playing with dogsLaundry all clothes and ironMaintain the house cleanEnvironmental sanitationEat the right kind of foodRegular changing of clean clothing, beddings and towels

4. Pediculosis

Other name:Phthipiasis

PediculosisCapitis (head lice)Corporis (body lice)Pubis (crab lice)

Direct contact

Common in school age

Itchiness of the scalp Kwell shampoo

One tbsp water + one tbsp vinegar

Proper hygiene

VIII. INTESTINAL PARASITISM




1. Ascariasis Ascaris lumbricoides Fecal-oral route Pot-belliedVoracious eater

Diagnostic Test: Fecalysis Proper handwahing


Other names:RoundwormGiant worms

(nematode) 5 Fs: Finger, Foods, Feces, Flies, Fomites

Thin extremities Treatment:Antihelminthic: Mebendazole / Pyrantel Pamoate

2. Taeniasis

Other name:Tape worm

Taenia solium – porkTaenia saginata – beefDyphyllobotruim latum – fish

Eating inadequately cooked pork or beef


Muscle sorenessScleral hemorrhage

Diagnostic Test: Fecalysis

Treatment:Antihelminthic: Mebendazole / Pyrantel Pamoate

Proper handwahing

Cook pork and beef adequately

3. Capillariasis

Other name:Whip worm

Trichuris trichuria

Capillararia Philippinensis

Eating inadequately cooked seafood


Abdominal painDiarrheaborborygmi


Treatment:Antihelminthic: Mebendazole / Pyrantel pamoate

Proper handwahing

Cook seafoods adequately

4. Enterobiasis

Other name:Pinworm

Enterobium vermicularis Inhalation of ovaToilet seatInfected bedsheets


Nocturnal anal itchiness Diagnostic Test: Fecalysis / tape test


Proper handwahing

Proper disinfection of beddings

5. Ancyloclos-tomiasis

Other name:Hookworm

Ancyclostoma duodenal

Necatur americanus

Walking barefooted


Dermatitis

Anemia

Black fishy stool



Proper handwahing

Avoid walking barefooted


IX. OTHER COMMUNICABLE DISEASES




1. Pneumonia

Types:a. Community Acquired Pneumonia (CAP)

Bacteria:Pneumococcus, streptococcus pneumoniae, staphylococcus aureus, Klebsiella pneumonia

Droplet


Rusty sputumFever and chillsChest painChest indrawingRhinitis/common coldProductive cough

Diagnosis:Based on signs and symptomsDull percussion on affected lungSputum examination – confirmatory Chest x-ray

Avoid mode of transmission

Build resistance

Turn to sides


b. Hospital / Nosocomialc. Atypical

(Friedlander’s bacilli)

Virus:Haemophilus influenzae

Fungi: Pneumonocystis carinii pneumonia

Fast respirationVomiting at timesConvulsions may occurFlushed faceDilated pupilsHighly colored urine with reduced chlorides and increased urates

Management:BedrestAdequate salt, fluid, calorie, and vitamin intakeTepid sponge bath for feverFrequent turning from side to sideAntibiotics based on CARI of the DOH

Oxygen inhalationSuctioningExpectorants / mucolyticsBronchodilatorsOral/IV fluidsCPT

Proper care of influenza cases

2. Mumps

Other name:Epidemic Parotitis

Mumps virus, a member of family Paramyxoviridae

Direct contact

Source of infection:Secretions of mouth and nose

Incubation Period:12 to 26 days, usually 18 days

Painful swelling in front of the ear, angle of the jaws and down the neckFeverMalaiseLoss of appetiteSwelling of one or both testicles (orchitis) in some boys

Supportive and symptomatic

Sedatives – to relieve pain from orchitisCortisone – for inflammation

Diet: Soft or liquid as tolerated

Support the scrotum to avoid orchitis, edema, and atrophy

Dark glasses for photophobia

MMR vaccine

Isolate mumps cases

3. Influenza

Other name:La Grippe

Influenza virus A – most commonB – less severeC – rare

Period of Communicability:Probably limited to 3 days from clinical onset

Direct contactDroplet infection or by articles freshly soiled with nasopharyngeal discharges Airborne

Incubation Period:Short, usually 24 – 72 hours

Sudden onsetFever with chillsHeadacheMyalgia / arthralgia

Supportive and symptomatic

Keep patient warm and free from draftsTSB for feverBoil soiled clothing for 30 minutes before laundering

Avoid use of common towels, glasses, and eating utensilsCover mouth and nose during cough and sneezeImmunization: Flujob/Flushot – effective for 6 months to 1 year

4. Streptococcal sore throat

Other name:Pharyngitis

Group A beta hemolytic streptococcus

Other diseases:Scarlet fever

Droplet

Complication:Rheumatic Heart Disease

Sudden onsetHigh grade fever with chillsEnlarged and tender cervical lymph nodes

Diagnosis:Throat swab and culture

Treatment: erythromycin

Avoid mode of transmission


Tonsillitis St. Anthony firePuerperal sepsisImoetigoAcute glomerulonephritisRheumatic Heart Disease

Inflamed tonsils with mucopurulent exudatesHeadachedysphagia

Care:Bed restOral hygiene with oral antiseptic or with saline gargle (1 glass of warm water + 1 tsp rock salt)Ice collar

5. Meningitis

Other name:Cerebrospinal fever

MeningococcusNeisseria meningitides

Direct (Droplet)

Incubation Period:2 - 10 days

A. Sudden Onset- high fever accompanied by chills- sore throat, headache, prostration (collapse)

B. entrance into the bloodstream leading to septicemia (meningococcemia)a. rash, petchiae, purpura

C. Symptoms of menigeal irritation- nuchal rigidity (stiff neck) – earliest sign- Kernig’s sign – when knees are flexed, it cannot be extended- Brudzinski signs – pain on neck flexion with automatoc flexion of the knees- convulsion- poker soine (poker face / flat affect)- Increased ICP (Cushing’s triad: hypertension, bradycardia, bradypnea) and widening pulse pressure

Diagnostic Test:

Lumbar puncture or Lumbar tap - reveals CSF WBC and protein, low glucose; contraindicated for increased ICP for danger of cranial herniation

Hemoculture – to rule out meningococcemia

Treatment:Osmotic diuretic (Mannitol) – to reduce ICP and relieve cerebral edema; Alert: fastdrip to prevent crystallizationAnti-inflammatory (Dexamethasone) – to relieve cerebral edemaAntimicrobial (Penicillin)Anticonvulsany (Diazepam / Valium)

Complications:HydrocephalusDeafness (Refer the child for audiology testing) and mutism Blindness

Respiratory Isolation

IX. KILLER DISEASES OF THE NEW MILLENNIUM


DISEASECAUSATIVE

AGENTMODE OF



1. Meningococcemia Neisseria meningitides Direct contact with respiratory droplet from nose and throat of infected individuals


High grade fever in the first 24 hoursHemorrhagic rash – petechiaenuchal rigidityKernig’s signBrudzinski signShockDeath

Respiratory isolation within 24 hours

Drug-of-Choice: Penicillin

Universal precaution

Chemoprophylaxis with Rifampicin to protect exposed individual from developing the infection

Proper hand washing

2. Severe Acute Respiratory Syndrome / SARS

Earliest case: Guangdong Province, China in November 2002

Global outbreak: March 12, 2003

First case in the Philippines:April 11, 2003

Coronavirus Close contact with respiratory droplet secretion from patient


Prodromal Phase:Fever (>38 0C)ChillsMalaiseMyalgiaHeadacheInfectivity is none to low

Respiratory Phase:Within 2-7 days, dry nonproductive cough progressing to respiratory distress

No specific treatment

PREVENTIVE MEASURES and CONTROL1. Establishment of triage2. Identification of patient3. Isolation of suspected probable case4. Tracing and monitoring of close contact5. Barrier nursing technique for suspected

and probable case

Utilize personal protective equipment (N95 mask)

Handwashing

Universal PrecautionThe patient wears maskIsolation

3. Bird Flu

Other Name:Avian Flu

Influenza Virus H5N1 Contact with infected birds

Incubation Period:3 days, ranges from 2 – 4 days

FeverBody weakness and body malaiseCoughSore throatDyspneaSore eyes

Control in birds:1. Rapid destruction (culling or stamping out of all infected or exposed birds) proper disposal of carcasses and quarantining and rigorous disinfection of farms2. Restriction of movement of live poultry

In humans:1. Influenza vaccination2. Avoid contact with poultry animals or migratory birds

Isolation techniqueVaccinationProper cooking of poultry

4. Influenza A Influenza Virus A Exposure to droplets - similar to the symptoms Diagnostic: - Cover your nose and


(H1N1)

Other Name:Swine Flu

May 21, 2009 – first confirmed case in the Philippines

June 11, 2009 - The WHO raises its Pandemic Alert Level to Phase 6, citing significant transmission of the virus.

H1N1

This new virus was first detected in people in April 2009 in the United States.

Influenza A (H1N1) is fatal to humans

from the cough and sneeze of the infected person

Influenza A (H1N1) is not transmitted by eating thoroughly cooked pork.

The virus is killed by cooking temperatures of 160 F/70 C.

Incubation Period:7 to 10 days

of regular flu such as

Fever Headache Fatigue Lack of appetite Runny nose Sore throat Cough

- Vomiting or nausea- Diarrhea

Nasopharyngeal (throat) swabImmunofluorescent antibody testing – to distinguish influenza A and B

Treatment:Antiviral medications may reduce the severity and duration of symptoms in some cases:Oseltamivir (Tamiflu) or zanamivir

mouth when coughing and sneezing- Always wash hands with soap and water- Use alcohol- based hand sanitizers- Avoid close contact with sick people- Increase your body's resistance- Have at least 8 hours of sleep- Be physically active- Manage your stress- Drink plenty of fluids- Eat nutritious food


REFERENCES: THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN

CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10th EDITION DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov

Documents

COMMUNICABLE DISEASE NURSING (Part II: Diseases)