By: Orlan Defensor Balano, RN, MAN©

What is Communicable Disease?

highly transmissible disease that could be transfer from 1 person to another
the disease could be transmitted rapidly


Is an illness due to an infectious agent which
is transmitted directly or indirectly from one
person to another
Transmitted from one person to another
Applied to disease not transmitted by
ordinary contact and that which requires
direct inoculation
 Three Factors Relating to the
Development of Infection

 Agent – an infectious microorganism capable of
invading and multiplying in the body of the host
should be capable of infecting the body

 Host – any organism that can support the nutritional

and physical needs of the agent for growth

 Environment – condition that favors the progression

of the infection the most difficulty to alter/ change among the three --> ENVIRONMENT
 Factors Responsible for the
Transmission of Infection

Causative Agent/ Etiologic Agent
Reservoir of Infection --> area where would microorganism grow

Two Types of Reservoir

 Human Reservoir
 Animal Reservoir
Portals of Exit from Reservoir
anus --> through feces, urine or saliva PORTALS
 Factors… (continued)

 Modes of Transmission
 Contact Transmission TOUCHING
 Vehicle/ Route ZOONOTIC --> ANIMALS
 Airborne Transmission
 Vector Transmission
 Portal of Entry Into the Body
MOST COMMON FORM OF ENTRY --> SKIN --> MOST
 Susceptible Host ACCESSIBLE

TOO YOUNG, TOO OLD, AND IMMUNOCOMPROMISED

 Factors Affecting of Entry of
Infection to the Body

 Age, sex, genetic constitution
 Nutritional status, fitness, environmental factors
 Absent of abnormal immunoglobulins
 General Physical, Mental and emotional factors
 Status of hematopoietic system, efficacy of
reticuloendothelial system
 Presence of underlying disease
 Patients with radiation, chemotherapy, costicosteroid
or other immunosuppressive agents
How many times or hours do you exercise per day? --> 30-45 MINS / 3-4 WEEKS
 Distribution of Disease

Sporadic --> Few Isolated Cases --> appear once --> then stops

Endemic --> continuously present within a community

Epidemic --> Sudden increase of disease over a short period of time

Pandemic --> WORLDWIDE

Cholera --> Epidemic
Malaria --> Endemic
Schistosomiasis --> Endemic
Rabies --> Sporadic

Epidemic 2 types

1. Cyclical --> "Dengue" --> rainy season

2. Secular --> It takes a long time before the disease appear again
---> example: KAWASAKI --> STRAWBERRY TONGUE
Principles of Immunization:

Immunity --> CAPABILITY OF THE BODY TO FIGHT OUT INFECTION WHEN IT ENTERS THE BODY

Resistance --> BEFORE THE DISEASE ENTER THE BODY

IMMUNOGLOBULINS

G --> CROSSES PLACENTA

A --> SALIVA, TEARS
E --> ALLERGY (BINDS WITH BASOPHILS AND MAST CELLS TO RELEASE HISTAMINE
M --> RESPONSIBLE FOR ABO
D --> CELL MATURATION
 Classification of
Immunoglobulin
 IMMUNITY!!

IgG --- 75%

Present in majority of B cells
Coontains antiviral antitoxin and antibacterial
Ab
Only IG that crosses the placenta
Responsible for the protection of the newborn
Activates complement and binds to
macrophages
 Classification of
Immunoglobulin

IgA --- 15%
Predominant in body secretions such as
saliva, nasal and respiratorysecretions,
breastmilk
Protects mucus membranes
 Classification of
Immunoglobulin

IgM --- 10%
Forms natural Ab such as that for ABO
blood antigens
Prominent in early immune responses
 Classification of
Immunoglobulin

IgD --- 0.2%
Action not known
May affect cell maturation
 Classification of
Immunoglobulin

IgE --- 0.004%
Binds to mast cells and basophils
Involved in allergic and
hypersensitivity reactions
Inflammatory response --> pagnasugatan? --> FIRST REACT IS PAIN --> because body produces bradykinin and prostaglandin --> which
causes pain (non specific)

It becomes specific when your body releases antibodies such as t-cells, nk cells

Host Defense
BOARD: if cell mediated immunity, is there a lifelong immunity? --> YES! Specially cases like chicken pox, measles


because your body creates memory t cells pertaining to that antibodies

First Line of Defense Second Line of Defense

 1. Chemical Substances  1. Inflammatory
 2. Cilia response (non- specific)
 3. Normal Flora  2. Cell mediated
immunity (specific)
Where could you find your chemicals? --> SKIN, SALIVA (kiss)
--> kissing makes you happy --> increases your happy hormones
 3. Human Immunity
Where could you find the Cilia? --> Nose "protects you from dust, allergens, and pollen
BOARD: What is the normal flora in your Vagina? --> DODERLANES BACILLUS --> "Normal Floura" Acidic "3.5-6.5"

Ecoli could be found in stomach that is why women who have ecoli means they are not wiping their vagina
right!! --> prone to shorter urethra

If male have Ecoli --> Sure anal sex

 Types of Immunity

Active Passive
Natural Natural
Artificial Artificial
ACTIVE --> lifelong (lifetime)

Natural --> Exposure to the disease

Artificial --> Vaccines

PASSIVE --> transferred from another source and is shorterm (6-12 mos then mawala na

Natural --> Mom via breastfeeding

Artificial --> Gammaglobulins
BOARD: What is the first sign of measles? --> Coryza
What is the first sign of HIV? --> Fever, Coryza
What is the first sign of Chicken pox? --> Coryza

Stages of Illness
ALL VIRAL INFECTIONS WILL MANIFEST CORYZA --> FLU LIKE SYMPTOMS "runny nose, cough, itchiness, fever


 Incubation Period – the time interval between the
first exposure to the appearance of the first sign and
symptoms before the disease will appear

 Prodromal Period – premonitory sign; indicates the

impending attack IMPENDING ATTACK

 Acme/ Period of Illness – manifestation of typical

signs and symptoms

 Period of Convalescence – on the road to recovery

 Standard Precautions

 Strategy to reduce the risk and to control nosocomial
infections Purely Handwashing
 Have replaced universal precautions
 Applies to:
 Injured skin
 Non- intact mucus membrane
 Blood
 Body fluids except sweat
 Transmission – Based
Precautions

 Applied to clients with highly transmissible diseases

BOARD:

1. Airborne --> gaano kalaki ang microorganism? "less than 5 microns" --> because they can be suspended from the air
--> example: variella, TB, Measle

2. Gaano dapat kalayo if may Airborne Precation? --> 6 feet or further

3. Saan mo ilalagay ang patient? -->

If meron isolation room --> best answer
If wala --> private room with 6 air exchanges --> "negative pressure" "well ventilated"

4. Cohabitation other term --> Cohorting " you place patient in the same room"
--> same s/s and disease
 1. Airborne Precautions

 Reduce the risk of airborne transmission of infectious
agent through air
 Requires special protective measures in addition to
standard precaution
 Measles, TB, varicella
 Recommendations;
 Private room with negative air pressure
 Co- habitation
 Limit contact with susceptible clients
 Limit movement inside the room
 2. Droplet Precaution

 Size >5um
 Does not remain suspended in the air
 Rubella, Mumps, diphtheria EXAMPLES: PERTUSIS, MENINGITIS ALSO
 Recommendations:
 Private room
 Co-habitation
 Wear mask within 3 feet from the client
BEST PRECAUTION FOR DROPLET --> WEARING MASK
BEST PRECAUTION FOR AIRBORNE --> WEARING OF N95 "MTVC"
--> COVID "AIRBORNE/DROPLET
 3. Contact Precautions

 Recommendations:
 Private room
 Co-habitation
 Wear gloves and gowns
 Limit movement inside the room
 Skin, GI, wound infections, diphtheria, herpes
simplex virus, scabies
 Direct contact --> TOUCHING
 Indirect contact --> THROUGH OBJECTS
 4. Enteric Precaution

 To prevent the spread of the disease that can be
transmitted through direct contact with infected
person MOST COMMON IS THE DIARRHEA
 5. Respiratory Isolation

 To prevent omission of organism by means of
droplets that are coughed, sneezed and breath into
the environment
COVERING YOUR NOSE ONLY
 6. Strict Isolation

 To protect the medical staff and other persons

WHAT IS THE DIFFERENCE BETWEEN STRICT ISOLATION AND REVERSE ISOLATION AND QUARANTINE

QUARANTINE --> Exposure to appearance of signs and symptoms (Limitation of action)

REVERSE --> Protect the patient

--> Cancer, Leukemia, HIV

ISOLATION --> Protect the health workers

--> TB, mumps, german measles,rabies
--> Rabies --> para di mangagat " saliva may transmission of disease
 7. Wound and Skin Precautions

To prevent cross infection of personnel and
patients from infections transmissible by
direct contact with wounds and other
conditions resulting to skin secretions and
heavily contaminated particles
 8. Reverse Isolation

 To protect the patient from acquiring other diseases
because of lowered resistance
 Prevent the Spread of the
Communicable Disease through:

Health Education
Immunization
Environmental Sanitation
Supervision in the Preparation of Food
Prevention and Promotion --> focus in NP1 (Not curing)

Best to know if the patient is ready to learn?? --> there is already participation and curious
--> to know if the patient/ client have learned from you? --> return demonstration
 1. ISOLATION

 The separation of persons suffering from
communicable diseases or carriers of the infecting
organism from other person and placing them under
such condition that direct transmission to susceptible
persons is prevented base don the period of
communicability
 2. Quarantine

 Limitation on freedom of movement based on
longest incubation period.
 3. Disinfection

 Destruction of pathogens
 Concurrent – done in the presence of infection
 Terminal – done after the patient is discharged from
the hospital

Disinfection --> You dont kill everything --> may spores pa

Sterilization --> you kill everything --> even spores
Medical Asepsis --> Handwashing
Surgical Asepsis --> Sterile technique

4. Medical Asepsis

 Gowning – protects the inner part of the body
 Mask – filters the microorganism
 Medical Hand Washing – the simplest and most
effective way of reducing transmission
 Placarding – placing reminders in the patients room.
Ex: do not palpate, reverse isolation

--> Wilms Tumor patient request for a placarding. What will you write?
--> "DO NOT PALPATE" --> "Neproblastoma" Tumor for children 3-5 years of age
 Signs and Symptoms
 CAUSATIVE AGENT: MYCOBACTERIUM TUNERCULAE

 Cough hallmark: cough persist for 2 weeks or more

 Fever --> low grade afternoon fever
 Chest or back pains --> see in xray --> "KOCH TUMOR" present in upper lobe
--> "KOCH TUMOR preseny in lower lobe --> PNEUMONIA

 Hemoptysis
 Significant weight loss
 Other signs and symptoms such as: sweating,
fatigue, body malaise, and shortness of breathe
Mycobacterium Marinarum --> FROM the marines.
Ex: Swimming with samad --> pasok ang infection --> TB

Mode of Transmission

Airborne droplet Could you get TB from eating cattles, carabaos, horses? -->
YES --> Mycobacterium Bovis

--> improperly eating of cooked meat (in ethiopa --> they eat raw

Direct invasion meat)

Period of communicability:
-depends on the number of bacilli
discharged
-the virulence --> acquired mutations (some may not be responded to the treatment

-adequacy of ventilation --> IF NOT WELL VENTILATED ANG AREA MAS PRONE
ANG TB

WHEN IS TB NON COMMUNICABLE AFTER

MEDICATION --> AFTER 2 WEEKS ON THE ONSET OF
TREATMENT
 Methods of Control
 BOARD:

 Prompt diagnosis and treatment Where will you find your BCG?
Accurate and Effective and BCG if?

 BCG vacccination --> Scar, Right Deltoid

If no scar?? --> REPEAT

 Health education
 Improve social conditions such as overcrowding
 Make available medical activities
 Provide public health nursing and outreach services
for home supervison. TB Meds --> FREE!
GO TO TB DOTS FACILITY!!!
Health teaching:
--> Mode and Spread of transmission of TB TB is still a public health concern in the Philippines because of knowledge
deficit
BOARD:
Should you separate eating with utensils?
--> NO!! but make sure that the patient already started the medication for 2 weeks
The National TB Control
Program

Vision: A country where TB is no longer a
public health problem
Mission: Ensure that the TB DOTS services
are available, accessible, and affordable to the
communities in collaboration with the LGU
and other partners.
Goal: to reduce prevalence and mortality
form TB by half by the year 2015
 Targets:

95 --> target till 2040

 Cure at least 85% of the sputum smear positive

TB patient discovered
 Detect at least 70% of the estimated new sputum
smear positive TB cases
 
What is the primary
diagnostic tool in NTP
case finding?
DSSM --> Direct Sputum Smear Microspscopy

BOARD:

1. Screening and Primary Tool --> DSSM

2. Confirmatory Test -->
--> Golden Quantiferon Test --> Mahal
--> Culture and Sensitivity --> CONFIRM
 
What is the only
contraindication to
direct sputum smear
microscopy?
HEMOPTYSIS

In old guidelines --> you need to collect 3

In new guidelines --> you need to collect 1 but 10-20 ml of specimen
--> if not achieve butang sa sa ref to maintain integrity
 DOTS STRATEGY:

 Recording and reporting
 Uninterrupted supply of quality assured drugs
 Standardized SCC for all TB cases
 Access to quality assured sputum microscopy
Sustained political commitment
Is the Government essential in eradicating the 95% of cases of TB? --> YES!
 Who can perform
DSSM? LICENSED MEDTECH


 Smearing
 Fixing
 Staining
 Recording and Interpreting

 Who can perform in a farflung community:

 BHW trained and supervise by NTP medtechs
 What are two
formulations of anti TB

drugs?
 Fixed Dose
 Single Drug Combination

When is the best time to drink TB drugs?

--> Morning upon waking up before breakfast

Treatment Partner
--> Family Members or if none BHW
--> see to it that the meds are inom

If the patient complain that they dont want to take the meds?
--> Continue taking the meds but take it closer to meal time 30-15 mins before
--> IDEAL SHOULD BE: 1 HOUR BEFORE MEALS
 TB TREATMENT
CATEGORY

Category 1: 6 months NEW CASES

New smear positive PTB

New smear negative PTB with extensive
parenchymal lesions on CXR
EPTB and
Severe concomitant HIV disease
 Category II
 --> HINDI NAGAMOT AFTER TREATMENT STILL POSITIVE

 Treatment failure IF POS, GO ANOTHER TREATMENT --> IF EXHAUSTED THE 12 MOS -->
AUTOMATIC "CHRONIC TB"

 Relapse
 Return after default

RELAPSE --> CURE BUT NAGBALIK BECAUSE NOT TOTALLY NAWALA

RETURN AFTER DEFAULT --> THE PATIENT DID NOT FINISH THE TREATMENT. STOP --> THEN
RETURN
 Category III

 New smear negative PTB with minimal parenchymal
lesions on CXR as assessed by the TBDC

POSITIVE FOR XRAY AND SMEAR (CAT 1 --> NEW CASE)

POSITIVE FOR XRAY AND NEGATIVE SMEAR (-->TBDC OR GENE EXPERT WHO WILL DECIDE FOR THE PT.)
 Category IV

 Chronic (still smear positive after supervised re
treatment 2 TIMES RE TREATMENT!!! AFTER 12 MONTHS --> CHRONIC TB

 BEST MGT: referral

 Treatment regimen

 PULMONARY TB --> 6 MONTHS TREATMENT
 Drugs:
RIP MEDICATIONS

 INTENSIVE: INH, RIF, PYRAZINAMIDE

 CONTINUATION: INH, RIF

 EXTRAPULMONARY PTB: --> 10-12 MONTHS TREATMENT RIPES

 Drugs: INH RIF, PYRAZINAMIDE, ETHAMBUTOL
OR STREP BOARD:

 CONTINUATION: INH, RIF --> 2 MONTHS --> Not exceed because they are toxic
You could only take Ethambutol and Streptomycin for how long?

BOARD: What test should be performed before taking the meds?

TB OF THE BONES --> POTS DISEASE --> LIVER FUNCTION TEST --> all are hepatotoxic
--> through open would --> very painful TB
  Rifampicin = Body fluid discoloration; Permanent
discoloration of contact lens
numbness, tingling sensation

 Isoniazid-Peripheral neuropathy =Mgt: Vit

B6;pyridoxine

Your patient is taking anti tb drugs then suddely complains of
tingling of the hands suspect that it is caused by??

--> Isoniazid --> Health teaching --> Increase intake of foods

rich in green leafy "B6" if none "b6 vitamins

 Pyrazinamide: Gouty Arthritis/Hyperuricemia

 Increase fluid intake of at least 6-8 glasses of water

 Ethambutol: Optic Neuritis; Inability to recognize

green from blue Ototoxicity --> Ringing of ears and tingling of ears -->
BOARD:
If experiencing eye pain due to ethambutol 1. The patient stops already taking ethambutol but still experiences ringing of ear? what will
--> with hold then refer you do?
--> BEST NURSING ACTION --> to turn on the television or sounds for distraction
 Stretomycin: Damage to Cranial Nerve 8th;
Nephrotoxix
 
Route: ID --> Interpret after 48-72 or 2-3 days!! --> Health teachings? do not remove or wash the markings

 Tuberculin Test = exposure PPD agent - purified protein derivatives

 Mantoux Test = read or interpreted after 72 hrs; single

screening
 Tine Test = mass screening; 48 hours not performed anymore!!!

0-4 mm = insignificant
5 mm or more = significant = HIV or impaired immunity
10 mm or greater = significant with normal immunity
ANCIENT DISEASE DISCOVERED IN --> JERUSALEM FIRST CASE
--> "KETONG"
--> 1873 IN NORWAY BY GH ARMER HANSSEN
--> THAT IS WHY THE OTHER TERM FOR IT IS HANSSEN'S DISEASE OR HANSSEN'S BACILLUS

WHAT ANIMAL CAME FROM?

--> ARMADILLO (ARMORED PANGOLLIN)

AGENT?
--> MYCOBACTERIUM LEPRAE

HALLMARK SIGN
--> LIONS FACIES
 Signs and symptonms

 EARLY ANY SIGNS OF INFLAMMATIONS --> EARLY SIGNS

 Change in skin color = reddish or white

 Loss of sensation on the skin lessions
 Decrease or loss of sweating
 Thickened and painful nerves
 Muscle weakness and paralysis of extremities
 Pain and redness of the eyes
 Nasal obstruction and bleeding
 Ulcers that do not heal
 Late signs

 Madarosis --> LOSS OF EYEBROWS
 Lagopthalmos --> INABILITY TO CLOSE EYELIDS
 Clawing of finger and toes
 Contractures PHYSICAL ACTUAL DISABILITY ALREADY

 Sinking of the nosebridge

 Gynecomastia --> MALES MORE COMMON
 Chronic ulcers --> ULCERATION THAT NEVER HEALS
SCREENING TEST FOR LEPROSY?
--> SSS (SLIT SKIN SMEAR TEST
Method of Transmission

PROLONGED SKIN TO SKIN CONTACT
--> CANNOT GET BY MERELY TOUCHING SHOULD BE PROLONGED
 Who are the most
susceptible?

 Children below 12 years of age
 Prevention
3 DISEASES THAT COULD BE PREVENTED BY BCG VACCINE?

1. TB
2. LEPROSY
3. MENINGITIS
= ALL ARE ACID FAST BACILLUS

 avoidance of prolonged skin to skin
contact
BCG vaccination = acid fast bacillus
Good personal hygiene AT LEAST TWICE A DAY

Adequate nutrition
Health education
DOC FOR LEPROSY:
--> PROMINE (DAPSONE) --> 1ST
--> MORE EFFECTIVE --> COMBINATION OF CLOFAXAMINE + RIFAMPICIN
 WHO leprosy
classification

 Paubacillary (tuberculoid and intermediate) = non
infectious type --> PAUBACILLARIY:

 -Duration: 6 to 9 months NON COMMUNICABLE

LESS THAN 5 LESIONS

 -Rifampicin and Dapsone --> MULTI:

 HT: Dapsone: itchiness HIGHLY COMMICABLE
MORE THAN 5 LESIONS

 Multibacillary (lepromaatous and borderline) -

infectious and SKIN DISCOLORATION

 Clofazimine = S/E: dryness or flaking of the skin

 Self administered: Dapsone and Lamprene
IF YOUR NOT STARTED WITH MEDICATIONS --> THE LEPROSY IS COMMUNICABLE FOR 4 WEEKS
--> PREVENT PROLONGED SKIN TO SKIN CONTACT AND AIRBORNED PRECAUTION FOR THE NEXT 4 WEEKS
 DIAGNOSTIC TEST

 SSS= Slit Skin Smear Test = determines the presence
of M. Leprae
 Lepromin Test = susceptibility to leprosy

 Treatment: RA 4073 = advocates for home treatment

of tuberculosis and LEPROSY
DOMICILIARY(HOUSE) TREATMENT ONLY --> BECAUSE OF STIGMA OF ISOLATION
MDT (Multi-drug Therapy)

 It reduces communicability period of leprosy in 4-6
weeks
 It prevents development of resistance to drugs
 It shortens the duration of treatment





COMMON IN AFRICA

VIRUS OR BACTERIA? --> NONE!! ITS A FLUKE OR A NEMATODE
--> THAT IS WHY CALLED BLOOD FLUKE "THEY ATTACK THE VASCULAR SYSTEM"
--> MAIN ORGAN THEY ATTACK --> LIVER

BOARD:
1. IF THE PATIENT HAS BILHARAYASIS
--> AKA: KATAYAMA FEVER
--> AKA: SNAIL FEVER (COMMON IN BICOL, DAVAO, SAMAR, LEYTE)
 Signs and symptoms:
 Diarrhea 
 Bloody stool
 Enlargement of the abdomen
 Spleenomegaly --> Graveyard of RBC is the spleen
 Weakness
 Anemia CAUSE OF DEATH MOSTLY:

 Inflamed liver
--> LIVER CIRRHOSIS

 Causative Agent: Japonicum, Mansoni, Haematobium,

Malayanensi
 Japonicum = common in the Philippines
 Pathophysio: Lives in the blood vessels of the intestine and
liver attachs in the skin and secretes enzyme that will allow them to enter the spores and travel the bloodstream --> after
they will find area that is highly vascularized and rich in nutrients --> INTESTINES --> till they carried until LIVER

 Dx Test: COPT (cercum ova precipitin)

 Preventive measure
 What is the best way to prevent it
1. use of mullocides / pampatay ng kuhol
 Health education --> FIRST ANSWER

2. use of toilet facilities

 Proper disposal of feces and urine --> prone because no toilet
 Improve irrigation and agricultural practices
 Treat snail breeding sites with molluscides
 Prevent exposure to contaminated water =Wearing of
boots
 Treat patient in endemic areas to preevent disease
progression
 Apply 70% of alcohol to skin immediately
Drinking water: allow water to stand 48-72 hours before use
--> but put iodine. chlorine is more toxic
70% --> to kill the circaria
 What is the treatment?

 Drug: PRAZIQUANTEL (Biltricide)
DOC!!!

 Oxamniquin for Mansoni

 Metrifonate for Haematobium

 Most common cause of death: Hepatic complication

 Vector: Snail (Oncomelania quadrasi)


 ALL ARE FLUKES

DOC: PRAZIQUANTEL ALL THREE


 Capillariasis  Paragomniasis
 Ca: Capillaria  CA: Paragominus
philippinensis westermani
 Eating of freshwater
fish Eating fresh water crabs
and shrimps , ULANG. (MAY SIPIT NA MAHABA)
BLOOD FLUKE THAT ATTACKS THE CAPILLARIES
--> LATCH AND RUPTURES THAT IS WHY THERE IS SWELLING
OF HANDS AND FEET

1. TILAPIA
2. HALWAN

Lung gluke
3. GURAMI
FLUKE

HALLMARK SIGN: COUGH

HOW TO KNOW IF TB OR PARAGOMNIASIS?

--> IT DOES NOT RESPOND TO YOUR USUAL TB MEDICATIONS
--> AND LIVE ENDEMIC AREAS OF PARAGOMNIASIS
CA: Wuchereria bancrofti
Brugia malayi AKA: HUMAN LYMPHATIC FILARIASIS
B. Timori --> Affects lymph vessel and lymph nodes

Nematodes --> worm that would affect your lymphatic

 How it is transmitted?

 Bites of female mosquito --> CARRIER

 Aedes poecillus (Primary)

 Aedes flavivostris (secondary)

 Incubation period: 8-16 months

 Peak biting time: 10 pm to 12 midnight

NIGHTSHIFT BITERS --> ACTIVE AT MIDNIGHT

FEMALE MOSQUITO --> USUALLY NEEDS NUTRIENTS

MALE MOSQUITO --> DIE
 Asymptomatic stage

Characterized by the presence of
microfilarae in the blood
No clinical signs
Asymptomatic for years
Other progress to acute and chronic
stages
 Acute Stage

Lymphadenitis INF OF LYMPH NODES

Lymphangitis INF OF LYMPH VESSELS

In some cases, the male

genitalia is affected leading
to orchitis --> INFLAMMATION OF THE TESTES OR SCROTUM
 Chronic Signs and
Symptoms

Hydrocoele --> SWELLING OF SCROTUM

Lymphedema --> TEMPORARY SWELLING OF UPPER EXTREMITIES

elephantiasis --> NOT IMMEDIATE --> TAKES 10 TO 15 YEARS

DADAMI MUNA BAGO MAG SWELL
 Diagnosis

Physical exam
History taking
Observation of signs and symptoms

Finger prick test = giemsa stain=

microfilariae BEST TIME FOR FINGER PRICK TEST:

--> USUALLY IN THE EVENING WHEN THEY ARE ACTIVE

 Laboratory
Examinations

Nocturnal Blood Examinations
(NBE)
- after 8:00 pm
Immunochromatographic Test
(ICT) --> ANYTIME OF THE DAY!!!

- rapid assessment method;

anytime of the day
 What is the drug of
choice?

 Diethylcarbamazine citrate (Hetrazan)

WEAR A LONG GARMENTS THAT COVERS THE BODY!!! --> HEALTH TEACHING
+
ANTIHELMINTHIC --> BECAUSE THEY ARE NEMATODES

 Albendazole and ivermectin

 For elephantiasis: Doxycycline

Should you wash the feet with soap and water? YES
Should you apply anti fungal cream? YES
Should you apply anti bacterial? YES

Why? --> SUSCEPTIBLE

 

ORCHITIS

PRONE ABACA INFESTED AREA!!!

 

ELEPHANTIASIS --> GREEN BECAUSE OF THE

FUNGAL

 Signs and symptoms

 Recurrent chills MALARIA --> ATTACKS THE RBC

PHASES

 Fever 1. ERYTHROCITIC
--> RBC (MALARIA ATTACKS THE RBC --> CAUSES ANEMIA OR BLACK
VOMITUS

 Profuse sweating
2. EXOERYTHROCITIC

 Anemia --> OUSTIDE THE RBC (LIVER OR BLOOD VESSELS FOUND

 Malaise
 Hepatomegaly
 spleenomegaly --> GRAYEYARD OF RBC
 Mode of transmission:

Bite of female anopheles mosquito
BLOOD SUCKERS

Blood transfusion CAN YOU DONATE BLOOD? --> MALARIA IS LIFETIME SOO
NO!!

Sharing IV needles
Transplacental --> HEALTH TEACHING : PROPHYLAXIS OF CHLOROPHINE

MALARIA --> 9PM TO 3 AM --> DUTY

FILARIASIS --> 10-12 MN
DENGUE --> MORNING
 Infectious agents
 NOT BACTERIAL AND VIRAL BUT => PROTOZOAN

 Plasmodium falciparum = most fatal; most fatal

 Plasmodium vivax
 Plasmodium ovale --> RAREST
 Plasmodium malariae
 Early diagnosis

 Clinical method – signs and symptoms; had you
been on a malaria endemic area; do you in a malaria
endemic area SHOULD YOU ASSESS ALL FEVERS WITH MALARIA UNDER IMCI?
--> NO!! ASK "ARE YOU LIVING IN A MALARIA ENDEMIC AREAS?" / ONLY WHO
HAVE TRAVEL

 Microscopic method – blood smear

 QBC = quantitative buffy coat= fastest

 Malarial smear = best time; high fever
 What drug is give for
chemoprophylaxis?

 Chloroquine = given at weekly intervals
 1-2 weeks before entering endemic area
DOC: HEALTH TEACHING -->
ITCHINESS IS NORMAL IN THE
FIRST 24 HOURS

 Pregnant: for the netire duration of pregnancy

GIVE IN THE ENTIRE PREGNANCY
 Treatment:

 Blood schizonticides:
 Quinine = cinchonism = ototoxicity
 Chloroquine: S/E: Itchiness
 Primaquine:
 Fansidar = pyrimethamine and sulfadoxine
 Vector control measures
 --> HOW? BOILED THEM IN CENTRONELA PREPARATION
--> IN ORDER FOR IT TO BE ORGANIC

Insecticide treatment of mosquito net

House spraying FOGGING --> DEPENDS IF THERE IS EPIDEMIC IF NOT --> USELESS
--> LINIS 3PM -4PM IN THE AFTERNOON

On stream seeding = bio-ponds; larvavirous

TILAPIA
HITO
fishes --- 2-4 fishes/sq. m: 200-400 fosh per ha
On stream clearing – cutting the vegetation
overhanging along stream banks
COMMON IN BASILAN AND SULU

ZOO PROPHYLAXIS --> SILA ANG GINA PAIN PARA SILA ANG KAGATIN (PIGS, BAKA)
 Recommended
antimalarial drugs

 Choroquine sulfate
 Sulfadoxine --> WOF: HYPERSENSITIVITY
 Quinine sulfate
 Quinine hydrochloride
 Tetracycline hydrochloride --> HIGHER RISK FOR RESISTANCE

 Quinidine sulfate
 Quinidine gluculate
BOARD:

1. QUININE WILL CAUSE?

--> SYNCHONISM OR OTOTOXICITY
 Public Health Nursing
Responsibilities

Participate in the implementation of the
following:
 Treatment policies
 Provision of drugs
 Laboratory confirmation diagnosis
 Training of BHW on diagnosis and treatment
 Supervision of malaria control activities
collection, analysis and submission of reports
 Public Health Nursing
Responsibilities

Recognition of early sins and
symptoms
Health education
Availability of anti-malarial drugs and
chemoprophylaxis drugs
STREAM SEEDING --> WITH USE OF FISHES
ZOO PROPHYLAXIS --> USE OF ANIMALS SUCH AS COW
 
 Chemically treated mosquito net
 Larva eating fish
 Eenvironmental sanitation
Antimosquito soap
 Neem tree (eucalyptus) --> WARD OF MOSQUITOES!! SINDI IN THE AFTERNOON

 Zooprophylaxis = USE OF ANIMALS!!!

 ATTACKS IMMATURE PLATEPLETS (MEGAKARYOCYTES) --> WEAKENING OF ENDOHELIAL TISSUE --> CAUSING
BLEEDING

DENGUE --> IS EPIDEMIC --> CYCLICAL --> JUNE TO JULY AND THE PEAK IS SEPT TO OCT


 Pathophysio:

 Viral → bone marrow → attacks your immature

platelet megakaryocytes

 Bleeding
DENGUE --> MOSQUITO WITH WHITE BANDS
MALARIA -->
FILRIASIS

CAUSATIVE AGENT: DENGUE TYPE 1-4 OR CHIKONGUNYA VIRUS


 Signs and Symptoms

First 4 days: REFERRED TO AS FEBRILE PHASE (39 AND ABOVE)

 High fever
 Abdominal pain and headache
 Flushing accompanied by vomiting
 Conjunctival infection
 Epistaxis

WHAT PLEXUS IN THE NOSE IS THE COMMON SITE FOR EPISTAXIS

--> Kiesselbach plexus
 4 -7
th thdays

Lowering of the temperature
Severe abdominal pain
Vomiting and frequent bleeding
Unstable BP and narrow pulse
pressure and shock--> HYPO, TACHY, TACHY
--> YOU NEED TO SURVIVE FOR THE NEXT 7 DAYS!
 7 -10
th th day

Generalized flushing with
interventing areas of flushing
Appetite regained
Stable blood pressure
WILL YOUR TORNIQUET TEST BE POSITIVE IN THE 4TH TO 5TH DAY?
--> NOT ANYMORE --> COLLAPSE VESSELS ALREADY
--> ONLY EFFECT IN 1ST AND 2ND DAY
 H-fever classification

Severe, frank type
Moderate
Mild
What is the source of
infection?

BITE OF AEDES AEYGYTI

FILARIASIS --> AEDES POECILLUS

MALARIA --> ANOPHELIS
 Mode of transmission

 Period of communicability: first week of illness;
virus is present in the blood

 Peak aged: 5-9 years old

 Diagnostic test

 Torniquet test/ Rumpel Leads Test/ Capillary
fragility test = Presumptive
 =20 petechia (Herman’s sign) 20 OR MORE!!
 =+ Tourniquet test

 Confirnatory: Platelet count Normal: 150-

400x10^3/ml --> TEST FOR CIRCULATING IMMUNOGLOBULINS
NBSAT1 -- TESTING IF WHAT TYPE 1-4
 DO NOT GIVE ASPRIN

Management

DENGUE W/O SYMPROM --> ORAL THERAPY
WITH BLEEDING --> BLOOD TRANSFUSION

Paracetamol, analgesic
Rapid replacement of body fluids
Includes intensive monitoring and follow up
Give ORS to replace fluid BOARD:

--> MOTHER PREPARED ORS AND WAS NOT

CONSUMED AFTER 24 HOURS, COULD YOU STILL
USE?
--> NO! DISCARD
 Control Measures

 Eliminate vector by:
 Changing water and scrubbing sides of lower vases
once a a week
 Destroy bleeding places of mosquito
 Proper disposal of rubber tis, empty bottles and cans
TIRES
 Keep water containers covered
DIET: LOW FAT, LOW FIBER, NON IRRITATING, NON CARBONATED DRINKS
MEASLE

RUBEOLA

--> MEASLES
--> INANTHEM --> INSIDE THE BODY (KOPLIKS SPOTS) --> BUCCAL MUCOSA
--> EXANTHEM --> RASH (MORBILIFORM RASH) --> SMALL RED RASHES
--> FOR INFANCY--> RISK FOR DEATH BECAUSE OF PEUMONIA

RUBELLA --> GERMAN MEASLES

--> FORSCHIEMERS --> PANTAL RASH --> PALATE
--> MOST COMMON OF DEATH --> DANGEROUS TO MOTHERS WHO ARE PREGNANT BECAUSE PRONE TO CONGENITAL
DEFECTS
--> THAT IS WHY NEED TO TEST FOR --> RUBELLA TITER (NORMAL 1:8 OR HIGHER) IF LESS THAN? WE GIVE ACTIVE VACCINE
--> HEALTH TEACHING: NO PREGNANCY FOR 3 MONTHS --> TERATOGENIC

MOST COMMON IN DEATH

 AIRBORNE!!

Signs and Symptoms


 Fever
 Rashes
 Symptoms referrable to upper repiratory tract
infection
 Koplik spot
 What is the mode of
transmission

AIRBORNE!!! NOT DROPLET

 Droplet secretions
 PERIOD OF
COMMUNICABILITY

 Incubation period:

 10 days = fever
 14 days =rashes (8-13 days)

TRUE OR FALSE

1. DO YOU ACQUIRE PERMANENT IMMUNITY AFTER HAVING MEASLES?

--> YES! LIFELONG IMMUNITY

WHE IS IT COMMUNICABLE?

--> CATARRHAL PERIOD --> ONSET OF CORYZA (FLU LIKE SYMPTOMS

 Method of Prevention
and Control

Avoid exposing children to any person with
catarhhal symptoms
Isolation of cases from diagnosis until 5-7
days after the onset of rash
Disinfection of articles soiled with infected
secretions
Administration of measles immune globulin
to susceptible infants
 Nursing care:

 Protect eyes of patient from glare KEEP PATIENTS AWAY FROM DRAFT --> "HAMOG"
 Keep the patient in adequately ventilated room
 Teach, guide, supervise adequate nursing care as
indicated
 Check corrections of medication and treatment
prescribed by the physiscian

WE NEED TO COVER THE EYES --> PRONE TO BLINDLESS --> BECAUSE OF CONJUNCTIVAL IRRITATION --> GIVE VITAMIN A-->
STARTING 6 MONTHS OF AGE.

HOWEVER IF EPIDEMIC --> EARLIEST TO GIVE --> 6 MONTHS --> GIVE ONLY 50,000 IU

MOST COMMON CAUSE OF DEATH RELATED TO MEASLES --> PNEUMONIA AND MALNUTRITION
BEST WAY TO PREVENT MEASLE?
--> MEASLE VACCINE --> WHEN TO GIVE? LEGAL BASIS RA 10152

9 MONTHS --> ROUTE:SQ --> BEST TIME (PROTECTION IS ONLY 85%

1 YER --> 95% PROTECTION

BOARD:
WHY DO WE GIVE AT 9 MOS AND NOT JUST WAIT FOR 1 YEAR?
--> BECAUSE MORTALITY IS HIGH AT 1 YEAR AND IN ORDER TO AUGMENT IT WE HAVE MMR GIVEN AT 1


YEAR

EALR

 Measles: filterable virus of measles THREE PRINCIPLES OF EPI

1. EPEDIMIOLOGIC APPROACH

--> INCREASE PROTECTION

 Outstanding sign: Kopliks (enanthem) 2. MASS APPROACH

 Exanthem: Rashes --> HERD IMMUNITY

3. IIMUNIZATION AS A BASIC HEALTH

SERVICES

 sign of rash: Facial rash --> CE WINSLOW (BIRTHRIGHT AND

LONGEVITY)

 Stimson’s line: bilateral red line on the lower conjunctiva

--> BILATERAL RED LINE ON THE LOWER CONJUNCTIVA

 Prevent: PNEUMONIA; DIARRHEA; MALNUTRITION

SARS
--> Started as a respiratory disease like Covid in Hwangdong China
--> Usually causes severe respiratory distress
--> Most common death related to SARS is --> RESPIRATORY DISTRESS SYNDROME
--> We treat symptoms based on symptoms (symptomatic management)

Covid 19 and Corona Virus

--> Started at Wuhan China
--> Zoonotic from bats (loss of smell, taste, bleeding --> because of cytokines storms
--> Vaccines --> BEST PREVENTIVE MEASURES
--> Most death because of complications with --> SARS, and Cytokine storms

Emerging / Re-emerging diseases --> considered eliminated but resurfaces

Zika
--> cause by mosquito (it becomes problem when you are pregnant --> causes microcephaly

Ebola
--> Zoonotic (Animals) --> Still over Animals to Human
--> Contact --> early detection needed

Mers Cov
--> Camels
--> Get this from eating camels
 CHICKEN POX
--> Cause by: Varicella


SMALL POX
--> Cause by: Variola

 Causative: Herpes Zoster Virus

ETIOLOGIC AGENT: HUMAN HERPES VIRUS TYPE 3
--> ALSO CAUSE HERPES

WHAT MAKES YOU COMMUNICABLE?

--> THE LESIONS FROM THE FLUID OF THE SCABS
 Signs and Symptoms

Slight fever
Maculo-papular rash for a few hours/
vesicular (fluid filled)
--> WITH BLISTERS AND VESICLES

Vesicular for 3-4 days = scarring= pneumonia

Incubation: 2-3 weeks commonly 13-17 days

 Period of
communicability

 Presence of scabs : fluid in the lesion

 Second attack are rare: Shingles

 Outstanding: pain→ nerve endings
DRUG TO MINIMIZE THE COMMUNICABILITY
--> EXECLOVIR (LESSEN IMPACT)

SECOND ATTACK OF CHICKEN POX IS CALLED

--> SHINGLES --> PAIN IN THE NERVE ENDINGS
--> PAIN MEDS: DOLONEUROBION --> PARACETAMOL + B COMPLEX FOR PAIN
--> PREVENT PERIPHERAL NEURITIS
 Methods of Prevention
and Control

Case over 15 years of age should be
investigated to eliminate the possiblity of the
small pox
Isolation --> BEST WAY TO PREVENT CHICKEN POX

Current disinfection of throat and nose

discharges
Avoid contact with susceptible
TYPE OF RASH --> MACULOPAPULAR RASH



FIRST SIGN OF PUBERTY? HALLMARK FOR FEMALE PUBERTY

FEMALE --> BREAST ENLARGEMENT FEMALE: MENARCHE / FIRST MENS

MALE --> ENLARGEMENT OF PENIS AND SCROTUM MALE: EJACULATION

CA: Paramyxovirus
HALLMARK SIGN THAT PATIENT IS

STERILE --> DOES NOT PRODUCE GAMETE

Salivary glands = Parotitis INFERTILE --> YOU PRODUCE GAMETE BUT NO
MEETING OF SPERM AND EGG BECAUSE
Incubation period: 6-12 days THERE IS BLOCKAGE OR INABILITY TO
RELEASE IT

When is mump dangerous: puberty→

sterility/infertility
 PENIS

Period of >2 --> MICROPENIS

communicability
 --> AS LONG AS THERE IS FEVER AND SWELLING IS NOT SUBSIDED

MUMPS
--> "BAYUOK" --> PAROTID SWELLS BECAUSE OF PARAMYXOVIRUS
 Signs and Symptoms

 Painful swelling in front of the ear, angle of jaws and
down the neck
 Fever
 Malaise
 Loss of appetit e
 Swelling of one or both testicles = orchitis; excessive
temperature SEE TO IT THAT TEMP IS MORE THAN 39 DEGREE CELCIUS
 → ice packs and prevent the scrotum from hanging
USUALLY WE GIVE HYDROCORTISONE --> ESPECIALLY DURING PUBERTY

SUPPORT THE SCROTUM --> PILLOW UNDERNEATH

 Treatment

 Prophylactic: vaccine/ immunization againts the
disease VACCINE MMR --> 1 YEAR BEST TIME
 Active treatment: the average case before puberty
requires little attention
 After the age puberty: immediate oral dose of
cortisone 300 to 400 mg followed by 100 mg every 6
hours

 MMR = measles mumps and rubella

DIPTHERIA -->

CAUSED BY: CORINE BACTERIUM DIPTHERIAE

--> UNPASTURIZED MILK
--> HALLMARK SIGN: PSEUDOMEMBRANE (GRAYISH SPECS)
--> DOC: ERYTHROMYCIN
--> MAY COMPLICATE TO: MYOCARDITIS

PERTUSSIS
--> CAUSED BY: BORDETELLA PERTUSSIS
--> MILK ALSO, SECRETIONS OF PERSON INFECTIED AND OVERCROWDING
--> HALLMARK: WHOOPING COUGH
--> DOC: ERYTHOMYCIN
--> MAY COMPLICATE TO: MYOCARDITIS / VOMITING AND ASPIRATION

TETANUS
--> CAUSED BY: CLOSTRIDIUM TETANI --> FAMILY OF FOOD POISONING "CLOSTRIDIUM BUTOLINOM" --> USED IN BOTOX AND
CANNED GOODS WITH INDENTATIONS
--> IN SOIL
--> HALLMARK: TRISMUS (LOCK JAW OR SARDONIC SMILE)
--> DOC: PURE VACCINATION OF TETANUS
--> MAY COMPLICAYE TO: RESPIRATORY PARALYSIS --> CAUSES MUSCLE PARALYSIS

IS CAUSED BY --> CORINE BACTERIUM DIPTHERIAE AKA: KLEBS LOEFHER BACILLUS

Mode of transmission

DIRECT CONTACT --> UNPASTERIZED MILK OR UNHYGIENIC PRACTICES

COMMON UPPER RESPIRATORY PROBLEM

Incubation period

2-5 DAYS OR LONGER
 Methods of Prevention
and Control

Active immunization on all infants and
children with 3 doses od DPT toxoid PENTAVALENT

Pasteurization of milk BOARD:

1. WHICH AMONG THE PENTALAVENT HIP CAUSES
CONVULSION? --> PERTUSSIS

Education of parents --> BECAUSE ITS A WEAKEN VACCINE (ALIVE) THE

REST IS DEAD

Reporting of the case to the health

officer for proper medical care
AS LONG AS THERE IS BACCILI IN THE DISCHARGES --> STILL COMMUNCABLE

YOU DONT GIVE PENTAVALENT 1 IF THERE IS NEUROLOGIC DISORDER

YOU DONT GIVE PENTAVALENT 2-3 AFTER SEIZURE OF PENTA 1 OR 2 RESPECTIVELY
Nursing responsibilities

 Follow prescribed dosage in administering anti toxin
 Comfort of the patient should always be in mind
PREVENT TANSMISSION TO OTHER PATIENTS
 The visiting bag set up should be outside the room of
the room of the patient or should be far from the
bedside of the patient and a separate upon a appear
towel as in temperature taking may be brought and
placed on the bedside by a table or chair.
 Signs and Symptoms

Ordinary cold which becomes increasingly
severe
Paroxysms of cough --> GINBARUKOY

Vomiting may follow spasm

Cough may last several weeks and some 2-3
months
USUALLY THE WHOOP --> STARTS AFTER BREATHING IN
Mode of transmission

DIRECT CONTACT --> OVERCROWDING
 Period of
communicability

CATARRHAL STAGE --> CORYZA (COUGHING AND FLU LIKE SYMPTOMS
HIGHEST INCIDENCE IN 7 ABOVE
HIGHEST MORTALITY --> 6 MONTHS -- HIGH RISK FOR ASPIRATION
 Methods of prevention
and control

 Routine DPT immunization in all infants
 Booster dose given at 2 years and again at 4 to 5
years PENTAVALENT HIB --> GIVEN 6 - 10 - 14 MONTHS
BOOSTER --> BETWEEN 2 TO 4-5 YEARS

 The patient should be segregated until after 3 weeks

from the appearance of paroxysmal cough

LIFE LONG IMMUNITY

 Nursing care

 Care should be focused on prevention and
complication: special attention to diet is needed if
patient vomits after cough paroxysms --> SOFT DIET
 Teach parents how to pick up the infant or child
during paroxysmal cough, giving abdominal support
 General care of the nose and throat. --> SECRETIONS
 SOIL, DUST AND FECES OF ANIMALS

TETANUS PASMIN --> WILL CAUSE SPASM OF NERVES

Mode of transmission

DIRECT CONTACT

TETANUS 2 FORMS

1. NEONATAL TETANUS

--> BATA, UMBILICAL CORD --> BREACH IN 3 C'S

--> CLEAN HANDS, CLEAN CORD, CLEAN SURFACE

2. NON NEONATAL

--> SOIL CONTAMINATION, FECES, OR DUST

--> HALLMARK: WEAKENING OF SUCKING REFLEX
 Method s of prevention
and control

 Pregnant women should be actively immunized in
region where tetanus neonaturum is prevalent
 Licensing of midwives into professional supervision
and education as ro methods of equipment and
techniques of sepsis on childbirth
 Health education on mothers relatives and
attendants in the practice of strict aseptic methods of
umbilical care in the newborn
FOCUS IN UMBILICAL CORD --> PREVENTABLE BY: DPT HIP
 COMMON FLU:
ABC AKA: TRANGKASO
DANGEROUS TO CHILDREN?
--> BECAUSE IT MAY PROGRESS TO PNEUMONIA

HOW IT IS TRANSFER?
--> DISCHARGES FROM NOSE AND MOUTH
 Signs and Symptoms

 Abrupt onset of fever
 Chilly sensations/ chills
 Aches or pains in the back
 Respiratory symptoms include: coryza, sore throath
and cough

 First sign: CORYZA (flu like symptoms)

INCUBATION PERIOD --> 24-72 HOURS
 Period of
communicabilty

 3 days from clinical onset
 Methods of Prevention
and Control

 Education of the public as to sanitary hazard from
spitting, sneezing and coughing COVER MOUTH
 Avoid use of common towels, glasses and eating
utensils --> ESPECIALLY WITH SYMPTOMS
 Active immunization with influenza vaccine
provided prevailing strain of virus matches the
antigenic component of vaccine
BOARD:

1. HOW OFTEN SHOULD INFLUENZA VACCINE BE MADE? --> YEARLY ( USUALLY MARCH TO JUNE) --> MORE
EFFECTIVE
DIFFERENCE OF XRAY OF PNEUMONIA TO TB?

TB --> UPPER LOBE (BLACK IN WHITE DOTS) "BUKOL OR TUMOR" --> ORDER CT SCAN -->

IF YOU KNOW THE PATHO --> SPUTUM EXAM

PNEUMONIA --> LOWER LOBE ( LUNG CONSOLIDATION --> FOUND IN XRAY --> HAZY DENSITIES
 Etiology

Majority of cases due to
diploccocus pneumoniae
Occasionaly pneumoccocus of
Friedlander TRUE OR FALSE

Viruses WILL INFLUENZA CAUSE PNEUNOMIA?

--> YES! BRONCHOPNEUMONIA
 Predisposing causes

 Fatigue
 Overexposure to inclement weather
 Exposure to polluted air
 Malnutirition
USUALLY EXTREME HOT OR COLD
IC: 2-3 DAYS

IN SEVERE PNEUMONIA

--> 2 WEEKS OF COMPLETE BED REST

 Signs and symptoms:

 Rhinitis  Flushed face
 Chest indrawing  Dilated pupil
 Rusty sputum  Severe chills in young
 Productive cough children
 Fast respiration  Pain over the affected
 Fever lung
 Vomiting
 Convulsions may occur
 Diagnosis

Based on history and clinical signs and
symptoms
Dull percussion noted on the affected
side of the lungs
X ray
 Complications:

 Emphysema or pleural effusion --> ACCUMULATION OF LFUIDS IN THE PLEURAL
SPACES

 Endocarditis or pericarditis MGT:

1. THORACENTESIS

 Pneumoccocal meningitis
 Otitis media in cbhildren
 Hypostatic edema and hyperemia of unaffected lung
in the elderly
PERICARDITIS

 Jaundice --> INFLAMMATION OF THE PERICARDIUM

 Abortion ENDOCARDITIS

--> INFLAMMATION OF THE ENDOCARDIUM

--> FOUND: GENE WAY LESIONS, PUSLERS NODES, SPLINTER
HEMORRHAGES (KUKO), ROT SPOTS (EYES), ERYTHEMA MARGINATUM
 Management

Bedrest --> IF MILD 7 DAYS, SEVERE --> 2 WEEKS

Adequate salt, fluid, calorie and vitamin

intake
TSB for fever
Frequent turning from side to side
Antibiotic based on Care of the Acute
Respiratory Infection of the Department of
Health AMOXICILLIN --> FIRST LINE OF ANTIBIOTIC
AZITHROMYCIN
CEFEXIME OR CEFUROXIME --> WORST CASE
AKA: El Tor/ Vibrio El Tor
--> MAINLY FROM VOMITUS AND FECES OF INFECTED PERSON
 Signs and Symptoms

 Sudden onset of acute and profuse colorless diarrhea
 Vomiting
 Severe dehydration== Rice watery stools --> HALLMARK SIGNS
--> SEVERE DEHYDRATION

 Muscular cramps
 cyanosis

 Deficits:
 Extra cellular volume loss
 Acidosis
 Hypokalemia --> INCREASE INTAKE OF POTASSIUM (BANANA, AVOCADO, RAISIN, CANTALOUPE)
--> BUKO JUICE
 Mode of transmission

 Food and water contaminated with vomitus and
stools of patients an carriers
HOW FAR SHOULD YOUR TOILET FACILITY FROM YOUR WATER SOURCE?
--> 25 METERS AWAY FROM THE LAST CR/TOILET FACILITY

 Incubation period: few hours to 5 days usually 3

days

 Period of communicability: 7-14 days ; 2-3 months

 Methods of Prevention
and Control

 Report case at once to the health officer --> UNDER NOTIFIABLE DISEASE
 Bring patient to the hospital for proper isolation and
prompt and competent medical care
 Other general preventive measure to control the
spread of the disease
 All contact of the cases should submit themselves for
stool examination and be treated accordingly if
found or discovered positive.
UNDER NESSS --> (NATION EPIDEMIC SENTINEL SURVEILLANCE SYSTEM --? CHOLERA IS ONE OF THOSE
MONITORED AS LABORATORY MODIFIABLE DISEASES --> YOU HAVE TO NOTIFY WITHIN 24 HOURS IF THERE IS
A SUSPECTED CASE OF CHOLERA
 Nursing care

 Continue and increase the frequency of breastfeeding
 Give additional fluid , “am” soup, cereals, mashed
vegetables, AM --> IS A RICE BROTH

 Coconut water is said t be rich in potassium, one of the

electrolytes found in choleric stools
 Make patient comfortable as possible
 Give ORESOL according to the prescribed anount
according to age DISCARDED AFTER 24 HOURS --> PRONE TO CONTAMINATION

 DOC: TETRACYCLINE
 CA: SALMONELLA TYPHOSA
CAUSED BY TYPHOID BACILLUS OR SALMONELLA TYPHOSA

5 F's of Cholecystitis / Cholelitiasis

F --> FAT
F --> FAIR
F --> FEMALE
F --> FORTY
F --> FERTILE
 
 5 F’s: Finger, foods, feces, flies and fomites
Finger --> eating pati ang kuko (hands transmitted
Foods --> Street food "Hepalanes"
Feces --> no proper washing
Flies --> 1 poop to your food
Fomites --> rats, and cockroaches

MOST COMMON AMONG THE FIVE --> FECES AND URINE

Source of infection

5 F'S --> FECES AND URINE COMMON
 Signs and Symptoms

 Fever – ladderlike/steplike fever --> INCREASE FEVER THEN MAINTAIN
 Anorexia
 Slow pulse
 Involvement of lymphoid tissues
 Ulceration if the peyer’s patches
 Spleenomegaly
 Rose spots --> NAMUMULA ANG TIYAN --> CALLED AS ROSASEA PETECHIA
--> CAUSE IF THE PEYER'S PATCHES IS INFLAMED

 Diarrhea
--> SA LOOB PEYERS PATCH SA LABAS ROSE SPOTS
 Incubation period

 2 weeks or 1 -3 weeks

 Communicable: as long as the bacilli is present

 Nursing care

 Demonstrate to family how to give bedside care,
such as tepid sponge bath, feeding, changing of linen
bed, use of bed pan and mouth care
 Any bleeding from the rectum, blood in the stools,
sudden acute abdominal pain, restlessness and
falling of temperature should be reported at once to
the physician or the patient should be brought at
once to the hospital
 Take vitals signs and teach family member how to
take and record. HOW TO GIVE BEDSIDE CARE?
1. CHECK FOR ANY BLEEDINGS --> IT MAY CAUSE HEMORRHAGE
2. TAKE VITAL SIGNS --> TO KNOW MANIFESTATIONS OF FEVER
--> THERE WILL BE A SUDDEN DROP OF BLOOD PRESSURE (SO MONITOR
FOR SIGNS OF HYPOVOLEMIC SHOCK)
HALLMARK SIGN: --> BLOOD IN THE STOOL
--> CAUSED BY SHINGELLA WHICH CAUSES THE BACILLARY DYSENTERY
--> FOUND IN THE IMCI
 Etiologic agents

There are four main group:
 Shlesneri
 Shboy-dii
SHIGELLA ALL

 Sn- connei
 Sh-dysenterae
 Signs and Symptoms:

 Diarrhea=bloody and mucoid
 Fever
 Tenesmus = feeling of incomplete defecation
TENESMUS --> 30 MINS NA KA SA CR PERO FEELING GIHAPON NIMO WALA NA EMPTY IMONG STOMACH BECAUSE
OF BACILLI PROTRUDING

 DOC: COTRIMOXAZOLE
OR CEPROFLOXACIN
 Period of
communicability

AS LONG AS THERE IS ORGANISM IN THE FECES
 Methods of Prevention
and Control

 Sanitary disposal of human feces
 Sanitary supervision of processing, preparation and
serving of food particularly when eaten raw
 Adequate provision for safe washing facilities
 Fly control and screening to protect foods againts fly
contamination BOARD:
--> PUT A SCREEN DOORS IN YOUR HOUSE IF LIVING NEAR THE POULTRY STATION

 Protection of purified water supplies and

construction of safe privy
 Methods of Prevention
and Control

Control of infected individual contacts and
environment
Reporting to local health officer
Isolation of patient during acute illness
Rigid personal precautions by attendants


THIRD MOST PREVALENT INFECTION
--> COMES FROM THE SOIL
 Etiologic agents

Ascaris lumbricoides
Trichuris trichiura and;
 hookworm (ancylostoma doudenale
and necator americanus
TRICHURIS TRICHIURA
ASCARIS LUMBRICOIDES (BITOK) --> WHIPWORM, TAPE WORMS OR FLAT WORMS
--> AKA ROUND WORMS --> LONG; SO IF MAPUTOL THE OTHER BECOMES A SEPARATE ENTITY
--> CAUSES ASCARIASIS --> YOU GET THIS IN PORK (DI NALULUTO NG SAMGYUP)
--> LOOK LIKE SPAGHETTI IF YOUNG (WHITE) --> FISHES HAS TAPE WORMS WITH THEM (TUNA) / BAREFOOT
--> IF OLD LOOK LIKE EARTHWORM (BROWN)
--> CAUSES STUNDED GROWTH AND SKINNY BUT STOMACH IS BIG
--> WALKING BAREFOOT
ENTEROBIASIS
--> PINWORM
--> ITCHINESS OF THE RECTAL AREA
HOOKWORM --> WHY ITCHY? FEMALE LABAS TO DEPOSIT EGGS OUTSIDE
--> CAUSE BLEEDING THUS ANEMIA --> TOILET SEATS

TEST: SCOTCH TAPE TEST --> FOUND EGGS

 Signs and Symptoms

Anemia --> PARASITIC COMPETITION

Malnutrition
Stunted growth in height and body size
Decreased physical activity
Impaired mental development and
school performance BEST INDICATOR IF YOUR CHILD HAS WORM INFESTATION

--> POOR SCHOOL PERFORMANCE

TREATMENT? (PERFORM DEWORMING)

1. TWICE A YEAR FOR A PERIOD UNTIL 3 YEARS OLD

--> WE USE ABENDAZOLE AND MEBENDAZOLE
2. BEFORE GIVING MEDICATION, WHAT IMPORTANT HEALTH TEACHING?
--> TO PREVENT ERRATIC MIGRATION --> GIVE ANTIHISTAMINES (PARA MATULOG ANG WORMS)
 Prevention and Control
 WHAT MEDICINAL DRUGS TO USE IN ASCARIS IN CHN?
 Health teaching on: --> NIYUG-NIYOGAN
--> SCIENTIFIC NAME QUISQUALIS INDICA
--> USE THE SEED
 Good personal hygiene --> ALTERNATIVE: IPIL-IPIL OR AGHO

 Keeping fingernails clean and short

 Use of footwear
 Wash fruits and vegetable very well HOW LONG SHOULD YOU BOIL?
--> 2 TO 3 MINS AFTER ROLLING BOIL
 Advocate use of sanitary toilet
 If water is not safe for drinking, boil properly
 Once sign and symptoms appear consult RHU staff
 Early diagnosis and
treatment

Consult RHU and BHS staff
Laboratory/ stool/ blood exam
Ensure proper dosage of medication and
completion of treatment
Referral and follow up as needed.
CAUSATIVE AGENT: PAROGONIMUS WESTERMANI
--> WHEN YOU EAT IMPROPERLY COOKED CRABS

HALLMARK SIGN: SAME WITH PTB

 Endemic areas
identified:

 Mindoro
 Camarines sur
 Camarines norte
 Sorsogon
 Samar
 Leyte
 Negsro Island
 Cebu
 Basilan
 Island of Mindanao including Basilan
 Etiologic agents

 Paragominus westermani
 Paragominus siamenses
IN THE PHILIPPINES

--> PARAGONUMIS WESTERMANI PHILIPPINENSIS

 Known intermediate
host in the Philippines

Antemelania asperata
Crabs and
Varona litterata
Crayfish --> ULANG MAY SIPIT
Mode of transmission

INGESTION OF INSUFFICIENT COOKED CRABS
 Signs and Symptoms

Cough of long duration
Hemoptysis or recurrent blood
streaked sputum
Chest/ back pain
PTB like meds
 Diagnosis

Sputum examination
WHAT WILL YOU SEE IN THE SPUTUM?

Immunology --> RUSTY SPUTUM WITHOUT MYCOBACTERIUM

TUBERCULI

Cerebral paragonimiasis
THERE WOULD BE INCREASED EOSINOPHIL IN THE CSF + EGGS


 Treatment

Praziquantel
Bithionol
 Prevention and Control

Treatment of infected person
Sanitary disposal of excreta
Anti-mollusk campaign --> FRESHWATER SUSO

Education of the population

Avoid eating infected foods
Avoid bathing in infected water
HEPA A
CAUSE --> HEPA A VIRUS
--> FECAL ORAL
--> INTERFERON AND GAMMA GLOBULIN

HEPA B
CAUSE --> HEPA B VIRUS
--> BLOOD OR BLODLY SECRETIONS
--> HEP B VACCINE USUALLY GIVEN 24 HOURS AFTER BIRTH +
INTERFERON AND GAMMA GLOBULIN

BOTH
--> TURN KERNICTERUS (JAUNDICE --> TURNS YELLOW)
--> LIVER IS AFFECTED THAT IS WHY --> LOW FAT, LOW PROTEIN, BUT
HIGH IN CARBOHYDRATES --> GIVE SUGAR BALLS (SUGAR CANDY)
 Predispsosing factors

Poor sanitation
Contaminated water supply
Unsanitary preparation and
serving of food
Malnutrition
INCUBATION PERIOD IS
--> 15 TO 50 DAYS
 Signs and symptoms

 Influenza like such as headache
 Malaise and easy fatigability
 Anorexia and abdominal discomfort
 Nausea and vomiting
 fever
 Lymphadenopathy
 Jaundice accompanied by pruritus and urticaria
 Bilirubinimea with clay colored stools
CLAY COLRED --> BECAUSE LIVER IS AFFECTED
 Management and
treatment

 Prophylaxis --> INJECT GAMMA GLOBULINS AFTER INFESTATION
 Complete bed rest
 Low fat diet but high in sugar
 Prevention and Control

 Ensure safe water for drinking
 Sanitary method in preparing and handling food
 Proper disposal of feces and urine
 Washing hands very well before eating and after
using the toilet
 Proper cleaning of articles used by patients
 CA: RED DINOFLAGELLATES
WHY IS IT CALLED RED TIDE?
--> THE SHORELINES TURNS COLOR RED
--> CAUSE BY RED DINOFLAGELLATES
--> USUALLY HAPPEN WHEN THERE IS LONG PERIOD OF DROUGHT THEN RAIN SUDDENLY
 Mode of transmission

 SEAFOODS

 INCUBATION PERIOD: 30 minutes to several hours

 Signs and Symptoms

 Numbness of the face especially around the mouth
 Vomiting and dizziness
 Headache
 Tingling sensation, paresthesia and eventual paralysis of
the hands and feet
 Rapid pulse
 Difficulty of speech and difficulty swallowing
 Total muscle paralysis with respiratory arrest and death
in several cases

 Patients who survive 12 hours = has greater chances of

survival --> YOU NEED TO SURVIVE WITHIN THIS TIME!!!
 Management and
control Measures

 Induce vomiting
 Drinking pure coconut milk --> KAGOD GIHAPON MASKIG MAMATAY NA!!!
 Shellfish affected by red tide must not be cooked
with vinegar --> NOR MAKE SAWSAW IN VINEGAR BECAUSE IT POTENCIATE THE TOXIN 14 TO 15 TIMES
STRONGER

 Toxin of red tide is not totally destroyed upon

cooking hence consumers must be educated tp avoid
bi-valve mollusks such as tahong, talaba, halaan,
kabiya, abaniko when the red tide warning has been
issued. --> COMMON IN ZAMBALES, LAGUNA AND MANILA BAY
 Signs and symptoms
 2 PHASES OF LEPTOSPIROSIS

 fever with sudden onset 1. LEPTOSPYREMIC PHASE

--> MANIFEST S/S SAME WITH MENINGITIS
--> PASOK SA CSF

 headache 2. IMMUNE PHASE

--> CAUSES INCREASE IN CIRCULATING IGG

Chills
Severe myalgia (calves and thighs)
Cough and chest pain.
LEPTOSPIROSIS
--> CAUSATIVE AGENT: LEPTOSPIRA ENTEROCANS

OR SPIROCHITAL JAUNDICE --> IT IS CAUSE BY A BACTERIA SPIROCHETE AKA: 7 DAYS JAPANESE FEVER
BECAUSE IT WILL STAY IN YOUR BLOOD FOR SEVEN DAYS OR THIS IS ALSO CALLED AS TRENCH OR FLOOD FEVER
 Mode of transmission

 Wading in floody waters --> BAHA!!
--> OPEN WOUNDS
--> FECES AND URINE OF RATS
 Diagnosis

 Clinical manifestations
 Culture of the organism
 Examination of blood and CSF during the first week of
illness and urine after the 10th day

 CONFIRMED BY: rising titers in serologic test (MAT)

MAT --> MICROSCOPIC AGLUTINATION TESTING

 Blood (1st 7 days) --> SEVEN DAY JAPANESE FEVER

 CSF (4-10 days)
 Urine after the 10th day
 Treatment

Penicillin and other related B-
lactam antibiotic
Tetracycline
IN THE COMMUNITY THE FIRST DRUG OF CHOICE THAT WE GIVE
IS?

--> DOXICYCLINE

Erythromycin
Prevention and Control

1. Educate public on the modes of transmission, to avoid
swimming or wadding in potentially contaminated
waters and to use proper protection when work
requires such exposure.

2. Protect workers in hazardous occupations by

providing boots and gloves.

3. Recognize potentially contaminated waters and soil

and drain such waters when possible.

4. Control rodents in human habitations, especially

rural and recreational. Burn cane fields before
harvest. --> MADAMING RATS ANG NAG IINFEST NG AREA
 Leptospirosis….

 Control of patient, contacts and the immediate
environment:
1. Report to local health authority.
2. Isolation: Blood/body fluid
precautions. MOST IMPORTANT HERE IS THE URINE

3. Concurrent disinfection: Articles

soiled with urine.
4. Quarantine: None
5. Immunization of contacts: None

 WHAT IS IMPORTANT IS THAT THE BITE

1. THE PROXIMITY OF THE BITE TO THE NEUROLOGIC SYSTEM WILL DETERMINE HOW FAST YOU WILL DIE

MAS MALAPIT SA ULO --> MORE HIGHER CHANCES OF DEATH

2. THE RABIES WILL ALSO CAUSE THE ACUTE VIRAL ENCEPHALOMYOLITIS

3. WHAT IS THAT SIGN THAT MORE OR LESS YOU WILL DIE FROM RABIES AND IRREVERSIBLE

--> WHEN YOU HAVE HYDROPHOBIA OR AEROPHOBIA DIE 24-48 HOURS

Lysa virus CAUSE BY RHABDOVIRUS

RA 9482 – act elimination rabies among humnas
IT TALKS ABOUT

RESPONSIBLE PET OWNERSHIP

SAAN MAKUHA?

1. BITE OF STRAY DOGS --> CALLED AS URBAN OR CANINE RABIES

2. BITE OF WILD ANIMALS --> SILVATIC RABIES

WE COULD GET THIS FROM BEARS

 Mode of Transmission

 Bite of a rabid animal

 Human to human transmission is possible

 Incubation period: 2-8 weeks

 Period of communicability: 3-10 days
 Signs and symptoms

 Sense of apprehension --> BECAUSE OF ENCEPHALOMYOLITIS
 Headache
 Fever USUALLY THE SENSORY CHANGES?

--> BITE AREA

 Sensory change near bite of animal

 Spasm of muscle HYRDOPHOBIA AND DEGLOTATION
DEGLOTATION
 Paralysis – respiratory paralysis SWALLOW --> ATTEMPT TO SWALLOW!! BUT CANNOT
BECAUSE AFRAID WATER

 Delirium and convulsions

IF EXPERIENCED HYRDROPHOBIA
--> THE TOXIN IS IN THE BRAIN --> AFFECT PERIPHERAL NERVES --> CAUSE
PARALYSIS OF RESPIRATORY

BETWEEN CATS AND DOGS CASES?

--> CASES ARE MORE PRONE TO CATS
 Management and
prevention

 The wound must be immediately and thoroughly
washed with soap and water
 Pt. may be given antibiotic or anti tetanus
 Post exposure treatment is given to patient who have
been exposed to rabies. It consist of local wound
treatment, active and passive immunization
 Consult a veterenarian or trained personnel to
observe pet for 14 days
WHAT IF YOU DONT KNOW WHO HAVE BITEN YOU (DOG)?
--> AUTOMATIC 28 OR 30 DAY --> HUMAN IMMUNOGLOBULIN SHOULD BE GIVEN

IF ALAM MO
--> YOU NEED TO OBSERVE THE DOG FOR 14 DAYS
  CATEGORY OF DOG BITES
 0-3-7-14-28 INITIAL DOSES IS 4

3,7,14 --> PROPHYLAXIS

CATEGORY 1:
--> LICKING
28-30 --> IMMUNOGLOBULIN
--> LOW RISK
THIS WILL LAST FOR 3 YEARS
CATEGORY 2:
 Regular basis: --> SCRATCH BUT NOT IN NECK
--> BELOW HEAD

 14 days: CATEGORY 3:
--> LARGE WOUND
--> SCRATCHES ABOVE THE NECK
 If the dog dies= cut the head; DA
--> VETERENARIAN

 0-3-7-14 = PEP; 28/30

--> IF THE DOG NEVER DIED FROM RABIES NO NEED IMMUNOGLOBULIN
--> IF THE DOG DIED FROM RABIES --> MANDATORY IMMUNOGLOBULIN IN 28TH TO 30TH DAY
 Be a Responsible Pet
Owner

Have pet immunized at 3 months of age and
every year thereafter
Never allow pets to roam the streets
Take care of your pet; bathe, feed them
regularly with adequate food, provide them
with clean sleeping quarters
THE DOG SHOULD BE FED:

IF SMALL TYPE --> ONCE A DAY ONLY!!!

IF LARGE AND ACTIVE --> TWICE A DAY!!

 CAUSED BY:
--> SARCOPTES SCABIE

--> USUALLY IT IS THE FEMALE ITCH MITE CAUSES THE SCABIES

BECAUSE THE ITCH MITE WILL BORROW TO YOUR SKIN AND

IT WILL LAY THEIR EGGS ON YOURS --> BECAUSE UNDERNEATH YOUR SKIN THERE IS ENOUGH
NUTRIENTS FOR THE EGG TO SURVIVE AND ENOUGH TEMP
 Signs and Symptoms

Itching
When secondarily infected, the skin
may feel hot and burning with minor
discomfort
When large areas are involved and
secondary infection is severe, there will
be fever, headache, and malaise
 Diagnosis

Appearance of the lesion, and the intense
itching
Scraping from its burrow with a hypodermic
need or curette and examined under the
microscope
HYPODERMIC NEEDLE CURRETTE --> FOR DIAGNOSIS
 Treatment

Benzyl Benzoate emulsions WHEN TAKING BBE
--> DO NOT TAKE A BATH FOR 4 DAYS!

Kwell ointment
REMEMBER!!

1. YOU NEED TO ASSESS ALL THE FAMILY MEMBERS --> ALL AFFECTED
2. TREAT 1 TREAT ALL
3. CLOTHING, LINENS, AND TOWELS --> BOILED
 Prevention and Control

 Good personal hygiene
 Regular changing of clean clothing and beddings
and towels HOW OFTEN SHOULD YOU CHANGED? --> ONCE A WEEK!!
 Eating the right kind of food, green leafy vegetables
and plenty of fluids
 Keeping the house clean
 Improving sanitation in the sorrounding



ANTRAX

HOW DO YOU GET ANTHRAX?

--> AKA: RAGPICKERS DISEASE --> GALING SA ALIKABOK
--> IT IS A BIOCHEMICAL OR BIOLOGIC WELFARE WEAPON
--> CAUSED BY: BACILLUS ANTHRACIS DIFFERENT FROM BUBONIC PLAGUE OR YERSINIA PESTIS

BUBONIC PLAGUE / PESTIS

--> AKA BLACK DEATH
--> ALSO CAUSED BY SPIROKETES --> RESPOND TO PENICILLIN AND DOXYCYCLINES

THREE TYPES OF ANTHRAX DOC:

--> PENICILLIN (RESPOND IN EARLY BUT IF
1. CUTANEOUS RESPIRATORY END OF LINE)
--> ITCHING (SKIN IRRITATION)
--> MAY LEAD TO SEPTICEMIA IF NOT TREATED
--> MAY BE CAUSE BY ENVIRONMENT

2. RESPIRATORY
--> FATAL IF NOT TREATED WITH THE 24 HOURS --> DEATH
--> MAY BE CAUSE BY INHALATION

3. GASTROINTESTINAL
--> DIARRHEA, VOMITING, AND BLOODY STOOL
--> USUALLY FROM CAMELS (RAW MEET)
 Cutaneous form

Exposed part of the skin begins to itch and
the papule appears in the inoculation site .
This papule becomes vesicle and then evolve
into depressed eschars IT IS NOT NOTICEABLE BECAUSE IT IS PAINLESS
 Pulmonary form

 The onset resembles as that upper respiratory tract
infection
 After 3-5 days the infection becomes acute , with
fever, shock and death
Gastrointestinal Anthrax

Violent gastrointeritis with vomiting
and bloody stools.
 Methods of control

Immunize the high risk person with cell free
vaccine
Educate employees handling potentially
contaminated articles about mode of
transmission
Control dusts and proper ventilation in
hazardous industries especially those that
handle raw animal materials
 "TULO"
CAUSED BY --> NEISSERIA GONORRHEA

WILL GONORRHEA AFFECT THE INFANT?

--> YES! WHY?

--> BECAUSE OF OPHTHALMIA NEONATARUM --> TO PREVENT: USE CREDE'S PROPHYLAXIS
--> WE GIVE ERYTHROMYCIN --> IDEAL FOR BROAD SPECTRUM NOT JUST COVER GONORRHEA BUT ALSO CHLAMYDIA
 Signs and Symptoms

 Males:
 Burning urination and pus discharges from infection
of urethra PAG UMI IHI MAY BOB WIRE
Females:
vaginal discharge TULO
Infection of the eyes is rare in adults
--> COMMON IN INFANTS
 Diagnosis

 Gram staining
 Culture of cervical and urethral smear
IF MAY GONORRHEA MAY CHLAMYDIA --> MAG BESTFRIEND SILANG DUHA

--> BOTH WILL COMPLICATE AND CAUSE --> PELVIC INFLAMMATORY DISEASES AND SALPHINGITIS
CAUSATIVE AGENT: TREPONEMA PALLIDUM
HALLMARK SIGN: CANKER SORES OR APHTHOUS STOMATITIS

--> PAINLESS (MAY GO UNNOTICE)

--> IF MAY PUTI NA MAY PUTI --> X

PRECUM COLOR --> CLEAR AND WATERY

GREENISH IN VAGINA --> TRICHOMONIASIS

 Signs and symptoms

 Primary stage:
 Painless chancre at the site of entry and swoollen glands
Secondary stage:
rash
patchy hair loss
sore throat
swollen glands
Late syphilis:
varies form no symptoms to indication of damage to other
organs such as the brain, heart and liver.
NEUROLOGIC SYPHILIS --> WAIT FOR 5 TO 20 YEARS!
 Diagnosis

 Dark field illumination test
 Kalm test
DOC FOR GONORRHEA (ORAL) DOC FOR SYPHILIS (IM)

CEFTRIAXONE BENZANTHINE
AZITH PENECILLIN
DOXYCYCLINE PEN G

WORST COMPLICATION OF SYPHILIS?

--> CENTRAL NERVOUS SYSTEM DAMAGE
CANDIDIASIS
--> FUNGAL INFECTION (COTTAGE CHEESE
--> DOC: AMPOTHERICIN B OR KETOCONAZOLE

CHLAMYDIA
--> CAUSE BY: CHLAMYDIA DRACOMATIS
--> SAME MANIFESTATION SUCH AS VAGINAL DISCHARGES AND PENILE DISCHARGES
 Signs and symptoms

 Females:
 Sometimes a slight vaginal discharge, itching and
burning of the vagina, dyspareunia, abdominal pain,
fever in late stages
Males:
discharge from penis, burning and itching of urethral
opening, burning sensation upon urination
EXAMPLE OF PROTOZOAN
--> NEEDED METRONIDAZOLE
 Signs and Symptoms

Slight grayish or yellow odorous
vaginal discharge
Mild itching
Burning sensation
 Diagnosis

 Microscopic slide
 Chemical analysis of vaginal material and culture
test from infection site
PROTOZOAN --> DOC: METRONIDAZOLE

HEALTH TEACHING FOR METRONIDAZOLE TAKING

--> NEVER DRINK ALCOHOL --> CAUSES DISULFIRAM LIKE REACTION
--> SEVERE VOMITING --> BECAUSE OF AVERSION THERAPY
 Signs and Symptoms

 Female: AVOCADO LIKE DISCHARGES

 Yellow or greenish odorous discharges

 Vaginal itching and soreness
 Painful urination
Males:
slight itching of penis
painful urination
clear discharge from penis
 diagnosis

 Microscopic slide of discharge
 Culture test
 examination
HEPA A --> FECAL ORAL
HEPA B --> BLOOD, BODILY SECRETIONS
HEPA C --> BLOOD TRANSFUSION
HEPA D
HEPA E

MOST COMMON CAUSE OF DEATH RELATED TO HEPATITIS??

--> LIVER CIRRHOSIS
IN MS? PAG NAGKAROON NG LIVER CIRHOSIS BECAUSE OF HEPA A AND B
--> POST NECROTIC HEPATITIS
 Signs and symptoms

 Loss of appetite
 Easy fatigability
 Malaise
 Joint and muscle pain
 Low grade fever
 Nausea and vomiting
 Right sided abdominal pain
 Jaundice
 Dark colored urine
 Mode of transmission

From person to person
Parenteral
Perinatal
 High risk group

 Newborns, infant, children of an infected mother
 Sexual and household contacts of acute cases and
carriers
 Health workers handling blood products
 Persons requiring/ undergoing frequent BT
 Sexually promiscuous heterosexuals and
homosexuals
 Commercial sex workers
 Drug addicts using IV drugs
 Preventive measures

 Immunization with Hep B vaccine
 Universal precaution when dealing with body fluids
 Avoid injury with sharp instruments
 Use disposable needles and syringes and discard
properly
 Sterilize instrument use for circumcision, ear holing,
tattoing, acupuncture and those use for surgical
dental procedures
 Preventive measures…

 Avoid sharing toothbrush, razor and other
instrument that can become contaminated with
blood
 Observe safe sex --> USE CONDOM
 Make sure that blood and blood products for
transfusion have been properly screened for hepatitis
B
 Have adequate sleep, rest, exercise and eat adequate
nutritious foods to build and maintain body
resistance NO DOC!!! BUT MANY PREVENTIVE MEASURES!!!
HIV
--> HUMAN T LYMPHOCYTE VIRUS TYPE 3
--> VIRUS ATTACKS T CELLS AND DECREASE IMMUNITY --> CD4 DECREASES --> DROPS TO LESS THAN 600 SUSCEPTIBLE
TO AIDS --> IF BELOW 200 (AIDS)
--> FIRST SIGN OF HIV --> CORYZA (FLULIKE SYMPTOMS)

SCREENING: --> ELISA TEST

--> WINDOW PERIOD 3-6 MONTHS

CONFIRMATORY --> WESTERN BLOT

AIDS
--> CAUSES DECREASE IN IMMUNE SUPPRESION
--> PATIENT BECOMES IMMUNOCOMPROMISED
--> INCUBATION PERIOD 1-3 MONTHS
--> IT WILL RANGE 1 TO 5 YEARS BEFORE FULL BLOWN HIV

--> KAPOSI SARCOMA --> CANCER OF HIV IN THE SKIN

--> PNEUMONIA --> PNEUMOCYCTIS JEROVICCI
--> CRYTOCOCCAL MENINGITIS --> MENINGITIS OF THE AIDS
--> AIDS DEMENTIA COMPLEX --> WHERE THERE IS DECREASE IN LOC (LATE SIGN)

DOC: ANTIRETROVIRALS
--> IT DOES NOT CURE BUT DELAYED ONLY PROGRESSION

INDINAVIR AND ZIDOVUDINE

--> WOF: CRIX BELLY --> WHICH CAUSES LIPODYSTROPHY

COULD YOU STOP ANTIRETROVIRALS IF CD4 OR HIV VIRUS GOES UNDETECTED?

--> NO!!!
 Mode of transmission

Sexual contact
Blood transfusion
Contaminated syringes, needles, nipper,
razor blades
Direct contact of open wound/ mucus
membrane with contaminated blood and
body fluids
 Signs and symptoms

 Physical
 Maculo-papular rash
 Loss of appetite
 Weight loss
 Fever of unknown origin
 Malaise
 Persistent diarrhea PERSISTENT DIARRHEA FOR 30 DAYS!!

 TB(localized and disseminated) --> MULTIDRUG RESISTANT

 Esophageal candidiasis
 Kaposi’s sarcoma
 Pneumocystis carinii pneumonia
 Apprehensive
 Signs and Symptoms

 Mental (early stage)
 Forgetfulness
 Loss of concentration
 Loss of libido
 Apathy
 Psychomotor- retardation
 Withrawal
Later stage:
Confusion
Disorientation
seizure
Mutism
Loss of memory, coma
 Diagnosis

 ELISA --> SCREENING
 WESTERN BLOT --> CONFIRMATORY

PREVENTION!!

A --> ABSTINENCE (NOT THE MOST EFFECTIVE)

B --> BE FAITHFUL
C --> CONSISTENT USE OF CONDOM --> FIRST TO ANSWER IF WALA BE FAITHFUL!
D --> DO NOT PENETRATE
 Prevention

 Maintain monogamous relationship
 Avoid promiscuous sexual contact
 Sterilize needles, syringes and instruments use for
cutting operations
 Proper screening of blood donors
 Rigid examination of blood and other products of
transfusion
 Avoid oral, anal contact and swallowing of semen
 Use of condoms and other protective device
CAUSATIVE AGENT:
--> NEISERRIA MENINGITIDIS
Mode of transmission

DIRECT CONTACT WITH RESPIRATORY DROPLETS
 Signs and Symptoms

 High grade fever 24 hours
 Weakness
 Joint and muscle pain
 Hemorrhagic rash
 Progressing from few petechiae to widespread
purpura and ecchymosis
 Meningeal irritation like headache, nausea and
vomiting, stiff neck, bulging of fontanels, seizure or
convulsion
 Methods of Prevention
and Control

 Respiratory isolation for the first 24 hours upon
admission to prevent exposure to hospital staff
 Hospital personnel upon entry to meningococcemia room
are required to wear mask, gloves, googles, gown
especially when doing endotracheal intubation
 Chemoprophylaxis should be given
 Public should be educated to avoid overcrowded places
 Those with intimate exposure to nasopharyngeal
secretions of patients also need to be given
chemoprophylaxis NOTIFIABLE DISEASE (REPORTED BEFORE 24 HOURS)
1. MENINGOCOCCEMIA
2. MEASLES
3. CHOLERA




CAUSE BY: AVIAN INFLUENZA

--> HOW WILL YOU GET BIRD FLU? --> MIGRATORY BIRDS

WHAT WILL YOU DO TO BIRDS THAT DIE

--> EO 220 --> BURN ALL BIRDS AFFECTED WITH BIRD FLU
 Signs and Symptoms

 Fever
 Body weakness or muscle pain
 Cough
 Sore throat
 May have difficulty of breathing in severe cases
 Sore eyes GENERALLY --> BIRD FLU IS NOT HARMFUL TO HUMANS UNLESS EXPERIENCED --> SEVERE
RESPIRATORY DISORDERS

DOC: OSELTAMIVIR OR TAMIFLU

 YOU NEED N95:

Nursing care
1. AVIAN INFLUENZA
2. SARS
3. TB
4. MEASLES


Patients will be isolated is designated
hospital using hospital referral network
Same principles of infection control
applied for SARS will be observed
 early recognition of cases of highly
pathogenic avian influenza (HPAI)
during outbreak among poultry
 Signs and Symptos

 Prodromal phase:
 Fever
 Chills
 Malaise
 Myalgia
 Headache
 Signs and Symptoms

 Respiratory
 Dry, non productive cough with or without
respiratory distress
 Crackles, rales
 Dullness on percussion and decreased breath sounds
 Preventive measures
and control

 Establishment of Triage
 Assign a specific area of traige of patients who may have
SARS
 Patient wears mask
 Screen patients for travel history, symptoms and close
contact with cases
 Admit if they meet the case definition
Identification of patient
Isolation of suspected probable case
Tracing and monitoring of close contact
Barrier nursing technique for suspected and probable cases
 Nursing Care

 The infection control goals should be which of the
following:
 Detect early suspect cases
 Implement appropriate isolation measures
 Protect health personnel
 Protect other patients
 Protect family and community members
 Nursing Care

 Establishing a separate isolation facility ibcluding the
following:
 Hand washing facility
 Dedicated bathroom facilities
 Capacity for waste and laundry
 Control and monitor elevator traffic
 Sufficient number of staff
 Good ventilation
 Turn off conditioning if isolation room cannot be
isolated
 Nursing care

 Utilize Personal Protective Equipment which include
the wearing N 95 respirator mask, goggles,
disposable gown and gloves cap and shoe cover
 Apply the principle of handwashing


 BRIEF HISTORY

 is a flavivirus that was first isolated in 1947 from a
febrile rhesus macaque monkey in the Zika Forest of
Uganda and later identified in Aedes
africanus mosquitoes from the same forest
 In 1954, the first 3 cases of human infection were
reported in Nigeria
 This pattern changed in 2007, when the first major
outbreak of Zika virus infection occurred in Yap
(Federated States of Micronesia), where ≈73% of the
population were infected and symptomatic disease
developed in ≈18% of infected persons

 
 May 2015, the Pan American Health Organization
(PAHO) issued an alert regarding the first confirmed
Zika virus infection in Brazil and on Feb 1, 2016, the
World Health Organization (WHO) declared Zika
virus a public health emergency of international
concern (PHEIC).
 NATIONAL NOTIFIABLE DISEASE

 SYMPTOMS
 ASYMPTOMATIC

 common symptoms of Zika are fever, rash, joint pain, or
conjunctivitis (red eyes). Other common symptoms include
muscle pain and headache.
 INCUBATION PERIOD: not known, but is likely to be a
few days to a week.
 IF PREGNANT: See your healthcare provider if you are
pregnant and develop a fever, rash, joint pain, or red eyes
within 2 weeks after traveling to a place where Zika has
been reported. Be sure to tell your health care provider
where you traveled.
 Once a person has been infected, he or she is likely to be
protected from future infections.
 DIAGNOSIS

 The symptoms of Zika are similar to those
of dengue and chikungunya, diseases spread through the
same mosquitoes that transmit Zika.
 diagnosed by performing reverse transcriptase-
polymerase chain reaction (RT-PCR) on serum.
 Virus-specific IgM and neutralizing antibodies typically
develop toward the end of the first week of illness; cross-
reaction with related flaviviruses (e.g., dengue and yellow
fever viruses) is common and may be difficult to discern.
 Plaque-reduction neutralization testing can be performed
to measure virus-specific neutralizing antibodies and
discriminate between cross-reacting antibodies in primary
flavivirus infections
 TREATMENT:

 Get plenty of rest.
 Drink fluids to prevent dehydration.
 Take medicine such as acetaminophen
 If you have Zika, prevent mosquito bites for the first week
of your illness.
 During the first week of infection, Zika virus can be
found in the blood and passed from an infected person
to a mosquito through mosquito bites.
 An infected mosquito can then spread the virus to
other people.
 ZIKA AND
PREGNANCY

Most common complication during
pregnancy: MICROCEPHALY

 ADDITIONAL NOTES
for ZIKA VIRUS:

 Serum or cerebrospinal fluid (CSF)
 RT-PCR, antibody testing (IgM and PRNT), and viral
isolation can be performed on serum and CSF. At least 0.5 mL
of serum and/or 1.0 mL of CSF is required for antibody
testing. Transfer serum or CSF to a plastic tube with screw
cap (possibly secured with thermoplastic, self-sealing lab
film) measuring no more than 5 cm tall and approximately 13
mm in diameter (e.g., 1.8 mL cryotube or 2.0 mL microtube).
 For virus isolation testing, specimens should be frozen as
soon as possible (-70° C, e.g. liquid nitrogen).
 For antibody testing, and RT-PCR specimens should be kept
cold (2-6° C) or frozen (-70° C).

 
 SPILLOVER EVENT- occurs when an animal or
human becomes infected with Ebola virus through
contact with the reservoir hosts. This could occur
thorugh hunting or preparing the animal’s meat for
eating.
 CURRENT OUTBREAK: WEST AFRICA
 SPECIES: Zaire, Bundibugyo, Sudan, Reston and Taï
Forest.
 TRANSMISSION:

 Fruit bats of the Pteropodidae family are natural
Ebola virus hosts.
 Ebola is introduced into the human population
through close contact with the blood, secretions,
organs or other bodily fluids of infected animals
such as chimpanzees, gorillas, fruit bats, monkeys,
forest antelope and porcupines found ill or dead or
in the rainforest.
 human-to-human transmission via direct contact
 TRANSMISSION:

 Burial ceremonies in which mourners have direct
contact with the body of the deceased person can
also play a role in the transmission of Ebola.
 People remain infectious as long as their blood
contains the virus.
 SEXUAL
TRANSMISSION

 Male Ebola survivors should be offered semen testing at
3 months after onset of disease, and then, for those who
test positive, every month thereafter until their semen
tests negative for virus twice by RT-PCR, with an interval
of one week between tests.
 Ebola survivors and their sexual partners should either:
 abstain from all types of sex, or
 observe safe sex through correct and consistent
condom use until their semen has twice tested
negative.
 
 Having tested negative, survivors can safely resume
normal sexual practices without fear of Ebola virus
transmission.
 Based on further analysis of ongoing research and
consideration by the WHO Advisory Group on the Ebola
Virus Disease Response, WHO recommends that male
survivors of Ebola virus disease practice safe sex and
hygiene for 12 months from onset of symptoms or until
their semen tests negative twice for Ebola virus.
 Until such time as their semen has twice tested negative
for Ebola, survivors should practise good hand and
personal hygiene by immediately and thoroughly
washing with soap and water after any physical contact
with semen, including after masturbation.
 Symptoms of Ebola
virus disease

 First symptoms are the sudden onset of fever fatigue,
muscle pain, headache and sore throat. This is
followed by vomiting, diarrhoea, rash, symptoms of
impaired kidney and liver function, and in some
cases, both internal and external bleeding (e.g.
oozing from the gums, blood in the stools).
Laboratory findings include low white blood cell and
platelet counts and elevated liver enzymes.
 
 Confirmation that symptoms are caused by Ebola virus
infection are made using the following investigations:
 antibody-capture enzyme-linked immunosorbent
assay (ELISA)
 antigen-capture detection tests
 serum neutralization test
 reverse transcriptase polymerase chain reaction (RT-
PCR) assay
 electron microscopy
 virus isolation by cell culture



 Key facts

 first identified in Saudi Arabia in 2012.
 Coronaviruses
 36% of reported patients with MERS have died.
 Major reservoir: CAMELS
 Mode of Transmission: CLOSE CONTACT
 Signs and Symptoms

 Asymptomatic to Severe Acute Respiratory Disease
 Typical: fever, cough and shortness of breath
 Pneumonia
 Diarrhea
 Severe in elderly
 TRANSMISSION

 Non-human to human transmission: The route of
transmission from animals to humans is not fully
understood, but camels are likely to be a major
reservoir host for MERS-CoV and an animal source
of infection in humans. Strains of MERS-CoV that are
identical to human strains have been isolated from
camels in several countries, including Egypt, Oman,
Qatar, and Saudi Arabia.
 
 Human-to-human transmission: The virus does not
appear to pass easily from person to person unless
there is close contact, such as providing unprotected
care to an infected patient. There have been clusters
of cases in healthcare facilities, where human-to-
human transmission appears to be more probable,
especially when infection prevention and control
practices are inadequate. Thus far, no sustained
community transmission has been documented.
 Prevention and
treatment

 Treatment is supportive
 General hygiene
 The consumption of raw or undercooked animal
products, including milk and meat, carries a high
risk of infection from a variety of organisms that
might cause disease in humans.



Airborne Precaution
M Measles (Rubeola)

T Tuberculosis
-even suspected, even with history

V Varicella

HZ Herpes Zoster

(+) Contact if with rashes

Droplet Precaution
D -Diphtheria
R -Rubella (German Measles)
O -Oral pharyngitis
P -Pertusis
-Pneumonia
E -Erythema infectiosum (a.k.a Fifth
disease)
cause: PARVO VIRUS
T “slapped cheeked appearance”
I -Tonsilitis
S -Influenza
-Scarlet fever (GABHS)
M-SARS (Corona Virus)
-Mumps
-Meningitis
Contact Precaution
C -CDAD (Clostridium Defficile
Associated Diarrhea)
-Conjunctivitis
R -Respiratory Syncytial Virus (RSV)
DOC: RIBAVIRIN (Virazole)
I -Impetigo

B -Bronchiolitis (DOC: RIBAVIRIN)

M -MRSA (methicillin-resistant staph aureus)

DOC: VANCOMYCIN
V -VRSA (vancomycin-resistant staph aureus)
-VRE (vancomycin-resistant Enteroccocus)
H - HEPA BCDG