POLIOMYELITIS

> Also called:

- Infantile Paralysis-Heine-Medin Disease

>Affects children below ten (10) years of age

Less risk for people above ten (10) years Old

Causative Agent

VirusLegio debilitans

Type 1 – BrunhildeType 2 – Lansing

Type 3 – LeonIf Brunhilde

Gives permanent immunityIf Lansing or Leon

Gives temporary immunity

Important Concepts!When Brunhilde infects you, Leon or Lansing will no longer affect

you!

In the Philippines, the most prominent type is Brunhilde!

Mode of Transmission

>Droplet

In early stage of infection, virus if found at nasopharyngeal secretions

>Fecal-Oral RouteIn late stage of transmission, virus is found

at the mouth

Portal of EntryGastrointestinal Tract

Pathophysiology

>Legio debilitans goes to the nasopharynx or the mouth>If in the nasopharynx, it goes to the tonsils and causes:

-Sore throat-Fever and chills

-Headache with body malaise>If at the mouth, it goes to the Peyer’s patches and

causes:-Abdominal pain

-Anorexia-Nausea and Vomiting

-Diarrhea or Constipation

STAGES of POLIOMYELITIS

1ST Stage: Invasive Stage or Abortive StageAll the abovementioned signs and symptoms will appear

Patient recoversDisease process is aborted

But there will be instances when disease process will not be aborted

Tonsils Peyer’s Patches ▼ ▼

Cervical Mesenteric Lymph Lymph Nodes Nodes

▼▼▼ ▼▼▼ B L O O D S T R E A M

▼▼▼ Central Nervous System

2nd Stage: Pre-paralytic Stage of PoliomyelitisCentral Nervous System is already involved but there will be no

paralysis

Signs and Symptoms:Once in the CNS, microorganism will cause:

Sever muscle painDo not keep on turning or holding patient

Do not do massageNo positioning will relieve patient

Instead, what would relieve the patient would be:Application of warm packs

AnalgesicsNever administer Morphine

Once in the CNS, the microorganism will also cause:Stiffness of the hamstring

Patient will be positive for HOYNE’S Sign and exhibit a HEAD DROP

To check for Hoyne’s SignLift shoulders of patient when lying supine or extend

head of patient beyond the edge of the bedIf head of patient drops, he is said to be positive (+) for

Hoyne’s Sign

Once in the microorganism is in the CNS, the patient would elicit a POKER SPINEOphistotonus with head retractionSitting position cannot be assumed

Therefore, patient will assume a TRIPOD POSITION

Central Nervous System ▼▼▼

ParalysisConcept!

From the CNS, the patient will experience paralysis.This leads to the third (3rd) stage of the disease

3rd Stage: Paralytic StagePresence of paralysis

Characteristics of Paralysis:Flaccid

SoftFlabbyLimp

Important Concept!Flaccid Paralysis is PATHOGNOMONIC SIGN of Poliomyelitis

Three (3) Types of Paralysis

1. Bulbar TypeCranial nerves are affected

9Th cranial nerve (Glossopharyngeal Nerve) and 10th cranial nerve (Vagus Nerve) affectations give rise to:

Respiratory problemsVocal cord swelling / paralysis

Excessive salivationAspiration

Regurgitation

2. Spinal TypeMost common type of paralysis Affects ANTERIOR HORN CELLS

Affects MOTOR FUNCTIONParalysis of extremities

Paralysis of intercostal muscles leads to DIFFICULTY OF BREATHING

Exams and TestsThe health care provider may find signs of meningeal irritation (similar to meningitis), such as stiff neck or back stiffness with

difficulty bending the neck. The person also might have difficulty lifting the head or lifting the legs when lying flat on the back, and

their reflexes might be abnormal.Tests include:

Routine CSF examinationTest for levels of antibodies to the polio virus

Viral cultures of throat washings, stools, or cerebrospinal fluid (CSF)

Medical Mgmt:Treatment

The goal of treatment is to control symptoms while the infection runs its course.

People with severe cases may need lifesaving measures, especially breathing help.

Symptoms are treated based on how severe they are. Treatments include:- Antibiotics for urinary tract infections

- Medications (such as bethanechol) for urinary retention- Moist heat (heating pads, warm towels) to reduce muscle pain and spasms- Pain killers to reduce headache, muscle pain, and spasms (narcotics are not

usually given because they increase the risk of breathing difficulty)- Physical therapy, braces or corrective shoes, or orthopedic surgery to help

recover muscle strength and function

3. Bulbo-Spinal TypeCombination of Bulbar and Spinal types

Patient has cranial nerve affectations and anterior horn cell affectations

Important Concepts!!!

Not all patients will develop paralysisIf patient is non-paralytic,He has GOOD PROGNOSIS

Diagnostic Tests

1. Lumbar PunctureLaboratory results would reveal:Increased White Blood Cell levels

Increased Protein levelsNormal Sugar levels

2. Muscle TestingTo determine what specific muscle is affected

3. ElectromyelogramTo determine extent of muscle involvement

4. Stool ExaminationPerfomed at the late stage

About ten (10) days after being affected5. Nasopharyngeal Examination

Performed at the early stage

Medical ManagementSymptomatic

Causative agent is viralIf there is respiratory paralysis

Place patient in a MECHANICAL VENTILATORUse the IRON LUNG MACHING

This works on the principle of Negative Pressure BreathingNo tracheostomy tube needed (tracheostomy tube or endotracheal tube

work on the principle of Positive Pressure Breathing)Capsular in shape

With glass windowsWith metal plate

Works on electricityDuring brownout or power shortages, operate the machine manually

It has a steering wheel, which can be manipulated manuallyPatient stays in the Iron Lung Machine for months

Surgical managementa. Muscle and tendon transplantation

Operation of Tendonstenotomy- division of tendonmyotomy- division of muscle

fasciotomy- operation on deep fascia the most useful procedure in the surgical treatment of

poliomyelitis are operations that restore stability to failed joints.

b. Arthrodesis- fusion of bones across a joint space by surgical

means, which eliminates movement, usually performed to

eliminate pain over a joint.c. Osteotomy- cutting of bone into 2 parts followed by realignment of

ends to allow healing

d. Operation to equalized the leg length discrepancy After poliomyelitis, growth affected leg is slowed down as

much 6 to 7 cm by disuse, atrophy and diminished blood flow to the

limb. The degree of shortening depends of the severity of the paralysis and the age at which

paralysis begins.

Orthotic devices:1. Hook’s corset

Prevent deformity2. Long leg brace

To provide needed support3. Oppenens Splints

Prevent weakening of muscles4. Mobile arm support

To increase hand function

Nursing Care for PoliomyelitisSymptomatic and SupportivePsychological Aspect of Care

Use empathy

Preventive Measures1. Immunization

Vaccine given:Oral Polio Vaccine (OPV) or Sabin

Dose:Two (2) to three (3) drops

Route:Oral

Number of Doses:Three (3)Interval:

Four (4) weeksWhen given:

1st Dose – at six (6) weeks old2nd Dose – at ten (10) weeks old

3rd Dose – at fourteen (14) weeks oldImportant Concepts!!!

Do not feed child for thirty (30) minutes after administration of OPV

Rationale:For better absorption

If child vomits, REPEAT!!!If child has diarrhea

Give OPVBut do not record it

Not all of the vaccine may be absorbed properlyWhen OPV 3 is given four weeks after, record it as OPV 2

Integrated Management of Childhood Illnesses (IMCI)

Tell mother also that she should be very careful in handling stool of child because this vaccine

eliminates virus to the stoolIf significant others at home are

immunocompromisedDo not administer OPV

Due to feces of childRather give, IPV or Inactivated Polio Vaccine /

SALK

Dose:0.5 ccRoute:IntramuscularNumber of Doses:Three (3)Interval:Four (4) weeksWhen given:1st Dose – at six (6) weeks old2nd Dose – at ten (10) weeks old3rd Dose – at fourteen (14) weeks old

Rationale:Because stool of child may contain the virus if OPV is given

. Avoid mode of transmissionProper disposal of nasopharyngeal

secretionsCover mouth when coughing

Do not put anything through the mouth