Pox Shing Rubeo Rubel

7/28/2019 Pox Shing Rubeo Rubel

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Definition

Acute infectious disease of sudden onset with slight fever,

mild constitutional sx & eruptions which are maculo-papular

for a few hours, vesicular for 3-4 days & leaves granular

scabs.

mild, self-limiting viral illness with occasional complications

common & highly contagious

affects nearly all susceptible children before adolescence


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Chicken Pox

One of the most readily communicable

diseases, especially in the early stages of

eruption

Ranks 7th - Top Ten Morbidity Causes By

Sex / 100,000 population(2004 Phil Health Statistics Last Updated February 2008)


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Chicken Pox

Other name: Varicella

C. Agent: Human(alpha) herpesvirus 3

varicella-zoster virusMOT:

Direct contact or droplet spread

Indirect through articles freshly soiled bydischarges of infected person


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Contagious 5 days before & 5 days after

blister appearance

Incubation Period: 2-3weeks, commonly

13-17 days

daiy07

Chicken Pox


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Susceptibility, Resistance &

Occurrence

Universal among those not previously

attacked. Severe in adults. An attack confers

long immunity. Second attacks are rare. Probably 70% have

the disease by the time they are 15y/o.

Not common in early infancy


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Chicken Pox

S/S:

Reddish, itchy skin rash (abdomen, back, face

then everywhere else on the body)


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Chicken Pox

S/S:

Weakness

Muscle & joint pains Sudden onset of fever
http://www.lib.uiowa.edu/haRDIN/MD/dermnet/chickenpox.html


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Note:

Chickenpox rashes will disappear in 1-2weeks time even without treatment


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Chicken Pox

Immediate Treatment:

cut nails short (children)

do not scratch (older children)

For babies : light mittens or

socks on the hands
http://www.google.com.ph/imgres?imgurl=http://author.whebsite.com/media/images/baby-gloves-and-mittens-16.jpg&imgrefurl=http://pregnancy.whebsite.com/baby-gloves-and-mittens.html&usg=__45_7UL553-cxAoKoEotU2MD1kNI=&h=225&w=300&sz=18&hl=tl&start=2&zoom=1&itbs=1&tbnid=6kpW0ga7GEGjYM:&tbnh=87&tbnw=116&prev=/search%3Fq%3Dmittens%2Bfor%2Bbabies%26hl%3Dtl%26biw%3D1280%26bih%3D734%26gbv%3D2%26tbm%3Disch&ei=6rNATtWYG8SAmQXRscWoCQ


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Chicken Pox

Immediate Treatment:

Antipyretics / acetaminophens


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Chicken Pox

Nursing Care Treatment:

Reducing discomfort & fever

Applying wet compresses

Bathing with cool orlukewarm water once a day Adding 4-8 ounces ofbaking soda or one or two

cups ofoatmeal to the bath

Only mild soap should be used in the bath. Patting, not rubbing

Calamine lotion also reduces itchiness
http://www.answers.com/topic/lukewarmhttp://www.answers.com/topic/ouncehttp://www.answers.com/topic/baking-sodahttp://www.answers.com/topic/oatmealhttp://www.answers.com/topic/rubbinghttp://www.answers.com/topic/rubbinghttp://www.answers.com/topic/oatmealhttp://www.answers.com/topic/baking-sodahttp://www.answers.com/topic/ouncehttp://www.answers.com/topic/lukewarm


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Prevention & Control:

Avoid crowded areas during epidemics

Isolate known cases

Concurrent disinfection of throat & nosedischarges

Vaccine is available as precautionary

measure & as per doctors advice.

Report to local authority


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Chicken Pox

Note:

Varicella Vaccine Combination : MMRV

Those who had the disease before mayhave lifelong protection

Children younger than 13 yrs -1st dose starts

at 12-15 mos, 2nd

dose at age 4-6 years For 13 years & older who has never had

chicken pox - 2 doses, given 4-8weeks

apart!


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http://www.healthline.com/blogs/outdoor_health/uploaded_images/139_3925-778811.JPGhttp://z.about.com/d/dermatology/1/0/J/5/HerpLip.jpghttp://z.about.com/d/dermatology/1/0/7/5/Herp_init.jpg


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Shingles

An extremely painful viral infection of the nerve

roots resulting in a skin rash caused by the same

virus that causes chickenpox.

C. agent: reactivated virus Varicella zoster virus(VZV)

Dormant VZV can cause shingles!


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Shingles

At risk:
http://www.google.com.ph/imgres?imgurl=http://snappyworld.com/wp-content/uploads/2010/07/chemo1.jpg&imgrefurl=http://snappyworld.com/tag/cancer-suppress-treatment-chemotherapy&usg=__e1WINT7FDp0PKVQf_LlRVLTwPkk=&h=279&w=423&sz=115&hl=tl&start=4&zoom=1&itbs=1&tbnid=vGn3pYDW_8s10M:&tbnh=83&tbnw=126&prev=/search%3Fq%3Dchemotherapy%2Bpatient%26hl%3Dtl%26sa%3DG%26biw%3D1280%26bih%3D773%26gbv%3D2%26tbm%3Disch&ei=77ZATtaIMsH1mAX4kvDZCQhttp://images.google.com.ph/imgres?imgurl=http://blogs.fayobserver.com/faytoz/files/2009/05/old-people-crossing.gif&imgrefurl=http://blogs.fayobserver.com/faytoz/category/hot-topics/&usg=__Ee8m1mHYziLyB43Gu4XuKvWdsJ0=&h=400&w=453&sz=9&hl=en&start=50&um=1&tbnid=mz3iuZYCcuCcZM:&tbnh=112&tbnw=127&prev=/images?q=old+people+photos&ndsp=20&hl=en&rlz=1R2HPAA_enPH331&sa=N&start=40&um=1


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Shingles

S/S:

Pain, itching, tingling, or burning of the skin

Small blisters on a red base w/ new blister

continuing to form for 3-5days

Painful rash resembles the lesions of chickenpox

usually localized to a concentrated area
http://z.about.com/d/dermatology/1/0/I/5/Herpes-virion.jpg


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Shingles

Complications:

Infection

Postherpetic neuralgia

Loss of vision


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Treatment: Bathing permitted

Cool compress Anti-itching lotions

Steroids, antiviral

meds,pain relievers

Vaccine:

Zostavax cointains

booster dose of

chicken pox


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CHICKEN POX HERPES ZOSTER

SYNONYM VARICELLA SHINGLES

CAUSATIVE AGENT VARICELLA ZOSTER

VIRUS

DORMANT VZV OR HZV

MOT DROPLET. DIRECT

CONTACT

DROPLET

AGE OF

SUSCEPTIBILITY

CHILDHOOD YEARS 35 YEARS OLD AND

ABOVE

PERIOD OF

COMMUNICABILIT

Y

UNTIL THE LAST

CRUST

UNTIL THE LAST CRUST

ENANTHEM NONE NONE

EXANTHEM VESICO-PUSTULAR

RASH

VESICO-PUSTULAR

RASH

DIRECTION OF

SPREAD OF RASHES

CENTRIFUGAL FOLLOWS PERIPHERAL

NERVE PATHWAY

ICHY, GEN.

DISTRIBUTION

PAINFUL, LIMITED

DISTRIBUTION,UNILATERAL


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Measles

An acute highlycommunicable infection

caused by a virus

A type of maculopapular rash

disease

Other Names:Rubeola

Morbilli


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Mostly affects children

Ranks 1

st

Mortality amongimmunizable disease ages under

1-14 years

Ranks 4th

Top 10 Causes ofMortality ages 1-4 years

Philippine cases 2008: 341

Measles


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Measles

Causative Agent:Rubeola virus or

Paramyxo virus

Mode of Transmission:

Direct and indirect

contact withnasopharyngeal

secretions /droplet


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MeaslesIncubation Period:10 days from exposure to appearance of

fever and about 14 days until rashappears

Susceptibility, Resistance & Occurrence

All persons are

susceptible.

Babies born of motherswho had the disease before

the baby is born are

immune for the first

months of life.


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Stages of Manifestation:1. Pre-eruptive Stage*symptoms appear before rashes appear

Fever 3-4 days Dry cough/colds Sore throat Headache


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Measles Lymphadenitis

Stomatitis

Kopliks spot

- pathognomonic sign

of measles


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Measles

Stimsons sign Sore-eyes like

Excessive muco-purulent lacrymal discharge

Conjunctivitis

With photophobia


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Measles2. Eruptive Stage maculopapular rashes reddish in color blotchy appearance rashes follow the hairline and cephalocaudal

distribution

appears on the 3rd day of illness upon appearance within 2-3 days the entire

body is fully covered


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Measles3. Post-eruptive Stage

fine desquamation


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Complications:

Deafness

Ear infection Pneumonia

Encephalitis

Diarrhea and dehydration Blindness


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Treatment:

Symptomatic and Supportive care

Antibiotics for bacterial complications

Vitamin A supplements


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Measles

Nursing Care: STRICT ISOLATION

Keep in a well ventilated room

Highly contagious

COOLING MEASURES

Provide sponge bath for comfort

Give PARACETAMOL medication asprescribed by physician


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MeaslesNursing Care:

EYE CARE Protect eyes from glare of strong light

VITAMIN A supplementation

Clean the eyes using cotton balls withwater (PNSS) from inner to outer

canthus

EAR CARE

Because of catarrhal symptoms to

prevent otitis media


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MeaslesNursing Care:

ORAL CARE

Because of stomatitis

May use oral antifungal as prescribed

SKIN CARE

Use of calamine lotion


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MeaslesPrevention & Control: Avoid exposure to any infected person

Isolation from diagnosis until 5-7days after the

onset of rash

Disinfection of all soiled articles Immunization: gamma Globulin or MMRV
http://www.doh.gov.ph/


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Mass Measles Immunization Campaign

children 9 - 48 months
http://www.doh.gov.ph/http://www.doh.gov.ph/


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WHO & UNICEF are collaborating to reduceglobal measles death by 90% by 2010.

Strategies:

Strong routine immunization: children by their 1st birthday

A second opportunity for measles immunization throughmass vaccination campaigns.

Effective surveillance in all countries to quickly recognize

& respond to measles outbreak.

Better treatment of measles cases: Vit A supplements,

antibiotics and supportive care.
http://www.doh.gov.ph/http://www.doh.gov.ph/


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also known as RUBELLARubella is derived from the Latin word

meaning little red

Causes a relatively minor rash diseasewith few complications

With post auricular, post-cervical,sub-occipital lymph nodes

enlargementWill have teratogenic effect on the

fetus if acquired by a pregnant mother


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Other Names: Rubella

3-Day Disease

Little Red Disease

Generally a mild, benign

infectious disease in children

Philippines 2007 Cases - 172


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Causative Agent:

Toga virus/Pseudoparamyxo virus

Mode of Transmission:Droplets from discharge:nose & throat

Pregnant womans bloodstream


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Incubation period:

1423 days, with an average incubation

period of 1618 days


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Stages of Manifestation:

1. Pre-eruptive Stage

mild cough and colds

Forscheimers spot


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2. Eruptive Stage

rashes disappear on the 4th day of

illness

enlargement of lymph nodes(post auricular, post cervical, sub-

occipital)


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3. Post-Eruptive Stage- desquamation

Treatment: Acetaminophen or ibuprofen for fever

Monitor and provision of comfort


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Prevention and Control:

Vaccine usually given at 12-15months

Pre-natal Testing: Rubella screen

*Congenital Rubella Syndrome (CRS)-important cause of severe birth

defects!


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MEASLES GERMAN MEASLES

SYNONYM RUBEOLA RUBELLA

CAUSATIVE AGENT PARAMYXOVIRUS TOGA VIRUS

MOT AIRBORNE DROPLET,

PLACENTAL

AGE OF

SUSCEPTIBILITY

CHILDHOOD YEARS 35 YEARS OLD AND

ABOVE

PERIOD OF

COMMUNICABILITY

4 DAYS BEFORE/ 5

DAYS AFTER RASHESAPPEAR

ENTIRE COURSE

ENANTHEM KOPLIKS SPOTS FORSCHEIMERS

SPOTS

EXANTHEM MACULO-PAPULAR

RASH

MACULO-PAPULAR

RASH

DIRECTION OF

SPREAD OF RASHES

CEPHALOCAUDAL CEPHALOCAUDAL

ICHY, REDDISH, HOT

DRY SKIN

MAY OR MAY NOT

PINKISH, COLD,

MOIST


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POLIOMYELITIS

A highly infectious disease caused by avirus.

An acute enteroviral infection of thespinal cord that can causeneuromuscular paralysis.

It invades the nervous system, and can

cause total paralysis in a matter of hours.


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Other Names:

Polio

Infantile Paralysis

Heine-Medins Disease

POLIOMYELITIS


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WHO 2008 world polio-endemic

countries: Afghanistan, India, Nigeria

and Pakistan

Ranks 6th Phil Mortality causes of

immunizable disease

POLIOMYELITIS


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Causative Agent:

Legio debilitans/poliovirus

3 Strains/Types of Legio debilitans: Type 1- Brunhildepermanent

immunity

Type 2- Lansing

Type 3- Leon

POLIOMYELITIS


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Mode of Transmission:

Early stage

- droplet infection/direct contact Late stage

- fecal-oral

- direct contact with infected feces

POLIOMYELITIS


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The Stage of Infection and Pathogenesis ofPoliomyelitis

First, the virus is ingested and carried to the throatand intestinal mucosa.

The virus then multiplies in the tonsils. Smallnumber escapes to the regional lymph nodes andblood.

The viruses are further amplified and cross intocertain nerve cells of the spinal column and CNS.

Last, the intestine actively sheds viruses.

POLIOMYELITIS


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Signs and symptoms:

Patterns:

1. Inapparent (subclinical) infections2. Abortive poliomyelitis

3. Major poliomyelitis

a. Nonparalytic

b. Paralytic

-Bulbar, spinal, bulbo-spinal

POLIOMYELITIS


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Signs and symptoms:

Abortive poliomyelitis (minor illness) FLU-

LIKE SYMPTOMS

fever accompanied by chills

Malaise

Sore throat

Headache

Abdominal pain Anorexia

N/V

Diarrhea or Constipation

POLIOMYELITIS


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Signs and symptoms:

Major poliomyelitis

For both types:- Resistance to neck flexion

- Hoynes sign

POLIOMYELITIS


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Signs and symptoms:

Major poliomyelitis

a. Nonparalytic

-moderate fever

-headache

-vomiting

-lethargy

-irritability

-pains in the neck, back,arms, legs and

abdomen-tenderness and

weakness

-spasms in the

extensors of theneck and back

POLIOMYELITIS


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PoliomyelitisSigns and symptoms:

Major poliomyelitis

b. Paralytic

- flaccid paralysis

- hypersensitivity to

touch

- urine retention

- constipation

Signs and symptoms:

Major poliomyelitis

b. Paralytic

- abdominal distention

- paresthesia

- loss of superficial and

deep reflexes


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- Bulbar

- Spinal

- Bulbo-Spinal

POLIOMYELITIS


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(+) Brudzinskis

signs

POLIOMYELITIS

(+) Kernigs signs


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PoliomyelitisDiagnostic Exam

1. Lumbar puncture,

cultures of throat

secretions & feces2. Muscle testing

3. EMG(electromyelography)

Treatment:

Asymptomatic

Mechanical

ventilator if withbulbar paralysis

Physical therapyor rehabilitation


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Poliomyelitis

Prevention:

No cure, but can be prevented by polio

vaccine given at multiple times

Vaccine: OPV, IPV


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POLIOMYELITIS

Causative agent Poliovirus

Most common

modes of

transmission

Fecal-oral, vehicle

Prevention Live attenuated (developing

countries/world) or inactivated

vaccine (developed world)

Treatment None, palliative, supportive


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inflammation of the meninges almost always caused by an infection,usually by a bacteria (bacterialmeningitis) or a virus (viral meningitis) can be triggered by a fungus or parasite(rare) occurs most commonly in :

young children under 5those aged 17-25people with compromised immune systems(cryptococcal meningitis)


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1. aseptic refers loosely to all cases of meningitis in which no

bacterial infection can be demonstrated

viral/acute lymphocytic meningitis ENTEROVIRUSES, ARBOVIRUSES, HSV, MUMPS VIRUS,

LYMPHOCYTIC CHO RIOMENINGITIS VIRUS2. septic/bacterial meningitis(N.meningitidis, H. influenzae, S. pneumoniae, E.coli)3. tuberculous/chronic meningitis

Mycobacterium tuberculosis

Certain CA, brain tumor


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Viral/Acute Lymphocytic Meningitis

benign "stiff neck" presents like bacterial meningitis, but usually is not soserious more prevalent than bacterial meningitis Most patients recover well after several very uncomfortabledays.MOT:

Enteroviruses1) from person to person through fecal contamination

2) through respiratory secretions (saliva, sputum, or nasal mucus

mumps and varicella-zoster virus1) through direct or indirect contact with saliva, sputum, or mucus of an

infected person


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Septic /Bacterial Meningitis

contagious, but not spread by casual contact

or by simply breathing the air where a person

with meningitis has been

MOT:

through the exchange of respiratory and

throat secretions (i.e., coughing, kissing)

/


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Tuberculous/Chronic Meningitis

lasts a month or longer

common in countries where tuberculosis is

common

also encountered in those with immune

problems, such as AIDS

Inflammatory response


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causative agentcolonizes the

nasopharynx

pathogens spread into

local tissuesand bloodstream

pathogens replicatein the bloodstream

Pathogens cross the

blood-brain barrier into

subarachnoid space

Bacterial replication

in CSF enhance local

inflammatory response

Inflammatory response

alters CSF dynamics and

cerebral blood flow

neurological complications


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Signs and Symptoms

cardinal signs1) fever, chills, malaise, headache, vomiting

nuchal rigidity whimpering and crying in a high-pitched tone

nausea &vomiting photophobia confusion, sleepiness seizures in late stage of disease

opisthotonus Brudzinskis and Kernigs sign

MENINGITIS


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MENINGITIS

SIGNS OF MENINGEAL IRRITATION

NUCHAL RIGIDITY

OPISTHOTONUS KERNIGS SIGN

BRUDZINKIS SIGN

MENINGITIS


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MENINGITIS

NUCHAL RIGIDITY

MENINGITIS


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MENINGITIS

OPISTHOTONUS

MENINGITIS


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(+) Brudzinskis

signs

MENINGITIS

(+) Kernigs signs

Diagnosis


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Diagnosis

CSF analysis through lumbar puncture

Culture of blood, urine, nose and throat

secretions

M


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Management

depends on the cause Constant VS taking Close neurological monitoring Bed rest

Protection during seizures Treating coexisting conditions Antibitiotics administration (PenG, ampicillin,

tetracycline, chloramphenicol) if bacterial Mannitol

Anticonvulsant or sedatives Isolation until 24 hours after initiation of

antibiotic Proper disposal of oral and nasal discharges


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Prevention

Keeping up to date with recommendedimmunizations

Hib

PCV 7 (Prevnar) children below 2 y/o

Pneumovax and PnuImmune 2 y/o and above

Good hygiene

Avoid sharing drinking glasses, water bottles, eating

utensils, tissues, and lip-gloss/lipsticks. Wash hands often with soap.


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Pox Shing Rubeo Rubel