Jumarang, Kim Enrico M.
CITY
BSN401
STI GLOBAL
POLIOMYELITIS
Polio, also called poliomyelitis, is an infectious disease that mainly affects the central nervous system (CNS). The central nervous system is made up of the brain and spinal cord. Nerves from the brain and spinal cord help your body move and feel. In polio, part of the CNS gets damaged, which may lead to paralysis (inability to move) or even death.
Polio is caused by different kinds of poliovirus (germ). The virus usually enters the body through the mouth and exits with bowel movements. Polio is spread from person to person by eating or drinking contaminated (dirty) food. Contaminated things, including hands, may also pass the virus when these are put into the mouth. Sometimes, the poliovirus may enter the body through the respiratory (airway) tract. A person may also get infected by breathing in the virus. Poliovirus may either grow in the intestine (bowel) or the pharynx (throat). Polio may be prevented by vaccinating children with the polio vaccine.
Signs and Symptoms
There are three basic patterns of polio infection: subclinical infections, nonparalytic, and paralytic. About 95% of infections are subclinical infections, which may not have symptoms.
SUBCLINICAL INFECTION SYMPTOMS General discomfort or uneasiness (malaise) Headache Red throat Slight fever Sore throat Vomiting
People with subclinical polio infection might not have symptoms, or their symptoms may last 72 hours or less. Clinical poliomyelitis affects the central nervous system (brain and spinal cord), and is divided into nonparalytic and paralytic forms. It may occur after recovery from a subclinical infection.
NONPARALYTIC POLIOMYELITIS
Back pain or backache Diarrhea Excessive tiredness, fatigue Headache Irritability Leg pain (calf muscles) Moderate fever Muscle stiffness Muscle tenderness and spasm in any area of the body Neck pain and stiffness Pain in front part of neck Pain or stiffness of the back, arms, legs, abdomen Skin rash or lesion with pain Vomiting
Symptoms usually last 1 - 2 weeks.
PARALYTIC POLIOMYELITIS Fever 5 - 7 days before other symptoms Abnormal sensations (but not loss of sensation) in an area Bloated feeling in abdomen Breathing difficulty Constipation Difficulty beginning to urinate Drooling Headache Irritability or poor temper control Muscle contractions or muscle spasms in the calf, neck, or back Muscle pain Muscle weakness that is only on one side or worse on one side o o o Comes on quickly Location depends on where the spinal cord is affected Worsens into paralysis
Sensitivity to touch; mild touch may be painful Stiff neck and back Swallowing difficulty
Pathophysiology
Poliomyelitis is a disease caused by a picornavirus (family
enteroviruses). There are 3 different
polioviruses, i.e. types 1, 2 and 3. They do not exhibit immunological cross-reactions. Chimpanzees, Rhesus monkeys and cynomolgus monkeys can be infected orally and suffer paralysis as a result, but in practice man is the only reservoir. Chronic latent carriers are very rare, but healthy long-term virus excretors were identified, excreting poliovirus for more than 20 years. The epidemiological importance of these people is not yet known. The virus does not survive in the wild for more than a few months, and then only under conditions of low temperatures and high humidity.
The virus enters through the mouth and nose, multiplies in the throat and intestinal tract, and then is absorbed and spread through the blood and lymph system. The time from being infected with the virus to developing symptoms of disease (incubation) ranges from 5 - 35 days (average 7 - 14 days).
Transmission is feco-oral. The viruses proliferate in the intestinal mucosa. The virus can still be found in the faeces up to a few months after infection. The virus does not cause diarrhoea. At the beginning of the disease it is also found in the throat. After passing into the body from the intestinal tract, the virus becomes localised in various tissues, such as the lymph nodes. On the cell membrane, the virus attaches itself to a specific protein: human poliovirus receptor (CD155). This protein belongs to the immunoglobulin superfamily and occurs in several tissues (brain, spinal cord, kidneys, heart, etc.). However, some cells that express the receptor appear not to suffer any adverse effect, probably because one of the subsequent stages in the intracellular replication of the poliovirus is blocked. Dissemination occurs to the central nervous system (it is "neurotropic"). This causes damage to the grey matter in the ventral spinal cord ("polios" = grey, "myelon" = marrow) where, in particular, the motor neurons are found. These are nerve cells that transmit impulses to the muscles. These cells become damaged or destroyed. Damage often occurs at other sites, but is usually less pronounced (medulla, cerebellar vermis, midbrain, thalamus, cerebral motor cortex).
Medical Management
The goal of treatment is to control symptoms while the infection runs its course. o o Antibiotics for urinary tract infections Medications (such as bethanechol) for urinary retention
Painkillers to reduce headache, muscle pain, and spasms (narcotics are not usually given because they increase the risk of breathing trouble)
Nursing Management
o o o o o o Encouraging bed rest is compulsory at the beginning of the disease Apply moist heat (heating pads, warm towels) to reduce muscle pain and spasms Attention should be paid to the possibility of urinary retention as a result of bladder paralysis. Frequently check blood pressure, especially if the patient has bulbar poliomyelitis. Administer physical therapy, braces or corrective shoes, or orthopedic surgery to help recover muscle strength and function Place the child on firm mattress with support for feet, change position frequently. Oral Polio Vaccine (OPV). Is given 6 weeks after birth at 3 doses with 4 weeks interval. The dosage is 2-3 gtts per orem. The client should be placed on nothing per orem (NPO) diet 30 minutes after administration. If the client vomited, repeat dose should be done. The family should be careful in handling the feces 2 weeks after.
Oral Polio Vaccine
The extent of protection against polio is increased the earlier OPV is given. Doses: 3 Route: Oral/Mouth Given at what month: 6 weeks minimum age; 4 weeks (1 month) succeeding dose Who should not get the oral polio vaccine? OPV should not be given when there is a higher risk of bad effects caused by the vaccine, including the following: Moderate or severe illness, with or without fever If someone in your house has a weak immune system History of a severe allergic reaction to a dose of OPV Long-term treatment with steroid medicine A weak immune system, which can be caused by cancer, HIV or AIDS, inborn immune deficiency, or medicines, such as chemotherapy