COMMUNICABLE DISEASES | BOARD EXAM REVIEW

Lecturer: Ms. Emelita M. Padilla, LPT, MAN, RN

COMMUNICABLE DISEASES ○ Constant presence and/or usual prevalence of a

(DEFINITION OF TERMS) disease or infectious agent in a population within a
● INFECTION geographic area
○ Invasion and multiplication of pathogens ○ If it becomes constantly present it will become
○ When there is the involvement of infectious pathogens endemic
which causes disease ○ Examples in the Philippines are Malaria (Palawan),
● NOSOCOMIAL dengue and filariasis (Samar)
○ aka Hospital acquired or Healthcare Associated ● HYPERENDEMIC
infection) ○ Persistent, high levels of disease occurrence
○ Occurs 48 hrs after hospital admission or within 30 ○ Cases are always increased
days after discharge ● EPIDEMIC
○ → So if the patient develops within this ○ An increase, often sudden, in the number or
period, there is a high possibility the infection was incidence of a disease above what is normally
acquired in the hospital during the time the patient was expected in a population
still in the hospital. ○ Having 1 case can be considered an epidemic if the
● COLONIZATION normal is 0
○ Pathogen reside in a body part without causing ○ Example: epidemic of measles, emerging and
disease (resident flora) reemerging diseases
○ Normal resident flora in our body can be also ● OUTBREAK
pathogenic like in immunocompromised host ○ Same as epidemic, but it is often used for a more
○ From the word, “colony” limited geographic area
○ Normally, they are there without causing any infectious ○ Example. Measles and Poliomyelitis during 2019
disease ○ For several years, we are polio-free but when there
● LOCAL INFECTION was one case of polio in 2019, we already consider
○ Infection in a specific body part that as an outbreak
○ Ex. wound on lower extremity manifesting ○ Higher than what is normally expected cases
inflammation, redness, pain, swelling, heat. Those are ● PANDEMIC
signs of inflammation that could be indicative of local ○ An epidemic that has spread over several countries or
continents, usually affecting a large number of people
infection.
● ISOLATION
○ Sometimes can lead to systemic infection ○ Limitation of movement of the sick person
● OPPORTUNISTIC ● ISOLATION IN COHORTING
○ Refers to infections that sets when the immune ○ Limitation of movement of sick people with the same
system is weak disease
○ Mapagsamantala → taking advantage of body’s ○ We have to consider those who are recovering from
defense the disease. Even if they have the same disease, if
○ Example: when our normal flora increases in number one patient is already recovering, he must be
and our immune system becomes weak = can become separated from the patient who is still in the acute
opportunistic infections later on stage of illness
● CARRIER ● QUARANTINE
○ An individual who harbors a pathogen without ○ Limitation of movement of the well and exposed or
manifesting symptoms, thus acting as a distributor of close-contact
infection ■ Exposure or close contact means direct
○ Human carriers are the most common (may be physical interaction with a probable or
asymptomatic or symptomatic) confirmed case within 1 meter for more
○ Animal carrier (causes zoonotic disease such as than 15 minutes without protective
rabies), equipment
○ Fomites (non-living organism) ● Probable case → pt has sx and
○ Plant carriers (soil, air is a vehicle which carries the is waiting for the result of the
pathogenic microorganism and remains suspended in test
air for a long period of time) ○ Question: If you are healthy and not exposed to a
○ Food carriers contagious disease, do you need to quarantine? →
○ Vectors NO, unless you are a close contact
● DECONTAMINATION ○ We do not just separate or restrain people’s
○ Process of treatment that cleanses a medical device, movement but we also have to monitor for their signs
instrument, or environmental surface to remove and symptoms
contaminants such as microorganisms ● INFECTIOUS
○ Ex. Terminal disinfection, regular disinfection ○ Caused by invasion of pathogen which subsequently
● DISINFECTION grows and multiplies in the body
○ The destruction of pathogenic and other ■ Vector borne diseases are infectious but
microorganisms by physical or chemical means not contagious
● STERILIZATION ○ Not all infectious diseases are contagious and
○ A physical or chemical procedure that destroys all communicable → there are pathogenic
organisms whether pathogenic or not, including large microorganisms that cannot be transmitted and just
number of resistant bacterial spores developed bc of a weakened immune system (ex. UTI)
○ Used in the OR ● CONTAGIOUS
● EPIDEMIOLOGY ○ Easily spread, directly transmitted from person to
○ Study of the cause, distribution, and control of a person
disease ○ All contagious are communicable → bc they can be
○ Health events studied under epidemiology are usually transmitted
infectious or communicable disease ○ All contagious are infectious → bc you are transferring
● SPORADIC pathogenic microorganism
○ A disease that occurs infrequently or irregularly ○ Ex. Ebola
○ No specific pattern when and where a disease will ● COMMUNICABLE
occur ○ Came from the root word “commune” meaning
○ Sporadic diseases can become endemic in some community, thus there is interaction between persons
areas ○ Can be passed from one person or animal to another
○ Direct or indirect transmission of infectious agents or
○ Ex: Tetanus, Rabies (however, sometimes it can be
its toxic products
geographic location based) ○ Ex: Respiratory droplet (pneumonia) lands on
● ENDEMIC surfaces and a person comes in contact with that

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 surface → communicable, not contagious bc if you
cleaned your hands and didn’t come in contact with c. Protects self from microorganisms in the wound
the infected surface then you won’t have the disease d. Minimize the number of opportunistic bacteria in the wound
○ Ex: Tetanus; from soil it can be transmitted to a
person Answer/ Rationale: B. Keeps the area free of pathogenic microorganisms
○ Ex: Rabies; from animal to person → this is why we have to regularly change wound dressing because
○ Both infectious and contagious are communicable moisture can be a good environment for bacterial growth
○ Question: If it is sexually transmitted, does it easily
spread? Is it communicable or contagious? A nurse is assisting in planning care for a child with a communicable
■ Communicable disease. The nurse determines that the primary goal of caring for this
○ Communicable diseases can be contagious but NOT client is that he:
ALL a. Child will experience only mild discomfort
■ Because not all communicable diseases b. Public health departments are notified
are easily transmitted c. Child will experience only minor complications
d. Child will not spread infection to others

Additional Notes: Contact tracing is only up to 2-14 days from the time of Answer/ Rationale: D. Child will not spread infection to others
appearance of signs and symptoms.

Epidemiological intervention is done by the nurse to establish the

INFECTIOUS DISEASE VS. COMMUNICABLE DISEASE presence of an epidemic. This activity is best defined as what level of
INFECTIOUS DISEASE (ID) prevention?
● The state in which the infected host displays a decline in a. Primary
wellness due to the infection b. Secondary
● A disease caused by the entrance into the body of pathogenic
agents or microorganisms causing illness Answer/ Rationale: B. Secondary → early detection of disease; the
disease is already there; prevent the spread of the disease
COMMUNICABLE DISEASE (CD)
● An illness caused by an infectious agent or its toxins that occurs
through the direct or indirect transmission of the infectious CHAIN OF INFECTION
agent or its products from an infected individual or via an animal,
SIX (6) CHAINS
vector, or the inanimate environment to a susceptible animal or
● A complete chain of events necessary for infection to occur
human host
● All of these elements must be present and in order for infection to
● An infectious disease that is transmissible by contact with
occur
infected individuals or their bodily discharges or fluids, by contact
● Causative agent → reservoir → portal of exit → mode of entry →
with contaminated surfaces or objects, by ingestion of
transmission (weakest link; manageable) → portal of entry →
contaminated food or water, or by direct or indirect contact with
susceptible host
disease vectors.
[1] CAUSATIVE ORGANISMS
EXAMPLES
● Microorganisms that cause infection (bacteria, rickettsia, viruses,
● Influenza – both infectious and communicable
protozoa, fungi, and helminths)
● Hepatitis – both
● We can break this chain by rapid identification of microorganism
● Dengue – communicability is not high unless there’s a vector
such as culture and sensitivity to easily manage the disease
● Malaria

CONTAGIOUS DISEASE CAUSATIVE DESCRIPTION DISEASES

● Another synonym of Communicable disease BUT ↓ AGENT
● An infectious disease that is transmitted by contact with an
infected individual or infected bodily discharges or fluids by
BACTERIA Prokaryotic, no Anthrax,Diphtheria,
contact of contaminated surface or objects or ingestion of
mitochondria, single Leptospirosis,
contaminated food or water
chromosome, have a rigid Tetanus, PTB
○ Human to human transmission either direct or indirect
cell
contact
○ Commonly used together with communicable disease
Living organism → can
● Does not go through intermediate host or vectors
make its own food and live
on their own
REMEMBER THAT:
● All communicable diseases are infectious
Smallest is about 0.4
● Not all infectious diseases are communicable
micron in diameter
● An infectious disease is contagious when it spreads through
direct, bodily contact with infected person, their discharges, or an
Localized → confined to a
object surface they’ve contaminated
body part

QUESTIONS: VIRUS Smallest microbe (size Hepatitis, Herpes,

When isolating a patient with communicable disease, this information will ranges from 0.02-0.24 HIV, Chicken pox,
be the most helpful as a basis for determining the period of isolation: micron) Measles, COVID 19
a. Presenting signs and symptom
b. Mode of transmission Non-living organism →
c. Patient’s social status dependent on host
d. Virulence of causative agent
Consists of genetic material
Answer/ Rationale: A. Presenting Signs and Symptoms (DNA or RNA)
A. YES → Before you isolate, there must be signs and
symptoms. Systemic → viruses infect
B. NO → vector is not a basis for isolation the whole cell and multiply
C. NO by thousands
D. NO → regardless of the virulence, if you don’t have sx, you
don’t have to isolate
PROTOZOA One celled microorganism Malaria, Amoeba,
Toxoplasmosis
The nurse is preparing to change the dressing of a client’s wound. The
statement that best explains the basis of surgical asepsis that the nurse
will follow this procedure is: FUNGI Decomposer Candida Albicans,
a. Confine the microorganisms in the wound Tinea Pedis
b. Keeps the area free of pathogenic microorganisms

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 [2] RESERVOIR scratches, transplacental
● Any person, plant, animal, substance, or location that provides ● INDIRECT CONTACT
nourishment for microorganisms and enables further dispersal of ○ Through fomites
the organisms ■ Inanimate objects that came into contact
● Source of microorganism with bodily fluids with the pathogens
● Human reservoir is the most common ○ Examples: stethoscope, utensils that are not washed
○ Carrier: infected person properly, cellphones, linens, toys
○ Endogenous: self-infection ■ Enclose the contaminated part of linens
● Animal with the uncontaminated linens
○ Rodent: leptospirosis ■ Avoid fanning of linens
○ Cattle: anthrax ■ Fold linens or clothing inside out
○ Cat/dog: rabies ● DROPLET TRANSMISSION
○ Poultry: bird’s flu ○ Droplet nuclei ≥ 5 microns in diameter
○ Swine: ASF ■ Pertains to bigger droplets that can be
● Insect transmitted thru close contact or landed in
○ Vectors: flies and mosquitoes fomites
● Fomites ■ Droplet precaution
○ Vehicles: water, food, blood, surgical instruments ○ It will reach 1 meter away from source
■ If person is within an infected person’s 1
HUMAN RESERVOIR meter distance they are considered “close
contact”
● Most common reservoir ○ Spread through exhaling, coughing, sneezing, talking
● Asymptomatic carriers humans infected but no symptoms are
capable of transmitting the pathogen
VEHICLE TRANSMISSION
● Incubatory carriers are those that can transmit agent during
incubation period ● AIRBORNE TRANSMISSION
● Convalescent carriers those who have recovered but are still ○ Air as vehicle
capable of transmitting; they had s/sx ○ Microorganism is transported through tiny droplets
● Chronic carriers those who continue to harbor pathogens for life ○ Droplet nuclei ≤ 5 microns in diameter
(ex. Hep B, salmonella typhi) ○ Dust (because it is very light and can be swept away
● Symptomatic persons have the s/sx but are less likely to with the wind), inside droplets
transmit because they know they are sick ○ Mode of Transmission (MOT): sneezing, coughing,
AC systems, sweeping, mopping, changing clothes or
ANIMAL RESERVOIR bed linens, etc.
■ Do not fan linens as to not introduce
● Zoonoses – transmissible from animals to humans like cows, pathogens into the air
pigs, rodents, dogs, etc. which can be carriers of certain ● FOOD/ WATER BORNE TRANSMISSION
microorganisms ○ Contamination
● Zoonotic diseases in which microorganisms are transferred from ■ Contaminated food = infecting
animal to human beings microorganism can be transferred to the
● Example: Rabies, encephalitis transmitted by birds; Avian person who will eat it
influenza, ebola virus, MERS-COV, COVID-19, SARS ■ May come from person who did not wash
hands after using toilet
ENVIRONMENTAL RESERVOIR ■ Infected feces can produce droplet nuclei
when flushed and adhere to hands
● From soil, water, plants (ex. clostridium tetani which are found in
○ Water as reservoir
soil, legionella which can be traced to water supplies)
○ 5F’s that can be vehicle in the food/ water-borne
● Example: Tetanus from contaminated soil, contaminated water
transmission:
that may contain the sources of infection
■ Food/ fluid
■ Flies
[3] PORTAL OF EXIT
■ Fingers
● An exit route for the pathogen to escape its reservoir: urine, vomit,
■ Feces
sputum, blood, feces, and airborne route
■ Fomites
● Through normal opening in the body, from breaks of skin of the
infected person
● Portal of exit is usually the same with portal of entry but not all the VECTOR TRANSMISSION
time ● Biological Vectors
● Common portal of exit: different openings in the body (GU, GI, ○ Biting arthropods (most common; mosquitoes, ticks,
respi) bloodsucking flies, fleas, lice, bugs, mites)
○ For GI infections, portal of exit is from lower GI tract ● Mechanical vectors
while the portal of entry is the upper GI tract ○ Houseflies and cockroaches
● Ex: Punctures that came from vectors/ animal vehicles ■ They do not contain the microorganism but
○ Portal of exit from infected animal is different from transports the microorganism from source
portal of entry of humans to another
○ Ex: Rabies → animal’s portal of exit is thru the saliva
while the human’s portal of entry is thru bites or [5] PORTAL OF ENTRY
opening of skin ● An organism’s access into the host
● Can be managed thru hand hygiene, control of excretions and ● Most of the time the portal of entry is the portal of exit
secretions, and trash and waste disposal ○ Inoculation: openings in patient’s skin created by
○ If it came from respiratory secretions, we have to injections
always observe proper respiratory isolation ○ Inhalation: droplets and aerosols
○ Tell pt to properly dispose respiratory secretions and ○ Ingestion
abt coughing and sneezing etiquette ● Specific organisms may require specific portals of entry (ex.
tuberculosis)
[4] MODE OF TRANSMISSION ● Example: Lesions found in varicella infections - portal of entry is
● HORIZONTAL TRANSMISSION through respiration but portal of exit is through the fluids from
○ Usually person to person patient’s lesions
○ Direct, Indirect Break in the skin ● Example: Fecal-oral transmission - portal of entry is the mouth
while portal of exit is through the feces
● VERTICAL TRANSMISSION
○ Mother to fetus transmission or placental transmission [6] SUSCEPTIBLE HOST
● Any human who can get the disease
CONTACT TRANSMISSION ● Susceptibility of a host depends on genetic or constitutional
factors, specific immunity, and nonspecific factors that affect an
● DIRECT CONTACT
individual’s ability to resist infection or to limit pathogenicity
○ Touching, kissing, sexual intercourse, bites or

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 ● Those who are immunocompromised are more susceptible to
acquiring an infection ● Pathogenicity - ability to cause a disease
● **Very YOW → young, old, weak ● Virulence - degree of pathogenicity or degree to cause a disease
● Model 1 - model that shows equal participation of the 3 characters
BREAK THE CHAIN ● Model 2 - considers pathogenicity

Universal Precautions (old name) → Standard Precautions IMMUNITY

1. Hand hygiene ● Immune system:
2. Correct use of PPE → depends on MOT ○ Functions as the body’s defense mechanism against
3. Control of environment invasion and allows a rapid response to foreign
substances in a specific manner
MODE OF ● Hand hygiene (most effective) ○ To remove foreign microorganisms from the body
TRANSMISSIO ● PPEs (serves as barriers to protect the person) ○ Healthier state has more ability to fight antigens
N (weakest link ○ Gloves and gown usually come together ● How to strengthen your immune system
in the chain) for contact precaution ○ Take vitamins
○ Mask for respiratory droplets (may be ○ Adequate sleep
surgical, N95 mask for airborne) ○ Immunization
○ Visors and aprons for splashes ○ Eat healthy food
● Environmental Control ○ Proper hygiene
○ Decontamination: should be done ○ Regular exercise
regularly; no borrowing if already used by ○ Adequate fluids
one patient; management of blood and ● Immune response
bodily fluid spillages ○ The coordinated response of the components of the
○ [Respiratory] Isolation / respiratory immune systems to a foreign agent or organism.
hygiene: there should be an appropriate ○ When you feel like you're having fever or too tired →
container where articles with respiratory immune response after duty
secretions are disposed of (sealed plastic ○ Do not let it further weaken
container; thrown in yellow bin); do hand ○ When you feel these, it means pathogens have
hygiene after invaded → body responds through different
○ Safe disposal of needles and sharps manifestations (means our immune system is working)
○ Managing splash injuries ○ Once we are exposed to an antigen, the body will
○ Safe disposal of hospital waste: properly react to the possible foreign substance that may have
disposing in respective bins entered the body
○ Cohorting: one common room for those
with the same infectious agent, disease, BODY DEFENSES
age, gender, phase or stage (do not mix ● Immune system removes foreign antigens such as viruses and
recovered with active) bacteria in order to maintain homeostasis
○ Airflow control: there should be good
ventilation in a room. INNATE IMMUNITY
○ Health ● External physical and chemical barriers provided by the skin and
○ Sterilization of equipment mucous membranes (first 2 lines of defense)
○ Proper aseptic technique ● Present at birth; also known as natural immunity
○ Recognition of high risk individuals
FIRST LINE: External physical barriers
INFECTIOUS ● Rapid accurate identification of organisms ● Skin and mucous membranes
AGENT ● Examples: skin and mucous membranes that line our normal
opening of the body such as respiratory, GI, urinary, and
reproductive tracts
RESERVOIR ● We have to keep ourselves healthy for our
● Any break in the first line of defense can be a very good entry of
immune system to fight infection
microorganisms
● Environmental sanitation
● Disinfection/ Sterilization
SECOND LINE: Internal physical barriers
● Internal, composed of protective cells, bloodborne chemicals, and
PORTAL OF ● Hand hygiene
processes that inactivate or kill invaders
EXIT ● Proper disposal of excreta, trash and other
○ There are no external barriers here
wastes
● Refers to phagocytes, chemicals, and inflammation processes
(fever and inflammation)
PORTAL OF ● Aseptic technique
ENTRY ● Catheter care, wound care ADAPTIVE IMMUNITY
● Avoid transmitting microorganism to the ● Third line of defenses
susceptible host ● Involves B and T lymphocytes
● Refers to our cells (lymphocytes) which responds to unique
SUSCEPTIBLE ● Treatment of the underlying diseases, species and strains of pathogens → alters body defenses and act
HOST ● Recognition of high-risk patients to protect them more effectively in subsequent infections
from acquiring the condition ● Happens after interaction, illness, or exposure

5 MOMENTS ● Before a procedure CELL B CELL T CELL

OF HAND ● Before touching the pt
WASHING ● After touching the pt
ORIGIN Stem cell in bone marrow Stem cell in red bone
● After coming in contact with the pt’s environment
marrow
● After touching or coming in contact with body’s
fluid
GROWTH Bone marrow Thymus gland
COMPLETION
EPIDEMIOLOGICAL TRIAD
● High agent pathogenicity and low host immunity = disease
OTHER Plasma Cell → mature B CD4/Helper T Cell
NAMES cell that produces CD8/Cytotoxic T
immunoglobulins Cell

*T cells determine
the level of
immunodeficiency
of the patient

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 TYPES OF IMMUNE RESPONSES
FUNCTION Humoral Cell mediated ● The phagocytic immune response: primarily involves the WBCs
immunoglobulins → work immunity: works (granulocytes and macrophages)
against extracellular against ○ Responds when there is an invasion of foreign bodies
pathogens intracellular ○ Diagnosis: CBC (to check WBC), Differential count to
pathogens determine if bacterial/ viral infection
■ Inc. neutrophils → bacterial infection
■ Inc. lymphocytes → viral infection
● HUMORAL IMMUNITY/ ANTIBODY IMMUNE RESPONSE
LYMPHOCYTES INVOLVED IN IMMUNE RESPONSE ○ Antibodies are formed by B lymphocytes
○ Transform themselves into plasma cells that
manufacture antibodies
TYPE OF CELL TYPE FUNCTION ○ Both macrophages of natural immunity and the special
IMMUNE lymphocytes of cellular immunity are involved in
RESPONSE antigen recognition
● CELL-MEDIATED IMMUNITY
○ This also involves the T lymphocytes, which can turn
PHAGOCYTIC into special or killer T cells that can attack the
pathogens
HUMORAL B lymphocyte Produces antibodies or
immunoglobulins (IgA, IgD,
IgE, IgG, IgM)

NONSPECIFIC Non-T or non-B

lymphocyte

Null cell Destroys antigens already

coated with antibody

Natural Killer Defends against

(NK) cell microorganisms and some
(granular types of malignant cells;
lymphocyte) produces cytokines

ACQUIRED IMMUNITY
● Immunity that develops during a person’s lifetime
● ACTIVE IMMUNITY
○ Develops in response to an infection or vaccination
○ Natural: antibodies developed in response to an
CELLULAR T Lymphocyte infection
○ Artificial: antibodies developed in response to a
Helper T Attacks foreign invaders vaccination
● PASSIVE IMMUNITY
(antigens) directly
○ Develops after you receive antibodies from someone
or somewhere else
Initiates and augments ○ Natural: Antibodies received from mother (e.g.
inflammatory response through breast milk)
○ Artificial: antibodies received from a medicine, from a
gamma globulin injections or infusion

Helper T1 Increases activated cytotoxic

T cells

Helper T2 Increases B cell antibody

production

Suppressor T Suppresses the immune

response

Memory T Remembers contact with an

antigen and on subsequent
exposures mounts an immune
response

Cytotoxic T (killer Lyses cells infected with virus;

T) plays a role in graft rejection

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 IgD ● Appears in small amounts of
(0.2% of Total serum
Immunoglobulin) ● Possibly influences
B-lymphocyte differentiation,
but role is unclear

IgE ● Appears in serum

(0.004% of Total ● Takes part in allergic and
Immunoglobulin) some hypersensitivity
reactions
● Combats parasitic infections

GENERAL NURSING CARE

PREVENTIVE
● Immunization
VACCINES
● Environmental sanitation
ACTIVE PASSIVE
CONTROL
● From weakened toxins ● Provide high titer of ● Isolation
or microorganisms antibodies ● Disinfestation → parasites and helminths (different from
● Stimulate antibody ● Provide treatment disinfection)
production ● Immediate effect but ● Fumigation
● Will take effect from 4-7 short lived ● Medical and surgical asepsis
days ● Barrier precaution (PPE)
● Placarding or putting signages
BCG, OPV, DPT, AMV, MMR, TT, Immunoglobulins (Tetanus ISOLATION PRECAUTION
PTD, PCV, Anti rabies, Vari Vx, immunoglobulin)
HPV, Covid vaccines ● Determine the mode of transmission in order to know what
isolation precaution is to be applied
● Universal Precaution (1981)
● Types of Isolation:
IMMUNOGLOBULINS ○ Direct/ Source Isolation: the sick individual can infect
other people which is why he is isolated
IgG ● Appears in serum and tissues ○ Reverse/ Protective Isolation: protecting sick/
(75% of Total (interstitial fluid) immunocompromised individuals from getting infected
Immunoglobulin) ● Assumes major role in ● Standard Precaution
bloodborne and tissue ○ Blood and all body fluids
○ Non-intact skin
**To remember: G- g na infections
○ Mucus membrane
kasi chronic na, umabot na ● Activates the complement ○ Example: BPH (barrier method, percutaneous
placenta system exposure, hand washing)
● Enhances phagocytosis ● Transmission-based
● Crosses the placenta ○ Airborne precaution → all PPEs + N95 respirator
● In chronic infections masks (head should be covered)
■ Must be isolated; from the farthest room in
● Seen in the late stage of a
the ward
disease ○ Droplet precaution → distance, gown, gloves, mask
(surgical)
IgA ● Appears in body fluids (blood, ■ May be cohorted, provided that there is a
distance of 1 meter from one pt to another
(15% of Total saliva, tears, breast milk, and
○ Contact precautions → gown, gloves
Immunoglobulin) pulmonary, gastrointestinal, ■ May be cohorted but we have to observe
prostatic, and vaginal wearing of gown and gloves
secretions)
● Protects against respiratory,
DISEASE-SPECIFIC ISOLATION RECOMMENDATIONS
gastrointestinal, and
genitourinary infections
STANDARD ● CMV
● Prevents absorption of PRECAUTIONS ● HIV
antigens from food ● Hepatitis B and C
● Passes to neonate in breast ● Aspergillosis
milk for protection
DROPLET ● Pertussis
IgM ● Appears mostly in PRECAUTIONS ● Influenza A or B
● MRSA
(10% of Total intravascular serum
● Neissera meningitidis (suspected or confirmed)
Immunoglobulin) ● Appears as the first ● Coxsackie
immunoglobulin produced in ● Bacterial meningitis (for 24 hours after effective
**To remember: M-aaga response to bacterial and antibiotic therapy)
(early stage of disease) viral infections ● RSV (droplet or contact)
● Mumps
● Activates the complement
● Rubella
system
● Usually in the acute stage of
CONTACT ● MRSA (mask if respiratory infections)
infections PRECAUTIONS ● VRE
● Early stages of a disease ● Adenovirus
● Diarrhea

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 ● C. difficile health center.
● Rotavirus
● E. coli 0157
● Enterovirus The mother of an infant who received the measles vaccine 3 days ago
● Salmonella came back to the health center because of fever and rashes that she
● Shingles observed in her baby. Which of the following actions will the nurse
● Hepatitis A undertake to approach the situation?
● Herpes Zoster (shingles, localized) a. Instruct the mother to bring the infant to the clinic to further
● Herpes simplex assess the condition
● Parainfluenza (mask if coughing) b. Give paracetamol drop and repeat every 4 hours, and
● RSV (mask if productive cough) reassess temperature
● Lice c. Refer the infant to the doctor for ATB therapy
● Scabies d. Teach the mother how to provide tepid sponge bath
● Chicken pox (symptomatic, until all lesions are
crusted and dried) Answer/ Rationale: D. Teach the mother how to provide tepid sponge
bath
AIRBORNE ● Chicken pox
PRECAUTIONS ● Measles A. NO → normal side effect within 3 days after vaccination
● Disseminated herpes zoster (Shingles) B. NO → Paracetamol PRN, not q 4 hrs
● N95 MASK C. NO → normal side effect within 3 days after vaccination
→ Tuberculosis
→ SARS
→ Avian Influenza Nurse is assigned to care for 4 clients. Nurse implements which of the
following to prevent the spread of infection from client to client?
a. Reads about performing treatments in the policy and
procedure manual
QUESTIONS: b. Use proper hand washing techniques when necessary
The principles of vaccine administration are stated in the following, c. Performs sterile technique will all procedures
except: d. Use clean technique with all procedures
a. Do not vaccinate if the child has been on chemotherapy
b. The risk of side effects from the vaccine is significantly less Answer/ Rationale: B. Use proper hand washing techniques when
than the side effects of the disease itself necessary
c. Divided doses decrease the risk of side effects
d. A pregnant woman can receive an MMR vaccine → Not all procedures can be done thru sterile technique, and not all
procedures can be done thru clean technique. Thus, handwashing is the
Answer/ Rationale: D. A pregnant woman can receive MMR vaccine best answer.

→ Rubella is fatal to the fetus and may cause fetal abnormalities

Use of gowns in isolation is important for the following reasons:
Before the administration of the Pentavalent vaccine, which of the 1. Prevent contact with infectious microorganisms that could
following considerations should be taken? have exited from the patient
a. There is increased risk of neurologic reactions in the 2. To protect a patent whose immune system is inadequate
administration of Pentavalent beyond 6 years of age 3. To protect the clothing from getting soiled while administering
b. Pentavalent may be given at 6 months or at 2 years of age patient care
c. Administration of vaccine earlier than 10 weeks is not effective 4. To prevent clothing from droplet nuclei
d. None of these a. 1, 2, 3
b. 1, 2, 4
Answer/ Rationale: A. There is increased risk of neurologic reactions in c. 2, 3, 4
the administration of Pentavalent beyond 6 years of age d. 1, 2, 3, 4

→ Pentavalent (Diphtheria, pertussis, tetanus, HIB, Hepa B) Answer/ Rationale: D. All of the above
Among these, pertussis increases the risk for neurological reactions,
which is why it is important for a child to complete PentaHIB before 6 yrs.
PentaHIB is ideally given at 6,10,14 wks but can still be given at 2 yrs Nurse is preparing to leave a client’s room and must remove her gown,
mask, and gloves before leaving the room. Which of the following actions
Jocelyn is a 28-year old G1P0 patient who came into the clinic. Her by the nurse could lead to the spread of infections?
prenatal antibody titer shows that she is not immune to rubella and will a. Using ungloved hands, removes the gown through the
receive the immunization after delivery. You would include which of the neckties
following instructions in your teaching plan? b. Washes the hands after the entire procedure is completed
a. Another immunization should be administered in the next c. Takes the gloves off first before removing the gown
pregnancy d. While removing the gown, avoids rolling it from inside out
b. Breastfeeding should be postponed for 5 days after the
injection → not a contraindication to vaccination Answer/ Rationale: D. While removing the gown, avoids rolling it from
c. An injection will be needed after each succeeding pregnancy inside out → should be rolled inside out because if not, the contaminated
d. Pregnancy must be avoided for the next 3 months part will be exposed, thus increased risk for infections

Answer/ Rationale: D. Pregnancy must be avoided for the next 3 months

Marifer is on her 3rd trimester of pregnancy and is worried that she might The CDC guidelines for universal precautions include the ff except:
acquire her daughter’s rubella infection. The nurse should do which of the a. Gloves worn for touching all blood and body fluids
following? b. Gloves worn for performing venipuncture
a. Explain to her the importance of prenatal check up c. Gloves change every after contact with a client
b. Tell the mother that nothing can be done about the situation, d. Gloves worn at all times when coming in contact with the
just pray that the fetus will not be affected infected individual
c. Inform the mother that is a German measles that can cause
deformities on the first trimester of pregnancy and not measles Answer/ Rationale: D. Gloves worn at all times when coming in contact
d. Discuss the importance of receiving gamma globulin as with the infected individual → gloves are not always required especially if
prophylaxis it doesn’t involve blood and body fluids

Answer/ Rationale: D. Discuss the importance of receiving gamma

globulin as prophylaxis The nurse has provided an in service presentation to ancillary staff
members about standard precautions in the birthing unit. The nurse
→ Pregnant woman exposed to rubella must receive gamma globulin. determines that one of the staff needs further instructions when the nurse
This is done through her obstetrician/ attending physician and not in the observes which of the ff?

7 4NUR7-2022 RN / CROSS CHECKED BY KKS

 a. Placement of bloody sheets in a container designated for COMMUNICABLE DISEASES
contaminated linens SYSTEM - BASED
b. Use of protective goggles during a cesarean section ● CNS infections
c. Wearing sterile gloves to bathe a newly delivered neonate 1 ● Respiratory infections
hour of age ● GI infections
d. Disposal of syringe in a puncture resistant container ● Diseases affecting the integumentary system (eruptive fever
disease)
Answer/ Rationale: C. Wearing sterile gloves to bathe a newly delivered
neonate 1 hour of age TRANSMISSION - BASED
● Vector - borne disease
● Sexually transmitted infections
When a health worker is washing his hands, which of the following ● Reemerging and emerging infections
observations made by the nurse would indicate that he understands the
principles of hand washing? DISEASES AFFECTING CNS
a. Removes ring before washing ● Tetanus
b. Washes hands for 5 secs ● Meningitis
c. Rinses hands with fingers pointed up ● Encephalitis
d. Washes hands prior to removing gloves ● Poliomyelitis
● Rabies
Answer/ Rationale: A. Removes ring before washing
[1] TETANUS (LOCKJAW)
● B → NO. Handwashing must be done for 20-30 seconds
● C → NO. This is done for surgical handwashing because the
elbow is considered the dirtiest part. But in medical
handwashing, fingers must be pointed down because the
fingertips are the dirtiest.
● D → NO. Not included in the principles of medical
handwashing

Home health nurse visits a client suspected of having scabies, which of

the following precautions will the nurse institute during the assessment of
the client?
a. Wear a gown and gloves
b. Avoid touching the furniture in the house
c. Wear gloves only
d. Wear mask and gloves

Answer/ Rationale: A. Wear a gown and gloves

→ Gown and gloves for contact precautions. Gown is worn to protect
one’s clothing from being contaminated by the surroundings.

Most suitable room in the home for isolation of a 3 year old child with
measles is:
a. Room next to the bathroom
b. Children’s room with twin beds
c. Well ventilated, sunny parents room
d. Playroom on the second floor

Answer/ Rationale: D. Playroom on the second floor CAUSATIVE AGENT

● Clostridium Tetani
→ Measles is airborne so the child must not be in contact with anyone ● Anaerobic
except for the caregiver ● Gram positive
● Produces potent exotoxin agent
FOUR STAGES OF INFECTIOUS DISEASE ○ Tetanuspasmin → responsible for muscle spasm
● INCUBATION PERIOD – from time of entry of pathogen to onset ■ Attacks the myoneural junction to the
of s/sx internusial of the spinal cord until to the
○ Happens after the person’s exposure to the brain
pathogenic microorganism from an infected person or ■ The brain will now stop by relaxing the
animal adjacent muscle
○ Contact with microorganism but no signs and ■ But as long as the toxins are present,
symptoms yet spasm will continue
● PRODROMAL PERIOD – early and non specific symptoms, occur ○ Tetanolysin → responsible for RBC destruction,
like flu like symptoms causing the pt to be anemic
○ General signs and symptoms: fever, body pain,
headache, malaise, sore throat, mild respiratory INCUBATION PERIOD
symptoms ● 3 to 21 days (average: 7-14 days)
● PERIOD OF CLINICAL ILLNESS – shows characteristic ○ Before the s/sx appear
symptoms; has different stages but depends on the diseases
○ Specific sx and symptoms SOURCES OF INFECTION
○ Ex: Acute stages, icteric, anicteric stages ● Sources of infection: animal and human feces; soil and dust;
● CONVALESCENCE PERIOD – recovery stage if pt has good unsterile sutures, pins, scissors, rusty materials; firecrackers
prognosis ○ Rust: It’s not the rust itself that causes the disease,
○ Period of restoration of health but the bacteria inside the rust
○ Firecracker injuries are common because of the
ingredients inside it such as animal feces (has the
capacity to inflate)
● Most common affected: Males since it is their environment of
work

8 4NUR7-2022 RN / CROSS CHECKED BY KKS

 MODE OF TRANSMISSION
● Through break in the skin contaminated by any of the above
sources
○ Tetanus neonatorum: tetanus of the newborn
because of unvaccinated mother → when the
umbilical cord is cut with unsterile tools, it enters the
unhealed umbilicus
● Not transmitted from person to person.
○ Saliva of the affected person contains the bacteria.

CLINICAL FEATURES OF TETANUS

CLASSIFICATION DESCRIPTION

GENERALIZED ● Most severe form

● Occurs from facial area and occurs in
descending manner
● Begins with trismus (spasms of muscle, jaw
and neck), stiffness of neck, difficulty in
swallowing, and rigidity of abdomen and
risus sardonicus (abnormal sustained
spasm of facial muscles that appears to
produce grinning), then proceeds to
generalized spasm and opisthotonos
● May have tonic clonic seizures and
autonomic instability

LOCALIZED ● Muscle rigidity limited to the site of spore

inoculation
● Involves muscle of the same anatomic area CLINICAL STAGING
● Numbness, paresthesia, and itchiness at the ● Clinical staging is done by comparing the incubation period and
site of injury comparing the time interval between the trismus and spasm

CEPHALIC ● Form of localized tetanus affecting cranial

nerves, often following a head injury INTERVAL BW
● Occurs from the facial area STAGE INCUBATION TRISMUS &
● Can lead to generalized tetanus later on PERIOD SPAMS PROGNOSIS

NEONATAL ● Generalized tetanus in newborns resulting I > 14 days (long) 7 days Good
from infection of the umbilical stump
● Happens because of poor aseptic technique II 7 - 14 days 4-6 days May progress to
in the birthing process of a mother who Stage 3
doesn’t have tetanus prophylaxis in
pregnancy
III < 7 days 3 days or less Poor
(short)
DIAGNOSIS
● Stage 3: severe form of tetanus; if no aggressive treatment, the
● Clinical observation with thorough history taking
patient will die within 72 hours
● Blood culture/CSF Analysis → determine presence of bacteria
● **To remember: Rubra (3 days) → Stage III, Serosa (4-6 days) →
● Clinical manifestations
Stage II, Alba (7 days) → Stage I
● Staging diagnosis of disease
● History of possible exposure to infection
TREATMENT MODALITIES
● Tetanus Prophylaxis within 24 hours
SIGNS AND SYMPTOMS
○ ATS/TIg, TT/DT/DPT
● Initial wound inflammation; tachycardia
■ ATS/ TIg → given in single dose
● Profuse sweating
■ TT → given with intervals (usually 3 doses)
● Increased muscle tone near the wound
to provide artificial active immunity
● Low grade fever; painful involuntary muscle contraction
○ Tetanus immunoglobulin (if pt is allergic or
hypersensitivity to anti tetanus serum)
PATHOGNOMONIC SIGNS (TRO) ○ To neutralize toxins
Seen in severe tetanus (Stage 3) ● Antibiotic therapy (Penicillin, Metronidazole)
○ To control infection that is an agent that helps in
anaerobic bacterias
● Trismus - muscles of the jaw, face, masseter, muscle going ○ Given in combination
down to the neck ○ Metronidazole is an antiprotozoal; given for parasites
● Risus Sardonicus - sardonic smile such as anaerobic microorganisms (usually in GI
● Opisthotonus - arching of back because of the spasms of the infections)
spine muscles; can happen in other CNS infections as well ○ Erythromycin and Tetracycline are other antibiotics
that can be given
● Muscle relaxant to decrease muscle rigidity and spasm
○ Diazepam → muscle relaxant, anti-convulsant, and
anxiolytic
○ Administration route:
■ IV bolus/ push every 8 hours depending
on the frequency of spasms
■ IV infusion/drip in severe forms; usually
in stage 3 tetanus
■ Oral muscle relaxant can also be given
for muscle spasms bc it can take a long
time for symptoms to completely disappear
● Methocarbamol (baclofen) or
myonid.
○ Nursing care: Maintain safety

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 ● Airway Management → priority management
○ This is because tetanus also affects respiratory micturate (bladder spasms), hunger,
muscles peristalsis involving borborygmi
○ Spasms of the diaphragm can occur, which can affect
the patient’s breathing EXTEROCEPTIVE ● Body’s perception
○ ET intubation or tracheostomy. STIMULI ● Stimulus arises from the external world
○ If emergency and can still insert ET, they will insert, which are picked up by the 5 senses
then transition to tracheostomy. ● Ex. bright lights, strong odors, noise in
○ If possible upon admission, especially for Stage 3, surroundings, touch, strong tastes like
tracheostomy connected to oxygen or a mechanical bitter, spicy
ventilator can be considered ● Avoid coming in contact with the patient’s
○ Maintain patency of these artificial airways by skin; cannot do continuous sponge baths
suctioning secretions (to prevent obstruction). for severe forms of tetanus
■ Pt may manifest muscle spasms.
■ PRN doses of diazepam may also be
prescribed if pt is experiencing muscle ● Prevent contractures and pressure sores.
spasms. ○ Turn the patient q2º to prevent sores.
● Nutrition and Elimination ● Watch out for urinary retention.
○ NGT or enteral feeding is initiated ○ From pt’s immobility
■ Since pt is drowsy due to continuous ○ Prone to UTI.
infusion of diazepam; thus pt is fed thru ● Provide optimum comfort measures by also minimizing
this stimulation to patients
○ Administering osterized feeding thru NGT ○ Quiet and calm room is implemented
○ Indwelling catheter for bladder emptying ● Clustered nursing care
○ Diapers may also be used ○ Example: patient is turned after diazepam is given
○ For bowel elimination, make sure that pt is not ○ Other interventions may be done as needed, but as
constipated thru laxatives so the stool of the patient is much as possible, they should be clustered together
not hard.
■ Laxative → Lactulose TETANUS PROPHYLAXIS
● Daily wound care on the site of injury ACTIVE VACCINE
● Physical therapy/ supportive psychotherapy ● Tetanus Toxoid (TT)
○ Part of rehab management ● Tetanus toxoid and adult diphtheria toxoid (Td)
○ Because of the different neurological effects ○ TD 0.5 mL IM deltoid of non - dominant arm
○ Child: developmental delays ■ TD1 - Day 0
○ Adults: residual neurologic signs and symptoms ■ TD2 - 4 to 8 weeks after Td1
PRIORITY NURSING DIAGNOSIS ■ TD3 - 6 to 12 months after Td2
● Altered nutrition: less than body requirement ● Tetanus toxoid and acellular pertussis (Tdap)
● Impaired Physical Mobility → bc of sedation and spasms
● Activity Intolerance Patient Teaching
● Sensory perceptual alteration ● Avoid massaging injection site
● Activity intolerance ● Manage low grade fever
● Sensory perceptual alteration
● Risk for infection/ injury PASSIVE VACCINE- we use serums/immunoglobulins
○ Risk of infection due to tubes and drains; other
● Tetanus Immunoglobulin (Tig)
infections from sites of injury
● Anti Tetanus serum (ATS)
○ Spasms may cause falls or other injuries
○ There should be ANST before administering this
● Knowledge deficit
● Done to inactivate the toxins
● HTIg (250 IU – IM)
NURSING CARE
● ATS (1500-5000 IU)
● Maintain adequate airway
○ Suctioning → make sure secretions are liquefied → so
patient nebulization before suctioning is a QUESTIONS:
collaborative management Mrs. Juris recently gave birth to a baby boy. She recalled taking care of a
● Maintain IV line for hydration, medication and emergency care as sick relative in San Lazaro though she underwent pre-natal check-ups and
needed received required doses of Tetanus Toxoid still she asked how to identify
○ If the pt has fever, the doctor might prescribe ORAL or beginning symptoms of tetanus neonatorum, which is:
IV a. Neonate will complain of low-lumbar backache
● Efficient wound care b. Neonate will stop sucking at about 5-7 days with tight mouth
● Minimize stimulation (prevent client from having spasm) that does not open
c. Neonate will be feverish with swollen eyelids
d. Stiffness of neck and muscular twitching will be noted
PIE STIMULI
Answer/ Rationale: B. Neonate will stop sucking at about 5-7 days with
PROPRIOCEPTIVE ● Physical exertion tight mouth that does not open
STIMULI ● Internal forces generated by the position or → First thing that the mother will notice is that she will stop sucking due to
movement of the body part spasms of the muscles of jaw and face, resulting in difficulty sucking.
● Voluntary movements that can trigger → C & D are the next symptoms that will happen after the spasm
spasm
● Ex: Coughing, reflex movements, limb
position against the force of gravity, The parents of a 10-month old who has developed signs of tetanus are
changing the pt’s positions concerned about how the disease will affect their child’s intellectual ability
● Make sure that the extremity shouldn’t to function in the future. The nurse can best respond that the child’s
voluntarily contract or move. Don’t let it intellectual functioning:
hang. a. Maybe damaged
● Make the patient feel comfortable b. Should remain intact
(positioning, etc.) c. May be temporarily retarded
d. Depends on the severity of complications
INTEROCEPTIVE ● Internal physical exertion
STIMULI ● Stimulus that arise from inside of the body, Answer/ Rationale: D. Depends on the severity of complications
which triggers spasms → Remember that tetanus has three stages and also different types of
● Ex. Straining, bowel movements, coughing, tetanus.
pain (headache, toothache, stomachache), The nurse caring for a child with symptoms of tetanus, responds to the
irritation, reflexes, emotional stress, urge to child’s parents request to assist with their daughter’s care by stating:
a. “You may talk but don’t touch her since it could cause

10 4NUR7-2022 RN / CROSS CHECKED BY KKS

 ● When meningitis already affects the blood; most fatal form of
uncontrolled seizures” disease and highly infectious
b. “I can’t understand you wanting help, but we must avoid all ● Rare disease that is manifested by patchy purpuric (purple) skin
unnecessary stimuli at this time” rashes
c. “Tell me more about you concerns we realize you must be ● Fulminant form: Waterhouse Friderichsen Syndrome; manifested
terribly upset and worried at this time” by severe form of hemorrhage in the patient
d. “We encourage you to speak to her and touch her even ● Can result to DIC that causes vascular collapse
though is unable to respond right now” ● Also known as Spotted fever
● Petechiae and ecchymosis
Answer/ Rationale: C. “Tell me more about you concerns we realize you ● Nuchal rigidity, Kernig’s sign, Brudzinski sign
must be terribly upset and worried at this time” ● Increased ICP → may cause herniation of the brain
○ Caused by the inflammation
→ The object of care in pt with tetanus is to avoid stimuli. Talking and ○ Symptoms in infants: Bulging fontanels, projectile
touching the pt may trigger spasms. vomiting
○ Symptoms in adults: Blurring of vision, altered
sensorium
She asked about immunizations against tetanus. The nurse explains that
the major benefit in using tetanus antitoxin is that is: MODE OF TRANSMISSION
a. Stimulates plasma cells directly ● (Direct) Droplet
b. Provides high titer of antibody ○ Measures more than or equal to 5 microns.
c. Provides immediate active immunity ○ Regular surgical mask is enough provided that
d. Provide long lasting passive immunity distance from the patient is maintained
■ If there are aerosol procedures that will
Answer/ Rationale: B. Provides high titer of antibody aerolize the droplet nuclei, it can reach as
→ Tetanus antitoxin/ Anti-Tetanus Serum (ATS)/ Tetanus immunoglobulin far as 1 meter
is different from Tetanus toxoid which is a vaccine
→ Tetanus antitoxin is an artificial passive that provides immunity for a INCUBATION PERIOD
short period of time (temporarily) as a form of treatment for the acute ● 2 - 10 days
onset of the disease. It is usually given together with tetanus toxoid.
→ Active immunity for vaccines takes 4-7 days for the body to produce [2.1] BACTERIAL MENINGITIS
antibodies. ● Primarily a disease of adults
● Community acquired disease is associated with 4 major
pathogens
[2] MENINGITIS (CEREBROSPINAL FEVER)
○ S. pneumoniae: most common
● Inflammation of the membrane that surrounds the brain and spinal
○ N. meningitidis: begins with colonization of the
cord (meninges)
nasopharynx
● Affects the Dura mater, Arachnoid mater (subarachnoid [CSF] and
■ Epidemics occur in crowded environments
Epidural space) and Pia Mater
○ L. monocytogenes occurs in neonates, pregnant
women, and immunocompromised patients
CAUSATIVE AGENTS
■ It is contracted by eating contaminated
● Viral
refrigerated foods
○ Commonly caused by Enterovirus
○ H. influenzae most common form of meningitis in
■ Causes Aseptic meningitis → meningitis
children
s/t childhood viral infections
● Neonates develop gram negative and group B streptococcus
○ Arboviruses (arthropod viruses - e.g. mosquito),
meningitis
○ Poliovirus (septic meningitis)
● Nosocomial meningitis is usually associated with neurosurgery
○ Measles virus
or placement of a ventriculostomy tube
○ Varicella-zoster virus,
○ It is caused by gram negative rods, staphylococcus
○ Cytomegalovirus (opportunistic) – common in
aureus, enterococci, S. epidermidis, B. subtilis, and
immunocompromised patients
corynebacterial
○ Adenovirus
○ Mumps virus
PATHOGENESIS OF BACTERIAL MENINGITIS
○ HSV
○ EBV → causes kissing disease/ infectious ● Starts with the colonization of the nasopharynx → invade to
mononucleosis bloodstream → leak into meninges
● Fungal ● Infectious organisms gain entry to the subarachnoid space
○ Cryptococcus neoformans (coming from excreta of and CSF:
birds) ○ Most commonly by high level prolonged bacteremia,
■ Opportunistic infections gaining entry through the cerebral vascular by
■ Rare form seen in immunocompromised adhering to endothelial cells
individuals ○ By nasopharyngeal spread through a CSF leak
● Bacterial caused by a cribriform plate defect or basilar skull
○ Haemophilus influenza B/ HIB (common in infants) fracture
■ Although its incidence has been reduced ○ Direct spread from a brain abscess or air sinus
due to the availability of the Hib vaccine infection
○ Neisseria meningitidis (common in adolescents) ○ Other possible causes:
■ Causes Meningococcemia ■ Otitis media can invade the blood and
○ Streptococcus hemoli cause brain abscess since it’s very near/
○ Streptococcus pneumoniae (common in adjacent to the brain
adolescents) ■ Sinus infection
■ Causes middle ear infection that is ■ Pulmonary infection → can cause TB
common among elderly meningitis
○ Staphylococcal meningitis that is secondary to skin ● Rapid growth occurs in the CSF because the blood brain barrier
infection blocks entry of immunoglobulins and complement
○ TB → TB meningitis ○ Bacteria pass thru but not the immunoglobulins → this
○ Pneumococcal is why infection occurs since there is no natural
● Other Causes: defense of the body
○ Chemical meningitis: Ingestion of poison or drugs, ● Inflammation damages the blood brain barrier, increasing
as well as injection of certain substances permeability, allowing entry of serum protein, and impairing
○ Can also be induced by the reaction of certain glucose transport
vaccines, as well as the specific pathogens ● Progressive cerebral edema → increased CSF pressure, and
decreased cerebral blood flow leading to irreversible ischemic
MENINGOCOCCEMIA damage
● May also cause encephalitis
● Neisseria Meningitidis

11 4NUR7-2022 RN / CROSS CHECKED BY KKS

DIAGNOSTIC RESULT OF BACTERIAL MENINGITIS ● Sinus arrhythmia
● CSF analysis ● Irritability
○ Cloudy CSF ● Delirium
○ Elevated protein ● Deep stupor, coma
○ Elevated WBC ● Vomiting (rare)
○ Decreased glucose

CLINICAL MANIFESTATIONS OF BACTERIAL MENINGITIS

● Upper respiratory or ear infection interrupted by the abrupt
onset fever and meningeal symptoms
○ Generalized, severe headache
○ Neck stiffness
○ Depression of mental status
○ Less commonly vomiting may be part of the
presentation
● Physical findings
○ Brudzinski (neck flexion) and Kernig (straight leg
raise) signs are insensitive; “head jolt” maneuver may
have higher sensitivity
○ Abnormal ear exam (S. pneumoniae or H. influenzae)
○ Pharyngeal erythema (N. meningitidis) DIAGNOSIS
○ Clear nasal discharge resulting from a CSF leak (S. ● Lumbar puncture
pneumoniae) ○ Procedure to obtain the CSF
○ Petechial or purpuric skin lesions most common with ■ Also check for pressure of the CSF →
N. meningitidis usually elevated pressure
○ Neurologic examination should look for focal findings ○ Findings:
and assess mental status ■ Yellowish CSF/ Cloudy/ Turbid
■ Increased CSF pressure
TREATMENT OF BACTERIAL MENINGITIS ○ Nursing Consideration:
● Antibiotics should be given within 60 minutes if bacterial ■ Pt is positioned in FOB for 6 hrs to prevent
meningitis is suspected spinal headache because of the sudden
● Blood samples for culture should be drawn and antibiotics given decrease of CSF flowing
before a CT scan is done ● CSF analysis
● Maximal doses of antibiotics must be given because of limited ○ Primary diagnostic test
passage through the blood brain barrier ○ Obtain 3 sets of specimen
● Give dexamethasone 30 minutes before antibiotics ○ Findings:
● Maintain ventilation, prevent increase in PaCO2, or decrease in ■ Elevated leukocyte
PaO2 ■ Elevated proteins
● Avoid hypotonic solutions and consider glycerol for increased CSF ■ Decreased/ no glucose
pressure ● CBC
● Antiseizure medications should be given after first seizure ● Culture and sensitivity (C&S) tests
○ Don’t give prophylaxis for seizure ○ To detect presence of causative agent
● Polymerase Chain Reaction (PCR)
[2.2] VIRAL MENINGITIS
PRIMARY CLINICAL MANIFESTATIONS: MEDICAL MANAGEMENT
● Headache and photophobia ● Antibiotic and anti-inflammatory
● Stiff neck ○ Should be immediately placed in ATB therapy after
● No loss of consciousness C&S
● Conjunctivitis ○ Used of broad spectrum ASAP
● Maculopapular rash ○ Antibiotics: Ampicillin, Cephalosporin in the form of
● Petechial rash Ceftriaxone, and Aminoglycosides (gentamicin)
○ Rashes are common in viral form of illnesses bc virus ■ After 24 hours of appropriate ATB, patient
causes systemic signs and symptoms can already be released from
precautionary measures such as droplet
SIGNS AND SYMPTOMS OF MENINGITIS precaution
○ Anti-inflammatory drugs: Dexamethasone,
Hydrocortisone (Corticosteroids) → can help relieve
HALLMARK SIGNS OF MENINGITIS the inflammation
■ Prednisone is not given since it causes
● Fever, severe headache fluid retention and does not cross the
● Nuchal rigidity (neck stiffness) blood brain barrier
● (+) Kernig’s sign ● Droplet precaution isolation
○ Droplet precaution may be stopped after 24 hrs of
appropriate ATB administration
Other signs: ○ If not yet 24 hrs, pt must still undergo droplet
● (+) Kernig’s sign precaution
○ Pt is positioned in supine with the hip and knee flexed ● Osmotic Diuresis (hyperosmolar agents)
to 90 degrees, then the examiner will extend it. When ○ Mannitol → decreases cerebral edema
there’s resistance, pain or inability to extend knee ○ It is better to administer mannitol via IV push/bolus
beyond 135 degrees → (+) kernig sign ○ Nursing responsibility:
○ **To remember: Kernig → Knee ■ Monitor BP & Strict I/O monitoring
● (+) Brudzinski’s sign ■ Easily crystallizes so it must be in a warm
○ Grasp pt’s head from behind, and place the other hand environment
on the pt’s chest. Then, gently flex the head bringing ■ Can cause hypotension
the chin towards the chest. If there is involuntary ■ Monitor levels of electrolytes (dependent
flexing of the hip and knee as we flex the head → (+) nursing action) bc we cannot order for
Brudzinski sign electrolyte test BUT what we can do is to
○ There is involuntary reflex of the knee to lessen the monitor pt for signs and symptoms of
stretch of the meninges electrolyte imbalance
○ **To remember: Brudzinski → Batok ● Anticonvulsants: not used for prophylaxis
● Photophobia ○ Phenytoin sodium (Dilantin)
● Diplopia (in some patients) ■ To reduce restless of patient
● Exaggerated deep tendon reflex
● Opisthotonus

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 ■ It can also easily crystallize since it is not
compatible with dextrose; thus they use A. NO → Streptococcus is common in adults
Diazepam B. YES
■ Administer in sandwich technique if using C. NO → Neisseria is common in adolescents and young adults;
dextrose cause of meningococcemia
■ Must only be given with PNSS
D. NO → Listeria is common in immunocompromised (hospital
acquired) and travelers; possible source from food
SANDWICH METHOD OF GIVING PHENYTOIN
WITH DEXTROSE The nurse knows that it is important to assess the child with meningitis for
signs of increased ICP. Along with the decrease in the LOC, the nurse
Turn off IVF with dextrose should be concerned with:
↓
a. RR of 24
Inject NSS
↓ b. PR of 90
Administer Phenytoin c. Temp of 36.9
↓ d. BP of 140/70
Inject NSS
↓ Answer/ Rationale: D. BP of 140/70
Continue IVF with dextrose
→ Signs of inc. ICP in children: HTN, projectile vomiting, headache
→ Signs of inc. ICP in infants: Irritability and bulging fontanel
This method is done to prevent crystallization of the
medication
[3] ENCEPHALITIS (BRAIN FEVER)
● OTHER NAME: Brain fever
○ Phenytoin may cause gingival hyperplasia if
● Acute inflammatory condition that affects the brain (encephalon)
administered orally
● Usually occurring as a complication or sequela to viral disease
■ Do gum massage to prevent this
CAUSATIVE AGENTS
NURSING MANAGEMENT
● HSV (Herpes Simplex Virus Type 1) : Most common in
● Assess neurological function, including the GCS
developed countries
● Maintain adequate nutrition and elimination
○ HSV-1: affects children and adults; more common than
○ Usually, the patient is on NGT due to decreased
HSV-2
sensorium
○ HSV-2: commonly affects infants
● Comfort measures
● Childhood viruses: measles virus, rubella, VZV
○ Rest, positioning, ROM exercises, diversional activity
○ Secondary infection from primary cause
● Symptomatic and supportive measures
○ Panencephalitis caused by measles virus
○ If patient is experiencing diplopia, provide safety
● Arbovirus (Arthropod borne virus)
○ Carried from one person to another thru arthropods
PREVENTION
such as wild birds, domestic fowls, mosquitoes
● Chemoprophylaxis (Rifampicin, Ciprofloxacin, Ceftriaxone)
○ Can also be transmitted by mosquitoes from genus
○ For bacterial infection (prophylaxis for exposed)
Culex
● Isolation (Isolate the patient)
● Epstein Barr Virus
○ Cohorting of the patients can be done
○ Passed from one person to another
○ Droplet precaution should be observed, especially if
● Protozoal (parasitic): Toxoplasmosis
ATB therapy has not yet been given for a period of 24
● Other bacterial infections that can lead to encephalitis (STIs,
hrs
etc…)
● Immunization (HIB in Pentavalent, PCV)
● Enteroviruses: Polioviruses, coxsackievirus, echovirus, and
● Proper coughing and sneezing etiquette
enterovirus 71
○ To prevent spread of infection
● Rabies virus → very difficult to diagnose d/t similarity of signs
and symptoms
COMPLICATIONS
● Retrovirus
● Progression to meningoencephalitis
● Increased ICP
TYPES/ CLASSIFICATION
● Subarachnoid hemorrhage or subdural/epidural hematoma
● Seizures or nonconvulsive status epilepticus
● Subdural empyema PRIMARY ● Affects the brain directly
● Antimicrobial treatment failure ENCEPHALITIS ● Commonly caused by arthropods/
arboviruses
● Causative agents:
QUESTIONS:
○ St. Louise, Japanese E,
A px with meningitis is said to be positive for the disease condition when Australian X, Equine
the nurse assessed all but one the following: (eastern and western)
a. Elevated WBC count in his CSF ● Mode of Transmission
b. Cannot bend his head ○ Mosquito bites: Aedes
c. Cannot extend his legs when his thighs are flexed Sollicitans, Culex
tritaeniorhynchus and
towards the abdomen → (+) Kernig’s
Culex Tarsalis
d. Px lower extremities involuntarily flex as the nurse bends ○ Tick of horses
his neck → (+) Brudzinski ○ Migratory birds
● (X) No need to use masks provided
Answer/ Rationale: A. Elevated WBC count in CSF that it has been diagnosed properly
that encephalitis comes from these
→ Nurse assessment involves physical assessment and not laboratory
arthropods
examinations

SECONDARY ● Complication of a previous infection

Most common cause of bacterial meningitis among young children is: ENCEPHALITIS (Vaccines: Antirabies)
a. Streptococcus pneumoniae ○ There is a primary infection
b. Haemophilus influenzae before encephalitis occurs
c. Neisseria meningitidis ● We have to use our masks depending
d. Listeria monocytogenes on the primary infection occurring
together with the encephalitis
○ E.g., if varicella is the
Answer/ Rationale: B. Haemophilus influenzae primary infection which is

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 transmitted via airborne

TOXIC ● Caused by metal poisoning (lead and

ENCEPHALITIS mercury)

[3.1] VIRAL ENCEPHALITIS

● 3 major categories
○ Mosquito borne (arbovirus)
○ Animal to human (rabies virus)
○ Human to human (HSV 1, mumps, measles, varicella,
human herpesvirus 6; less commonly, EBV,
cytomegalovirus, and enteroviruses
● Symptoms of cortical dysfunction are evident
○ Hallucinations, repetitive higher motor activity such as
dressing and undressing
○ Seizures
○ Severe headache
○ Ataxia
[4] POLIOMYELITIS
● Rabies causes distinct symptoms
● Also known as: Infantile paralysis, Acute flaccid paralysis,
○ Hydrophobia
Heine - Medin’s Disease
○ Rapid, short respirations
● Highly infectious viral disease that commonly affects children
○ Hyperactivity and autonomic dysfunction
○ Infantile paralysis (<10 y/o )
○ Ascending paralysis (less common)
○ Acute flaccid paralysis (soft, flabby and limp)
○ Organ donation can be a mode of transmission
● Can cause paralysis
● MOT: fecal - oral route; contaminated food and water source
SIGNS AND SYMPTOMS
● Behavioral changes (same as meningitis); lethargy
CAUSATIVE AGENTS
● Enterovirus Poliovirus (Legio Debilitans)
○ Filterable virus is a form of poliovirus

TYPES OF VIRUS
● Type I: Brunhilde: Permanent Immunity
● Type II: Lansing: temporary immunity
● Type III: Leon: temporary immunity

MODE OF TRANSMISSION
● Direct contact
● Ingestion
● First or early stage (1 - 4 days)
DIAGNOSTIC PROCEDURE ○ The microorganism could be contracted droplet
● Same as meningitis but all viral and electromyography (EMG) (direct) in the pharynx
● Often presumptive, requiring acute and convalescent serum ● Second stage (5 days onwards):
analysis ○ Feces in the GI
● CSF Analysis ○ Fecal oral route
○ Findings: ○ Contaminated food and water source
■ Low WBC (below 500 /mm3) ○ Person-to-person
■ Mild increase in protein ○ Indirect (contaminated articles) → identify vehicles
■ Possible RBC (in cases of HSV 1) that are possible agents
● PCR, culture ■ 5 F’S → fecal, flies (mechanical vector),
○ CSF culture is seldom positive foods/fluids, fingers, fomites
● CT or MRI scan
○ May show temporal lobe abnormalities INCUBATION PERIOD
● EEG ● Non paralytic: 3 - 6 days
○ Localized temporal lobe abnormalities ● Paralytic: 7 - 21 days
● Brain biopsy
○ Done if there is temporal lobe abnormality STAGES OF POLIOMYELITIS
STAGE 1: Invasive or Abortive stage
MANAGEMENT
● Disease may be healed at this time
● Medical management is symptomatic
● Sore throat (virus is seen in the nasopharynx), fever chills, body
● All patients with encephalitis should initially be treated with
malaise
Acyclovir for possible HSV 1 infection
○ Patients may feel it like tonsillitis only.
● Nursing management is the same as meningitis
● If nasopharynx in tonsils (sore throat, fever, chills, headache body
malaise, fatigue)
PREVENTION
● If mouth (fecal oral) to Peyer’s patches (ileum) of small intestine
● Eradicate source of infection (primary method of prevention)
(abdominal pain, N/V, anorexia, constipation)
● Manage the primary infection if it is a secondary encephalitis
● Avoid mosquito bites during epidemics (4’s)
STAGE 2: Pre - Paralytic Stage
○ Search and destroy breeding sites of mosquitoes
○ Self protection measures ● CNS involvement without paralysis
○ Stop indiscriminate fogging (only done during ● Cervical lymph nodes and mesenteric lymph nodes
outbreaks) ● Bloodstream reaching the CNS
○ Seek early consultation ○ Manifestation include severe muscle pain
● Wash wounds inflicted by rabies-infected animals ○ During this time, do not hold or turn the patient;
● Vaccination (MMR, polio, JE) instead, use warm compress or narcotic analgesics
● Give immune globulin and rabies vaccine (Codeine) through collaborative management
○ RIGS (Rabies Immune Globulin) ○ (X) Morphine and Nubain (narcotic analgesics) is not
○ Initial treatments used as this can cause respiratory distress
● Stiffness of the hamstring
● Hoyne’s sign (head drop)
● Poker sign (opisthotonus)
● Tripod position (head is retracted backwards)

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STAGE 3: Paralytic Stage ● Fatal viral zoonosis transmitted from the saliva of infected animals
● Involves the CNS with paralysis to humans
● After a long incubation period, patients develop an
3 SUBSTAGES encephalopathy followed by death
● Encephalopathic rabies is the classic and more common
● BULBAR: C: Cranial nerves (9th and 10th CN - glossopharyngeal presentation, notable for hydrophobia and spasms of the pharynx
and vagal nerves) that occur when the patient attempts to drink water
○ Least common
○ Dysphagia (difficulty swallowing), dysarthria (difficulty STATISTICS
in articulating words), dyspnea, pooling of oral ● A global concern:
secretion ○ Globally canine rabies causes approximately 59,000
● SPINAL: Anterior Horn Cell: Paralysis of the extremities and human deaths, over 3 million disability - adjusted life
external costal muscles years (DALYs) and 8.6 billion USD economic losses
○ Most common annually
○ Difficulty breathing ○ Largest component of the economic burden is due to
○ Can cause asymmetric weakness of the extremities premature death (55%), followed by direct cost of post
commonly affecting the lower extremities (can affect exposure prophylaxis (pep 20%) and lost of income
the upper extremities as well but it is more common on ■ 95% of rabies death occur in Asia and
the lower) Africa with the presence of 3 factors:
○ Deep tendon reflexes are diminished but the ■ (1) Poverty
sensations are intact ■ (2) Poor sanitation
○ More fatal than bulbar type ■ (3) Crowding
● BULBO - SPINAL: both CN and anterior horn cell ● Rabies in the Ph
○ All signs and symptoms will be elicited by the patient ○ Rabies is endemic in the Philippines and remains to
be a public health concern
DIAGNOSTIC EXAM ○ Bicol area, Calabarzon, Region XII
● Lumbar puncture: CSF, PCR, all viral ○ Fatality rate is almost 100%
● Throat washing: the first 4 days of the infection ■ Once there is already manifestations
● Stool exam: the 5th day onwards experienced by the pt
● Serology testing: detecting presence of antigen & antibodies ■ Most likely due to irresponsible pet
ownership
MEDICAL MANAGEMENT ○ 100% preventable - immunization
● Supportive ○ At least ⅓ of these deaths occur in children aged 15
● Iron lung machine (for spinal type) y/o and below.
○ Used for several months to years ■ Prone to be exposed to animals because
○ Some use it for the rest of their lives during polio era they tend to play with the animals.
○ Type of management used before that works on the Sometimes, they sustain bites, scratches
principle of negative pressure breathing; this will help without telling their parents
the patient breathe ○ Regions 3, 4-A, 5 and 12 (Bicol area, Calabarzon,
○ Problem lies on the nerves and muscles causing the Region XII) reported the greatest number of cases
paralysis from 2008 to 2018.
○ A chamber where the whole body of the patient is; the
head is the only part that is outside the chamber PATHOGENESIS
● Since polio is eradicated already, the medical management is now ● After inoculation, the rabies virus, multiplies in the muscle cells
focused to prevention (myocytes) or may invade the nerve directly without prior
multiplication in the myocytes
NURSING MANAGEMENT ● The virus then penetrates the peripheral nerve cells via viral
● Supportive care uptake at neuronal endings. The virus is transported through both
● Preventive MANAGEMENT: OPV and IPV the sensory and motor nerve fibers to the CNS
● Once the virus reaches the CNS, rabies replication occurs
**Since it is viral, there is no specific medication for the condition (antiviral) primarily in the neurons or brain cells through viral budding and
the virus spread and infects the nearby brain cells
[5] RABIES ● Rabies virus spreads into the peripheral tissues such as muscle
● Aka LyssaVirus, Hydrophobia or La Rage fibers, salivary glands, corneas, adrenal medulla, lacrimal glands,
○ Species: Most common (Canine like dogs and cats) myocardium, kidney, lungs, pancreas, epidermis
● Causative Agent: Rhabdovirus
○ Family of Rhabdoviridae PATHOPHYSIOLOGY
○ Also called as Lyssa virus ● Rabies virus is present in the saliva of animals from the few days
○ Bullet in shape before the display of clinical signs, throughout the clinical illness
○ Can easily be destroyed with a temperature of 60 until the animal dies or is euthanized
degrees celsius at 35 seconds ○ Can be transmitted to the site of the bite
● Mode of transmission: ● Rabies virus spreads out to the highly innervated tissues
○ Most common: bites from infected animals particularly in the salivary glands
○ Non-bite exposures ● Rabies virus undergoes further replication and dissemination to
■ Contamination of intact mucosa with saliva other neurons throughout the CNS
of infected animals ● Rabies virus, once in the brain spreads to:
■ Licks on broken skin ○ Cerebellum
■ Inhalation of aerosolized virus in closed ○ Hippocampus
areas ○ Medulla Oblongata
○ Rabies cannot be transmitted through food or ○ BUT spares the cerebral cortex hence, rabid patients
well-cooked dog meat unless you eat the animal raw present lucid intervals
(“kinilaw” in some cultures) ● Rabies virus inoculation and local replication occurs in
○ Dog meat should be cooked thoroughly because virus subcutaneous or muscle tissue and present as “itching, aching
might still be alive (NOT RECOMMENDED) and tingling” sensation
○ Corneal Transplant - if donor is rabid ● Rabies virus enters peripheral nerves and migrates up the nerve
● Human to human cases were through corneal as well as through to the spinal cord with speed of migration from 8 mm to 400
liver, kidney, and other organ transplants. The rabies virus is not mm/day
found in human or animal blood and feces ○ Average movement of virus: 3 mm per hour but still
● Casual contact such as touching/talking to a person with rabies or depends on the activity of the virus
contact with non-infectious fluid (blood, feces) ○ For patients who underwent corneal transplant
○ Does not constitute an exposure and does not require coming from a patient infected with rabies
post exposure prophylaxis encephalitis, movement of virus from the optic nerve is
○ Healthcare workers are given pre-exposure 12 mm per day
prophylaxis ● In vitro studies show that the velocity of axonal transport of the
virus is 25-50mm/ day (1-2 inches/ day)

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 ● Most characteristic symptom is spasm of the pharyngeal muscles
often triggered by an attempt to drink water (hydrophobia) or by
REMEMBER!! patient’s face (aerophobia)

● Should not kill the animal right away but observe by putting
them in a cage STAGES OF THE ACUTE NEUROLOGIC STATE
● Animal brain should be sent to the laboratory to check the
presence of Negri bodies (confirmatory that an animal is rabid) INVASIVE ● Microorganism invades the human
● Rabies once reached the brain (cerebellum, hippocampus, STAGE ● Itchiness, numbness or pain (either of the
medulla oblongata), the pt manifests s/sx already three)
● Flu-like symptoms
● Marked insomnia, restless, slight
INCUBATION PERIOD photosensitivity
● There are no signs and symptoms yet ○ Photosensitivity can be
● Rabies virus replicates in the muscle at bite site characterized by photophobia,
● Moves centripetally from periphery to dorsal root ganglia and which is a manifestation of the
spinal cord next stage; administer IM
● Usually 1 - 3 months; rarely > 1 year
● Length of IP affected by:
○ Infecting strain: lysa or rhabdovirus EXCITEMENT ● Aerophobia, hydrophobia, photophobia,
○ Size of inoculum: deep, penetrating, large or multiple STAGE maniacal behavior: same as a rabid
bites shorten the IP behavior
○ Amount of virus contained in the saliva: avoid ● Aerophobia: not necessarily fear of air but
inducing bleeding on the site of the bite as it will patient experiences difficulty or pain when
further inoculate the virus inside air comes in contact with the patient’s skin
○ Degree of innervation: more nerves surrounding the ○ Fanning test is done to
site of the bite (ex. hands) = easier to invade the target diagnose the presence of this
nerves symptom
○ Proximity to CNS: if in the facial or spinal area, it can ● In hydrophobia, every time the patient
shorten the IP swallows fluid, spasms of the pharynx and
● Compute date of bite versus date of onset of symptoms larynx occur that is painful for the patient
○ Range: 4 days to 10 years ○ Even the sound and sight of
○ 2.5% within 1 week, 16% within 1 month water can pharyngospasm
○ 76% within 3 months, 92% within 2 months laryngospasm, hydrophobia
○ 96% within 1 yr, 4% beyond 1 yr trigger
● For maniacal behavior: Haloperidol
SIGNS AND SYMPTOMS OF RABIES IN ANIMALS (haldol) + Benadryl is used to make the
patient calm
STAGE DESCRIPTION ○ This drug is a treatment of the
symptom, but not of the rabies
disease so this is only palliative
DUMB STAGE ● Personality is either depressed in one area
○ Haloperidol is an antipsychotic
(3-8 wks) or the animal will be overly affectionate
and benadryl is an
● Walks back and through and hyperactive
antihistamine with anxiolytic
(NOT BIPOLAR)
effect administered via IM with a
period of 46 hour-interval
FURIOUS ● Agitated, vicious look ■ Given IM bc IV is
STAGE ● Easily bites, drooling of saliva not anymore part of
(10-14 days) pt’s mgmt bc it is still
fluid
■ When they start IV
SIGNS AND SYMPTOMS OF RABIES IN HUMANS
infusion, they need
PRODROMAL STAGE
to cover the bottle in
● Last for 0 - 10 days with non-specific manifestations order for the patient
● Fever, sore throat, N/V, generalized body malaise, headache, abd to not see the fluids
pain inside
● Paresthesia or pain at the site of the bite ○ Lessens the risk of injury for
patient and other persons
ACUTE NEUROLOGIC STAGE ○ Diazepam and midazolam can
● Lasts 2 - 7 days also be given
● Neurologic or furious type (70-80%)
.
○ Hyperactivity, hypersalivation (pt tries to expel the
PARALYTIC STAGE
liquid that triggers spasms), disorientation,
hydrophobia, insomnia, confusion, paranoia anxiety, ● The final stage
agitation, hallucinations that progresses to coma and ● Complete paraplegia develops eventually with fatal paralysis of
death the respiratory and pharyngeal muscles
○ Also called encephalitic type ● (-) spasms, but paralysis will start from the toes to the head
● Paralytic or dumb type (20-30%) ○ Ascending paralysis will eventually be the cause of
○ Ascending flaccid paralysis, fever, confusion, coma, death of the pt
and death ○ May lead to cardiopulmonary arrest causing coma
● In acute neurologic stage, it happens in 2-7 days state and may lead to the patient's death
● Rabies virus infects brainstem, thalamus, basal ganglia and spinal ○ Outcome is usually death and recovery is very rare
cord
○ Autonomic manifestation such as hypersalivation (if DIAGNOSTIC EXAM
patient tries to swallow, it can trigger spasm of the ● Brain Biopsy
larynx and pharynx that causes hydrophobia), ○ Direct Fluorescent Antibody Test (DFA)
hyperactivity, disorientation, hallucinations, bizarre ■ Gold standard
behavior interspersed with lucid intervals, seizures, ○ Done in animals due to how invasive it is
nuchal rigidity, and paralysis eventually (for paralytic ● Serology
type) ● Histology
● Rabies virus travels centrifugally from brain to other organs ○ To determine negri bodies in the brain cells
● Once the patient manifest s/sx of hydrophobia, within 48 hrs, ● Polymerase-Chain Reaction (PCR)
patient dies ● Observation of Animal for 10-14 days
● Once it reaches the spinal cord → rabies virus infects brainstem, ○ Site/location of incidence/exposure, extent, and
thalamus, etc or once it reaches the CNS. reason

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 ○ Determine if there are cases of rabies in the area
where patient was bitten MANAGEMENT ● Wash wound immediately with soap
○ Determine if the animal was provoked or unprovoked and water for at least 10 minutes
when it bit the patient ● Start vaccine immediately
● Complete vaccination regimen until
NURSING MANAGEMENT day 7 (includes 3 doses)
● Supportive. symptomatic ● No RIG needed (only given in
● Dim and quiet environment category 3)
● Room should be away from sub utility room
○ Keep away from water RECOMMENDED POST - EXPOSURE
○ Patients should be admitted in a quiet, draft free, PROPHYLAXIS
isolation room (with grilled windows and doors that ● None, if reliable case history is
can be locked from outside) available
● Restraint before maniacal behavior ● Wound management and anti-
○ Restraint is part of medical management. rabies vaccine
○ Needs doctor’s orders ● Different forms: PVRV...
● Provision of comfort measures
● Use sedation
CATEGORY 3
● Avoid intubation and life support measures
● IV fluids may be given
TYPE OF CONTACT ● Transdermal bites (puncture
● Invasive and heroic procedures must be avoided (intubation,
wounds, lacerations, avulsions) or
mech vent, cutdown)
scratches) w spon. bleeding
● Emotional and physical support
● Licks on broken skin or mucous
● Discuss and provide important information to relatives concerning
membrane
transmission of diseases and indication for post exposure
● Exposure to a rabies patient through
prophylaxis of contacts
bites, contamination of mucous
● Honest gentle communication concerning prognosis should be
membranes (eyes, oral/ nasal
provided to the relatives
mucosa, genital/anal mucous
membrane) or open skin lesions
PREVENTION
with body fluids through splattering
● Be responsible pet owner
and mouth-to-mouth resuscitation
○ Anti - Rabies Act of 2007 (RA 9482)
● Unprotected handling of infected
■ Act for eliminating human rabies virus
carcass
■ Prescribing penalties for violation and
● Ingestion of raw infected meat
appropriate funding for pre and post
● Exposure to bats
exposure prophylaxis
● All category II exposures on head
■ Dog impoundment
and neck area
● Keep away from stray animals
● Keep animals caged or chained
TYPE OF ● Severe
CATEGORY OF BITE EXPOSURE
CATEGORY 1

TYPE OF ● Feeding/touching animal MANAGEMENT ● Wash wound with soap and water
CONTACT ● Licking of intact skin (with reliable ● Start the vaccine regimen
history and thorough physical ● Complete the vaccination regimen
examination) until Day 7 regardless of the status
● Exposure to patient with signs and of the biting animal
symptoms of rabies by sharing of ● Administer RIG immediately after
eating or drinking utensils vaccination against rabies
● Casual contact (talking to, visiting and
feeding suspected rabies cases) and RECOMMENDED POST - EXPOSURE
routine delivery of health care to PROPHYLAXIS
patient with signs and symptoms of ● Wound management
rabies ● Rabies immunoglobulin
● Anti-rabies vaccine
TYPE OF ● None
EXPOSURE
MANAGEMENT OF BITES
● Clinical history and physical examination
MANAGEMENT ● Wash exposed skin immediately with ● Determine vaccination status of the biting animal
soap and water ○ Given annually
● No vaccine or RIG needed ○ Can lessen risk of infection
● Pre-exposure prophylaxis may be ● Provoked versus unprovoked bites - determine the reason why
considered for high risk persons (those ○ Provoked - normal reaction of the animal; they are
with pets in the house, working in zoo, territorial
animal pounds, animal laboratories or ○ Unprovoked bites- something that you should be
slaughter houses) alert with; there could be abnormal behavior in biting
animal
■ Higher risk
CATEGORY 2
● Observation of biting animal
○ They are going to observe if there are effects on the
TYPE OF CONTACT ● Nibbling of uncovered skin without brain
bruising/hematoma ● Bite by wild animals
● Minor/superficial scratches/abrasion ○ Skunks, foxes, bats
without bleeding, including those ○ Always categorized as category 3
induced to bleed ● Bite by rodents
● All Category II exposures on the ○ No need for anti-rabies prophylaxis
head and neck area are considered
Category III and shall be managed WOUND MANAGEMENT
as such ● Physical
○ Prompt and gentle thorough washing with soap or
TYPE OF ● Minor detergent and flushing the wound with running water
EXPOSURE for 10 minutes
○ Mechanical removal of virus from the wound

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 ● Chemical
○ Promptly wash the wound with soap and water Note: Dosage depends on the weight of the patient
■ Wash the wound with running water-
minimum of 10 minutes PATIENT TEACHING
○ Apply disinfectant/ antiseptics to inactivate the virus ● Avoid hypoallergenic foods (Seafoods, poultry, fish, fermented
● Biological foods)
○ Infiltrate immunoglobulins in the depth and around the ● Avoid alcoholic beverages
wound in Category III exposures ● Do not massage injection site
○ Neutralization of the virus
● DONTS National Rabies Prevention and Control Program (RA 9482)
○ Touch the wound with bare hands ● Conditions for PH to be rabies free at year 2030
○ Apply irritants like soil, chilies, oil, herbs and betel ● Responsible pet ownership
leaves, etc.. ● Have your pet dog registered, vaccinated at 3 months old and
● Local infiltration of RIgs (Category III bites) yearly booster doses while dog is alive
● Suturing should be avoided as possible ● Do not allow your pet to roam the streets or any public place
○ Minimum loose sutures if needed without a leash
○ To prevent further inoculation of the virus ● Ensure your pets are properly fed and cared for
○ If suturing unavoidable = shall be delayed for at least 2 ● As the (pet) owner, you are responsible for your pet’s bite bite
hours after administration of RIG victim’s treatment and management, including all expenses to be
● Tetanus and antibiotic prophylaxis incurred for tx
○ Local and common infection ● Should your pet bite a victim, it is your responsibility to ensure that
○ Even though pt has no rabies, pt may be infected with your dog is properly confined during the 14 day observation
common bacterial infection which is tetanus ● It is also your responsibility to inform and consult the municipal
● Wounds may be capitated using sterile adhesive strips agricultural officer/municipal veterinarian/city veterinarian if your
● Ointment, cream, or wound dressing shall not be applied to the pet gets sick or died within the 14-day observation period for
bite site proper sample submission to designated laboratories for rabies
confirmatio
ACTIVE IMMUNIZATION
● PCEC (Purified chick embryo Cell ) - Rabipur 1ml/ vial
● PVRV (Purified Vero Cell Rabies Vaccine) - Verorab, Speeda QUESTIONS:
0.5ml/vial The following statements describe Rabies. Which is not a correct
● Route:
statement?
○ IM – ANST; used for those with chronic diseases or
comorbidities, immunocompromised, HIV, pregnant a. Characterized by formation of negri bodies in the brain cells
women b. Can be treated with anti rabies vaccine
■ Has 4 doses (Day 28-30 is optional) c. Manifestations are the same for man and animals
■ D0, D3, D7, D14, *D28-30 d. Once manifestations sets in, prognosis is poor
■ D0 (2)-D7(1) - D21 (1)
■ 1 vial/ dose
Answer/ Rationale: B. Can be treated with anti rabies vaccine
○ ID – 2 sites
■ D0, D3, D7, *D28-30 → No treatment for rabies; anti - rabies vaccine is only for prevention
■ 0.1mL/ site
■ First 3 doses are required While walking home, Mang Kanor was bitten by a dog. He is worried that
■ If no reliable assessment or history of the he might develop Rabies. The emergency treatment in this situation
biting animal is available or if the animal
includes which of the following?
died, 4th dose is administered (same with
IM injection) a. Kill the dog immediately
● Site: deltoid b. Go to the nearest hospital, health center for consultation
c. Wash the bitten part thoroughly with soap and water
d. File a complaint to the barangay office

Answer/ Rationale: C. Wash the bitten part thoroughly with soap and
water

All except one are nursing management of a patient with rabies:

a. The IV fluids should be openly positioned for accurate
monitoring of input
b. The patient should not be bathed
c. Concurrent and terminal disinfection are carried out
d. The room is be dimly light and minimized of noises

Answer/ Rationale: A. The IV fluids should be openly positioned for

PASSIVE IMMUNIZATION accurate monitoring of input
● Serum → Hydrophobia
○ ERIg (Equine Rabies Immunoglobulin) Equirab,
Favirab
■ Stock: 200 IU/ml in 5 mL Vial
■ Dosage: 40 IU/ KBW (0.2 mL/ KBW)
■ ANST prior to administration of ERIg
○ HRIg (Human Rabies Immunoglobulin)- Rabuman
■ Stock: 150 IU/ mL in 2 mL vial
■ 20 IU/KBW (0.33 mL/KBW)
● Route
○ IM – given between D0 to D7 (single dose)
■ After day 7, it is not recommended to be
given bc from day 0, pt has been given a
vaccine. We’re already expecting for it to
take effect at day 7, thus it is useless to
still give immunoglobulins after day 7
● Site: Vastus Lateralis
○ They usually administer half dosage for local
infiltration and half of the dosage for IM injection

18 4NUR7-2022 RN / CROSS CHECKED BY KKS

 DISEASES AFFECTING RESPIRATORY SYSTEM ○ Schick’s test
■ Determine immunity and susceptibility to
● Diphtheria
the bacteria)
● Pertussis
■ Traditional form of test
● Pneumonia
○ Moloney test
● Pulmonary TB
■ Determine hypersensitivity to diphtheria
toxins
[1] DIPHTHERIA (MEMBRANOUS CROUP)
■ Traditional form of test
● Pathognomonic sign: pseudomembrane
○ Could block the airway
○ Elek test /Virulence test/ Toxigenicity test
● Acute highly contagious bacterial disease of the upper respiratory
■ In the form of modified elek test
tract characterized by the inflammation and false membrane on
■ Provides accurate result in 16 hr
the throat, tonsils, pharynx, and larynx that hinders breathing and
incubation
swallowing
■ Tests toxigenicity of the bacteria
● Found in the throat, tonsillar area, pharynx & larynx that can
○ PCR Test
hinder the breathing of the patient
■ Can detect non-viable corynebacteria even
● The bacteria that produces diphtheria produces toxins
after ATB therapy
RISK FACTORS
**To remember: SEM for dx, pseudomembrane, bullneck, myocarditis
● Non - immunization
(complication) = diphtheria
● Poor socioeconomic conditions
● Travel history
MEDICAL MANAGEMENT
● Anti diphtheria Serum after ANST (-)
○ Serum: come from animal ; testing needs to be done
CAUSATIVE AGENT & MODE OF TRANSMISSION
● Antibiotics: Penicillin, Erythromycin
● CA: Corynebacterium diphtheria (Klebs-loeffler bacillus)
○ They named the disease after them (klebs- loeffler)
COMPLICATIONS
● MOT: Direct (droplet)
● Myocarditis
○ Droplet precaution should be employed
○ Most common complication and most fatal
○ N95 mask, gowns, gloves as PPE
○ When toxin damages the heart muscles, it can cause
○ Patients are placed in isolation rooms bc it is highly
fatal myocarditis
contagious
○ Very irregular pulse rate
● IP: 2-5 days
○ Marked facial pallor
○ Also produces exotoxins that causes potentially fatal
○ Hypotension
heart and nerve damage
○ Chest pain/epigastric pain
○ Damages the kidneys, liver and other organs
● Polyneuropathy
● Does not only affect the respiratory tract, but can also affect the
○ Nerves
skin and the mucus membranes
● Airway obstruction
● Can also be find in wound discharges (CUTANEOUS
○ Presence of pseudomembrane
DIPHTHERIA)
● Lung infection
● Sources: discharges coming from the nose, pharynx, eyes, ducts
● Peripheral neuropathy
in the eyes and ears
NURSING MANAGEMENT
SIGNS AND SYMPTOMS
● Maintain patent airway
● Sore throat, swollen glands in the neck
○ Airway obstruction is one of the most common
○ Dysphagia and neck edema (bull neck) →
complications so ensure the airway
characterized by neck enlargement and shiny skin on
○ DBCE
neck
○ Position upright especially when feeding
● Barking cough
● Increase oral fluid intake to liquify secretions
○ Affect the voice box that can lead to husky voice,
● CPT and turning to side
eventually the loss of voice (aphonia)
○ Postural drainage, vibration and percussion
● Racing heart
● Respiratory isolation
● Wheezing and difficulty breathing
○ Dispose properly respiratory secretions
● Sero - sanginious foul smelling odor (rat - like scent)
● Soft diet
● Fatigue, malaise, low grade fever
○ Pt having difficulty swallowing
● Hoarseness of voice – in severe cases
● Comfort measures and CBR to prevent the complication (e.g.
○ Characterized by dry metallic cough or barking cough
myocarditis)
can lead to husky voice and eventually aphonia (loss
of voice) or phony voice
PREVENTION
● Difficulty of breathing
● Never Kiss - prevention
● Paralysis, CHEVER, coma, death
○ Because mothers tend to kiss children in the mouth,
● Stridor upon auscultation.
so the infection can easily be spread
● Most common complication: when it damages the heart
● Droplet precautions
muscles, it can cause fatal myocarditis
● Pseudomembrane
○ Grayish - white membrane that looks like ash of QUESTIONS:
cigarette
Nursing care of patient with diphtheria should take priority of the following:
○ Found in the nasal septum, pharynx, uvula etc..
a. Conserving patient’s energy
CUTANEOUS DIPHTHERIA b. Omission of bath in every cases
● Common to persons with poor hygiene practices c. Early ambulation
● Living in crowded places d. Encouragement of fluids
● Inflamed/obviously infected
● Pre-existing wounds and later on infected with bacteria Answer/ Rationale: A. Conserving patient’s energy
● Some can also be sustained from burns and abrasions of the skin ● D → No. Pseudomembrane obstructs the airway and may
○ SCALING, sores, blisters
cause aspiration
○ Painful, swollen
● More contagious than the respiratory diphtheria
● Period of communicability: Which of the following statements about diphtheria is false?
○ If not treated → more than 34 weeks a. Recovery from clinical attack is always followed by a lasting
○ If treated → last only for 1 - 2 days immunity to the disease
b. Diphtheria transmission is increased in hospital households,
DIAGNOSTIC EXAMINATION
● DEFINITIVE TEST schools, and other crowded places
○ Nose and throat swab test c. Infants born to immune mothers may be protected up to 5

19 4NUR7-2022 RN / CROSS CHECKED BY KKS

 CONVALESCENT (2 - 3 weeks)
months
● Gradual decrease in paroxysms of coughing
d. Immunity is acquired through complete immunization with
○ the continuous coughing diminishes until it disappears
Diphtheria toxoid ● Vomiting ceases
● After 6 weeks, attacks becomes milder
Answer/ Rationale: A. Recovery from clinical attack is always followed by ○ The child is no longer communicable
a lasting immunity to the disease
DIAGNOSTIC EXAMINATION
● A → Yes. There is no lasting immunity with diphtheria. It
● Nasopharyngeal swab (culture and PCR)
can still occur to those who are vaccinated. There’s no vaccine ○ Bordet Gengou, Agar plate, cough plate
that provides 100% immunity, it only lessens risks of severe ● Sputum culture
cases/ complications. ○ Agar plate / Cough plate in which sputum test is done
● Serology testing
○ Obtained 2-8 weeks onset
○ Presence of antigens
[2] PERTUSSIS ○ Known as the ANTIGEN TEST
● Also known as Whooping cough ● CBC
● Highly contagious but vaccine preventable bacterial illness ● CXR
○ Easily transmitted to other objects/people/persons bc
the pt is always coughing MEDICAL MANAGEMENT
● Characterized by prolonged cough syndrome ● Supportive therapy
● 100 day cough ○ Replace fluid and electrolyte due to vomiting
● Commonly affects age 6 y/o and below ○ Codeine (Antitussive) → S/E: Mild sedation
● Respiratory tract infection characterized by a paroxysmal cough ● Antibiotics
○ Azithromycin
CAUSATIVE AGENT & MODE OF TRANSMISSION ○ Clarithromycin
● CA: Bordetella pertussis ○ Erythromycin
● MOT: direct (droplet) ○ Broad spectrum: TMP(Trimethoprim)
○ Due to the forceful coughing ● PERTUSSIS IMMUNE GLOBULIN
○ May also be aerosolized
■ Although it is not categorized as airborne, NURSING CARE
most of the time, we also use N95 mask ● Provide adequate rest
bc the possibility of aerosolization of the ● Maintain F&E balance
droplet nuclei ● Strict Aspiration precaution
● IP: 7-14 days ○ Bc pt vomits; Upright position
○ Already bluish in color and non - stop coughing
○ Uncontrollable, violent, and repeated spasmodic
coughing QUESTIONS:
During the second stage of the pertussis, the characteristic paroxysm is
SIGNS AND SYMPTOMS frequently accompanied by:
CATARRHAL STAGE ( 1 - 2 weeks ) 1. Involuntary micturition
● Pt is highly communicable → observe respiratory precautions 2. Spontaneous epistaxis
● Because of the s/sx that produces respiratory secretions: 3. Inspirational whoop
○ Coryza (common colds)
4. Expulsion of mucus from the trachea
○ Sneezing
○ Lacrimation a. 1, 2, 3
○ Fever b. 1, 3, 4
○ Dry bronchial cough (nocturnal) c. 2, 3, 4
○ Listless and tiredness (due to coughing)
Answer/ Rationale: B. 1,3,4
PAROXYSMAL/SPASMODIC STAGE (4-6 weeks)
→ We do not expect nose bleeding in pts with pertussis
● Spasmodic and recurrent cough which ends in a prolonged
inspiratory phase or a whoop
○ Usually coughs 5-10 forceful cough and ends in a In providing care for a child with pertussis the following measures are
whoop done EXCEPT:
○ Coughs continuously until mucus plug is expectorated a. Observes for convulsion
○ Followed by VOMITING b. Place patient on prone position
● Congestion of the face and tongue, may become cyanotic c. Use of abdominal binder
● Teary red eyes with eyeball neck veins
d. None of these
● Distended face and neck veins
● Involuntary micturition and defecation
○ Coming from continuous coughing Answer/ Rationale: B. Place patient on prone position
● Abdominal Hernia → Will cause more difficulty in breathing and coughing; must be FOWLER
○ Forceful coughing that pushes the diaphragm out OR HIGH FOWLER
upward
○ There is a tendency that the part of the intestines may
outpuch in the hyantic wound
● Chokes on mucus → aspiration [3] PNEUMONIA
○ Vomiting will proceed ● Inflammation of lung parenchyma, lung consolidation
○ When there is vomiting, the child can be prone to ● Normally, the tracheobronchial tree is sterile
aspiration. When there is aspiration, the child can ● The nasal turbinates trap foreign particles and the epiglottis
develop pneumonia covers the trachea
● Vomiting ● Mucin has antibacterial activity, and cilia transport mucin out of the
○ Because of the vomiting, pt can also develop fluid and lung
electrolyte imbalance ● Coughing expels foreign material that enters the tracheobronchial
● Exhaustion tree. When we cough, the mucin that filters air will be expelled
○ because of continuous coughing ● Alveoli can deliver polymorphonuclear leukocytes (PMNs),
● Rib fracture macrophages, immunoglobulins and complement to destroy
● Subconjunctival hemorrhages invading pathogens
○ Eyeball/teary red eyes ● Lymphatics drain macrophages and PMNs to the mediastinal
● Apnea in children lymph nodes
● Complication: Pneumonia ○ Swollen lymph nodes = dead cells from
phagocytosis

20 4NUR7-2022 RN / CROSS CHECKED BY KKS

 CAUSATIVE AGENT & MODE OF TRANSMISSION
BACTERIA CLASSIFICATION DESCRIPTION
OF PNEUMONIA
● Streptococcus pneumoniae
○ Commonly affects the adult individuals
○ Common cause of community-acquired pneumonia COMMUNITY ● Outpatient setting or within 48 hours
● Haemophilus influenzae ACQUIRED ● Most common pathogenic organism:
○ Commonly affects the young individuals PNEUMONIA (CAP) Streptococcus pneumoniae
● Staphylococcus aureus
○ Most commonly hospital acquired pneumonia
○ Gram negative bacteria
● Klebsiella pneumoniae HOSPITAL ● Occurs after 48hrs of admission
○ Hospital acquired pneumonia ACQUIRED
○ Gram negative bacteria PNEUMONIA (HAP)
○ Common among immunocompromised, alcoholics and
severe smokers
● Pseudomonas Aeruginosa
VENTILATOR ● After endotracheal intubation
○ Commonly grows in ICU
ASSOCIATED ● 48-72 hours after the procedure
● Acinetobacter Baumanii
PNEUMONIA (VAP) ● 48 hours is crucial
○ Prolonged ventilator use
VIRUS
HEALTHCARE ● Hospitalized for more than 2 days duration
● Cytomegalovirus/ CMV
ASSOCIATED within the last 90 days
PNEUMONIA ● Residing in a nursing home or long- term care
PROTOZOA
(HCAP) facility
● Pneumocystitis Jirovecii ● Received IV antibiotics, chemotherapy, or
○ Opportunistic infection in immunocompromised pts wound care in the last 30 days
● Attended a hospital or hemodialysis clinic
NOXIOUS SUBSTANCE within 30 days
● Substances that can be aspirated or that can be used when we
insert equipment in the patient’s nasopharyngeal tract
○ Ex. chemicals, oil-based lubricants, food particles
● Common in bedridden patients (for aspiration) OLD DESCRIPTION
CLASSIFICATION
CARDINAL SIGNS OF PNEUMONIA
● Fever
● Shaking chills
ATYPICAL ● Have a less abrupt course
● Productive cough
PNEUMONIA
○ RUST: Streptococcus
■ Hallmark sign of pneumonia; most
common
○ CREAMY YELLOW: Staphylococcus
○ GREENISH: Pseudomonas; ICU CLASSIC/ TYPICAL ● Constitutional and mild upper respiratory tract
○ CURRANT JELLY: Klebsiella PNEUMONIA symptoms preceding the onset of pneumonia
○ CLEAR: No infection/ Lipid/ aspiration ● Associated with an acute respiratory illness
● Shortness of breath characterized by prominent dyspnea and
● Chest pain or pleuritic chest pain productive cough
○ Due to inflammation of pleural membranes
■ Friction that happens in the visceral and
parietal membranes
○ Managed by splinting - using pillow, chest binders, CLASSIFICATION DESCRIPTION
turning to the affected side, compressing the affected OF PNEUMONIA
side to decrease pain BASED ON
■ If both sides affected, choose which is RADIOGRAPHIC
more painful/severe, that's where you will PATTERN
turn during inspiration/coughing by
compressing it
○ Triggered by coughing and deep inspiration LOBAR ● Classic type
■ Splinting can be applied using pillow/ ● Associated with a lobar pattern of opacity on
hugging pillow the chest radiograph
● Developed in the distal air sacs, spread to the
CLINICAL MANIFESTATIONS adjacent lung without primary involvement of
● Elderly and immunocompromised pts the airways → lower respiratory tract infection
○ Lethargy or delirium ● Common among children
■ Early sign
○ Poor oral intake BRONCHOPNEUMO ● Often a nosocomial infection caused by
○ Decompensation of other comorbid medical conditions NIA aspiration of secretions from a colonized
trachea
RISK FACTORS
● Age greater than 65 years
INTERSTITIAL ● Inflammation and edema within the
● History of alcoholism
pulmonary interstitium
● Antimicrobial therapy within 3 months
● Most commonly associated with atypical
● Immunosuppression and/or significant comorbid medical
pneumonia syndrome
conditions
● Additional causes are respiratory viruses and
● Exposure to children in daycare
Pneumocystis jirovecii in
immunocompromised patients
RISK FACTORS FOR MRSA
● Prolonged hospitalization and mech vent, COPD, and prior
corticosteroid use
● DM, head trauma, hemodialysis, prior antimicrobial therapy and/or PATHOGENESIS
ICU admission ● Pathogens are aspirated or inhaled as small aerosolized droplets
● Bacterial invasion of the alveoli induces:
○ Edema fluid that spread to other alveoli through the
pores of Kohn

21 4NUR7-2022 RN / CROSS CHECKED BY KKS

 ○ Infiltration of PMNs and RBCs, followed by
macrophages bacterial pneumonia
○ When there’s an accumulation of the PMNs and RBCs
in the alveoli → causes vasodilation Which of the following would be the most important to teach an elderly
● Infection spreads centrifugally client to prevent a recurrence of bacterial pneumonia
○ Newer regions in the periphery appear red “red
a. Change current diet preferences
hepatization”
○ Older regions are central and appear gray “gray b. Seek prompt antibiotic therapy for viral infections
hepatization” c. Receive prophylactic antibiotic therapy
● Streptococcal pneumonia does not cause permanent tissue d. Obtain annual influenza and pneumococcal vaccine
destruction
● S. aureus, gram negative rods, and anaerobes cause permanent Answer/ Rationale: D. Obtain annual influenza and pneumococcal
damage
vaccine
DIAGNOSTIC EXAMS
● CXR → determine consolidation; patchy filtrates on the parts of
the lungs
[4] INFLUENZA/ FLU/ “Trangkaso”
● Sputum exam → determine etiology
● Highly contagious viral infection
● CT Scan
● Characterized by abrupt onset of fever, chills, body malaise, catar
(coryza, or common colds)
MEDICAL MANAGEMENT
● Potential serious disease that can lead to hospitalization
● Antibiotic
○ Manifestation of severe signs and symptoms - it would
○ Azithromycin
require hospitalization or death
○ Doxycycline
○ Fluoroquinolone
CAUSATIVE AGENT & MODE OF TRANSMISSION
● Inhalation
● CA: enveloped, negative-sense, single stranded RNA viruses of
○ Nebulization
the family Orthomyxoviridae
● Bronchodilators
○ Influenza A, B,C (IAV, IBV, ICV)
● Expectorants
○ Occurs in seasonal epidemics
● NSAIDS - for chest pain/ pleuritic pain
● IP: 24 - 48 hours
● MOT:
NURSING MANAGEMENT
○ Airborne in crowded populations
● Maintain patent airway
■ If the pt is coughing in a crowded
○ CPT
populations, it can easily spread
■ Starts with postural drainage → chest
■ Distance is shorter than 1 meter
clapping (percussion and vibration) →
■ Aerosolized procedures like nebulization,
followed by DBCE
suctioning, etc.
● Rest and nutrition
○ Direct contact through droplet spread
○ Conserve the patient’s energy as much as possible
■ Droplet nuclei on surfaces (indirect
○ Increase energy uptake
transmission)
● Increase oral fluid intake
● POC: until 5th day of illness; up to 7th day in children
● Comfort measures
○ (SARS COV 1: airborne precaution respiratory
condition)
PREVENTION
● Other form of transmission:
● Pneumococcal vaccine
○ Unhygienic food preparation
● Proper disposal of secretion
■ Transmitted through among people who
● Proper coughing and sneezing etiquette
are in Slaughter and consumption of
● Proper respiratory isolation
meat
● Stop smoking
■ Eating properly cooked meat can lessen
the risk
QUESTIONS:
SIGNS AND SYMPTOMS
The client with pneumonia is coughing up tenacious purulent sputum.
● Persist for hours even if mucus is dry
Which of the following measures would most likely help liquefy this ● Cough
viscous secretion? ○ Initially minimal but can progress as the infection
a. Performing postural drainage involves
b. Breathing humidified air ○ May report non productive cough (no mucus
c. Back clapping and percussing the affected side of the lungs secretions)
○ Can also be related to pleuritic chest pain and DOB
d. Instructing the client to do a deep breathing and coughing
● Pleuritic chest pain
exercises ● Fever
○ May vary among patient - (may be high grade or low
Answer/ Rationale: B. Breathing humidified air grade)
→ Can be in a form of inhalation, nebulization, steam inhalation ○ Feverish feeling: shaking chills
● Sore throat
→ Other choices are included in performing CPT
○ Last for 3-5 days
● Myalgia
An elderly client has been ill with flu, experiencing headache, fever, and ○ Muscle pains
chills. After 3 days, she developed a cough and yellow sputum. The nurse ○ May range to mild to severe
auscultates her lungs and hears crackles. How would the nurse best ● Weakness / Fatigue
interpret these assessment findings? ○ Prevent pt from performing ADL
○ NURSING MEASURES: bedrest
a. The client is getting dehydrated and needs to increase fluid
■ Some may be bedridden, but still rest
intake to decrease secretion
b. It is likely that the client is developing a secondary bacterial DIAGNOSTIC EXAMS
pneumonia ● Blood examination
c. The assessment findings are consistent with influenza and are ○ Leukopenia: Decrease in WBC caused by virus
● Oropharyngeal swabbing (culture)
to be expected
● Viral serology
d. The client has not been taking her decongestants and ○ Complement fixation test
bronchodilators as prescribed ○ Hemo - agglutination test
○ Neutralization test
Answer/ Rationale: B. It is likely that the client is developing a secondary

22 4NUR7-2022 RN / CROSS CHECKED BY KKS

 COMPLICATIONS
● Primary pneumonia (Primary complex of childhood) fulfilled but diagnosis is made by the
● Other relevant sequela attending physicians on the basis of
○ Encephalitis clinical findings, x-ray abnormalities,
○ Reye syndrome suggestive histology and/or other
○ Myocarditis biochemistry or imaging tests
○ SIDS
● Superimposed bacterial infections PRIMARY TB ● Defines the events following the initial
○ If it is caused by the: infection with tubercle bacterium
■ Strep. pneumoniae
■ Haemophilus influenzae
LATENT TB INFECTION ● Persistent asymptomatic infection
■ Staph aureus
following primary TB that is contained by
● Mixed viral and bacterial pneumonia
host defenses
● Can be treated with prophylactic drugs
MANAGEMENT
● NO specific treatment
○ Self-limiting since viral POSTPRIMARY TB/ ● Occurs when immune control of latent
○ Supportive therapy is the management REACTIVATION TB infection is lost, and dormant bacteria
■ Bed rest reemerge
■ Plenty of fluids ● Most common site of reactivation is the
■ Manage fever and headache lungs
■ Sponge bath
■ Isolation
SIGNS AND SYMPTOMS
■ Limit strenuous activity
CARDINAL SIGNS
■ Watch out for complications
○ Cough up phlegm and blood
● Prevention is the most effective management
■ Last for more than 2 weeks
○ Vaccines (annually)
■ Can be productive
■ for elderly population ,
■ There can be hemoptysis
immunocompromised and children
○ Consistent fever
○ Avoid crowded places
■ Low grade fever
○ Educate about personal hygiene
○ Night sweat
○ Respiratory etiquette and isolation
○ Chest pain or pain with breathing or coughing
○ Unexplained weight loss
[5] TUBERCULOSIS
○ Fatigue
● Other names:
○ Consumption
DIAGNOSTIC EXAMS
■ Due to the physical characteristic of the ptx
● Physical examination to check fluid in the lungs and medical
■ Parang natuyot yung patient - higop
history of the patient for possible exposure and presumptive s/sx
ganern
● Chest X-ray
○ Koch’s disease/infection
○ To identify the extent of lung affectation and
○ PHTHISIS
consolidation
○ Scrofula (another type of extrapulmonary disease
○ Can be a minimal TB, moderate, advance or far
■ TB of the lymph nodes
advance
● Can be pulmonary/extra pulmonary depending on the organs
● Tuberculin Mantoux Test
infected
○ Determine exposure to active TB disease
○ Through ID injections
CAUSATIVE AGENT & MODE OF TRANSMISSION
○ Purified protein derivatives(PPD) induration
● CA: Mycobacterium tuberculosis/ M. Africanum / M. Bovis
■ Immunocompromised = less than 5mm
○ Can be killed and destroyed by sunlight/UV light
→ (+)
● MOT: airborne
■ if NOT immunocompromised = 10 mm
● IP: 4-6 weeks from the time of exposure
→ (+)
● DSSM/ Gene X-pert
TB CLASSIFICATION DESCRIPTION ○ Rapid diagnostic test and also determines resistance
to rifampicin
● Other exams include CT scan, bronchoscopy, thoracentesis, lung
ACTIVE TB DISEASE ● A presumptive TB case that is either
biopsy
bacteriologically confirmed or clinically
● X-pert MTB/RIF (RDT), DSSM/TB LAMP
diagnosed by the attending physician
● Tuberculin skin test (TST)

PULMONARY TB (PTB) ● A case of TB involving the lung TREATMENT

parenchyma PRIMARY ANTI-TB DRUGS (FIRST LINE)
● RIPE
EXTRAPULMONARY ● Case of TB involving organs other than ○ Rifampicin
TB (EPTB) the lungs (Ex: larynx, pleura, lymph ■ SE: red orange urine
nodes, abdomen, GU tract, skin joints, ○ Isoniazid (INH)
bones, meninges) ■ SE: peripheral neuropathy; given in
combination with Vit B6
PRESUMPTIVE ● Any person having 2 weeks or longer of ○ Pyrazinamide
PULMONARY TB any of the following: cough, unexplained ■ SE: can increase uric acid
fever, unexplained weight loss, night (hyperuricemia); provide analgesic for pain
sweats OR chest x-ray findings and instruct patient to increase fluid intake
suggestive of TB ○ Ethambutol
■ SE: can cause optic neuritis and can lead
to color blindness or blurring of vision; if
BACTERIOLOGICALLY ● Patient from whom a biological these appear = stop treatment and report
CONFIRMED TB specimen, either sputum or non- sputum to the MD; not given to children below 7
(BCTB) sample, is positive for TB by smear yrs old (for identification of color blindness)
microscopy culture, or rapid diagnostic ■ Can be used in combination to prevent
tests (such as Xpert MTB/RIF, line probe resistance
assay for TB, TB LAMP) ● For primary drugs, streptomycin is not anymore included because
they have seen resistance to this drug
CLINICALLY ● Patient for which the criterion for
DIAGNOSED TB bacteriological confirmation is not

23 4NUR7-2022 RN / CROSS CHECKED BY KKS

SECOND LINE DRUGS
● TB drugs that are used for treatment of drug resistant TB QUESTIONS:
○ Cycloserine (Seromycin)
Ria lives in a highly crowded community, and she had a positive tuberculin
○ Ethionamide (Trecator)
○ Capreomycin (Capastat) test and a negative chest x-ray. She asked the nurse the meaning of these
○ Kanamycin (Kantrex, Amikacin) findings. The nurse’s best response will be that:
○ Para-amino-salicylic acid (Pas) a. There was exposure to the tubercle bacillus without
● Fluoroquinolones: Levaquin, Avelox, Vigamox, Tequin development of the disease
● Streptomycin
b. The skin test is only a screening test
c. BCG stimulates formation of antibodies against TB
d. She has to repeat the chest x-ray

Answer/ Rationale: A. There was exposure to the tubercle bacillus

without development of the disease

In the national TB program, PTB suspects are encouraged to have

sputum examinations. In addition to cough for 2 weeks or more, what
other signs will make a person a PTB suspect?
1. Fever for 1 month or more
2. Progressive, unexplained weight loss
3. Chest pain for 2 weeks or more
PREVENTION 4. Hematemesis
● BCG a. 1,2,3
● Proper respiratory precautions and isolation b. 1,3,4
c. 2,3,4
d. 1, 2, 3, 4

Answer/ Rationale: A. 1,2,3

→ Not hematemesis, but HEMOPTYSIS

After providing health teachings in the prevention of transmission of TB,

the nurse evaluates if a client needs further reinforcement of information
when the client makes which of the following responses?
a. “I should use disposable plates, forks and spoon”
b. “It's important to cover my mouth if I laugh sneeze or cough”
c. “It's very important to wash my hands after I touch my mask,
tissues or body fluids”
d. “I should cough into tissues and throw them away carefully”

Answer/ Rationale: A. “I should use disposable plates, forks and spoon”

→ There’s no need to use separate utensils for the pt since it’s being
washed

One of the additional drugs ordered by the physician is Pyrazinamide

(PZA). The nurse evaluates that the teaching concerning the drug was
effective when the client says “I will”:
a. “Take the medication 2 hours after meals”
b. “Report any changes in my vision to the physician”
c. “Drink at least 2 quarts of fluid per day”
d. “Expect discoloration in my secretions”

Answer/ Rationale: C. “Drink at least 2 quarts of fluid per day”

→ To aid in excretion of urates

POLICIES FOR TREATMENT OF DRUG SUSCEPTIBLE TB Which nursing assessment findings might indicate hepatic impairment
● All diagnosed drug susceptible TB cases shall be provided with secondary to INH administration:
appropriate anti TB treatment within 5 working days from a. Fatigue and dark urine
collection of sputum
b. Elevated liver enzymes
● Standard treatment for DS-TB shall be given based on results of
X-pert MTB/RIF. If Xpert MTB/RIF test or any other DST is not c. Proteinuria and lethargy
done, history of treatment will be used as basis for the regimen d. Dilute urine and epigastric pain
● Quality of anti-TB drugs shall be ensured by ordering from a
source with a track record of producing first line drugs according Answer/ Rationale: A. Fatigue and dark urine
to national standards of quality as set by the FDA → Since it is a nursing assessment, the answer is A.
● Treatment adherence shall be ensured through patient centered
→ Although elevated liver enzymes indicate hepatic impairment, it is not a
approaches. Treatment support shall be provided by health
workers, community volunteers, or family members nursing assessment finding.
● Treatment response shall be monitored through follow up- smear
microscopy and clinical assessment Probable tuberculosis in children is suspected if the following are
● All adverse drug reactions shall be reported using the official manifested EXCEPT:
reporting form of the FDA and managed accordingly
a. An ill child has a history of contact with a suspect or confirmed
● All TB patients aged 15 years old and above shall be offered
provider-initiated HIV counseling and testing, according to the case of PTB
phased implementation of the TB- HIV collaboration b. History of severe cough
● All TB patients aged 25 years old and above shall be screened for c. The child does not return to normal health after measles
diabetes

24 4NUR7-2022 RN / CROSS CHECKED BY KKS

 ● Bacteria (Campylobacter, Shigella, Salmonella C, perfringens, S.
d. With painless, firm or soft swelling in a group of superficial aureus, B. cereus, E. coli, C. difficile
lymph nodes ● Parasites (giardia, cryptosporidium)

Answer/ Rationale: B. History of severe cough IMMUNOSUPPRESSED PATIENTS

● C → There could be another underlying infection ● General causes plus increased E. coli, Cryptosporidium,
● D → TB that affects lymph nodes (extrapulmonary TB) Mycobacteria, microsporidia, CMV, and HSV (especially HIV
patient with CD4 count < 200/mm3)
○ Mycobacteria is a common opportunistic pathogen
The client with TB is to be discharged home with CHN follow up. Of the
following interventions, which would have the highest priority? RETURNING TRAVELERS
a. Offering client emotional support ● For those who traveled in different places, when they go back
b. Teaching the client about the disease and its treatment home, they complain of gastroenteritis
c. Coordinating various agency services ● Enterotoxigenic - E. coli, Shigella spp, Salmonella spp.
d. Assessing the client’s environment for sanitation Campylobacter, V parahaemolyticus (shellfish)
● Viral (rotavirus and norovirus)
● Protozoal (can be found in water)
Answer/ Rationale: B. Teaching the client about the disease and its
treatment 6 COMMON TYPES OF BACTERIAL GASTROENTERITIS
● Shigellosis → Shigella
● Traveler’s Diarrhea → E. coli
○ Presence of coliform indicates a poor sewage system
DISEASES AFFECTING GASTROINTESTINAL ● Campylobacter Diarrhea → Campylobacter jejuni
○ Reservoir are wild or domestic birds, and animals
SYSTEM ● Antimicrobial-Associated Diarrhea → Clostridium difficile
GASTROINTESTINAL SYNDROMES
○ Opportunistic infection when a patient is placed on
● GI SYNDROMES - group of signs and symptoms related to
antibiotics for a long time
gastrointestinal problems
● Salmonellosis and Typhoid Fever → Salmonella
○ NON - INFLAMMATORY
○ Salmonellosis is the non- typhoid type; salmonella
■ Low-grade or no fever
lives in the intestines of all vertebrates; eliminated in
■ Diffuse watery non-bloody stools.
the feces; poultry/ chicken products are the most
■ E.g. Cholera, Enterotoxigenic, E. coli,
common reservoir; but may also come from rodents
Rotavirus, G. lamblia
and pets
○ INFLAMMATORY
● Cholera → Vibrio cholerae
■ High grade fever (>40c)
○ Only species that can survive both fresh and
■ Severe abdominal pain
saltwater; avoid water activities when with cholera;
■ Scant, Pus, Bloody stool
part of normal flora of brackish water such as
■ E.g. Shigella spp., Campylobacter sp..,
estuaries associated with algal blooms/ planktons;
Entamoeba histolytica
humans are one of the reservoirs
● Ex. Dysentery
○ INVASIVE
** All caused by Gram - Negative Bacteria/s.
■ Fever, abdominal pain, often no diarrhea.
** Note: Humans are the only reservoir of these bacterial causes of
■ E.g. Salmonella typhi (causes typhoid
gastroenteritis
fever), Yersinia enterocolitica
● Diarrhea
○ Exceeds the daily usual bowel movement by 3 or MODE OF TRANSMISSION
more ● Fecal-Oral Route
■ More than the normal (3 or more loose ○ Directly or indirectly transmitted.
watery stools) bowel movements within a ○ 5Fs: food, feces, fingers, flies, fomites
24-hour period
○ Change in stool consistency from that of a previous INCUBATION PERIOD
stool consistency ● 12 hours to 5 days (Ave: 1-2 days)
● If GI symptoms are followed by neurologic signs, consider food ○ Also depends on the causative agent
poisoning ○ C. difficile: 3 days
○ Dry mouth, descending weakness with respiratory and ○ Vibrio cholera: 2 hours to 5 days
autonomic dysfunction ○ Caliciviruses: 1-2 days
○ Can be caused Clostridium botulinum or Clostridium ■ Norovirus: 18-72 hours
jejuni ○ Rotavirus: 2-3 weeks

[1] ACUTE GASTROENTERITIS (STOMACH FLU) SIGNS AND SYMPTOMS

● Leading cause of infant mortality ● Viral
● Less than 5 years old (200 million cases globally) ○ Non bloody diarrhea, vomiting and fever (low grade)
● Symptoms last less than 7 days and not longer than 14 days. ■ Cardinal signs
● Associated with antibacterial: Clostridium deficit ○ Also included in the cardinal sign is abdominal pain
● Viral, bacteria or parasitic infection ● Bacteria
● Also known as “Stomach Flu” - disease of the stomach ○ Gross blood or mucus in the stool, high fever (>40ºC),
(inflammation of the stomach and intestinal lining) tenesmus, associated seizures, severe abdominal pain,
● Note: if there is a change of consistency, it is more indicative of smaller volume stools.
diarrhea ■ Tenesmus is seen in dysentery
● Parasitic
CAUSATIVE AGENTS ○ Watery diarrhea, abdominal cramping, vomiting and
GENERAL PATIENTS low-grade fever.

● Viruses (rotavirus, norovirus) COMPLICATIONS

○ Rotaviruses ● Hypovolemia/Dehydration
■ World’s most common cause of diarrhea in ○ Most common problem
infants and young children ○ Shock → multiorgan dysfunction → death
○ Caliciviruses (Noroviruses) ● Electrolyte abnormalities and acid-base disturbance
■ Most important cause of nonbacterial ○ Metabolic acidosis
acute gastroenteritis in all ages ● Lactose intolerance
○ Astroviruses ○ Mature enterocytes in the small intestines that contains
■ One of the causes of pediatric lactase
gastroenteritis ● Irritant diaper dermatitis
○ Enteric adenoviruses
○ Sapovirus

25 4NUR7-2022 RN / CROSS CHECKED BY KKS

 DIAGNOSTIC EXAMINATION ● Use gloves esp when handling
● Stool analysis/ Microscopy the diaper
○ Determines if it’s infectious or not, presence of pus and ■ Hand washing
blood ● Especially after using the toilet.
○ Already enough as a diagnostic ■ Proper excreta disposal
● Stool culture ● Especially those in the community
○ To get the specific pathogen and those who are wearing
● RT-PCR, Rapid antigen test diapers.
● Maintain personal hygiene
GOALS OF TREATMENT ● Proper excreta disposal;
● Prevention of dehydration if there are no signs of dehydration. ○ Contact precaution → gown and gloves
○ Doesn’t always require immediate hospitalization. Home ● Concurrent and terminal disinfection
management is already enough and hydration is the ● Can be managed at home as long as there is no dehydration and
number one intervention should not be longer than 2 weeks
● Treatment of dehydration when present: ORS, replace loss fluid
and electrolytes PREVENTION
● Prevention of nutritional sequelae, by continued feeding during ● Proper sanitation methods
and after diarrhea. ○ Methods for food processing and preparation since one
○ Food intake isn’t a contraindication for gastroenteritis. of the vehicles include foods
○ Even if the patient has diarrhea do not withhold food ○ Contaminated foods in the market are common sources
unless he/she vomits continuously ○ Include fresh and processed foods
○ Early reintroduction of food ○ Sanitary water supplies, pasteurization of milk, hand
○ Give antiemetic medications if vomiting present hygiene, excluding infected persons from handling foods
● Reduction of the duration and severity of the diarrhea ● Cook food thoroughly
○ IV rehydration should be the next step ● Frequent hand washing
○ Reserved for cases when oral fluid is not tolerated or ● Vaccines: Rotavirus
there is an impending hypovolemic shock
■ Sx: low BP, tachycardia, restlessness (IV
rehydration ASAP) QUESTIONS:
The best ascertain the magnitude of fluid loss is an infant with
MEDICAL MANAGEMENT
gastroenteritis and diarrhea, the nurse should:
● Oral rehydration therapy
○ Mild to moderate AGE → ORS a. Evaluate the infant’s skin turgor carefully
○ IV is done if oral rehydration is not tolerated b. Note the elevation of the infant’s HCT value
○ If child is not exclusively breastfed, oral maintenance c. Assess the moistness of the infant’s mucous membranes
fluid should be given and fluid replacement should be d. Compare the infants pre-illness weight with the current weight
dependent on the amount of fluid loss
■ Children younger than 2 y/o: approx. 500
mL/day of oral maintenance fluid Answer/ Rationale: D. Compare the infants pre-illness weight with the
■ 2-10 y/o: approx. 1000 mL/day of oral current weight
maintenance fluid → Person's weight is the best parameter to determine fluid loss
■ Older than 10 y/o: 2000 mL/day of oral
maintenance fluid To determine achievement of the expected outcome for an infant with
○ If with ongoing fluid losses: 10 ml/kg/day and additional
severe diarrhea and a nursing diagnosis of fluid volume deficit, what
ORS for every loose stool
■ Ex: child weighs 10 kg, you give 100 mL for assessment parameter should the nurse use?
every loose stool a. Moist mucous membranes
■ If child is also vomiting but can tolerate oral b. Passage of soft, formed stool
rehydration therapy in small frequent amount, c. Ability to tolerate IV fluids
there will be an addition of 2ml/kg of body
d. Absence of diarrhea during a 4-hour period
weight
● Early refeeding (breastmilk)
○ Nutrients + Hydration Answer/ Rationale: A. Moist mucous membranes
○ Food with complex carbohydrates such as oats, wheat,
rice, cereals, bread, some fruits, whole grain, potatoes
○ Lean meats, vegetable and fruits that contains fiber [2] AMOEBIASIS (AMOEBIC DYSENTERY)
○ Foods that should be avoided include simple ● Characterized by bloody diarrhea with mucus.
carbohydrates like soda, spicy foods as it can irritate the ● Painful straining in defecation (Dyschezia)
stomach lining and can trigger more diarrhea, fatty/
greasy foods CAUSATIVE AGENT
○ BRAT diet to prevent fluid losses (banana, rice, apple, ● Entamoeba histolytica
and toast) to speed the recovery of patient from ○ Protozoa
gastroenteritis, and prevent further diet ○ May become dormant in the system and invade the
■ However, having only BRAT diet is not liver causing hepatic amoebiasis
enough; other sources of food should also be ● Can be in a form of infective cysts or trophozoite
given ○ Infective cysts: patient is commonly asymptomatic
● Use of Antimicrobials ○ Trophozoites: commonly more pathogenic than the
○ Ciprofloxacin, Azithromycin, Erythromycin, TMP - SMX, cysts
Cefixime, Metronidazole, Vancomycin, Neomycin,
Doxycycline, Furazolidone MODE OF TRANSMISSION
● Adjunctive management (antidiarrheal and anti motility agents, ● Fecal - Oral Route
antiemetic drugs like ondansetron, probiotics) ○ Direct contact (ingestion of fecally contaminated food
or water, oral-anal sexual contact)
○ Indirect contact (fomites & vehicles)
QUESTION: How much fluid should be given in rehydration therapy? ■ Such as flies and pathogens
● Younger than 2 y/o: less than 500ml
● Older than 10 y/o: more than 2 L INCUBATION PERIOD
● 1 - 4 weeks (may be shorter or longer)
● Hepatic amoebiasis may be present from 2 - 5 months after
NURSING CARE exposure
● Maintain fluid and electrolyte balance to prevent dehydration. ○ 2-5 months in the liver and can be reactivated and can
● Isolation and enteric precaution cause hepatic amoebiasis
○ For enteric precaution:
■ PPE: gloves, gowns
● Because of the causative agent

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 SIGNS AND SYMPTOMS [3] SHIGELLOSIS (BACILLARY DYSENTERY)
● Another form of dysentery
ACUTE AMOEBIC ● Abdominal Cramps ● Most infectious bacterial diarrheal disease
DYSENTERY ● Mild to severe, foul-smelling, watery
or bloody-mucoid diarrhea CAUSATIVE AGENT [DFBS]
● Nausea ● Four serogroups of shigella, broken down into:
● Flatulence ○ Group A: S. dysenteriae
● Tenesmus, painful straining ○ Group B: S. flexneri
defecation ○ Group C: S. boydii
○ Group D: S. sonnei
CHRONIC ● Intermittent non-dysenteric diarrhea
AMOEBIC with abdominal pain ** To remember: DFBS → down to fuck boy shit
DYSENTERY ● Mucus
● Flatulence INCUBATION PERIOD
● Anorexia, wt loss & weakness ● 1 - 7 days (average: 3 days)
● Tenesmus MODE OF TRANSMISSION
● May manifest tender, palpable ● Fecal-oral route (5Fs)
masses or annular lesions ● Direct contact (ingestion of fecally contaminated food or water,
(amebomas) in the cecum and person-to- person
ascending colon → can be revealed
by colonoscopy SIGNS AND SYMPTOMS
● Diarrhea
● Fever
AMOEBIC COLITIS ● Lower abdominal pain & mild
● Abdominal pain and cramps
diarrhea
● Tenesmus - straining and painful defecation
○ Infection occurs in the
● Malaise
colon
● Nausea and vomiting
● Scant, bloody-mucoid stool
● Scant pus bloody stool (SPB)
● May develop toxic megacolon and
amebomas
COMPLICATIONS
○ Toxic megacolon:
● Hemolytic uremic syndrome (HUS)
Dilatation of colon
● Seizures in children
○ Amebomas:
● Rectal prolapse
Inflammatory mass
● Reactive arthritis
lesions
● Intestinal ulceration may lead to bowel perforation and death

DIAGNOSTIC EXAMINATION
HEPATIC LIVER ● Amebic Liver Abscess/Extraintestinal ● Stool culture
AMOEBIASIS forms ○ To detect the pathogenic organism
● Intermittent fever & RUQ ● PCR
● Fever, nausea & vomiting
● Wt loss MEDICAL MANAGEMENT
● Hepatomegaly ● Antibiotics
○ Azithromycin
○ Ciprofloxacin
DIAGNOSTIC EXAMINATION
● Fluid and Electrolyte replacement therapy
● Stool Analysis
● Blood Exam
NURSING MANAGEMENT
● Antibody Detection (EIA, IHA, PCR)
● Maintain fluid and electrolyte balance to prevent dehydration
○ Enzyme-linked immunosorbent assay (EIA)
● Isolation and enteric precautions
○ Indirect Hemagglutination (IHA)
● Maintain personal hygiene
● Proper excreta disposal
MEDICAL MANAGEMENT
● Concurrent and terminal disinfection
● Metronidazole (DOC)
● Restrict food until N/V subside
○ Antiprotozoal also known as Flagyl
○ Drug of choice
PREVENTION
● Tetracycline, ampicillin, quinolones, sulfadiazine, streptomycin
● Proper sanitation method
sulfate, chloramphenicol
● Protect, chlorinate, and purify drinking water
○ Antimicrobials (7-10 days)
● Frequent hand hygiene measures
● Fluid and electrolyte replacement (oral or IV)
● Proper food preparation handling and storage
● Fly control
NURSING CARE
● Isolation and enteric precautions
[4] CHOLERA/ EL TOR/ BLUE DEATH
● Maintain fluid and electrolyte balance to prevent dehydration
● Most common cause of death of soldiers during the Crimean War
● Maintain personal hygiene
during Florence Nightingale’s time
● Proper excreta disposal
○ Cholera was attributed to the poor sewage system in
● Concurrent and terminal disinfection
the hospital that contaminated the source of water
● Hallmark sign: profuse watery stool that is rice watery in
PREVENTION
characteristic
● Proper sanitation methods.
● Acute afebrile
● Protect, chlorinate, and purify drinking water.
● Painless bacterial diarrhea
○ Bc most common source of amoebiasis is drinking
● Profound fluid loss (hypovolemic shock)
water sources
● Frequent hand hygiene measures.
CAUSATIVE AGENT
● Proper food preparation, handling, and storage.
● Vibrio cholerae, vibrio comma
● Fly control
● Avoid using recreational water facilities since it can contaminate
MODE OF TRANSMISSION
the water
● Fecal-oral route (5Fs)
○ Direct contact (ingestion of contaminated food or
water, vomitus of infected person, naturally
contaminated shellfish)
○ Indirect contact (Fomites and vehicles)

27 4NUR7-2022 RN / CROSS CHECKED BY KKS

 INCUBATION PERIOD ○ Direct contact (ingestion of fecally contaminated food
● Few hours to 5 days (Average: 1-3 days) or water) such as:
■ Undercooked chicken meat and eggs
SIGNS AND SYMPTOMS ■ Processed foods like ice cream
● Nausea, vomiting ● Although frozen, can be
● Painless diarrhea contaminated during the food
● Lethargy processing
● Low grade fever ■ Unpasteurized cheese
● Non-bloody diarrhea, may contain fleck of mucus (rice water
stools), fishy odor SIGNS AND SYMPTOMS
● Signs of dehydration FIRST STAGE
● Acute febrile bacterial diarrheal illness ● Slow rising of temperature and fever fluctuations
● Severe electrolyte imbalances ○ Fever: remittent type (fever is rising in a stepwise
● Renal failure due to hypovolemia fashion or ladder like fever)
○ Happens during the first week of illness then the
DIAGNOSTIC EXAMINATION temperature becomes sustained (second stage)
● Rectal swab → definitive diagnostic ● Bradycardia
● Stool culture → definitive diagnostic ● Malaise
● PCR ● Headache
● Rapid diagnostic tests for cholera ● Cough
● Dark Field microscopy ● Nose bleeds (25% of the patients)
● Abdominal pain
MEDICAL MANAGEMENT ● Leukopenia, eosinopenia, relative lymphocytosis
● IV Fluid therapy with Lactated Ringer’s solution
● Oral rehydration solution SECOND STAGE
○ Given if pt can tolerate oral fluids
● ATB Therapy: Doxycycline, azithromycin, tetracycline, ● Higher fever (around 40ºC)
erythromycin ● Bradycardia
● Vaccines available in endemic areas with cholera ● Delirium (calm, but agitated)
● Rose spots on lower chest and abdomen appear (salmon
NURSING CARE colored)
● Isolation and enteric precautions ○ Pathognomonic sign of the typhoid fever
● Maintain fluid and electrolyte balance to prevent dehydration ○ Caused by the invasion of the microorganism into the
● Maintain personal hygiene bloodstream → perforation of bowels (particularly the
● Proper excreta disposal Peyer’s Patches) leading to bleeding
● Concurrent and terminal disinfection ● Constipation or diarrhea
● Hepatosplenomegaly
PREVENTION
● Proper sanitation methods. THIRD STAGE
● Protect, chlorinate, and purify drinking water. ● Intestinal hemorrhage (bleeding in congested Peyer’s patches)
● Frequent hand hygiene measures. ● Intestinal perforation (distal ileum)
● Proper food preparation, handling, and storage.
● Fly control. FOURTH STAGE (CONVALESCENT STAGE)
● Defervescence (Subsiding fever)
QUESTION: Priority medical and nursing concern when managing a ○ It will take several months for the patient to fully
patient with cholera is: recover
a. Control episodes of diarrhea and vomiting
b. Monitor I and O including VS COMPLICATIONS
c. Monitor and report possible hypovolemic shock ● Intestinal hemorrhage or perforation
d. Replace fluids and electrolytes lost ● Peritonitis and ascites (most common)
● Endocarditis, pericarditis, hepatic or splenic abscess
Answer/ Rationale: D. Replace fluids and electrolytes lost ● Orchitis (male patient) → can lead to infertility
DIAGNOSTIC EXAMINATION
● Direct detection method: culture and isolation, PCR
[5] TYPHOID FEVER (ENTERIC FEVER) ● Indirect method: Tubex, Typhidot, TyphiRapid, Widal Test
● Also known as Enteric/Nervous Fever ● Blood culture
○ Can also cause delirium ● Stool culture
● Common in countries where water and food are unsafe or when ● Widal Test
they have poor sanitation ○ Traditional test performed before; nowadays, no
● Common during summer months longer recommended
○ Temperature is warmer allowing microorganism to ○ Determines the presence of Salmonella antigen
multiply more rapidly especially in contaminated foods ● Typhidot
○ Antibody detection test
CAUSATIVE AGENT ● ELISA and dipstick test
● Salmonella typhi ○ Recommended; newer test
○ Salmonella Paratyphi causes paratyphoid fever ○ Better than conventional test
○ Attaches to the colonic cells and ejects the proteins ● PCR
that stimulates invasion into the intestinal cells
○ Can spread to mesenteric domes hence invading MEDICAL MANAGEMENT
lymphatic systems and enters the bloodstream ● Antibiotics
○ Multiples in the peyer's patches located in our ileum ○ Chloramphenicol, ceftriaxone, amoxicillin, TMP-SMX,
○ Can shed in patient’s feces Cefixime, azithromycin, ciproflixacin, ofloxacin
○ Can reinvade the small intestines causing perforation ○ First line drugs for uncomplicated type of fever:
and bleeding leading to peritonitis Chloramphenicol, Amoxicillin, TMP-SMX
○ Second line: Ceftriaxone, Cefixime, Azithromycin,
INCUBATION PERIOD Ciprofloxacin, Ofloxacin
● 5 to 40 days (10 - 20 days) ○ NOTE: Chloramphenicol → rarely used since it causes
○ Survives even if with macrophages phlebitis
○ Once it enters the body it multiplies in the peyer’s ● Surgery
patches that decreases the HCl - enabling them to ○ In patients with ileal perforation
multiply.
NURSING CARE
MODE OF TRANSMISSION ● Maintain or restore fluid and electrolyte balance
● Fecal-oral route (5Fs) ○ Patient may or may not have diarrhea if with typhoid
fever

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 ○ Constipation is usually a symptom of typhoid fever ● Through infected urine of mammals then contaminated WATER,
● Monitor patient’s vital signs. SOIL, FOOD. Then, the humans that are exposed to it can be
○ Characteristics of Fever (temperature) infected
● Prevent injury or falls in patients with typhoid psychosis ● Ingestion or contact of the skin and mucous membranes with
● Maintain good personal hygiene and mouth care the urine of infected animals or carcass of wild and domestic
● Manage fever and chills animals
● Watch for signs of intestinal bleeding ○ Can live in the water for weeks to months
○ Monitor patient’s stool characteristics ● Leptospira enters the blood and causes damage to the kidneys,
○ Avoid dark colored foods, oily and fatty foods liver, meninges, and conjunctivae
● Watch out for s/sx of dehydration:
○ Monitor the patient's weight PHASES OF THE INFECTION
○ Best indicator of water loss → patient’s weight
● Avoid fatty and irritating food. STAGE SIGNS AND SYMPTOMS
○ Small frequent feeding of proper diet.
● NPO to rest the GI tract then, progressive diet (Clear liquid - INITIAL PHASE ● Abrupt headache
general - DAT) ● Fever
● Severe myalgia (thighs and lumbar area)
PREVENTION ● Cutaneous paresthesia
● Proper sanitation methods. ● Chills and rapid rising temperature
● Enteric isolation ● Anorexia, nausea & vomiting
● Frequent hand hygiene measures ● Conjunctival effusion
● Proper food preparation, handling and storage ● Cutaneous hemorrhages
● Safe drinking water and supply ● Skin rashes
● Vaccination ● Red eyes (hallmark sign together with health
history)
QUESTION: Typhoid fever is considered no longer communicable when:
a. Hemoculture is negative for salmonella typhosa SECOND PHASE ● Mild fever, GIT symptoms and myalgia
b. Fecalysis is negative for occult blood ● For icteric type: persistent high-grade,
c. Stool is negative for the bacteria fever, jaundice, hepatic dysfunction,
d. No longer febrile myocarditis, decrease renal function,
pulmonary complications and hemorrhage
● Renal failure
Among the foods that will be contraindicated to a patient with typhoid
○ Patient undergoes dialysis
fever will be:
● Pulmonary involvement (can cause pleural
a. Champorado and dried fish for breakfast
effusion)
b. Porridge and noodles for dinner
c. Congee and well-cooked vegetable for lunch
d. No specific contraindication SEPTIC STAGE ● Fever (4 to 7 days) - remittent
● Chills
Answer/ Rationale: A. Champorado and dried fish for breakfast ● Headache
→ Champorado may mask possible bleeding in the stool ● Anorexia
● Abdominal pain
● Severe prostration
[6] LEPTOSPIROSIS ● Respiratory distress
● Bacterial disease that affects both humans and animals (animals
are the reservoirs)
IMMUNE/ TOXIC ● Iritis
○ If in the urinary tract of the animal = the bacteria stays
STAGE ● Headache
there lifetime
● Disorientation
● Also known as:
● Convulsions (aseptic meningitis)
○ Weil’s Disease
● Oliguria and anuria
○ Canicola Fever
● Shock, coma, CHF
○ Hemorrhagic Jaundice
● Death
○ Mud fever
○ Swine Herd’s Disease
● A zoonotic disease that is transmitted incidentally to humans due CONVALESCENT ● 4th to 5th week of illness
to sources from infected animals
● Signs and symptoms are wide-ranged; some patients may be
asymptomatic and carriers DIAGNOSTIC EXAMINATION
● Can lead to kidney damage (renal failure) which is the most ● Microscopic-Agglutination Test (MAT)
common complication of this disease ○ Confirmatory test
● Other complications: meningitis, respiratory failure ○ Leptospira agglutination test (LAT) was used
○ It can lead to renal failure, meningitis, liver failure, previously
respiratory distress, and death without prompt ● PCR
treatment ● Serology Test (IgM and IgG determination)
● Commonly transmitted through the contaminated urine of an
infected rats MEDICAL MANAGEMENT
● Some infected persons may not have symptoms at all but infected ● ATB
○ Chemoprophylaxis (Doxycycline), Ampicillin,
CAUSATIVE AGENT Amoxicillin, Penicillin, Ceftriaxone
● Leptospira interrogans ● Peritoneal dialysis / Hemodialysis if with Renal Failure
○ Can survive in water for weeks or months
○ Bacteria that affects humans and animals NURSING MANAGEMENT
● Isolation; urine must be disposed of properly.
INCUBATION PERIOD ○ Urine of infected humans may also contain the
● 5-14 days bacteria
○ Even if human-to-human transmission is rare
MODE OF TRANSMISSION ● Keep under close surveillance.
● Investigate contacts and source of infection
● Clean dirty places and pools; remove stagnant water
○ Soil may also be contaminated with the urine of the
disease-carrying rodents.
● Eradicate rates and other disease-carrying rodents.
○ Biological management of eradication of rats and
rodents; taking care of cats

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 PREVENTION [8] HEPATITIS
● Proper sanitation ● An acute inflammation of the liver parenchyma
● Prophylaxis ● Characterized by damage to the hepatocytes and elevation of liver
● Proper drainage system and control of rodents enzymes: serum AST, ALT
● Vaccination of animals ● Can be caused by variety of infectious and non-infectious agents
● Safe drinking water supply ● Body weakness (malaise) is usually the first symptom
● Avoid swimming and wading in flood water
● Use rubber boots in flooded areas
● Wash feet thoroughly with soap and water TYPES OF DESCRIPTION
HEPATITIS

QUESTION: In the care of patients with leptospirosis, which of the HEPATITIS A CAUSATIVE AGENT
following is important? (Infectious Hepatitis/ →HAV; Picronaviridae
a. Use of mask and apron catarrhal jaundice)
b. Concurrent disinfection of articles soiled with urine MODE OF TRANSMISSION
c. Immunization of contacts → Fecal-oral route
d. Patient should be in a mosquito proof area at night → Sexual (oral - anal sex)
Answer/ Rationale: B. Concurrent disinfection of articles soiled with urine INCUBATION PERIOD
→2-6 weeks
The following are modes of transmission of leptospirosis, except: SIGNS AND SYMPTOMS:
a. Ingestion of contaminated food → fever, malaise, headache, jaundice,
b. Direct contact with tissues of infected animals arthralgia, N/V
c. Droplet infection
d. Contact with skin or mucous membrane with contaminated DIAGNOSTIC TESTS
water → ALT/AST
→ Serological test (IgM antibodies)
Answer/ Rationale: C. Droplet infection
MEDICAL MANAGEMENT
[7] SCHISTOSOMIASIS → Supportive management
● Trematode infection of humans that is caused by snails carrying
blood flukes (schistosoma species) PREVENTION
● Also known: Snail fever or Bilharziasis → Hepa A Vaccine
● CA: blood flukes → Enteric Precaution
○ S. haematobium
○ S. japonicum
○ S. mansoni HEPATITIS B CAUSATIVE AGENT
● Portal and mesenteric venous system (S. japonicum, S. (Serum Hepatitis) →HBV; Hepadnaviridae
mansoni)
● Urinary bladder venous plexus (S. haematobium) MODE OF TRANSMISSION
● Next to malaria, it is the second most prevalent disease caused by →Direct contact with infected blood, saliva,
a parasite semen, and vaginal secretions, Perinatal
● Infects as many as 200 million people each year. Of these, 20 transmission
million are severely infected
● Death is usually due to liver cirrhosis or bladder cancer INCUBATION PERIOD
→ 1-6 months
SIGNS AND SYMPTOMS SIGNS AND SYMPTOMS
● Most infections are asymptomatic with severity of illness based on → fever, malaise, headache, jaundice,
worm burden arthralgia, N/V
● “Swimmers itch” or Schistosome
● Dermatitis occurs when the cercariae penetrate the skin → DIAGNOSTIC TESTS
urticaria, pruritus, macular rash → Hepa B SErum markers, HBsAg, PCR
● Previously sensitive individuals may have more pronounced
symptoms MEDICAL MANAGEMENT
● Acute schistosomiasis may cause Katayama fever, specifically →PEGylated interferon or interferon or
from S. japonicum and S. mansoni nucleoside/nucleotide analogs (lamivudine,
● Several weeks after exposure, patients may develop fever, chills, adefovir, entecavir, telbivudine and tenofovir)
malaise, abdominal pain, diarrhea, hematochezia, chest pain,
cough, and hepatosplenomegaly INCUBATION PERIOD
● Chronic infections can cause granulomatous changes in the liver → 1-6 months
(S. japonicum, S. mansoni) and hematuria (S. haematobium)
○ S. haematobium can cause bladder calcification and PREVENTION
ureteral reflux leading to kidney damage → Hepa B Vaccine
→ Contact Precaution
DIAGNOSTIC EXAMINATION
● Serial stool and urine sample are required to identify the
excreted schistosoma eggs HEPATITIS C CAUSATIVE AGENT
● Labs will reveal eosinophilia (high eosinophils) (Non-A, Non-B →HCV; Flaviviridae
Hepatitis)
PREVENTION & CONTROL MODE OF TRANSMISSION
● Drug treatment →Blood-blood contact (BT, sharing of personal
○ Praziquantel (Biltricide) single dose in all species items, parenteral means
● Environmental sanitation
○ Provision of adequate, safe water supply INCUBATION PERIOD
○ Proper disposal of human excreta and urine → 2 weeks- 6 months
○ Avoid standing water in endemic countries
○ Health education on mode of transmission SIGNS AND SYMPTOMS
○ Snail control through focal use of molluscicides → Malaise, fever, n/v, abdominal pain,
○ Improve irrigation and agriculture practices arthralgia, jaundice
○ Avoid contact with snail-infested water
○ Use of food bridges DIAGNOSTIC TESTS
○ Use of protective footwear → Hepatitis C antibody test screening
PCR

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 ICTERIC STAGE ● This stage begins 4-10 days after the onset of
MEDICAL MANAGEMENT the preicteric stage
→ Direct acting Antivirals (DAAs): elbasvir/ ● Jaundice and dark urine are the classic
grazoprevir, ledipasvir/sofosbuvir, symptoms
simeprevir/sofosbuvir and sofosbuvir/ ● Scleral icterus, pale-colored stools, vasculitis
velpatasvir (primarily with hepa B), and glomerulonephritis

PREVENTION CONVALESCENT ● The duration of this phase depends on the

→ Hepa A&B Vaccine STAGE severity of the attack and the viral etiology

HEPATITIS D CAUSATIVE AGENT

*you cannot get Hepa →HDV; Deltaviridae MANAGEMENT FOR ALL HEPATITIS TYPES
D, without Hepa B DIETARY MANAGEMENT OF VIRAL OR DRUG RELATED HEPATITIS
infection* MODE OF TRANSMISSION ● Recommended small, frequent meals
(Fulminant form) → Direct contact, blood, saliva, semen, vaginal ● Provide intake of 2000 to 3000 kcal/d during acute illness
secretions ● Although early studies indicate that a high protein, high calorie
diet may be beneficial, advise patient not to force food and to
INCUBATION PERIOD restrict fat intake
→ 1-5 months ● Carefully monitor fluid balance
● If anorexia and nausea and vomiting persist, enteral feedings may
SIGNS AND SYMPTOMS be necessary
→ Acquired as coinfection or superinfection ● Instruct patient to abstain from alcohol during acute illness and for
with hepatitis B at least 6 months after recovery
→severe and fulminant hepatic failure ● Advise patient to avoid substances (medications, herbs, illicit
drugs, and toxins) that may affect liver function
DIAGNOSTIC TESTS
→ Hepa B serum markers, IgG and IgM **Hepatitis A and E: enteric precautions
anti-HDV antibody test, PCR
PREVENTION
● Encourage proper community and home sanitation
MEDICAL MANAGEMENT ● Encourage conscientious individual hygiene
→PEGylated interferon ● Instruct patients regarding safe practices for preparing and
dispensing food
PREVENTION ● Support effective health supervision of schools,
→ Hepa B Vaccine dormitories,extended care facilities, barracks, and camps
→ Contact Precaution ● Promote community health education programs
● Facilitate mandatory reporting of viral hepatitis to local health
departments
HEPATITIS E CAUSATIVE AGENT
(Enteric Hepatitis) → HEV; Caliciviridae QUESTIONS:
As a community health nurse, you can prevent the spread of Hep A
MODE OF TRANSMISSION through the following interventions:
→ Fecal-Oral Route a. Information dissemination on proper preparation and cooking
→ Sexual Contact (Oral-Anal) of food
b. Emphasize the importance of handwashing
INCUBATION PERIOD c. Maintain surveillance of post transfusion hepatitis, including
→ 15-65 days registry of individuals who donated blood
d. Supervise families in disinfecting equipment contaminated with
SIGNS & SYMPTOMS blood, saliva, or semen
→ Most cases are asymptomatic
→ Malaise, fever, n/v, abdominal pain, Answer/ Rationale: A. Information dissemination on proper preparation
arthralgia, jaundice and cooking of food

DIAGNOSTIC TESTS
→ IgM, IgG, HEV PCRtest When caring for a patient with Hepatitis B, this statement will indicate
further instruction:
MEDICAL MANAGEMENT a. Members of the health team are at risk of developing Hepatitis
→ supportive treatment and ribavirin B
b. Recap needles after IM injections
PREVENTION c. Serve a high CHO, high CHON, low fat diet
→Hepa E vaccine (China) d. Administer essentiale phospholipids capsule three times a day
→ Enteric Precaution
Answer/ Rationale: B. Recap needles after IM injections
SIGNS AND SYMPTOMS
ACUTE HEPATITIS A nurse is providing information to a client with hepatitis about the
4 STAGES OF VIRAL HEPATITIS convalescence stage. Recognizing the need for psychosocial support for
this client, the nurse suggests which of the following?
a. That the client stays in his or her room to facilitate resting
INCUBATION ● Period varies from a few weeks to 6 months, b. Diversionary activities that are not physically taxing
PERIOD depending on the viral agent c. Joining an aerobic exercises class
● During this period, the patient has no d. That the client speaks with his or her doctor about prescription
symptoms medications

PREICTERIC ● Malaise, fatigue accompanied by generalized Answer/ Rationale: B. Diversionary activities that are not physically
STAGE weakness, anorexia, nausea, dull right upper taxing
quadrant, flu-like illness, fever, rash, and
arthritis or arthralgias
● Most of the symptoms associated with viral
hepatitis dramatically resolve with the onset of Since individuals infected with hepatitis are anorexic and weak, an
jaundice increased CHO diet is advised. To ensure intake of this:
a. Give stir fried noodles

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 SIGNS AND SYMPTOMS
b. Serve favorite food of patient
c. Encourage lemon drops PATHOGNOMONIC SIGNS:
d. Serve hot goto or lugaw

Answer/ Rationale: C. Encourage lemon drops ● Cutaneous skin lesions

● Neuromas (peripheral nerve enlargement)
● Sensory loss, anhidrosis, and loss of hair
● Positive skin smear test
DISEASES AFFECTING INTEGUMENTARY
SYSTEM OTHER SIGNS
ERUPTIVE FEVER DISEASE ● Hypopigmented skin patches
● Exanthem: Eruption in Skin ● Decreased sensations
○ Outside the body ● Paresthesias (tingling sensation)
● Enanthem : Eruption in Mucous membrane ● Muscle weakness
○ Inside the body ● Thickened earlobes
● MADAROSIS: Loss of eyebrows and eyelashes
TYPES OF RASHES ● Nasal perforation
● MACULE ● Saddle nose
○ Flat rashes ● Corneal scarring leading to blindness
● PAPULE ● In severe cases, auto-amputation of digits, perineal, tibial, ulnar
○ Elevated rashes neuropathy may be seen.
● VESICLES ● Peripheral nerve enlargement
○ Elevated filled with fluid ● Positive skin smear test
● PUSTULE
○ Elevated filled with pus. EARLY SIGNS AND SYMPTOMS
● MACULOPAPULAR RASH ● Color changes on skin
● PETECHIAL/ PURPURIC RASH ● Skin lesions that do not heal
○ Common in dengue ● Pain and redness of the eyes
○ Thrombocytopenia ● Muscle weakness and paralysis of the extremities
● VESICULOBULLOUS RASH ● Nasal obstruction and nose bleeding
○ Common in burns and ● Loss of sensation at site of hypopigmented skin
other bullous formations ● Loss of hair growth
● Anhidrosis
[1] LEPROSY (HANSEN’S DISEASE)
● Ancient disease and is a leading LATE SIGNS AND SYMPTOMS
cause of permanent physical
● Lagophthalmos: Inability to close the eyelids; eyes are half open
disability
● Infection of the skin, nasal mucosa,
nerves, caused by slow growing
gram-positive bacteria
● Historically known to be very contagious
○ Contagious but not very contagious
● Madarosis: Loss of eyebrows and eyelashes

● Saddle-nose deformity: sinking of the nose bridge

● Natural Amputation
○ D/t loss of sensation
○ Absorption of small bones
● Leonine facies

CAUSATIVE AGENT
● Mycobacterium leprae
○ Reproduces at cooler temperature
○ Limited to skin of humans
● RESERVOIR:
○ Armadillos ● Contractures: clawing of toes and fingers
■ Have lower core body temperature ● Chronic skin ulcers
● Gynecomastia in men

INCUBATION PERIOD DIAGNOSTIC EXAMINATION

● 9 months - 20 years (Average of 5 years) ● Based on clinical signs and symptoms
● Skin smear
MODE OF TRANSMISSION ● Skin lesion biopsy
● Skin-to-skin contact ○ To confirm disease
● Droplet precaution ● PCR
○ To confirm disease
● Lepromin Test
● Wassermann Reaction Test
○ Also specific for syphilis

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 BACTERIOLOGICAL CLASSIFICATION QUESTIONS:
Early diagnosis and treatment are essential in the control of leprosy.
PAUCIBACILLARY MULTIBACILLARY Which of the following is an early sign of this condition?
a. Sinking of the nose bridge
b. Paralysis of the extremities
● Non infectious ● Infectious c. Loss of the eyebrows
● Tuberculoid ● Lepromatous d. Enlargement of the breasts in males
● Incubation period 2-5 ● Incubation Period:
years 8-12 years Answer/ Rationale: B. Paralysis of the extremities
● < 5 lesions ● > 5 lesions → A,C,D are all late signs
● Normal CMI / Partially ● Deficient CMI
Deficient ● (-) Lepromin Test
○ CMI: cell ● Skin smear + Biopsy As the nurse in the community, your responsibility in the management of
mediated → Numerous Bacilli leprosy is:
immunity a. Help educate on the nature of the disease
● (+) Lepromin (lepromin b. Telling patients not to have skin to skin contact
test) c. Have their children be adopted by relatives
● Few Bacilli d. Isolate them from the society in order to block the spread of
infection
MEDICAL MANAGEMENT / TREATMENT
Answer/ Rationale: A. Help educate on the nature of the disease
ANTI LEPROSY DRUGS (DRC) – used for chemotherapy
● Dapsone
○ Dapsone principle: MDT is considered as an effective treatment modality for leprosy because
■ Prevent drug resistance of the following advantages EXCEPT:
■ Hasten recovery a. It renders the patient resistant to the disease for life
■ Lessen period of communicability b. It reduces communicability period of leprosy in 4 weeks time
○ Adverse reaction: Itchiness c. It prevents development of resistance to drugs
● Rifampicin d. It shortens the duration of treatment
○ Adverse reaction: hepatotoxicity
● Clofazimine (Lamprene) Answer/ Rationale: A. It renders patient resistant to disease for life
○ Adverse reaction:Dryness/flaking of the skin

ACCORDING TO WHO PROTOCOL [2] MEASLES (RUBEOLA)

● Highly contagious, vaccine-preventable
● Paucibacillary (tuberculoid) treatment (for 12 months)
● Subacute sclerosing panencephalitis is a rare and fatal
○ Treated with Dapsone and Rifampicin for 12 months
degenerative disease of the CNS that occurs in some patient 7-10
○ Dapsone and Rifampicin: once a month
years after initial infection
● Multibacillary (lepromatous) treatment (for 24 months)
● Infection with measles confirms lifelong immunity
○ Treated with Dapsone, Rifampicin, and Clofazimine for
○ Once infected, can no longer be reinfected
24 months
○ Rifampicin: once a month
CAUSATIVE AGENT
○ Dapsone and Clofazimine: once a day
● Measles virus (Morbillivirus of the family Paramyxoviridae)
● Alternative Antimicrobial Agents
○ Minocycline
MODE OF TRANSMISSION
○ Clarithromycin
● Respiratory droplets (airborne)
○ Levofloxacin
○ Less than 5 micron
● Reportable Cases
● Can be sustained in the air when patient coughs, sneezes, or
○ Rifampicin - hepatotoxicity
when talking
○ Dapsone: Generalized itchiness
○ Lampene: Dryness and flaking of the skin
INCUBATION PERIOD
○ Goes back to the health center: 28th day of the month
● 7 to 21 days from exposure (Average of 10 - 14 days)
LEPRAE REACTION
SIGNS AND SYMPTOMS
MILD
● R.E.S.T. STAGE SIGNS AND SYMPTOMS
○ Reddening around the nodule
○ Edema PRE ● High grade fever and 3C’s
○ Sudden increase in number of lesions ERUPTIVE ○ Cough, coryza, and conjunctivitis
○ Tenderness and pain on nerves ● Malaise
● Enanthem - Koplik Spots on buccal mucosa
SEVERE ○ Grayish spots on the center
● Iritis ○ Appear 2-3 days before the appearance of
● Sudden Acute Paralysis the rashes/ viral exanthem
● Acute Orchitis ○ If patient already has rashes, expect that
koplik spots disappear already
NURSING MANAGEMENT
● Psychological aspect of care ERUPTIVE ● Maculo-papular rashes
○ Impaired body image ○ Appear on the hairline first and spreads
○ There is still societal stigma cephalocaudally over 3 days
● Physical exercise ○ Appears on 2nd to 3rd day during the
○ To prevent contractures and to increase muscle tone eruptive phase
● Skin care ○ Reddish and blotchy in appearance
○ Bc of loss of sensation ○ Covers the body in 2 to 3 days
● Provide drug instructions

PREVENTION POST ● Maculopapular rashes turn brown and start to

● Immunization (BCG) ERUPTIVE peel off.
○ Just like TB because it is also caused by ○ Educate the client not to voluntarily peel off
mycobacterium because it can cause secondary infection
● Avoid Mode of Transmission (MOT) ○ Fine branny desquamation
○ Droplet & Contact precaution ○ Road of recovery (convalescence stage)

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 COMPLICATIONS [DOPESD]
● Diarrhea CAUSATIVE AGENT
● Otitis Media ● Pseudo Paramyxovirus (Togavirus or Rubella Virus)
● Pneumonia
● Encephalitis MODE OF TRANSMISSION
● Seizures ● Direct (Respiratory droplet)
● Death ○ Distance of 3 ft
○ Can be aerosolized during aerosol procedures
DIAGNOSTIC EXAMINATION
● Clinical symptoms INCUBATION PERIOD
● Serum IgM and IgG levels are observed. ● 12-23 days (Average: 14 days)
○ Serology test
● Polymerase chain reaction (PCR) SIGNS AND SYMPTOMS
○ Detect the measles virus in serum
○ Urine and oropharyngeal and nasopharyngeal STAGE SIGNS AND SYMPTOMS
secretion
PRE ERUPTIVE ● Presence or absence of fever (1-2
PREVENTION days)
● MCV, Disinfection, Isolation ● Mild cough/ mild colds
● Forscheimer’s spots
MEDICAL MANAGEMENT / TREATMENT
● Supportive therapy
ERUPTIVE ● Maculopapular rashes (ears to the
● Isolation and Eye protection
face, after 24 hours, whole body)
○ Blindness is a complication of the measles (because
● Enlargement of lymph nodes
of the enanthem)

KEY POINTS POST ERUPTIVE ● Rashes disappears (3rd day of

● Koplik spots are a temporary viral enanthem and are illness)
pathognomonic for measles ● Enlarged lymph nodes gradually
● Fever is high grade and tends to last for about 4 days and occurs subsides
concurrently with conjunctivitis, coryza, and cough
● Subacute sclerosing panencephalitis (SSPE) is a rare and fatal
DIAGNOSTIC EXAMS
degenerative disease of the CNS that occurs in some patients
● Same as measles
7-10 years after initial infection
● History of exposure
● Serology testing (IgM, IgG)
QUESTIONS: ● Thru signs and symptoms
To differentiate from German measles, the nurse will observe that in
measles, the following are true, except: KEY POINTS
a. Disease is highly contagious ● Rubella and measles are similar but have some distinct
b. Koplik spots may appear before the rashes in the skin differences
c. Causes enlargement of post cervical and post auricular lymph ● Rubella is characterized by low grade fever, lymphadenopathy,
nodes and rash
d. Rashes are blotchy and reddish ● Measles is characterized by high grade fever, cough, coryza,
conjunctivitis, and rash
Answer/ Rationale: C. Causes enlargement of post cervical and ● The rash in rubella is fainter (pink vs red) and lasts for a shorter
postauricular lymph nodes → lymphadenopathy in german measles duration (3 days vs 7 days)
● Rubella is a milder disease but can cause congenital defects in
pregnancy
Which of the following nursing interventions should be provided to the 6 ● Forchheimer spots are transient erythematous petechiae seen as
years old child with measles: enanthem on the hard palate in about 20% of patients with rubella
a. Monitoring compliance to medication/treatment as prescribed ○ Since these spots can also be seen in measles and
by the physician scarlet fever, they are not pathognomonic for rubella
b. Keeping the child in an adequately ventilated room, free from ● Koplik spots, however small white to gray spots on the buccal
draft and chilling surface opposite the lower molars, are a pathognomonic
c. All the nursing interventions enanthem for measles

Answer/ Rationale: C. All the nursing interventions

Vitamin A is given to a child with measles because it:

a. Reinforces the body’s immune response
b. Helps the immune system prevent other infections
c. Is needed for supplementation
d. Resists the viral infection in the eyes, cell layers in the lungs,
gastrointestinal tract, mouth and throat

Answer/ Rationale: D. Resists the viral infection in the eyes, cell layers in
the lungs, gastrointestinal tract, mouth and throat

[3] GERMAN MEASLES (RUBELLA) SUMMARY

● Contagious, vaccine-preventable ● Rubeola (Ordinary measles)
● 3 day measles ○ 3CS
● Characterized by low grade fever, lymphadenopathy and rash ○ Pathognomonic sign: Koplik spots on buccal mucosa
○ Patient can feel sore throat and coryza ○ Cephalocaudally spread of rashes (start form hairline)
● Forchheimer spots on soft palate ● Rubella (German measles)
○ Not a pathognomonic sign because also appears on ○ Start with low grade fever, sore throat and coryza
scarlet fever ○ Forchheimer spots on soft palate
● The rash in rubella is fainter (pink vs. red) and lasts for a shorter ■ Not a pathognomonic sign because also
duration (3 days vs 7 days) appears on scarlet fever
● Many cases are asymptomatic, children exhibit mild symptoms ○ Lymphadenopathy
● Rubella is a milder disease but can cause congenital defects in ○ Rashes: appears initially on face and spreads
pregnancy cephalocaudally
● Infection with measles can conform lifetime immunity

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 ● Roseola Infantum ○ Can be self-limiting without the help of antiviral
○ Exanthem subitum medication
○ Affects young children 6-36 months old ● Antipruritic Agents
○ Caused by human herpesvirus 6 ○ Itchiness is one of the common symptoms
○ Abrupt high fever ○ Ex: lotions
○ After fever subsides, a rash develops, starting from
the neck to the trunk and spreading to the face and NURSING CARE
extremities ● Supportive care
○ Skin care to provide comfort and lessen itchiness
[4] CHICKEN POX ○ Increase/ boost nutrition of patient to aid in healing
● Highly contagious, vaccine preventable, viral illness process
● Characterized by a rash that spreads in a cephalocaudal ■ increase vitamin C in the diet and protein
progression and rapidly progresses from macules and papules to rich food
vesicles and then scabs ○ Boost the nutrition - aid in the healing process of the
● Portal of entry still the respiratory tract; enters broken skin but lesions
rarely happens ○ Increased Vit C and CHON rich food
● During summer, patient most likely scratches the rashes making ○ Ask patient to take a bath first before applying/ taking
the virus spread antipruritic agents
● Mild in children and more complicated in adolescents, adult ○ Provide cold compress on lesion to lessen itchiness
patients, and immunocompromised ● Avoid complications

CAUSATIVE AGENT PREVENTION

● Varicella - Zoster Virus (VZV) ● Anti- Varicella Vaccine (Varivax)
○ Given to infants 12 - 18 mos; SQ
MODE OF TRANSMISSION ○ 13 yrs and above: 2 doses with 1 month interval
● Can be found in Nasopharyngeal secretion ● Proper Disposal of respiratory secretions
○ Transmitted through airborne ● Coughing and sneezing etiquette
● Can be found in fluid contained in vesicles
○ Transmitted through direct contact PREVENTION
● Rarely, it can be transmitted through break in the skin ● After a single dose of vaccine, some patients exposed to a wild
● Indirect contact with fluids from lesions strain of VZV may develop a mild form of chickenpox referred to
○ Although rarely happens as “breakthrough disease”
○ Use of gloves and gowns as part of PPE ● These patients will have a lower grade fever, atypical rash pattern,
and fewer lesions and are less likely to develop complications
INCUBATION PERIOD ● Although “breakthrough disease” could potentially occur after the
● 10-21 days (Average: 14-16 days) second dose of vaccine, it would be rare

SIGNS AND SYMPTOMS After recovering from the varicella, the patient asked whether he would
not have the disease again. The best response is:
STAGE SIGNS AND SYMPTOMS a. “Like chickenpox, you will develop a permanent immunity to it”
b. “It will recur especially when you had it during your childhood
PRE ● 24-48 hours years”
ERUPTIVE ● Presence of low grade fever c. “You can have the disease again if your immune system is
● Body malaise compromised”
● Muscle pain d. “You cannot have it anymore if you finished the treatment
regimen”

ERUPTIVE ● Prompts patient to go to the hospital Answer/ Rationale: C. “You can have the disease again if your immune
● Vesiculo-papular rash system is compromised”
● Macule-Papule-Vesicle-Vesiculopapular-
Vesiculopustular To hasten the drying of the lesions and relieve the itchiness in a child with
○ Starts from the hidden parts of the body like chickenpox, the nurse suggests that the mother should try:
chest or trunk and spreads peripherally a. Using wet to dry saline dressings over the oozing vesicles
○ Appearance of rashes is one at a time b. Rubbing bacitracin ointment into the open lesions
○ Does not fuse together to form clusters c. Having the child wear mittens and cutting the fingernails short
● Cellulitis Formation d. Patting the lesions gently with a paste of baking soda and
○ Lesions become infected through frequent warm water
scratching of skin
● Pock Marks Answer/ Rationale: D. Patting the lesions gently with a paste of baking
○ Developed due to scar formation soda and warm water
○ Also known as mother lesions; first ever
lesion that appeared Julius has lesions that appear as vesiculo-pustular and was diagnosed as
shingles. How would the nurse differentiate the lesions from chicken pox?
POST ● Crusts (dry), fall off (peels off) a. Lesions appear on the covered parts of the body, starting in
ERUPTIVE ○ DO NOT REMOVE because it can cause the scalp and trunk
secondary infections b. Lesions have a unifocular appearance
○ Usually takes two weeks to completely fall c. Lesions are painful and appear clustered
off d. Lesions are itchy and warm to touch
● Road to recovery
Answer/ Rationale: C. Lesions are painful and appear clustered

DIAGNOSTIC EXAMINATION
● Clinical Observation [5] HERPES ZOSTER/ SHINGLES
○ Common way since you will just see the lesions, you ● Dormant or Inactive Type
know its chicken pox ○ Need to have chicken pox first
● PCR ● Other terms: Shingles; Zona; Acute Posterior Ganglionitis
(ganglions of the posterior nerve roots)
MEDICAL MANAGEMENT ● Sequelae of varicella
● Milder in younger age; adult in more severe in complications ○ Reactivation of the VZV
● Acyclovir
○ 4 to 5/ day for 7 days CAUSATIVE AGENT
○ Antiviral medication ● Varicella zoster virus right after the initial varicella infection
○ Only decreases the time and s/sx of disease but (chicken pox)
DOES NOT cure. ● Dormant varicella-zoster virus
● Herpes zoster virus

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 MODE OF TRANSMISSION PREVENTION
● Direct (droplet) ● Avoid skin to skin contact with a person who has scabies and
● Airborne contact with items such as clothing or bedding used by a person
● Indirect through touching articles freshly soiled by secretions and infected with scabies mites
discharges ● Observe good personal hygiene

SIGNS AND SYMPTOMS VECTOR- BORNE DISEASES

● Same as chicken pox
[1] CHIKUNGUNYA
● Vesiculopustular rashes
● Rarely fatal
● Very painful lesions
● Symptoms are generally self-limiting
○ No crossing of nerves from one side of the body →
● Virus remains in the body for 5-7 days
unilateral in nature
● Appears in clusters and in the mucous membrane
CAUSATIVE AGENT
● Vectors: Aedes mosquitoes
DIAGNOSTIC EXAMINATION
○ A. aegypti
● Clinical observations (history and physical examination)
■ DLSU: Day biters, Low flying, Stagnant
● Tissue culture
water, Urban)
● Serology test
■ 2 hour before sunrise and 2 hrs before
● Smear of vesicle fluids
sunset
○ A. albopictus
MEDICAL MANAGEMENT
● Causative agent: Chikungunya virus
● Antivirals
● Reservoir: human and non-human
● Acyclovir
● Antipruritic
INCUBATION PERIOD
● Antipyretic
● 2-12 days (Ave: 3-7 days)
● NO aspirin (Risk of Reye’s syndrome)
MODE OF TRANSMISSION
NURSING MANAGEMENT
● Bite of infected female mosquitoes from an infected person’s
● Symptomatic / Supportive Management
blood
● Reduction of complications
● Bite by an infected mosquito while traveling in endemic places
[6] SCABIES
SIGNS AND SYMPTOMS
● Seven year itch
● Abrupt onset of fever
● Highly contagious parasitic skin disease that usually affects
● Headache and myalgia
people living in poor living conditions
● Nausea with occasional vomiting
● Easy fatigability
CAUSATIVE AGENT
● Maculopapular rashes (more prominent in lower extremities)
● Sarcoptes Scabiei variation: hominis - human itch mite
● Joint pain (arthralgia) → chronic polyarthritis 1 year after initial
infection
INCUBATION PERIOD
● GBS may occur (post infectious complication)
● Initial infection: 2-6 weeks; Repeat exposure: Rapid Onset
DIAGNOSTIC EXAMS
MODE OF TRANSMISSION
● Serological ELISA
● Direct Contact (Prolonged skin to skin contact)
○ Viral nucleic acid or chikungunya-specific IgM and IgG
● Indirect contact (Fomites)
○ 1 week of symptoms → inc. IgM
● Contact with dogs, cats, and small animals (infestation from
○ 2 weeks of symptoms → inc IgG
animals
● Virological Method - RT PCR
SIGNS AND SYMPTOMS
TREATMENT
● Intense pruritus (Hallmark sign)
● No specific antiviral drug treatment
● Small papular rash
● Supportive or symptomatic therapy
● Thick crusts
○ Antipyretics
○ Analgesic
COMMON SITES OF INFECTION
○ Fluids
● Hands (interdigital spaces)
● No vaccine yet
● Inner part of the wrist, inner elbow, armpits and waist
● Sole of the feet and around the toes
NURSING MANAGEMENT
● Buttocks and male genitalia
● Hyperthermia
○ Improve the body temperature
DIAGNOSTIC EXAMS
○ TSB, increase fluid intake, remove excessive clothing,
● Thorough history
antipyretics as ordered, cooling measure
● Physical Assessment
● Deficient fluid volume
● Skin scraping - mineral oil will be dropped on the burrow, then
○ Restore adequate amount of fluid volume
scraping and evaluation of the skin under a microscope
○ Increase fluid intake
○ Assess signs and symptoms of dehydration
MEDICAL MANAGEMENT
○ Amount and color of urine
● Pediculicide (Permethrin 5% cream or Lindane lotion 1%)
○ Parenteral fluids as ordered
● Oral Ivermectin 200 mg/kg as a single dose and repeat after 2
● Pain
weeks
○ Relief from pain
● Antihistamine
○ Pain reliever, rest periods, relaxation technique
● Bedding, clothing, and towels used by infected persons and
○ Analgesics
people they are in close contact with should be decontaminated
● Impaired skin integrity
○ Wash them in hot water and dry in a hot dryer to dry-
○ Improve the integrity of the skin
clean
○ Monitor the color changes, redness, any swelling, skin
○ Store items that can’t be washed in a sealed plastic
care as needed, avoid scratching the skin to avoid
bag for at least 72 hours
further impairment of skin and cut the fingernails short,
○ Thoroughly clean and vacuum rooms
wear gloves
○ Antibiotics for secondary infections
NURSING MANAGEMENT
● Instruct patient to apply cream at bedtime
PREVENTION
● Contaminated clothing or bedclothes should be dry cleaned or
● Avoid mosquitoes
boiled
● 4S Strategy
● Practice good hand washing or use glove while performing
procedures
● Terminal disinfection should be carried out after patient discharge

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 [2] DENGUE SIGNS AND SYMPTOMS
● An endemic disease in the Philippines, can occur anywhere and ● Fever and aches and pains
anytime of the year
● Other terms: dengue hemorrhagic fever or breakbone fever GENERAL SIGNS AND SYMPTOMS
● An acute febrile illness ● Rashes
● Characterized by flu-like symptoms and, aches and pain in the ● Sudden onset of high fever
body ● Vomiting
○ Headache, arthralgia, and myalgia are experienced ● Headache
● Often asymptomatic, but it can cause mild symptoms ● Muscle and Joint pain
● Can also become severe in the form of dengue hemorrhagic fever ● Pain behind the eyes
● Self-limiting disease but possible complications should be ● Stomach pain
prevented ● Diarrhea
● You can acquire dengue 4x in your life (due to 4 causative agents)

CAUSATIVE AGENT PHASE SIGNS AND SYMPTOMS

● Dengue Virus (DEN)
○ Single strand RNA with 4 major serotypes (DENC- 1,
FEBRILE PHASE ● High grade fever, facial flushing, erythema
2, 3, 4)
(2 - 7 days) ● Malaise, arthralgia, headaches
○ Can get dengue 4 times in lifetime
● Respiratory signs
○ Flaviviridae virus
● Easy bruisability
● Vector: Aedes aegeypti/ A. albopictus/ A. Polysensius
● Herman’s sign
○ A. aegypti is a day biting mosquito (predominant)
○ Generalized redness on the
■ Live in clear stagnant water (dirty water
extremities caused by presence of
has no oxygen)
petechiae rashes
○ A. albopticus is the night-biting mosquito
○ Believed to be the Pathognomonic
○ These are low flying mosquitos (usually bites on
sign, but not all patients manifest this.
lower extremities )
Thrombocytopenia is the hallmark
○ White body with gray lines
sign
● Epistaxis
INCUBATION PERIOD
● Mucosal bleeding
● 3-14 days, commonly 5-7 days
● Positive tourniquet test (Rumpel-leede test)
● Fever, headache, myalgia, arthralgia, rash,
MODE OF TRANSMISSION
petechiae
● Vector - Mosquito bite to humans
○ Can’t be transmitted through human to humans
CRITICAL PHASE ● Temp drops and remains 37.5-38 C
DIAGNOSTIC EXAMINATION (24 - 48 hrs) ● Circulatory Failure:
● Rumple Leede Test - (+) > 20 petechial formation in 1 square ○ Cold and clammy skin
inch ○ Decreased PR (thready) which can
○ Also known as tourniquet test later on be → inc PR
○ To determine capillary fragility ○ Increased RR
○ Can also be performed in other eruptive fever disease ○ Thready RR → impending circulatory
(i.e scarlet fever) failure
○ Placing a BP cuff in a patient’s arm for a period of ○ Watch out for bradycardia
time: ● Dec platelet count and possible shock
■ Get the average of the systolic and ● DENGUE SHOCK SYNDROME
diastolic bp then inflate cuff for a period for ○ Hypovolemic shock
10 mins (adult) or 5 mins (pedia) ○ Death can occur unless fluid
○ Only performed in children 6 months or older resuscitation is initiated.
○ Only if patient has fever for more than 3 days and ● GI hemorrhage and plasma leakage into the
there are no other signs of DHF chest and peritoneal cavities
○ If with warning signs of bleeding, this is not performed ● Abdominal pain, ascites, and dyspnea
because it indicates that there is capillary fragility ● DSS can occur
● Platelet count & Hematocrit count
○ Increased HCT and thrombocytopenia RECOVERY PHASE ● Well-being improves
○ Determines the different pathophysiological (48 - 72 hrs) ● Capillary leakage stops and fluid starts to be
mechanism due to the presence of the virus reabsorbed in the system
○ Virus causes capillary fragility, vascular permeability, ● Bradycardia
destroys cells that forms platelets ● White patches in the skin indicates road to
○ Vascular permeability causes leakage of plasma that recovery - “Islands of white in a sea of red”
causes increased HCT
○ Decrease of WBC due to viral infection
● CBC CRITERIA AND WARNING SIGNS [BEHH]
○ Leukopenia, thrombocytopenia, increased HGb and ● Bleeding of gum
HCt (papillary leakage) ● Epistaxis
● Liver enzymes ● Hematemesis
● Decrease in albumin ● Hematochezia
○ Decrease in albumin level which indicates capillary
leakage (edematous signs and symptoms)
● Fecal occult blood test PROBABLE ● Live in or travel to dengue endemic area
○ To determine GI bleeding DENGUE ● Fever and 2 of the ff:
● Dengue Duo Test ○ Nausea and Vomiting
○ Dengue NS1 ○ Rash
■ Determine virus antigen at the early stage ○ Aches and Pains
of infection ○ Tourniquet test positive - Leukopenia
○ Serology tests (IgG and IgM) ○ Any warning sign
■ IgM - acute stage ○ *Lab-confirmed dengue - important when no
■ IgG - late onset sign of plasma leakage
● PCR
○ Done if available but usually, dengue-duo test is WARNING ● Abdominal pain or tenderness
performed (Dengue NS1 and serology tests) SIGNS ● Persistent vomiting
● Clinical fluid accumulation
● Mucosa; blood
● Lethargy, restlessness

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 ● Liver enlargement >2cm d. Realize that this is within normal value
● Laboratory
○ Inc in HCT concurrent with rapid inc in Answer/ Rationale: D. Realize that it is within the normal value →
platelet count 150,000 to 400,000 is the normal range
○ Require strict monitor and medical
intervention The child diagnosed with dengue hemorrhagic fever must be referred
immediately to the physician upon which of the following nursing
assessments?
SEVERE PLASMA LEAKAGE a. Complaint of epigastric pain and nausea
● Dengue Shock Syndrome leading to: b. Headache and dizziness
○ Shock DSS c. Blood pressure of 90/70 mmHg
○ Fluid accumulation with respiratory distress d. Hematocrit of 40%
○ Severe bleeding as evaluated by the clinician
■ Severe organ involvement Answer/ Rationale: C. Blood pressure of 90.70 mmHg
■ Liver: AST or ALT > or = 1000 → narrowed BP may indicate circulatory collapse
■ CNS: impaired consciousness
■ Heart and other organs
[3] ZIKA VIRUS
● CA: Zika virus
● Reservoir: human and nonhuman primates
● Vector: Aedes aegypti
● Incubation: 3-12 days
● MOT: bite of infected mosquitoes from an infected person’s blood

MEDICAL MANAGEMENT
SIGNS AND SYMPTOMS
● Hydration
● Fever (low grade)
○ Leakage of plasma that cause imbalance in
● Conjunctivitis
homeostasis intravascularly
● Skin rash
● Symptomatic treatment
● Arthralgia
● Antipyretics, analgesics
● Headache
○ Avoid NSAIDS
● Myalgia
○ Can further lead to bleeding
● Retro Orbital pain
● IV Fluids and blood products
● Vomiting
● No antiviral drugs
COMPLICATIONS
NURSING CARE
● GBS
● Prevention and control of bleeding
● Microcephaly: neonatal malformation
○ Protect from injuries
○ Avoid vigorous activities
TREATMENT
○ Avoid picking the nose
● No known cure/ vaccine
● Increased fluid intake
● Avoid mosquitoes → 4S
● Increase body resistance (rest and nutrition)
● Avoid sex/ use condoms
● Pain management, if not relieved, refer to MD
● Avoid dark-colored food
○ Can mask the color of the stools that can be indicative QUESTION: The Zika virus has not entered the country but is an
of GI bleeding emerging infection worldwide. The nurse knows that the following facts
○ Avoid red meat during fecal occult blood test about this disease condition are correct, least likely is:
● Avoid GI-irritating foods a. There is no known cure or vaccine for this disease
○ Can trigger bleeding in the mucosa b. Infection during pregnancy can cause birth defects such as
microcephaly
PREVENTION c. It could be transmitted through sexual intercourse
● Educate the Client to observe 4s d. None of the above
○ Search and destroy
○ Seek consultation Answer/ Rationale: D. None of the above
○ Say No to fogging
○ Self protection
● 4’o habit [4] MALARIA (AGUE)
● King of Tropical Diseases
● Life-threatening disease caused by plasmodium parasites
QUESTIONS: transmitted by anopheles mosquito
In the Philippines, the peak prevalence of Dengue fever is usually ● Has an indefinite period of chills and fever
observed in the months of July to November. Which of the following are ● Characterized by paroxysmal chills, fever and diaphoresis
true regarding this disease? ● Stages occur due to the specific protozoa or causative agent
1. Many cases of Dengue fever are misdiagnosed because of ○ Cold Stage - chills
absence of signs of abnormal bleeding tendencies ○ Hot Stage - fever
2. The major strategy for control of the disease is eradication of ○ Wet Stage - diaphoresis
the vector mosquito, Aedes aegypti
3. A patient with fever of three days or longer needs to undergo a CAUSATIVE AGENT & INCUBATION PERIOD
tourniquet test ● IP: Usually 4 - 6 wks
4. The mosquito vector bites only during the daytime ● P. falciparum: 9 to 14 days
a. 1, 2, 3 ○ Causes fatal malaria
b. 1, 3, 4 ● P. vivax and P. ovale: 12 to 18 days
c. 2, 3, 4 ● P. malariae: 18 to 40 days
d. All of these are true
MODE OF TRANSMISSION
Answer/ Rationale: A. 1,2,3 ● Vector: Female Anopheles
○ Night biting mosquito
Hematology report of platelet count of a patient with dengue revealed ○ Female anopheles resides outdoors in agricultural and
250,000/cc. Mm. From your knowledge of laboratory value, you will: rural settings
a. Call the physician’s attention to this value and anticipate ○ Active in hours before sunrise and several hrs after
transfusion of whole blood sunset
b. Have vitamin K available for IV infusion ○ Breeds in slow flowing water, mountainous area
c. Call the physician and laboratory for platelet transfusion ○ Common in Palawan

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 ● Rarely, through blood transfusion and sharing of contaminated ○ Abortifacient → can cause neonatal malaria and to
needles severe anemia and death
■ Can lead to miscarriage
● IV Quinidine Gluconate + Doxycycline or Clindamycin (Severe
form)

NURSING CARE
● Symptomatic treatment
● Provide rest periods
● Apply standard precautions
● Increased fluid intake (especially during the wet stage)
● Monitor I/O
● Provide comfort measures
● Monitor vital signs
● WOF neurologic toxicity
● Keep a mosquito-free environment

PREVENTION
● Mosquito control (4S)
● Control measure for mosquito borne illness
SIGNS AND SYMPTOMS ● Malaria prophylaxis
● Cold stage (10-15 mins) ○ For those travelers in endemic regions
○ Chills ○ In the form of primaquine
○ Provide hot water bath, blanket, warm compress on ○ Chemoprophylaxis
foot part, lamp ■ Chloroquine taken weekly 1 to 2 weeks
● Hot Stage ( 4 - 6 hrs) before going to a malaria-endemic area
○ Expect fever accompanied by headache ■ During pregnancy
○ Also accompanied by abdominal pain, vomiting ● Screening of blood donors
○ If with neurologic symptoms, refer patient immediately ● Care in handling syringes and needles use on patients with
because it can aggravate the patient’s condition malaria
○ Perform TSB, cold compress, change clothing to light
comfy, provide fluid, MOSQUITO CONTROL
■ Be careful to increase fluids. Assess first ● Based on characteristics of the Anopheles
the presence of edema or renal function ● Chemical methods
test ○ Mosquito repellents
● Wet stage ○ House fumigation
○ Profuse sweating or the diaphoresis stage ○ Use of chemically treated mosquito net
○ Dehydration ● Biological
○ Body weakness due to the first two stages ○ Stream seeding (use of larva-eating fish: 2 to 4 fish/sq
○ Change clothing, linens, and increase fluid intake m)
○ Neem trees and other aromatic plants
○ Zooprophylaxis
UNCOMPLICATED ● Paroxysmal fever ● Environmental methods
MALARIA ● Chills ○ Stream clearing
● Malaise ○ Screening of houses
● Arthralgia ● Education
● Myalgia ○ Avoid outdoor activities during peak biting hours (9pm
● Headache - 3am)
● Diaphoresis ○ Wear clothing covering arms and legs in the evening
● Tachycardia
● Tachypnea NOTE:
● Abdominal pain ● Zika can cause anencephaly in fetus or infants
● Splenomegaly ● Chikungunya → no bleeding but can cause hepatic failure
● Nausea ● Zika, Chikungunya, and dengue are caused by aedes aegypti
● Vomiting

SEVERE ● Altered mental status (AMS) QUESTIONS:

MALARIA ● Seizures The malaria control program focuses on mosquito control measures.
● Shocks These include the following except:
● ARDS a. Destruction of breeding places of the anopheles
● Metabolic Acidosis b. Stream seeding with larvae eating fish
● Hemoglobinuria c. Stream clearing of breeding places
● Renal Failure d. Screening of houses/use of animal screen
● Hypoglycemia
● Hepatic failure Answer/ Rationale: A. Destruction of breeding places of the anopheles
● Coagulopathy
Malaria is endemic in several provinces in the country. Knowledge of the
nature of this disease and its mode of transmission will help the nurse in
OTHERS ● Severe Anemia → cerebral hypoxia planning and implementing preventive control measures. Clinical
● Blackwater fever symptoms of malaria include the following:
a. Profuse perspiration after chills and fever
DIAGNOSTIC EXAMINATION b. Tingling sensation along the spine
● Complete history c. Slight fever and headache
● Labs may reveal anemia, thrombocytopenia, elevated AST/ALT, d. Shaking chills, fever, pleural pain, and dyspnea
elevated bilirubin, and elevated BUN/ creatinine
● Thick and thin blood smears - Malarial smear Answer/ Rationale: A. Profuse perspiration after chills and fever
○ Thick - detect parasites
○ Thin - identify species As malaria could be fatal, especially to children, the IMCI particularly
● Rapid Diagnostic Test - QBC (Quantitative Buffy Coat) recommends a combination of medications to combat this disease. These
include the following, except:
MEDICAL MANAGEMENT a. Artemether-Lumefantrine
● Chloroquine → mainstay drug b. Artesunate with Amodiaquine
● Sulfadoxine, Primaquine and Quinine → last resort c. Quinine
● Tetracycline, Atovaquone/Proguanil, Artemether → first choice d. Nizatidine
● Lumefantrine, Quinine sulfate plus doxycycline or mefloquine

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 ○ Post Validation Surveillance
○ Private-Public Partnership
Answer/ Rationale: D. Nizatidine ● Program Accomplishments or Status
○ Provinces have reached elimination level and declared
Nurse Hannah is educating the community about malaria. Which as Filariasis-free as of 2017: 38 provinces
statement, if made by the client, indicates correct understanding?
a. I can get malaria from the bite of an infected female mosquito
b. I can also get malaria from drinking water contaminated with SEXUALLY - TRANSMITTED DISEASES
mosquito egg [1] HIV/ AIDS
c. I can develop partial immunity after getting sick with malaria ● Can cause immunodeficiency and lead to a lot of risks and
d. Clear flowing streams are the breeding sites of these complications because they are vulnerable to infections
mosquitoes ● AIDS: manifest group of symptoms due to immunodeficiency
● HIV infection at first → infection if not treated promptly → lead to
Answer/ Rationale: A. I can get malaria from the bite of an infected severe form → AIDS (acquire - infx has been transmitted to
female mosquito person that causes group of symptom → further suppresses the
immune system)

[5] FILARIASIS / “ELEPHANTIASIS” CAUSATIVE AGENT

● Complex of parasitic diseases caused by threadlike nematodes ● Retrovirus (HIV-1, HIV-2)
transmitted by the bites of mosquitoes and black flies ○ Virus from genus lente (slow, attacks slowly and
● Elephantiasis is a severe manifestation of lymphatic filariasis attacks immune system) virus
causing blockage in lymphatic system → lymphadenitis and ○ HIV-1: etiologic agent of AIDS
lymphedema causing enlargement and thickening of the skin of ○ HIV-2: identified in 1986 in West Africa; contains the
lower extremities viral RNA with glycoproteins
● Human T-Cell lymphotropic virus (HTLV)
CAUSATIVE AGENT ○ Lengthy (slowly) attacks the immune system
● Wuchereria bancrofti
● Brugia malayi, B. timori MODE OF TRANSMISSION
● Direct contact
MODE OF TRANSMISSION ○ Blood, seminal fluid, vaginal secretions, amniotic fluid
● Mosquito bite and breast milk, sexual contact, sharing needles to
● Vector: inject drugs, vertical transmission, breastfeeding,
○ Aedes poecilus (female/ night biter) blood transfusion, organ donation
○ Culex quinquefasciatus ○ Reservoir: body fluids and blood
○ Anopheles minimus flavirostris ■ Body fluids → 4 hours survival
○ Nematode forms contains the causative agents ■ Blood → 12 hours survival
● Virus is still alive even after death
INCUBATION PERIOD ○ Body should be cremated or buried in sealed casket
● 8-16 months within 24 hours

SIGNS AND SYMPTOMS

SOURCE PERCENTAGE OF EXPOSURE
ACUTE STAGE ● Chills
● Fever Sexual contact 0.1-1% transmission
● Lymphangitis (inflamed lymph vessels)
● Lymphadenitis (lymph nodes) Blood transfusion 90% transmission
● Funiculitis Multiple or repetitive contact increases
● Orchitis (redness, painful and tender scrotum) chances

CHRONIC ● Hydrocoele (swelling of scrotum) Exposure to infected blood 0.1-0.5%

SYMPTOMS ● Lymphedema (Swelling of upper and Lower products or tissues
ext)
● Elephantiasis (thickening of the skin)
Perinatal transmission 30% but if treated 5%
(pregnancy)
DIAGNOSTIC EXAMINATION
● Blood Smear Sharing needles or syringes 0.1-0.5%
○ Nocturnal blood exam done every 8 PM
● Immunochromatographic (ICT)
○ Antigen test at daytime STAGES OF HIV INFECTIONS/ AIDS
1. PRIMARY INFECTION (Acute/ Recent HIV Infection, Acute HIV
MEDICAL MANAGEMENT Syndrome)
● Diethylcarbamazine citrate (DEC) or Hetrazan and
Doxycycline ● Window period: false negative; Asymptomatic
● Surgical: Lymphovenous anastomosis (lymphedema), ligation & ○ 2-4 weeks after infection (seroconversion illness)
stripping ○ Flu-like symptoms
○ High level of viral replication → virus attacks and
NURSING CARE destroys CD4 T-cells
● Symptomatic ○ Dramatic drop of CD4 T-cell count

PREVENTION 2. HIV ASYMPTOMATIC (CDC Category A: More than 500 CD4 T

● Eradication of vectors lymphocytes/mm3)

FILARIASIS ELIMINATION PROGRAM ● CDC Category A: >500 CD4 T lymphocytes/mm3

● Mass annual treatment using the combination drug ● Clinical latency
○ Diethylcarbamazine citrate (DEC) and Albendazole ● 8 to 10 years
for a minimum of 5 years to individual ages 2 years old ○ Prolonged chronic stage
and above living in established endemic areas ○ Ptx may be feeling well; minimal manifestations
○ An administrative Order declaring November as ● Good health, because CD4 T cells remains at high levels enough
Filariasis Mass Treatment Month to preserve the immune defensive response of the patient
● Strategies, Action Points, and Timeline ● Associated with gradual decline of CD4 count
○ Mass Drug Administration
○ Disability Management
○ Monitoring through Midterm Sentinel Surveys and
Evaluation through Transmission Assessment Survey

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3. HIV SYMPTOMATIC (CDC Category B: 200 to 499 CD4 T
Lymphocytes/ mm3) MEDICAL MANAGEMENT
ANTIRETROVIRAL AGENT
● CDC CATEGORY B: 200 - 499 cells/mm3 ● Nucleoside Reverse Transcriptase Inhibitors (NRTI)
○ May still decline below 200 ○ Terminates viral replication
● Average: 1-3 years ○ AZT (Azidothymidine)
● Viral load may still rise ■ Side effect: agranulocytosis
● Caused by HIV infection or defect in cellular immunity ■ CBC every 2 weeks
○ May require clinical course or management that is ○ Zidovudine, Retrovir
complicated ● Non Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
● HIV POSITIVE- ARC (AIDS- Related Complex) symptoms start ○ Blocks DNA activity
to appear; requires 2 positive results before proceeding to western ○ Nevirapine (viramune)
blot ● Protease Inhibitor (PI)
○ Fever and night sweats without a reason (fever of ○ Prevents the maturation of the HIV
unknown origin) ○ Saquinavir (invirase), indinavir (Crixivan), ritonavir
○ Lymphadenopathy that transfer to lymphs (novir)
○ Body malaise ● Fusion Inhibitor
○ Temporary memory loss ○ Prevents fusion of the virus to human cell
○ Altered gait ○ Enfuvirtide (fuzeon)
○ Given in cocktail = multidrug therapy (21 tablets per
4. AIDS (CDC Category C: Fewer Than 200 CD4 Y Lymphocytes/ day)
mm3)
NOTE: Drugs are given in combination (multi-drug therapy)
● CDC CATEGORY C: CD4 less than 200 cells/ cubic millimeter
○ less than 50 NURSING CARE
● Major symptoms of AIDS: ● Health education on 4CS
○ Persistent fever ○ Counseling
○ Persistent diarrhea (1 month) ○ Compliance
○ 10% weight loss/ stunted growth ○ Contact tracing
● Minor symptoms of AIDS: ○ Condoms
○ Persistent cough (1 month)
○ Persistent generalized lymphadenopathy PREVENTION
○ Generalized pruritic dermatitis ● ABCDE - prevention of STIs
○ Oropharyngeal candidiasis ○ Abstinence (no sex) sad life
○ Recurrent herpes zoster ■ Magimagine nalang :)
○ Progressive disseminated herpes simplex ■ Tigang stage
● To be categorized as AIDS: ○ Be monogamous
○ In adult: 2 major, 1 minor ■ Be faithful to one partner
○ In children: 2 major, 2 minor ■ In short: wag mangabit!!!!
● Death usually occurs 10 - 11 years after exposure if not treated. ○ Consistent and correct use of condom
○ If with treatment, patient may live for more than 11 ■ Prevention of STIs not contraception
years ○ Do not share syringes
● Opportunistic infections appear (Ex: candidiasis, fungal and ■ Do not share injections
bacterial infections, generalized lymphadenopathy ■ Do not do drugs
○ Kaposi's sarcoma → Ca of the blood vessels walls ○ Early detection, Education and counseling
DIAGNOSTIC EXAMINATION [2] GONORRHEA (CLAP/GC)
● EIA (Enzyme immunoassay) ● Common cause of urethritis (for men) and cervicitis (for women)
● ELISA: Initial screening test ● In tagalog: “Tulo”
○ Cheaper but long duration of time for results ● Second most common reportable STD
○ Screening test
○ 2 positive ELISA test is needed before patient is CAUSATIVE AGENT
subject to Western blot (confirmatory test) ● Neisseria gonorrhoeae or gonococcus
● Western blot: Confirmatory
● HIV viral load MODE OF TRANSMISSION
● CD4 count ● Sexual contact
○ Determines the immunosuppression
○ Normal range 500 - 2500 cells per cubic millimeter INCUBATION PERIOD
○ If it is already below 500, the pt can still have ● 1-14 days (2-25 days after contact)
adequate immune response but usually it gradually
declines and once it reaches below 200 = thats SIGNS AND SYMPTOMS
already immunosuppression
○ Below 200: severe immunodeficiency MEN WOMEN
● For Pediatrics:
○ Blood culture for HIV
● Urethritis ● PID (frank, abdominal
○ Immune complex dissociated p24 assay
● Purulent urethral pain, fever, chills, n&v)
○ Polymerase chain reaction
discharge ● Cervicitis (discharge,
● Dysuria intermenstrual bleeding,
● Formation of scar in dyspareunia (painful
TEST FINDINGS IN HIV INFECTION the epididymis sexual intercourse),
● Chronic: sterility urethritis, dysuria and
○ Usually pelvic pain)
ENZYME Antibodies are detected, resulting in positive unilateral ○ May also
IMMUNOASSAY results and marking the end of the window period lead to
(EIA) salpingitis
→
WESTERN BLOT Also detects antibodies to HIV; used to confirm EIA inflammation
of fallopian
VIRAL LOAD Measures HIV RNA in the plasma tubes →
sterility/ectop
ic
CD4/CD8 These are markers found on lymphocytes. HIV kills ● Sterility or ectopic
CD4+ cells, which results in a significantly impared pregnancy
immune system.

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 DIAGNOSTIC EXAMINATION LATENT STAGE ● Asymptomatic but communicable
● Culture
● Gram staining of urethral discharge TERTIARY ● Patient is no longer communicable but
○ To determine presence of causative agent STAGE complications can happen
● GUMMA: infiltrating tumor appears on skin,
COMPLICATIONS bone and liver; “decaying tumors”
● Infertility
● Epididymis ● CV changes:
● Arthritis ○ Aortitis, aneurysm
● Conjunctivitis ○ Primary cause of death
● Meningitis and Endocarditis ● CNS degeneration (paresthesia; abnormal
● Ophthalmia neonatorum reflex; shooting pain dementia; psychosis;
○ If the fetus is born to a mother with gonorrhea abnormal gait)
○ given prophylaxis for neonates called:
ERYTHROMYCIN OINTMENT (crede’s prophylaxis)

MEDICAL MANAGEMENT
● Penicillin: Benzathine Penicillin G
○ Best administered IM with a large bore needle in a
large muscle
○ if administered via IV, can cause drug coagulation,
phlebitis
■ If IV, slow drip and diluted
● Cephalosporin (Ceftriaxone, cefurozime)
● Tetracycline (Doxycycline)
○ Can be given with chlamydial infection

DIAGNOSTIC EXAMINATION
NURSING CARE ● Dark field microscopy
● Health education ● Serology testing
○ Sex education → adhere with standard of safe sex/ ○ FTA-ABS (Fluorescent Treponema Antibody
abstinence to prevent STDs Absorption Test): Confirmatory
● Psychological care ○ VDRL (Venereal Disease Research Laboratory)
○ For the partner ○ RPR (Rapid plasma reagin)
○ more so if it is the cause of infertility
COMPLICATIONS
PREVENTION ● Infertility
● ABCDE - prevention of STIs ● Epididymitis
● Arthritis
[3] SYPHILIS / THE GREAT IMITATOR ● Conjunctivitis
● Common among men having sex with men which has greater risk ● Meningitis and endocarditis
● Can be acquired congenitally ● Ophthalmia neonatorum
● Can aggravate other STI
● Caused by gram negative CHEVER MEDICAL MANAGEMENT
● Chronic → progresses in stages ● Penicillin: Benzathine Penicillin G
○ Given IM, not IV because it is irritating on veins, can
CAUSATIVE AGENT cause phlebitis.
● Treponema pallidum subsp. pallidum ○ If IV, slow drip and diluted
○ Characterized by one or more symptoms ● Cephalosporin: Ceftriaxone, Cefuroxime
● Tetracycline: Doxycycline and ceftriaxone
MODE OF TRANSMISSION ○ Doxycycline can be given with chlamydial infection
● Sexual contact
NURSING CARE
INCUBATION PERIOD ● Health education
● 10-90 days ● Psychological care
● Average: 3 weeks
● Without treatment, secondary syphilis may occur PREVENTION
● ABCDE - prevention of STIs
SIGNS AND SYMPTOMS
[4] HERPES SIMPLEX
STAGE SIGNS AND SYMPTOMS ● Lifelong viral infection caused by the herpes virus (HSV 1 or HSV
2)
PRIMARY ● One or more firm, painless, nonpruritic ● CA: herpes simplex virus (HSV 1 and HSV 2)
STAGE chancre (painless, moist ulcer that heals in 3-6 ○ HSV 1: can lead to encephalitis
weeks) ○ HSV 2: primary cause of sexually transmitted
○ Commonly appear on mouth and infections
tongue ● MOT: sexual contact
● Regional Lymphadenopathy - follows where ● Incubation period: 2-12 days (4 days)
chancre is found ● 3 types:
○ Herpes gingivostomatitis (mouth and gums)
○ Whitlow (finger)
SECONDARY ● Skin lesion appear in the form of condyloma
○ Herpes simplex keratitis (cornea)
STAGE lata
○ Highly infectious
KEY POINTS
○ Found in breast and genitals
● Primary infection occur when a patient is initially infected with
○ Looks like warts
either HSV 1 or HSV 2 for the first time
○ Lesions fused together
○ Recurrent infections or outbreaks occur when the HSV
● Oral mucous patches
infection is reactivated
● Patchy alopecia
● Recurrent infections can occur under stress
● Generalized lymphadenopathy
○ Tend to be milder than initial infections
● Pt is highly communicable
○ Heal more quickly and depending on frequency may
● Flu-like symptoms (fever and body malaise)
benefit from suppressive therapy
● Since HSV viral shedding can occur without obvious lesions,
people might not realize they are infectious

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 SIGNS AND SYMPTOMS a negative result. Which of the following should the nurse plan to include
● Herpetic lesions appear the same in both primary and recurrent in the post test counseling?
infections a. The test should be repeated after 6 months
● Begins as papules → vesicles → ulcerations → crust over → heal b. The test assures that the client is not infected with HIV
without scarring c. The client no longer needs to protect sexual partners
● Fever, malaise, headache, and regional lymphadenopathy d. The client has immunity to HIV
● Burning or tingling sensation
Answer/ Rationale: A. The test should be repeated after 6 months
DIAGNOSTIC EXAMINATION
● Viral culture
● PCR testing During a follow-up of a client recently diagnosed with HIV, the nurse
● DFA knows that this test would be most helpful in determining effectiveness of
● Serology testing antiretroviral therapy
● Tzanck smear → Outdated method of testing a. Viral load
b. ELISA
MEDICAL MANAGEMENT c. Western blot analysis
● Acyclovir – drug of choice d. Lymphocyte count
● Valacyclovir
● Famciclovir Answer/ Rationale: A. Viral load

NURSING MANAGEMENT
● Health education Health teachings on the prevention of HIV infections include safe sex
● Psychological care practices, education and counseling, behavior modification and the use of
condom. Which of the following is not a component of safe sex?
PREVENTION a. No sex
● ABCDE - prevention of STIs b. Long term mutually monogamous relationship
c. Mutual masturbation without direct contact
d. Coitus interruptus

QUESTIONS: Answer/ Rationale: D. Coitus interruptus

Which of the following conditions best defines tertiary prevention among
patients with STI?
a. Teaching HIV patients about the nature and epidemiology of The nurse is evaluating whether nonprofessional staff understand how to
the disease prevent transmission of HIV. Which of the following behaviors indicates
b. Referral of HIV patients to appropriate health and non-health correct application of universal precaution?
agencies for support a. A lab technician recapping the needle after drawing blood
c. Encouraging sex workers to undergo HIV testing specimen
d. Contact tracing of HIV infected individuals b. Nursing aide wears gloves to feed an elderly patient
c. Nursing aide puts on mask and protective eyewear before
Answer/ Rationale: B. Referral of HIV pts to appropriate health anon non assisting the nurse in tracheostomy care
health agencies for support d. Pregnant worker refuses to take care of an HIV (+) patient

Answer/ Rationale: C. Nursing aide puts on mask and protective eye

A nurse is caring for a child with HIV. The nurse plans care based on wear before assisting the nurse in tracheostomy care
which of the following accurate descriptions of this disorder?
a. It is an inflammatory autoimmune disease that affects the
connective tissue of the heart, joints, and subcutaneous issues A woman diagnosed with HIV asked about the possibility of having a baby.
b. It is a chronic multisystem autoimmune disease characterized Which of the following is the best response of the nurse?
by their inflammation of connective tissue a. HIV positive women should not get pregnant at all, to prevent
c. It is a febrile generalized vasculitis of unknown etiology the baby from having the infection
d. It is an acquired cell mediated immunodeficiency disorder b. Your partner must wear condom during intercourse to prevent
him from having HIV
Answer/ Rationale: D. It is an acquired cell mediated immunodeficiency c. You may get pregnant as long as the levels of the virus cannot
disorder be detected anymore
d. You must consult with your physician first, as they can confirm
the answer to the that inquiry
A child is seen in the health care clinic and initial testing of HIV is
performed because of the child’s exposure to HIV infection. Which of the Answer/ Rationale: C. You may get pregnant as long as the levels of the
following home care instructions would the nurse provide to the parents of virus cannot be detected anymore
the child?
a. Avoid all immunizations until the diagnosis is established
b. Avoid sharing toothbrushes Mrs. Dimacali lives in an urbanized community. She is positive to syphilis
c. Wipe dry any blood spills with soap and water and allow to air so she goes to the Health Center for proper management. This disease is
dry characterized by:
d. Wash hands with half strength bleach if they come in contact a. Greenish yellow odorous discharges in females
with the child’ blood b. Feeling of dryness and discomfort about the genitals and
conjunctivitis
Answer/ Rationale: B. Avoid sharing toothbrushes c. Painless chancre at site of entry of germ with serous exudates
d. Painful frequent urination

A clinic nurse is caring for a pregnant woman with AIDS is Answer/ Rationale: C. Painless chancre at site of entry of germ with
exhibiting signs of fever, weight loss, and candidiasis. The nurse would serous exudates
place highest priority on which of the following interventions?
a. Provide clear information about the consequences of AIDS of
the unborn child The following facts will guide you in health teachings to
b. Use disposable gloves when in contact with non- intact skin Mrs. Dimacali, except:
c. Provide emotional support to the mother a. A pregnant can transfer syphilis to her unborn child
d. Assess history for AIDS risk factors b. There is no danger of any complication
c. The community can be protected through the control of
Answer/ Rationale: B. Use disposable gloves when in contact with prostitution
non-intact skin d. Aside from physical examination diagnosis of the disease can
be confirmed through blood test

A client who was tested for HIV after recent exposure had Answer/ Rationale: B. There is no danger of any complication

43 4NUR7-2022 RN / CROSS CHECKED BY KKS

 observe:
a. Small macular rashes on the scalp
A priority nursing diagnosis for a client with primary syphilis is: b. Pruritic scaling plaques and patches with well- defined borders
a. Pain related to cutaneous skin lesions on palms and toes c. Beefy red erythematous areas with some surrounding papules
b. Disturbed body image related to alopecia and pustules
c. Ineffective tissue perfusion related to bleeding chancre d. Inflamed hair follicles with pus filled nodules
d. Deficient knowledge related to lack of exposure to information
about mode of transmission Answer/ Rationale: C. Beefy red erythematous areas with some
surrounding papules and pustules
Answer/ Rationale: D. Deficient knowledge related to lack of exposure to
information about mode of transmission
The nurse inspects the skin of the client suspected of having scabies.
Which of the following assessment findings would the nurse note if this
Mrs. Dimacali was later diagnosed as having late stage of syphilis. When infection is present?
obtaining the health history, the nurse recognizes that the statement by a. Vesicles and pustules with honey colored crust
Mrs. D that would most support this diagnosis would be: b. White patches scattered around the trunk
a. I have noticed a wart on my penis c. Multiple straight or wavy, threadlike lines beneath the skin
b. I have been losing a lot of hair lately d. Patchy alopecia and round red scaly macules
c. I have sores all over my mouth
d. I am having trouble keeping my balance Answer/ Rationale: C. Multiple straight or wavy, threadlike lines beneath
the skin
Answer/ Rationale: D. I am having trouble keeping my balance

The newborn with congenital syphilis develop vesicular lesions and A home health nurse visits a client suspected of having scabies. Which of
rashes over his feet and hands. The nurse’s first action will be: the following precautions will the nurse institute during the assessment of
a. Call the physician immediately the client?
b. Apply Neosporin ointment to the lesions a. Wear a gown and gloves
c. Protect the hands and feet with mittens b. Avoid touching the furniture in the house
d. Give Benadryl Diphenhydramine per Orem c. Wear gloves only
d. Wear mask and gloves
Answer/ Rationale: C. Protect the hands and feet with mittens
Answer/ Rationale: A. Wear a gown and gloves
Herpes simplex virus has the ability to stay in the body in a latent state
and can cause recurrent disease. In caring for a patient with herpes, the
nurse is aware that:
a. Herpes is infectious only during the early stages BIOLOGICAL WEAPON DISEASE
b. Is infectious during each episode of recurrence [1] ANTHRAX
c. Provides immunity against another attack ● Acute infectious disease caused by spore forming rod shaped –
d. Having genital herpes provides immunity for herpes labialis Bacillus anthracis
● Found naturally in soil
Answer/ Rationale: B. Is infectious during each episode of recurrence ● Affects wild and domestic animals
● CA: Bacillus anthracis
● Reservoir: domestic sheep, cattle, and goats
A nurse is reinforcing home care instructions with a female client ● Incubation Period:
diagnosed with trichomoniasis. Which statement by the client indicates a ○ GI and cutaneous: 1-7 days
need for further teaching? ○ Injection: 1-4 days
a. I should perform good perineal hygiene ○ Inhalation: 1 day-2 weeks
b. I should avoid sexual intercourse ● MOT: thru inhalation and contact with skin
c. I should discontinue treatment when menstruation begins ○ Exposure to spores in animal hides, like those used in
d. I should take metronidazole for 7 days traditional drums
● Spores have been used as an agent of bioterrorism
Answer/ Rationale: C. I should discontinue treatment when menstruation
begins SIGNS AND SYMPTOMS
● Cutaneous
○ Local tissue infection with edema
The nurse would anticipate a cesarean birth for a client who has which ○ Black eschar
infection present at the onset of labor? ○ Regional lymphadenopathy
a. Toxoplasmosis ● Inhalation:
b. Herpes-simplex virus ○ Fever, chills, malaise, cough, chest pain, and flu-like
c. Human papilloma virus symptoms
d. Hepatitis ○ Fulminant phase with severe dyspnea, hypoxia,
pulmonary edema
Answer/ Rationale: B. Herpes-simplex virus ○ Acute respiratory distress syndrome (ARDS), shock
and death
A client is seen in the health care clinic and a diagnosis of conjunctivitis is ● Gastrointestinal:
made. The nurse provides instructions to the client about care of the ○ Edema, inflammation and ulceration
disorder while at home. Which of the following statements, if made by the ○ Nausea, vomiting, abdominal pain, diarrhea
client, indicates a need for further instructions? ○ GI hemorrhage
a. I do not to be concerned about spreading this infection to ● Meningeal:
others in my family ○ Hemorrhagic meningitis
b. I should apply warm compress before instilling antibiotic drops
if purulent discharge is present in my eye DIAGNOSTIC EXAMINATION
c. I should perform saline eye irrigation before instilling the ● Gram stain
antibiotic drops into my eye if purulent discharge is present ● Cultures
d. I can use an ophthalmic analgesics ointment at night if I have ● PCR testing
eye discomfort ● Serology tests
● Histopathology and immunohistochemistry testing
Answer/ Rationale: A. I do not to be concerned about spreading this
infection to others in my family TREATMENT
● Vaccination
● Ciprofloxacin or doxycycline can be used as prophylaxis
Inhalation anthrax requires IV antibiotics Ciprofloxacin and
The school nurse initiates a screening program for pediculosis capitis. Linezolid
When searching for nits clinging to the hair shafts, the nurse may also ● An immune globulin

44 4NUR7-2022 RN / CROSS CHECKED BY KKS

 EMERGING AND RE EMERGING INFECTIONS COMPLICATIONS
● Pneumonia
[1] AVIAN INFLUENZA
● ARDS
● Zoonotic disease caused by influenza a virus
● Multisystem organ failure
● Also known as Bird flu, Asian flu, Asian Avian Influenza A
● Death → caused by severe signs & symptoms
● 60% mortality rate
DIAGNOSTIC EXAMINATION
CAUSATIVE AGENT
● RT-PCR (reverse transcriptase polymerase chain reaction)
● Avian Influenza A viruses: Asian H5N1 and Asian H7N9
● CXR
○ Depending on the severity of the illness
MODE OF TRANSMISSION
○ May reveal bilateral infiltrates which is a sign of ARDS
● Bird to bird; Bird to human transmission
● Serology test
● Rare: Human to human
○ Can become a pandemic if there is human to human
MEDICAL MANAGEMENT
transmission
● Supportive treatment
● Close contact with infected birds and bird droppings
● Intubation and MV in severe disease
○ They kill birds to prevent transmission
● Broad-spectrum antibiotics
● Plucking of infected birds
● Antiviral agents
● Inhalation of aerosolized materials in live bird markets
● Swimming or bathing in water contaminated with droppings of
NURSING CARE
infected birds
● Supportive therapy
● Fighting cocks
● Psychological care
● Reservoir: wild aquatic birds (e.g. swans and ducks)
● Consuming improperly cooked foods
PREVENTION
● Isolation, contact tracing
INCUBATION PERIOD
● Rigorous infection control measures
● A (H5N1): 2-17 days: average of 2-5 days
● Proper coughing and sneezing etiquette
● A (H7NN9): 1-10 days; average: 5 days
● care and proper handling of specimen
●
● Adherence to standards precautions
SIGNS AND SYMPTOMS
● Enteric isolation should be observed
● Fever, chills, malaise, myalgia, headache, cough
● Nausea, vomiting, abdominal pain, and diarrhea
[2] EBOLA VIRUS DISEASE
● Also known as Ebola hemorrhagic fever
COMPLICATIONS
● Has been detected first among animal reservoirs
● Severe pneumonia
● Originated from bats
● Shock
● Once humans are infected, it can be transmitted through bodily
● adult respiratory distress syndrome (ARDS)
fluids such as mucus, feces, vomiting, semen, sweat, blood
● Multisystem organ failure
● Deadly disease
● Death
CAUSATIVE AGENT
● Ebola virus
DIAGNOSTIC EXAMINATION
● Nasopharyngeal swabs
MODE OF TRANSMISSION
○ Done for novel influenza viruses
● Direct contact with infectious bodily fluids (e.g. mucus, vomitus,
○ Way of obtaining specimen
blood, feces, breastmilk, sweat, semen)
● Polymerase reaction (PCR) test
○ blood, vomitus and feces were the most infectious
● Direct contact with infectious blood or bodily fluids
MEDICAL MANAGEMENT
● Oral Oseltamivir
** Dead bodies can also be contagious - that’s why cremation is done to
○ advisable to be taken in a 10 day duration for
prevent spread
immunocompromised patients
● Outpatient prophylaxis for 5 days with oral oseltamivir is
INCUBATION PERIOD
recommended for those who have had contact with infected
● 2-21 days; Average: 8-10 days
patients
SIGNS AND SYMPTOMS
● Initially patients will manifest flu-like symptoms
NURSING CARE
● Nausea and vomiting
● Supportive therapy / symptomatic treatment
● Watery diarrhea
○ Provision of rest
● Abdominal pain
○ Adequate nutrition
● Maculopapular rash
○ Increased fluid intake
○ Regular exercise
SEVERE DISEASE
PREVENTION ● Renal failure
● Flu vaccine ● Transaminitis
● Cook poultry or eggs properly ● Disseminated intravascular coagulation (DIC)
● Avoid swimming or bathing in water contaminated with droppings ● Hemorrhage
of infected birds
DIAGNOSTIC EXAMINATION
[2] SEVERE ACUTE RESPIRATORY SYNDROME (SARS) ● RT-PCR
CAUSATIVE AGENT ● ELISA
● SARS novel coronavirus (SARS-CoV 1) ● Serology test (IgM, IgG)
○ 2002: First case of SARs in China. ● Virus isolation

MODE OF TRANSMISSION MEDICAL MANAGEMENT

● Respiratory droplets ● Supportive treatment
● Fecal shedding ● Isolation
● Direct and indirect contact
** Easily transmissible but preventable NURSING CARE
● Supportive care
INCUBATION PERIOD ● Psychological care
● 2-10 days (Average: 2-7 days)
PREVENTION
SIGNS AND SYMPTOMS ● Isolation, contact tracing
● Flu-like symptoms ● Rigorous infection control measures
● Non-productive cough ● Proper coughing and sneezing etiquette

45 4NUR7-2022 RN / CROSS CHECKED BY KKS

 ● Adherence to standards precautions ● Anosmia, dysgeusia
● Enteric isolation should be observed ● Nasal congestion
● Care and proper handling of specimen ● Conjunctivitis
● Sore throat
[3] MIDDLE EAST RESPIRATORY SYNDROME (MERS- CoV2) ● Headache
● Also known as MERS, Camel Flu ● Muscle or joint pain
● First case reported in the Middle East ● Different types of skin rash
● Largest outbreak in South Korea, 2015 ● Nausea & vomiting
● Diarrhea
CAUSATIVE AGENT ● Chills or dizziness
● MERS Coronavirus SEVERE COVID 19
● Shortness of breath
MODE OF TRANSMISSION ● Loss of appetite
● Person to person through respiratory secretions ● Confusion
● Persistent pain or pressure in the chest
INCUBATION PERIOD ● High temperature (above 38C)
● 2-14 days (Average: 5 to 6 days) ● RR =>30
● O2 Sat <=93%
SIGNS AND SYMPTOMS
● Flu-like symptoms LESS COMMON SYMPTOMS
● Shortness of breath
● Nonproductive cough ● Irritability
● Nausea, vomiting ● Confusion
● Abdominal pain, diarrhea ● Reduced consciousness (sometimes associated with seizures)
● May also present typical gastroenteritis syndrome ● Anxiety
COMPLICATIONS ● Depression
● Severe pneumonia ● Sleep disorders
● ARDS ● More severe and rare neurological complications such as strokes,
● Renal failure brain inflammation, delirium, and nerve damage
● Death
DIAGNOSTIC EXAMINATION
DIAGNOSTIC EXAMINATION ● Nucleic Acid Amplification Testing (NAAT)
● RT-PCR (reverse transcriptase polymerase chain reaction) ○ RT-PCR
● Serology test ○ RT-LAMP
● Antigen test can be done during the early course of the disease
MEDICAL MANAGEMENT due to high viral load
● Supportive treatment ○ ppl prefer this since it is low-cost & results can be
● Intubation and MV in severe disease known immediately
● Broad-spectrum antibiotics ● Rapid diagnostic tests
● Antiviral agents ○ to detect the viral proteins (antigens)

NURSING CARE MEDICAL MANAGEMENT

● Supportive therapy PREFERRED THERAPIES
● Psychological care ● Nirmatrelvir 300 mg with ritonavir 100 mg (Paxlovid) (Alla); or
Sotrovimab 500 mg(Alla) or Remdesivir 200mg (Blla)
PREVENTION
● Quarantine, contact tracing, isolation ALTERNATIVE THERAPIES
● Vaccination against pneumonia
● Bebtelovimab 175 mg (CIII)
● Rigorous infection control measures
● or Molnupiravir 800 mg (CIIa)
● Care and proper handling of specimen
● Dexamethasone
● Adherence to standards precaution
○ IV for patients requiring O2 support from results of
emergency triad
[4] CORONAVIRUS DISEASE (COVID - 19)
● Isolation
CAUSATIVE AGENT
● Caused by a new coronavirus (SARS-CoV 2)
SUPPORTIVE/ SYMPTOMATIC MANAGEMENT
○ December 31, 2019 following a report of viral
pneumonia cases in Wuhan, China ● Oxygen therapy
○ Feb 22,2022, more than 426 million cases and 5.8 ● Conservatice fluid management
million deaths. ● Intubation and mech vent in severe diseases

MODE OF TRANSMISSION How to implement IPC measures for patients with suspected or
● Person-to-person through respiratory secretions confirmed:
● Direct and indirect contact ● Screening and triage for early recognition of suspected COVID-19
● Droplet can be aerosolized by certain aerosol procedures patients and rapid implementation of source control measures
○ Respiratory secretions are normally transmitted within ● Apply standard precautions for all patients
1 meter or 3 feet distance ● Apply contact and droplet [precautions for suspected or confirmed
○ transmissible when aerosolized COVID-19 patients
● Apply airborne precautions when performing aerosol-generating
INCUBATION PERIOD procedures
● 1-14 days; average of 4-5 days
○ 97.5% of COVID with symptoms will do so within 11.5 NURSING CARE
days ● Supportive care
○ Even if vaccinated or had infection before, reinfection ● Psychological care
is still possible
● Higher risk for Senior citizens, congregate populations (nursing PREVENTION
homes, chronic medical facilities), and with chronic diseases ● Isolation, contact tracing
● Mutations could cause severe conditions ● rigorous infection control measures
● care and proper handling of specimens
SIGNS AND SYMPTOMS ● Adherence to standard precautions
MILD COVID 19 ● How to know if you are a close contact?
○ Interacted with COVID within 1 meter for more than 15
● Most common symptoms
minutes, without wearing a PPE (close contact)
○ Fever, muscle ache, headache
○ Dry cough
○ Fatigue
● Less common symptoms

46 4NUR7-2022 RN / CROSS CHECKED BY KKS