INTENSIVE REVIEW 3

Communicable Diseases

1. Incubation Period: Time interval from the FIRST EXPOSURE to the appearance of the FIRST S/SX.
2. Prodromal Period: Time interval from the FIRST S/SX to the appearance of the GENERAL S/SX.
• Exemption: Measles and German Measles (Pathognomic sign appears in the prodromal period)
3. Illness: FULL-BLOWN DISEASE, characteristics of sx are experienced and are observable by others (ACME)
• All S/sx of the Dse. appear → Pathognomonic signs appear (sign specific to a disease)
4. Convalescence (RECOVERY Phase): S/sx are gradually disappearing
5. Defervescent Period: Onset of COMPLICATIONS that may result to DEATH

NERVOUS SYSTEM (Tetanus, Meningitis, Rabies, Poliomyelitis, Leprosy)

1. TETANUS (Bacterial Infection → Involuntary Muscle Spasm) → Clostridium Tetani (anaerobic)

• AKA: Lockjaw (Trismus) → (Because this is the earliest sign of tetanus)
• Incubation Period: 3 to 30 days
• MOT: Entry to a Non-Intact Skin (c. tetani from the soil enters a “pre-existing” wound)
Example: Foot got poked by sharp object → entry of c. tetani into non-intact skin → stepped on soil with c. tetani → c. tetani enters the open wound
(c. tetani is still deactivated because of air) → once wound closes (c. deficile is activated because there is no air) → tetanus

S/Sx of Tetanus Dx test for Tetanus

Earliest: Lockjaw (Trismus) 1. Confirmatory test: Wound Culture
Pathognomonic: Risus Sardonicus (grinning facial spasm) 2. Spatula test: patient will sit and the uvula will be stimulated
(via tongue depressor)
Tetanic Triad → Tetanic “LOS”
• Positive: bite the material (+) muscle spasm → Tetanus
1. Laryngospasm: contraction of vocal cords → dob
2. Opisthotonus: Severe or exaggerated back arching • Negative: (+) Gag reflex
- Death: Cremated because unable to fit coffin
3. Spastic Paralysis: Long lasting spasm (large muscle)
Prevention & Control of Tetanus Nursing Mgmt. for Tetanus
1. VACCINATION #1 Goal: Avoid Spasm
Children: DPT or Pentavalent • Non-stimulating Environment (Quiet, dim-lit, well-ventilated)
Pregnant: Tetanus Toxoid (atleast 2 SHOTS) • Apply Sedatives during Morning Care
• Given to pt. (-) infected wound #2 Goal: Prevent injury
Tetanus anti-toxin: antibody form • Seizure precautions (if with seizure)
• Given to pt. (+) infected wound • Opisthotonos: place pt. in a side-lying position
2. WOUND CARE • add supporting pillow under the spine (if no other nurse
is there to help side lie the pt)
Use of HYDROGEN PEROXIDE (first) or Betadine
and apply THIN Dressing (to allow air → kill anaerobic b.) Diet: High-caloric diet (hypermetabolism due to spasm)

DOC for Tetanus → Antimicrobials DOC for Seizure in Tetanus

1. Metronidazole: anti-microbial & anti-seizure • Dilantin (adult)
• Avoid alcoholic beverage • Phenobarbital (child)
2. Penicillin • Color of urine for Dilantin (pinkish to reddish)
3. Tetracycline DOC for Spams in Tetanus → Muscle Relaxants
• Avoid: calcium rich foods • Robaxin and Diazepam
4. Erythromycin
2. MENINGITIS (Bacterial/Viral Infection → Inflammation of Meninges) → Neisseria Meningitidis
Protective layers covering the brain & spine (where CSF circulates)
• AKA: CEREBROSPINAL FEVER and Meningococcal Meningitis
• Incubation Period: 2 to 10 days
• MOT (Bacterial): DROPLET transmission (Coughing or Sneezing)
• MOT (Viral): Fecal-oral route or Direct contact w/ secretions
• Other CA of meningitis: S. pneumoniae, Hib (Hemophilus influenza type b); Enteroviruses (viral meningitis)
Note: N. meningitidis is found in the normal flora of the oropharynx but it causes inflammation in the brain.
Note: Although rare, cryptococcus neoformans (fungi) can also cause meningitis in immunocompromised patients
• Classic triad: Fever, Nuchal rigidity, Altered mental status
• Neonatal Meningitis: Bulging fontanel, poor feeding, irritability

S/Sx of Meningitis Dx test for Meningitis

Pathognomonic sign: Nuchal rigidity (Stiff neck) 1. Lumbar tap or lumbar puncture (CSF analysis)

• Photosensitivity (mabilis masilaw) • Bacterial: Cloudy (Turbid) CSF, low glucose

• ↑ ICP + ↓ LOC (irritable then lethargic) • Viral: Clear CSF, normal glucose

Kernig’s (Knee) and Brudzinski (Batok) Note: CHECK MRI FIRST before performing lumbar tap to avoid

1. Positive Kernig’s test (for meningeal irritation) causing brain herniation!

✓ Stimulates knee → Raise buttocks • Normal ICP: Proceed

✓ Lift leg, butt will follow with (+) pain d/t resistance • Increased ICP: Diuretic (Mannitol) before Lumbar tap
2. Positive Brudzinski VACCINES
✓ Stimulates batok → Raise foot
• Meningococcal vaccine
✓ Dorsal recumbent, flex neck, foot move upward
• Hib vaccine (PENTA V.) and Pneumococcal vaccine
Prevention & Control of Meningitis Nursing Mgmt. for Meningitis
1. Rifampicin or Cephalosporin (close contact prophylaxis) 3. Frequent neuro checks (GCS, VS, PERRLA)
• Used as a Meningococcal prophylaxis 4. WOF danger signs (report to md)
2. Droplet precaution: surgical f. mask in public places  Remittent fever (continuous increase)

DOC for Meningitis → Antimicrobials (Abx)  Onset of seizure

• Penicillin G  Altered respiration
• Cephalosporin 5. Position: Semi-fowlers (facilitate drainage if inc. ICP)
• Chloramphenicol 6. Environment: Non-stimulating

DOC for Inflammation in Meningitis → Corticosteroids 7. Avoid: Valsalva maneuver (bearing down) may ↑ ICP

• Dexamethasone 8. Diet: High fiber

3. RABIES (Fatal Viral Infection → Myeloencephalitis) → Rhabdovirus
Inflammation of the brain and spinal cord

• AKA: HYDROPHOBIA, La Rage (French), Lyssa (Greek for madness)

• Incubation period: 2 to 8 weeks (depends on bite location and proximity to the brain)
• MOT: DROPLET Transmission (Saliva of infected animal → enters through bites or scratches)
- Virus binds to the peripheral nerve cells and travel to the CNS causing inflammation of brain and spinal cord!

• High-risk Animals: Canine (Pet animals: Dogs), Sylvatic (Non-pet animals: Bats)
• Pathognomonic signs: Hydrophobia and Aerophobia

RABIES ACQUISITION IN DOGS

1. Unvaccinated dog bitten by a Rabid animal
2. Bitten by a Vampire Bat
3. Parvovirus-infected dog vaccinated for rabies (parvo weakens immune system → unable to produce antibodies for rabies)

3 STAGES Dog Human

First stage • Withdrawn and Hides (matamlay, takot • Fever + Photosensitivity and Photophobia
(Initial signs) sa tao, takot sa liwanag) • Site sensations (tingling, numbness, itchiness)

Excitement stage in human

Furious stage in dogs (may be skipped)
• Virus enters the brain (Cranial Nerve dysfunction)
Second stage 1. Hyperactive: Dog running aimlessly around
1. Dysphagia and Odynophagia (painful swallowing)
(Furious or 2. Biting: fights & bites anything and anyone
2. Laryngospasm (dob)
Excitement) 3. Howling
3. Hydrophobia → hypersalivate (avoid swallowing saliva)
4. Hydrophobia: Avoids swallowing saliva
4. Aerophobia (no perfume, no noise → make air obvious)
(hypersalivation)
5. Seizure and Maniacal behavior (nawawala sa sarili)
Paralytic stage (Quiet phase, Spasm stops)
Paralytic stage (ends with respi/cardiac arrest)
Third stage • Patient become quiet; laryngospasm stops!
• Dog becomes still
(Paralytic) • Onset of respiratory and cardiac arrest
• Dog dies from respiratory/cardiac arrest
• Death in as fast as 3 minutes

Dx test for Rabies Nursing Mgmt. for Rabies

1. Brain Biopsy: Detect Negri bodies in the brain First Aid for Bite Victims:
2. FRA (Fluorescent Rabies Antibody) 1. Wash bite wound with soap (detergent soap) and running
3. 10-Day Dog Observation
Specific to rabies water for 10 minutes
VACCINES FOR RABIES 2. Let wound bleed to release virus (Do not arrest bleeding)
1. ERIG: Equine Rabies Immunoglobulin (from horse) 3. Apply antiseptic (Bayabas leaves if needed)
• Most effective but ↑ risk for hypersensitivity
4. Consult Animal Bite Center ASAP!
2. HRIG: Human Rabies Immunoglobulin
• Safer alternative but more expensive Management for Rabies Patients:

3. PVRV: Purified Vero cell Rabies Vaccine 1. Monitor Cardiopulmonary Status

• Modern and Widely used (Cell-culture-based) 2. Position patient away from stimuli (triggers hydrophobia)

Prevention & Control of Rabies • Away from toilet or sink

Three-Pronged approach • Cover IV and IV lines

1. Dog bite victim management (DOH) 3. Seizure Precautions
Immediate wound care and rabies vaccination
4. Restrain patient (Maniacal behavior)
2. Vaccination of all dogs (Dept of Agriculture)
Nationwide animal immunization programs
3. Responsible Pet Ownership (LGU & DepEd)
4. POLIOMYELITIS (Viral Infection → Flaccid Paralysis) → Legio Debilitans (Polio virus)
Weakness and Paralysis of the limbs (nerve impulses unable to reach the muscles)

• AKA: Heine-Medin Disease and Infantile Paralysis

• Incubation period: 7 to 21 days (High-risk groups are children under 5 years old)
• MOT: FECAL ORAL ROUTE (contaminated water, food, poor hygiene)
• Cause of Death: Respiratory Failure

TYPES OF POLIOMYELITIS (POLIO)

1. BRUNHILDE or Mahoney (PV1): Most common, Most severe; Named after a female chimpanzee (first isolated case)
2. Lansing (PV2): Milder disease; Named after a city in Michigan (where it originated)
3. Leon (PV3): Rare yet Severe; Named after a patient from LA who died from PV3

CATEGORIES OF POLIOMYELITIS (POLIO)

MINOR POLIO (Milder symptoms, Non-paralytic) MAJOR POLIO (Severe, Non-paralytic and Paralytic)
1. Non-Paralytic Major Polio
1. Subclinical Polio: Asymptomatic
• HOYNE SIGN: Head lag of polio (neck muscle weakness)
2. Abortive Polio: Lasts up to 72 hours • Pathognomonic sign: STIFFNESS OF THE SPINE
• Low grade fever, Sore throat (difficulty lifting the spine, crawls on the floor)
• Tripod position: compensatory posture to maintain balance
What are the sites of multiplication (target of PV)? • ASYMMETRIC Paresis and Paresthesia
Unlike GBS which has Symmetric Paralysis
• Oral cavity and Pharynx (Vaccine: OPV)
2. Paralytic Type Major Polio
• GI Tract • Same signs as Non-paralytic polio plus:
- Loss of tendon reflex
Usual target of PV (responsible for motor control) - Positive Kernig’s and Brudzinski’s Sign (due to
meningeal irritation)

TYPES OF PARALYSIS IN MAJOR POLIO

BULBAR PARALYSIS SPINAL PARALYSIS BULBOSPINAL PARALYSIS
(Brain stem) (Anterior Horn Cell of Spinal Cord) (Both Brain stem and Spine)
• CN IX: Loss of swallow reflex • Weakness or paralysis of Extremities - Brain stem
(Provide NGT) (unilateral or bilateral) - Anterior Horn Cell of Spinal Cord
• CN X: Respiratory & Cardiac • Intercostal muscle paralysis (difficulty
breathing → diaphragm cannot expand)
reflex

Dx test for POLIO P/C for POLIO Nursing Mgmt. for POLIO

“SLEM” 1. VACCINATION 1. Analgesic for Paresis and Paresthesia

2. Avoid Morphine: may cause respi depression due to
1. Stool exam • OPV (Sabin vaccine)
paralyzed lung muscle
Gold standard for Oral, Live attenuated
confirmation (detects 3. DO NOT MASSAGE (spread of MO)
PV in stool) • IPV (Salk vaccine) 4. Instead: Apply Warm compress (dilate vessels)
IM, Inactivated 5. Provide FIRM, NON-SOGGY BED + FOOT BOARDS
2. Lumbar tap
to prevent contractures
↑ wbc and protein csf
2. Enteric precaution 6. IRON LUNG MACHINE: Assist breathing if intercostal
3. Electromyelogram Proper disposal of muscles are paralyzed (Functional lung, paralyzed muscle)
Checks for muscle feces
DOC for POLIO
activity; No wave
indicates paralysis 1. BETHANECHOL Chloride
• Prevents respi depression & urinary retention
4. Muscle grading
2. PLECONARIL (Antiviral)
Severity of weakness
• Prevent PV from entering nervous system
5. LEPROSY (Bacterial Infection → Nerve damage & Sores on skin) → Mycobacterium leprae
• AKA: Hansen’s Disease or “Hansenosis” → KETONG
• Incubation Period: 6 mos to 8 yrs ↑ (slow replication of MO)
• MOT: DROPLET transmission (primary; most infectious) & DIRECT CONTACT (secondary; requires prolonged exposure)
• Leprosy primarily affects: Skin, Peripheral nerves, Eyes
• Peripheral nerve thickening leads to sensory and motor loss
o Ulnar nerve (Claw hand), Median nerve (Ape hand), Peroneal nerve (Foot drop)

FOUR CLASSIFICATIONS OF LEPROSY

1. Lepromatous: Equal or greater than 5 OPEN LESIONS, Negative LRT (communicable)
2. Tuberculoid: Equal or less than 5 CLOSED LESIONS, Positive LRT (non-communicable)
3. Borderline: Combination of L&T; More than or less than 5 OPEN + CLOSED LESIONS (communicable), Positive LRT
4. Indeterminate: Single CLOSED lesion but Negative LRT (communicable)

S/Sx of Leprosy Dx test for Leprosy

1. EARLY signs of leprosy 1. Slit skin smear (Confirmatory test)
• Anesthesia (loss of sensation) • Skin biopsy → put carbon cushion, MO will go out of skin
• Skin discoloration
2. Lepromin Reaction Test (LRT)
• Anhidrosis (loss of sweat)
• Communicability test (nakakahawa or not)
2. LATE signs of leprosy • Seen after 8 days of skin test
• Madarosis (eyebrow loss)
• Lagophthalmos (inability to close eyes → dryness) • Positive LRT (non-communicable)
• Contractures and Chronic ulcers - Present rashes (body is fighting the MO)
• Leonine appearance (Leonine Facies) • Negative LRT (communicable)
o Pathognomonic sign - Absent rashes (active infection)
o Thickened facial tissue + saddle nose
• Gynecomastia

3. TERMINAL signs of leprosy

• Amputation (d/t chronic ulcers)
• Blindness (secondary to lagophthalmos)
• Lucio’s Phenomenon (severe skin ulcer)
Prevention & Control of Leprosy Nursing Mgmt. for Leprosy

Leprosy Prophylaxis 1. Maintain hygiene (chronic ulcers)

• Regular bathing to clean wounds & prevent infxn
1. ROM Therapy
2. Prevent injury (loss of sensation)
• Rifampicin, Ofloxacin, Minocycline
• NO Sharp/Rough Objects (RF cuts d sensory loss)
2. VACCINE • Padded (Closed) Shoes
• BCG (effective on mycobacterium) • Wooden (Padded) Utensils (avoid accidental injuries)

3. For Lagophthalmos: Artificial Tears (prevent dryness)

PAUCIBACILLARY TREATMENT → Tuberculoid and Indeterminate Leprosy

• Duration: 6 to 9 months
• DOC: Rifampicin monthly and Dapsone daily

MULTIBACILLARY TREATMENT → Lepromatous and Borderline Leprosy

• Duration: 24 to 30 months (2 to 2.5 years)
• DOC: Rifampicin, Dapsone, and Clofazimine (Lamprene) → Causes skin darkening and flaking
CIRCULATORY SYSTEM (Dengue, Malaria, Schistosomiasis, Ebola, Zika)

1. DENGUE (Viral Infection → Hemorrhagic fever) → Flavivirus

• AKA: Hemorrhagic Fever, Break bone fever (Chikungunya), Dandy fever, Infectious thrombocytopenic purpura
• CA: Flavivirus, Chikungunya, Onyong-nyong virus
• Incubation Period: 6 to 7 days
• Vectors: Aedes Aegypti (indoor, prefers human blood) and Aedes Albopictus (outdoor, prefers animal blood)
• 4S Campaign: Search (breeding sites), Self-protection, Seek consultation (symptoms), Support fogging (outbreaks)

“DLSU” Characteristics of “Aedes” Mosquito

1. Daytime: Bites during the coldest time of the day → 6AM to 8AM and 4PM to 6PM
2. Low flying: Dengue patients are admitted at the 2nd floor and above of the facility
3. Stagnant water: Breeding sites (flower vases, tires, drains) → Drain standing water to prevent breeding
4. Urban: Found more in Cities due to garbage accumulation

Febrile Phase (1-3 days) Critical Phase (4-7 days) → Defervescence period
• High-grade fever → > 39 °C • Most dangerous phase Dengue Warning Signs
• Headache, myalgia, arthralgia, • Fever subsides BUT 1. Severe abdominal pain
retro-orbital pain • Plasma leakage: ↑ Hct, ↓BP, 2. Persistent vomiting
• Petechial rash Shock, Organ compli (GI bleed) 3. Mucosal bleeding
• Herman’s sign (skin flushing) 4. Lethargy
✓ Aggressive IV fluid therapy 5. Cold clammy skin and weak pulse
✓ Hydration + Antipyretics ✓ Platelet transfusion if needed 6. Liver enlargement (>2 cm)

NIMANITYA Classification (Signs and Symptoms)

Grade 1 Dengue Grade 2 Dengue Grade 3 Dengue Grade 4 Dengue
1. Flu-like symptoms 1. Grade 1 symptoms + 1. Grade 1 + 2 symptoms 1. Hypovolemic shock
• Fever, myalgia,
2. Bleeding 2. Circulatory failure • BP unobtainable
arthralgia
• Epistaxis • Hypotension with • Pulse imperceptible
2. Periorbital pain • Gingival bleeding narrowed pulse (cannot be palpated)
(not seen in chikungunya) pressure
• Hematuria
3. Herman’s sign • Melena • Tachycardia rapid
generalized flushing of skin but thready pulse
• Tachypnea
4. > 20 petechial rashes
Indicates capillary fragility • Cold clammy skin
3. No shock yet just
IMPENDING SHOCK

Prevention/Control of Dengue Dx test for Dengue Nursing Mgmt. for Dengue

CLEAN Method 1. CBC Symptomatic Treatment
1. Chemically treated mosquito nets - ↓ PLT (thrombocytopenia) 1. Hydration
• Permethrin chemical - ↑ Hct (plasma leakage) - ORS and IV fluids
2. Larvae-eating fish 2. Dengue NS1 Antigen Test (IgM 2. Complete bed rest
• Tilapia → 4 pieces per square meter and IgG markers)
3. Anti-fever (Paracetamol)
3. Environmental sanitation - Detects dengue virus within
- Avoid NSAIDS (Aspirin)
• 4 o’clock habit (go out and clean every the first 7 days of illness
may increase bleeding
4PM) • Primary dengue: + IgM, - IgG
4. Loose clothing
4. Antimosquito • 2ndary dengue: +IgM, +IgG
- Prevent overheating
• Use of OFF lotion
3. Rumpel-Leede Sign 5. Avoid dark colored foods
• Avoid Fumigation (pampausok)
- drives mosquito elsewhere temporarily
• Torniquet Test - May cause black stools
(affecting another community) • Sign of capillary fragility or
6. Platelet transfusion
thrombocytopenia - Severe thrombocytopenia
5. Natural repellents
• > 20 petechial rash (dengue)
• Neem Tree, Citronella, Oregano,
• No longer recommended d/t low
Eucalyptus predictive value
2. MALARIA (Parasitic infection → King of tropical disease) → Plasmodium (f.v.o.m.k)
• AKA: Ague, Marsh disease, King of tropical disease
Characteristics of “Anopheles” Mosquito
• Causative Agents:
1. Plasmodium falciparum: IP 10-12 days 1. Night-biting
2. Plasmodium vivax: IP 14 days 2. High-flying
3. Plasmodium ovale: IP 14 days 3. Flowing water
4. Plasmodium malariae: IP 30 days 4. Rural (Mountainous area and Forest)
5. Plasmodium knowles

• MOT: VECTOR transmission → Anopheles Flavirostris

• Cerebral Malaria: Plasmodium falciparum can cause encephalopathy, coma, and death.

Signs and Symptoms of Malaria

• Sudden chills and goose flesh

Cold stage 15 mins to 2 hours
• Feel cold despite having a fever
• High fever up to 40 °C
Hot stage 4 to 6 hours • Black water fever: hemolysis leads to black urine (dark, tea-colored)
• The time blood smearing is done
• Profuse sweating and weakness as the fever subsides
Diaphoretic stage 2 to 4 hours
• Recovery occurs gradually

Dx test for Malaria Prevention/Control for Malaria Nursing Mgmt. for Malaria
1. Blood Smearing 1. Stream seeding: Introduction of 1. Complete bed rest during attack -
• Done during the Hot stage larvae-eating fish into water - Avoid orthostatic hypotension
• Used in Community Setting 2. Zoo prophylaxis: Domestication 2. Record onset-duration-severity
of CARABAO of the attack
2. Quantitative Buffy Coating (QBC)
3. Environmental control 3. Blood transfusion (PRBC)
• Confirmatory test for malaria
- For severe cases of anemia or
• Done anytime during fever cycle • Stream clearing: Removing
hemolysis
• Used in Hospital Setting vegetations along the riverbanks
• Screening doors & windows: DOC for Malaria
Install netting or mesh
1. First line treatment (Co-Artem)
• Avoid loitering in the forest at night • Artemether-Lumefantrine
• Use mosquito nets/repellants • Effective for Acute Malaria
4. Chloroquine (Prophylaxis) 2. Second line treatment
• Take 1 capsule per week • Chloroquine
• 2 capsules before travelling to
3. Third line treatment
Malaria-risk area!
• Fansidar → used when drug
resistance is present
3. SCHISTOSOMIASIS (Blood fluke infection → Snail fever) → S. japonicum, S. mansoni, S. haematobium

• AKA: BILHARZIASIS
• CA: S. japonicum (GIT), S. mansoni (GIT), S. haematobium (GUT)
• Incubation Period: 2 months
• MOT: FECAL-ORAL route (contaminated water where cercariae (larval stage) penetrate the skin)
• S. japonicum: Most common in the Philippines
• High-risk occupations: Farmers, Fishermen, and Children in Endemic Area

Life Cycle of Schistosoma:

1. Human host → lay eggs through feces; enters water sources
2. Egg stage → Eggs hatch into MICARCIDIA (not yet harmful)
3. Snail intermediate host → Oncomelania quadrasi snail
4. CERCARIA stage → Free swimming (Harmful)
5. Human infection → Cercariae penetrate human skin in contaminated water

S/Sx of Schistosomiasis Dx test for Schistosomiasis

Most common symptoms 1. Circum-Ova Precipitin Test (COPT)
1. Diarrhea • Confirmatory test (detect specific antibodies in pt.
2. Bloody stool serum → blood sample)
3. Hepatomegaly
2. Stool exam
4. Splenomegaly
• Detect ova (eggs) and parasite in stool
5. Anemia and weakness
• Most cost effective used in community setting
Uncommon symptoms (usually seen in tb patients w/ schisto) ✓ S. japonicum: Small eggs with a lateral spine (git)
1. Hemoptysis ✓ S. mansoni: Larger eggs with a lateral spine (git)
2. Bronchitis ✓ S. haematobium: Eggs with a terminal spine in urine.
3. Abdominal Pain
Prevention/Control of Schistosomiasis Nursing Mgmt. for Schistosomiasis
1. Case Finding and Treatment 1. HYDRATION (for fluid loss d/t diarrhea)
• Endemic regions: Region 5, 8, 11 (Especially Samar
Leyte)
DOC for Schistosomiasis
1. First line drug: Praziquantel (effective for all species)
2. Health Education
• AVOID WADING or SWIMMING in Cercariae- • For S. Mansoni: Oxamniquine
infected water - Used where praziquantel resistance is suspected
• If accidentally waded: wash with 70% alcohol,
• For S. Haematobium: Metrifonate
betadine or chlorine solution
- Reserved for urinary schistosomiasis
• Household purposes: let the water standstill for
72 hours (cercaria die within 48 hours without
human host)
3. Environmental Sanitation
• Proper irrigation systems, Proper waste disposal
4. Snail eradication
• Use molluscicides or clear vegetation near water
bodies

COMPLICATIONS of Schistosomiasis
1. Chronic Liver Damage: Eggs trapped in liver tissues, leading to fibrosis and portal hypertension.
2. Bladder Cancer: S. haematobium infection.
3. Cor Pulmonale: Secondary to pulmonary hypertension caused by egg embolism in the lungs.
4. Katayama Fever: Acute schistosomiasis with fever, urticaria, and eosinophilia.
4. EBOLA (Viral infection → Severe inflammation, Tissue damage, Internal Bleeding) → Ebola virus
• AKA: Ebola Hemorrhagic Fever (severe, often fatal)
• CA: EBOLAVIRUS
1. Strain 1: BUNDIBUGYO
2. Strain 2: ZAIRE (most virulent, highest fatality rate)
3. Stran 3: SUDAN
4. Strain 4: RESTON (Originates in the Philippines, found in pigs; Non-fatal in humans but fatal in monkeys)
5. Strain 5: TAI FOREST
• Incubation period: 2 to 21 days (symptoms typically appear around 8-10 days of exposure)
• MOT: DROPLET transmission (DIRECT contact with infected body fluids except sweat)
• Vector: CGF MAP (Chimpanzee, Gorilla, Fruit bat (natural reservoir), Monkey, Antelope, Porcupine)
• IATF (Inter-Agency Task Force) was established in the Philippines due to EBOLA outbreaks
• West African Epidemic during 2014 to 2016 (Largest recorded cases)

S/Sx of Ebola Dx tests for Ebola Nursing Mgmt. for Ebola

Early symptoms 1. Polymerase Chain Reaction 1. Rehydration Therapy (IV fluids)
1. Fever (sudden onset) • Confirmatory test for Ebola 2. Blood Transfusion
2. Myalgia (muscle pain)
Prevention/Control of Ebola - For severe blood loss
3. Arthralgia (joint pain)
4. Conjunctivitis (red eyes) 1. Ervebo Vaccine (Zaire strain) 3. Strict Isolation Precautions
- Post-exposure prophylaxis - Strict contact and droplet
Progressive symptoms precautions
- NO Vaccine for other strains
1. Maculopapular rash
• Rash that bleeds easily 2. Ebola Immunoglobulin (EBOV Ig) 4. Burn or bury waste materials
2. Bleeding of all orifices - Emergency tx (Acute infection) contaminated with Ebola virus
Eyes, nose, mouth, rectum, ears - Provides temporary protection
- Derived from the plasma of pt. 5. Use of 0.5% chlorine solution for
Complications who survived the Ebola cleaning surfaces
1. Hypovolemic shock
2. Multi-organ failure 3. Isolation of suspected cases
- Negative pressure rooms
4. Full-body PPE for Health workers

5. ZIKA (Viral infection → Similar with Dengue Fever but with Milder symptoms) → Zika virus
• AKA: ZIKA FEVER (r/t dengue, yellow fever, Japanese encephalitis, and west nile virus) → Mild and Good Prognosis
• CA: Zika virus (flavivirus related to dengue and yellow fever)
• Incubation Period: 3 to 14 days
• MOT: VECTOR transmission → Aedes aegypti and Aedes albopictus; NON-VECTOR transmission → Mother to fetus
during pregnancy; SEXUAL transmission → Virus detected in semen and vaginal sections

S/Sx of Zika Dx tests for Zika Nursing Mgmt. for Zika

Mild symptoms (Self-limiting) 1. Polymerase Chain Reaction (PCR) 1. Analgesics & Antipyretics

• Low grade fever, Myalgia, • Confirmatory test for Zika 2. Hydration

Arthralgia, Conjunctivitis PREVENTION AND CONTROL COMPLICATIONS of ZIKA

• Same rashes with Rubella but 1. CLEAN Method (same with dengue) 1. Preggy: Baby → MICROCEPHALY
2. Pregnant AVOID TRAVELS to Zika endemic area
Zika heals faster → 3 days 2. Adult: GBS
3. Use of CONDOMS during sexual activity
LYMPATHIC SYSTEM (Filariasis)

1. FILARIASIS (Parasitic infection → Chronic lymphedema + Thickened Skin “Elephantiasis”) → Filarial worms
Carried by an Infected MOSQUITO
• AKA: ELEPHANTIASIS (Lymphatic Filariasis) → Lymphatic worm infection
• CA: Wuchereria bancrofti (Most common; 90% of cases), Brugia malayi (SE Asia; PH), Brugia timori (Indonesia)
• Incubation Period: 8 to 16 months
• MOT: VECTOR transmission → Aedes Poicilius (night biting mosquito)
• Endemic regions: Eastern Visayas, Bicol, CARAGA, Northern Mindanao → Neglected Tropical Disease

Life Cycle of Filarial Worms

1. Infective Stage: Mosquito introduces third-stage larvae into human host
2. Adult worms: Larvae mature in the lymphatic system causing obstruction and damage
3. MICROFILARIAE: Produced by adult worms released into blood stream, taken up by mosquito during feeding

Acute Stage Chronic Stage

1. Filarial Fever 1. Chronic lymphedema
2. Lymphangitis (inflamed lymphatic vessels) • Persistent swelling of limbs
• Hydrocele (large scrotum)
3. Lymphadenitis (swollen lymph nodes)
4. Orchitis (inflamed scrotum) 2. Elephantiasis (Thickening and hardening of skin)
• Elephant size foot
5. Lymphedema (could be chronic sign)
3. Skin changes (thickening and cracking of skin)
6. Eosinophilia (wbc that combats parasitic infection)

Dx test for Filariasis Prevention/Control of Filariasis Nursing Mgmt. for Filariasis

1. NOCTURNAL BLOOD EXAM 1. CLEAN Method (same w/ dengue) 1. Antipyretics & Analgesic
- Used in Community setting 2. ELEVATE AFFECTED LIMB to
- Collect blood on/after 8PM 2. Mass Drug Administration (MDA)
facilitate lymphatic drainage
- Specific time: 10PM to 2AM • WHO recommends annual
(time microfilariae are present in 3. Use of compression bandages
administration of anti-filarial
the peripheral blood) 4. Hydration and Daily Hygiene
drugs in endemic areas
2. Immunochromatographic test 5. Address stigma and promote
- Filariasis ICT reintegration to community
- Used in Hospital setting
- Done anytime DOC for Filariasis
1. Diethylcarbamazine (Hetrazan)
- Kills microfilariae & adult worms
- Can be used as prophylaxis

2. Albendazole
- Enhances efficacy of Diethyl!

3. Ivermectin
- Effective against microfilariae
RESPIRATORY SYSTEM (TB, SARS, Diphtheria, Pertussis)

1. TUBERCULOSIS (Bacterial infection → Lung affectation; Hemoptysis) → Mycobacterium tuberculosis

• AKA: Catch infection, Phtis

• CA: M. tuberculosis, M. Africanum, M. Bovis
• Incubation Period: 2 to 20 weeks
• MOT: DROPLET transmission (primary via coughing or sneezing); AIRBORNE transmission (secondary; occurs only in
the absence of sunlight as sunlight kills TB bacteria)
• Reminder: TB does NOT spread through shaking hands, sharing food, or using the same utensils
• Types of TB: Pulmonary TB (Most common) and Extrapulmonary TB → TB meningitis (brain), Pott’s dse. (Bones; Spine),
Renal TB (Kidneys; can mimic a UTI), Scrofula (lymph nodes)
• Active TB: Symptomatic and contagious → Latent TB: No symptoms, not contagious, positive PPD test

TB Classification based on HISTORY

1. New: Patients who NEVER received TB Treatment
2. Retreatment: Patients received PREVIOUS TREATMENT for atleast 1 MONTH

S/Sx of Tuberculosis Dx test for Tuberculosis

TRIAD of Pathognomonic signs 1. Gene Xpert and Sputum Smear Microscopy
1. Hemoptysis • Confirmatory test for TB
2. Night sweats A. Sputum collection
3. Night fever
• Best time: Early in the morning
Other COMMON signs • Who collects & analyze in hospital: Medtech
1. Anorexia, Fatigue, Significant weight loss • Who collects in far flung community: BHW
2. Persistent cough for more than 2 weeks • How many samples: 3 consecutive samples
3. Chest pain
2. PPD Test (Mantoux test or Tuberculin test)
Prevention/Control of TB • Purified protein derivative test → Skin test
1. Vaccination: BCG (at birth) → BCG scar (deltoid area) • Measures TB exposure
2. All utensils are Exposed to SUNLIGHT (kill bacteria) • Positive Result:
3. Eating utensils: Reusable utensils ✓ Normal individuals: > 10 mm induration
- Disposable can be used by other people (pulubi) ✓ Immunocompromised: > 5 mm induration
4. Droplet & Airborne precautions → Negative pressure room 3. Chest X-ray
• Cloudiness & Whitish patches in the lungs
Nursing Mgmt. for Tuberculosis
• WOF for the S/E of the RIPE drugs 5. New WHO Memo on Tuberculosis
1. Rifampicin: Red to Orange secretions • Streptomycin is not included anymore in the
• Avoid contact lens (even lacrimation change color) standard TB treatment
2. Isoniazid: Peripheral Neuritis 6. Monitor Liver Function Test
• Give Vitamin B6 (Pyridoxine) • RIPE drugs are HEPATOTOXIC
3. Pyrazinamide: Hyperuricemia 7. Health education
• Increase Oral Fluid Intake • Take meds before meals for optimal absorption
8. Undergo TB-DOTS Program
4. Ethambutol: Optic neuritis (temporary color blindness)
• Direct Observation Treatment Short-course
• After taking ethambutol, vision goes back to normal
Chemotherapy ensure compliance to treatment
• 6-MONTH treatment regimen
• To AVOID MDR-TB (Multiple drug-resistant TB)
2. SARS (Viral infection → Severe respiratory distress & Pneumonia) → Novel Coronavirus
• AKA: Severe Acute Respiratory Syndrome
• Characterized by: Flu-like symptoms that can progress to severe respiratory distress and pneumonia
• Place of Origin: Guangdong, China (2002)
• Notifiable disease: Healthcare providers MUST report cases to local authorities

SARS 2002 MERS-CoV 2012 COVID 2019 (SARS-CoV 2, 2019)

• Cause: Novel Coronavirus • Cause: Middle East Respiratory • Cause: Novel Coronavirus 2
- mutated strain of adenovirus Syndrome Coronavirus • Incubation Period: 2 to 14 days
• Incubation Period: 2 to 10 days • Incubation period: 2 to 10 days • Vector: Bats
• Vector: Civet Cat • Vector: Bats → Camel → Human Quarantine Guidelines:
• Place: Guangdong China • Place: Middle-East 1. Home quarantine: 5 to 7 days
2. Facility quarantine: 14 days
➢ FIRST Coronavirus Epidemic ➢ Higher fatality rate than SARS
Key dates in the Philippines:
• First detected case: January 30, 2020
• Confirmed case: February 1, 2020
• Community Outbreak: March 7, 2020

S/Sx of SARS Dx test for Meningitis

Pathognomonic signs 1. RT-PCR (Reverse Transcriptase Polymerase Chain Reaction)
1. Anosmia (loss of smell) • Detects Viral RNA in respiratory sample
2. Ageusia (loss of taste)
2. Chest X-ray
3. Dysgeusia (altered taste → metallic taste)
• Patchy or ground-glass opacities (lung
Common symptoms: Fever, Cough, SOB inflammation)
Prevention & Control of SARS Nursing Mgmt. for SARS
1. Vaccination 1. Symptom management
• Sinovac, Pfizer, Moderna, AstraZeneca, Johnson’s • Oxygenation: Hypoxemia
and Johnson, Sputnik • Corticosteroids: Lung inflammation
2. Infection control measures 2. Treatment of comorbidities
• Isolation → Negative pressure rooms • To not exacerbate the disease
• PPE: N95 FM + Face Shield + Gloves & Gown 3. Monitor for complications
• Handwashing w/ soap & water for 20 SECONDS • ARDS, Sepsis, Multi-organ failure
• Cover mouth/nose with elbow/tissue (cough)
• Maintain atleast 1-meter distance from others LONG TERM EFFECT (Post-SARS Syndrome)
• Use bleach-based solutions to clean surfaces 1. Pulmonary Fibrosis: Scarring of lung tissue

QUARANTINE CLASSIFICATIONS
1. Enhanced Community Quarantine (ECQ) → STRICTEST Lockdown Measures
• Home isolation, No mass gathering, No public transport (except for essential personnel)
2. Modified Enhanced Community Quarantine (MECQ) → RELAXED VERSION of ECQ
• Gradual reopening of essential industries, Wear PPE when doing limited outdoor activities
3. General Community Quarantine (GCQ) → MODERATE Restrictions
• Resume economic activity while controlling virus transmission (more business/service are operational)
• Social gatherings allowed with restrictions (social distancing, PPE)
4. Modified General Community Quarantine (MGCQ) → Eased Restrictions (MOST LENIENT quarantine level)
• Transition to the “New Normal”, Curfew is lifted, Gatherings are allowed but with health protocols (vaccines)
Note: DOH (coordinates quarantine protocol nationwide) → LGU (enforce or implement community quarantines)
3. DIPHTHERIA (Bacterial infection → Pseudomembrane) → Corynebacterium diphtheria
Thick, gray coating of dead tissue that can build up in nose and throat

• AKA: Syrian Ulcer, Membranous angina, Malignant coup, Boulogne sore throat
• CA: Corynebacterium diphtheria
• Incubation period: 2 to 5 days
• MOT: DROPLET transmission (coughing, sneezing)
• Pseudo membrane: Grayish-white membrane adherent to the throat; hallmark of diphtheria.
• Complications: Respiratory failure (due to obstruction) and Myocarditis (may lead to arrhythmias and heart failure).

FOUR TYPES OF DIPHTHERIA

PHARYNGEAL Diphtheria LARYNGEAL Diphtheria
• Dangerous Complication → Myocarditis • Dangerous Complication → Airway obstruction
• Pathognomonic sign: Symptoms
- BULL NECK (swelling of neck lymph nodes & soft tissue) 1. Brassy cough (metallic-sounding cough)
• Other symptom: High fever 2. Dyspnea
3. Cyanosis
• At bed side: TRACHEOSTOMY SET
NASAL Diphtheria (Surface Diphtheria) CUTANEOUS Diphtheria (Surface Diphtheria)
• Most communicable (Infxn is external, can easily spread) • Common in large wound (burns)
• Excoriation of the nares: Skin irritation around the nose • Pseudo membrane resembling IMPETIGO (lesions
similar to a burn)

Dx test for Diphtheria Nursing Mgmt. for Diphtheria

1. Culture and sensitivity (Confirmatory test) 1. For Pharyngeal Diphtheria
• Ensure complete bed rest (upright positions may
2. Schick’s test: Susceptibility for diphtheria
worsen the spread to the heart, ↑ risk of myocarditis).
3. Moloney’s test: Hypersensitivity to diphtheria
2. For Laryngeal Diphtheria
Prevention & Control of Diphtheria • Tracheostomy set at the bed side (airway obstruction)
1. VACCINATION 3. General Management
• DPT or PENTAVALENT vaccine • Monitor for respi distress and worsening symptoms.
- If patient has seizures after first DPT dose, • Hydration and Nutrition
use only the DT vaccine (Diphtheria and 4. DOC for Diphtheria
Tetanus without Pertussis).
• PENICILLIN: First line treatment
2. Droplet precaution: Face mask • Erythromycin: if pt is allergic to penicillin
• Diphtheria antitoxin (DAT): Neutralize toxins.
3. For Nasal Diphtheria, handle utensils and personal
items carefully to avoid spread. 5. Adjunct Therapy:
• Corticosteroids for severe inflammation.
• Oxygen therapy for respiratory complications.
4. PERTUSSIS (Bacterial infection → Whooping cough) → Bordetella pertussis

• AKA: Whooping Cough → Successive coughing followed by a distinct inhalatory sound

• CA: Bordetella pertussis
• Incubation Period: 7 to 10 days
• MOT: DROPLET transmission (coughing, sneezing)
• Diagnostic Culture: Bordet Gengou Agar (supports Bordetella pertussis growth)

CATARRHAL Stage PAROXYSMAL Stage CONVALESCENT Stage

MOST COMMUNICABLE STAGE INTENSE COUGHING STAGE RECOVERY STAGE
1. Early stage (Watery and Swampy) 1. Difficult symptoms 1. No longer communicable
2. Cold-like symptoms • Successive Whooping cough 2. WOF: Residual paroxysm
• Coryza (sipon) - high-pitched inhalatory sound (coughing) until 6 months
• Sneezing after coughing
3. Avoid stressing the child to
• Lacrimation (watery eyes) • Feelings of eyes popping out avoid residual paroxysms
during coughing
• Nose and ears bleeding due to
increased pressure while coughing

2. Stage when Bordet Gengou Agar is

done for diagnosis

Prevention & Control of Pertussis Nursing Mgmt. for Pertussis

1. VACCINATION: • Promote Rest and Avoid stressing the child in the next 6 months
- to prevent triggering residual paroxysm
• DPT or PENTAVALENT vaccine
- If patient has seizures after first • Place the child in a PRONE position during attack
DPT dose, use only the DT vaccine - Make the child Wear an Abdominal binder
(Diphtheria and Tetanus without - Advise the child to HUG A TEDDY BEAR
Pertussis)
• Do not feed the child during attack to prevent choking
2. Droplet precaution: Face masks • Offer Fuit juices over milk as milk thickens respiratory secretions

• Keep emergency suction equipment at the bedside

• DOC for Pertussis: Azithromycin

INTEGUMENTARY SYSTEM (Rubeola, Rubella, Chicken Pox, Shingles, Scabies)

1. MEASLES (Rubeola) and GERMAN MEASLES (Rubella)

Measles (Rubeola) German Measles (Rubella)

AKA 7-day Measles 3-day Measles → Tigdas hangin
EA Paramyxovirus of the morbillivirus family Rubivirus
Incubation 8 to 20 days 14 to 21 days
MOT Droplet and Airborne Transmission
Prodromal Period (CCCK) Prodromal Period (LSF)
1. Coryza, Coughing, Conjunctivitis 1. Low grade fever, Sore throat
2. Koplik’s spots → Pathognomonic sign 2. Forchheimer spots → Pathognomonic sign
• Inner surface of the cheeks • Soft palate or roof of the mouth
Eruptive stage Eruptive stage
Signs and
1. Maculopapular rash (cephalocaudal) 1. Maculopapular rash (cephalocaudal)
Symptoms
2. Pronounced fever 2. Lymphadenopathy
3. Respiratory symptoms
Convalescent Period Convalescent Period
1. Branny desquamation of skin 1. Negative or Minimal desquamation
• Peeling or flaking of the skin • Minimal shedding of the skin
• No complications
• Ears: Otitis media • Only harmful for fetus during 1st trimester
• Eyes: Photosensitivity, Photophobia  Harmful 2nd & 3rd trimester: Syphilis
- Due to conjunctivitis  Harmful 3rd trimester: Toxoplasmosis
Complications
 Maternal mortality 3rd trimester: Hepatitis E
➢ If hospitalized: dim lit room - due to vomiting and anorexia
➢ If home based: dark glasses or shades Avoid going near pt. with Rubella: Cousin of the
newly wed (possible pregnancy of the bride)

1. Bronchopneumonia
Serious
2. Encephalitis No serious complications
Complications
- after 5 to 10 days “Pan sclerosing encephalitis”
1. MMR at 15 months of life
Prevention 1. AMP: 9 months, subcutaneous • Pregnant MMR: Avoid sex for 3 months
and Control 2. MMR at 15 months of life • If exposed at 11 months, give vaccine. Then
give again at 15 months.
1. Vitamin A
Nursing
2. Artificial Tears: conjunctivitis Symptomatic management
Management
3. Ear wicking: otitis media
2. CHICKEN POX (Varicella) and SHINGLES (Herpes Zoster)

Chicken pox (Varicella) Shingles (Herpes Zoster)

AKA Varicella Acute posterior ganglionitis
EA Varicella zoster virus (Herpes virus 3)
Reactivation of latent infection
• Virus from the previous chicken pox infection
hides in the dorsal nerve root and antibody was
not able to kill it. → Adult chicken pox
Incubation 13 to 17 days
• CN V: Gasserian ganglionitis
- blindness of both eyes
• CN VII: Ramsay-Hunt Syndrome
- paralysis of one side of face; ipsilateral
• Unilateral, clustered, and painful vesicles
• Scattered pruritic vesicles - Makati at masakit
Signs and
- makati pero di masakit - The vesicles tend to coalesce
symptoms
- usually seen on parts covered by clothing (localize sa part ng nerve affected, manifest externally,
magkukumpulan sa part na yon)
Prevention
Vaccine: VARIVAX (Zostavax)
and Control
Trim fingernail
Nursing
Calamine lotion and Diphenhydramine (Pruritus)
management
Oatmeal bath (nclex) and Baking soda (nle)
DOC ACYCLOVIR

3. SCABIES (Itch mite infection) → Sarcoptes Scabiei

• AKA: GALIS ASO
• CA: Sarcoptes scabiei
• Incubation Period: Undefined (depends on host’s immune response and mite infestation)
• MOT: DIRECT CONTACT transmission (infected skin or contaminated items like bedding or clothing)

S/Sx of Scabies Dx test for Scabies Nursing Mgmt. for Scabies

Pathognomonic sign: 1. MINERAL OIL DROP DOC for Scabies
• Thread like lesion seen at: • A drop of mineral oil is placed 1. Benzyl benzoate emulsion (25%)
“ICABNU” on the lesion and scraped off. • Apply from the neck down, leave
The sample is examined under overnight, and wash off after 24 hours.
1. Interdigital space (between fingers) a microscope to confirm the
2. Crotch presence of mites, eggs, or 2. Permethrin Cream (5%)
3. Axilla feces. • A safer option for children and
4. Belt line (waist area) pregnant women.
5. Nipple
3. Ivermectin (oral)
6. Umbilicus
• Severe or crusted scabies cases.
• Itching is MOST INTENSE: AT NIGHT • “Norwegian Scabies” is highly
contagious and seen in immune
compromised patients
GIT SYSTEM (Typhoid, Cholera, Leptospirosis)

1. THYPHOID (Bacterial infection → Typhoid fever and Rose spots) → Salmonella typhi
• AKA: ENTERIC FEVER
• CA: Salmonella typhi
• Incubation Period: 5 to 40 days
• MOT: Fecal-oral route (Contaminated food and water)

S/Sx of Typhoid Dx test for Typhoid Nursing Mgmt. for Typhoid

Pathognomic signs 1. Widal’s test • Enteric precaution
1. Ladder-like fever • Screening test • Proper disposal of feces
2. Splenomegaly • Safe water supply and proper food handling
2. TYPHIDOT
3. ROSE SPOTS (abdomen) • Confirmatory test • Hydration therapy
• High calorie, Low fiber Diet
• Typhoid psychosis: Mental
3. Blood Culture • avoid bulk stool causing intestinal obstruction
confusion due to high fever
• Gold standard for
• Coma vigil: appears alert but
dx in early stage DOC for Typhoid
unresponsive
• Subsultus tendinum: twitching 1. Chloramphenicol (Ciprofloxacin)
of the muscles

2. CHOLERA (Bacterial infection → Rice-watery stool) → Vibrio cholerae

• AKA: Blue death (Tae ng tae at Suka ng suka)

• CA: Vibrio cholera (Choleragen toxin reduces ATP to AMP which eliminates all body fluids → massive fluid loss)
• Incubation period: 1 to 3 days
• Mot: Fecal-Oral Route (contaminated water and food)

S/Sx of Cholera Dx test for Cholera Nursing Mgmt. for Cholera

• Severe vomiting and diarrhea 1. Stool culture • Enteric precaution
1 liter per hour (24 liters in a day) • Confirmatory test for • Hydration therapy
• Pathognomonic sign vibrio cholerae ORS and IVF (Plain LR) for
1. RICE-WATERY STOOL severe dehydration
2. Symptom analysis
2. Washerwoman’s hands (wrinkled hands • WOF Hypokalemia
due to severe dehydration)
DOC for Cholera
3. Vox cholerica: loss of voice due to
1. Tetracycline or Doxycycline
extreme dehydration (aphonia)

3. LEPTOSPIROSIS (Bacterial infection → Jaundice and Kidney Injury) → Leptospira interrogans

• AKA: Weil’s disease, Spirochetal jaundice, Mud fever, Flood fever, Canicola disease, 7-day Japanese fever, Trench fever.
• CA: Leptospira interrogans
• Incubation period: 7 to 19 days
• MOT: Entry to NON-INTACT SKIN (Contact with contaminated water, soil, or urine)

S/Sx of Leptospirosis Dx test for Leptospirosis Nursing Mgmt. for Leptospirosis

• Fever and Severe Myalgia 1. Leptospira agglutination test • Fluid and electro replacement
• Liver injury (Jaundice) Prevention and control • Low potassium diet
• Kidney injury (dark urine)
1. Avoid wading in infected water DOC for Leptospirosis
• SEVERE CASES: Weil’s Disease 2. Rat eradication 1. PENICILLIN
- Jaundice, Renal failure, Hemorrhage 3. Prophylaxis
• Doxycycline (200 mg) For SEVERE cases (Weil’s disease)
1. DIALYSIS
SEXUALLY TRANSMITED DISEASES (Gonorrhea, Syphilis, Trichomonas, HIV/AIDS)

1. GONORRHEA → Neisseria gonorrhea

• AKA: Clap, Gleet, Florest blancas, Drip, MORNING DROP → “TULO”
• CA: Neisseria gonorrhea
• Incubation period: 3 to 5 days
• MOT: SEXUAL contact and Perinatal transmission (Mom to fetus) → NEWBORN CONJUNCTIVITIS (Crede’s prophylaxis)
S/Sx of Gonorrhea Dx test for Gonorrhea Nursing Mgmt. for Gonorrhea
MALE: Abrupt onset of symptoms • Thayer-martin • Safe sex + consent
• Dysuria (painful urination) agar
DOC for Gonorrhea
• Urethritis (Thick, yellow-green, pruritic discharge) • Nucleic Acid
1. PENICILLIN (first line treatment)
Amplification
FEMALE: Often asymptomatic 2. Ceftriaxone
Test (NAAT)
• May develop Gonococcal sepsis 3. Azithromycin

2. SYPHILIS → Treponema pallidum

• AKA: Lues venerea, The pox, Morbus gallicus, BAD BLOOD DISEASE
• CA: Treponema Pallidum
• Incubation period: 10 to 90 days
• MOT: SEXUAL contact and Congenital (transmitted during pregnancy → Congenital Syphilis)
S/Sx of Syphilis Diagnostic/Prevention/Mgmt. of Syphilis
1. Primary Stage • SCREENING: Rapid Plasma Reagin (RPR) or Venereal
• Chancre (painless, round ulcer at the site of Disease Research Laboratory (VDRL)
infection. Self-limiting but infectious)
• CONFIRMATORY: Fluorescent Treponemal Antibody
2. Secondary Stage Absorption Test (FTA-ABS)
• On/Off fever, Malaise, Sore throat
Prevention and Control
• Mucous patches in the mouth
• Syphilides: Maculopapular rash palms and soles • Safe sex + regular STI screenings
• Condylomata lata: Moist, warts in the genitalia DOC for Syphilis
3. Latency Stage (asymptomatic, not infectious) 1. Benzathine Penicillin G (Single dose IM) → First line tx
2. Ceftriaxone: if pt. has penicillin allergy
4. Tertiary Stage
• Neurosyphilis (brain): impaired balance, dementia WOF: Jarisch-Herxheimer Reaction (Acute febrile reaction
• Cardiosyphilis (heart): aortic aneurysm, heart failure during antibiotic treatment

3. TRICHOMONAS → Trichomonas vaginalis (Protozoan)

• Incubation period: 5 to 28 days
• Male: Often Asymptomatic → Carrier - Diagnostic test: PAP SMEAR
• Female: Symptomatic - Prevention: Safe sex + Personal Hygiene
1. Frothy, Green-Yellow, Foul-smelling discharge DOC for Trichomonas
2. Itching, burning, redness of vulva 1. Oral METRONIDAZOLE
3. Dysuria and Dyspareunia (pain during coitus) 2. Vaginal suppository: If pregnant

4. HIV and AIDS → Retrovirus

➢ Incubation period: 2 months to 20 years ➢ MOT: Sexual contact, Blood, Perinatal (Mother to child)
➢ Symptoms: On/off FEVER for > 1-month, On/off DIARRHEA for > 1-month, Significant WEIGHT LOSS
➢ Flu-like sx (Acute phase), Persistent lymphadenopathy (Chronic phase), Severe immunosuppression (AIDS)
• Screening: ELISA • Reverse Isolation for immunocompromised patients
• Confirmatory: WESTERN BLOT • Remind patient that HIV is not a life sentence and can be treated

• PrEP: Pre-exposure prophylaxis DOC for HIV/AIDS

- Daily medication to prevent HIV 1. INDINAVIR (Protease inhibitors) → first line tx to dec viral load
• ART: Antiretroviral Therapy 2. Abacavir (Nucleoside Reverse Transcriptase Inhibitors)
- Combination therapy to ↓ Viral load