CMPA 411 | COMMUNICABLE DISEASES

Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

COMMUNICABLE DISEASE ● determine the types of disinfectants,

Illness due to an infectious agent or its toxic antiseptics & antimicrobials to use.
products transmitted to a person or animal
directly or indirectly
● intermediate animal host (vector)
● vehicle ( water, food, blood)
● inanimate environment.
CONTAGIOUS = easily transmitted from
person to person.
INFECTIOUS = Not transmitted by ordinary
contact, require a direct inoculation through a How Microorganisms Cause infectious disease?
break in skin/ mucus membrane. 1. Colonization - Replicate the host.
THE INFECTION PROCESS 2. Adherence - Adhere to the host.
3. Poor Sanitation (Contamination) - Gain
access to the host
4. Invasion - Invade the tissues
5. Toxins - produce/other agents cause host
harm (tissue damage)
2. Reservoir
● Habitat where the organism survives &
multiplies.
● Can be the environmental: hospital
setting, food, water supply, fomites
● Or in a living organism: people, rodents,
birds, plants.
1. Causative Agent
● Microorganism that are capable of
causing an infection
● Aerobic bacteria = grow in the
presence of oxygen.
● Anaerobic bacteria = grow without
oxygen and cannot survive in the
presence of oxygen.
● Virulence - ability of a causative agent
to invade and multiply within a host
● Pathogenicity - ability of an agent to 3. Portal of Exit
cause disease once it has infected a ● Exit of the microorganisms from the
host. reservoir.
● Toxin production - affect the course of ● Can be droplets, excretions, secretions,
the infection. and breaks in skin.

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

1. Respiratory Tract - sneezing, coughing, & a. Vehicle Transmission: Spread Through

talking. articles or substances that harbor the
2. GIT - vomitus & feces. microorganisms
3. Genito-urinary Tract - urine, vaginal, b. Vector - Borne Transmission: Occurs when
discharge, semen intermediate carriers transfer the microbes to
4. Open lesions, Blood, & Body fluids another living organism
5. Non- intact skin & mucous membrane c. Biological Transmission: the agent
develops or propagates within the vector
d. Mechanical Transmission: simple transfer
of agents from one host or contaminated
substrate to a susceptible host
e. Transovarial or transovarian: transmission
from parent to offspring
4. Mode of Transmission 5. Portal of Entry
● Can be contact, droplets, & airborne. ● Way infectious agents get into the next
● Organisms transmitted from one host to host.
the next host. ● Any opening of the body can be a portal
● Does it need a living vector? of entry like; Nose, mouth or break in
● Hand-to-mouth is a common mode for skin.
gastrointestinal pathogens. ● Can be through mucous membrane, GIT,
1. Contact Transmission - through physical GUT, respiratory tract, integumentary
contact. tract. Can be through; Inhalation, insect
● Direct = person to person bite, or contaminated food.
● Indirect = from fomites - contaminated ● Determine what type of PPE to use, to
object keep health care workers, family &
2. Droplet Transmission - spread of visitors safe.
respiratory secretions that settles on surfaces. 6. Susceptible Host
3. Air-Borne Transmission - Microbes remain ● Any person who is at risk of acquiring
suspended in the air for prolonged periods. an infection.
● immunosuppressed patients with
diabetes, surgery, burns & elderly
patients.
● Major contributing factors in
determining the susceptibility of a host
to infections are
➢ Patient’s age, general health
condition, active immunity, pre
-existing condition. Invas
Nutritional status, inadequate
primary & secondary defenses &
inadequate procedures
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Trauma, pharmaceutical agents, ● Returns to normal but may continue to

increased environmental exposure & be a source of infection even if feeling
insufficient knowledge in avoiding better.
exposure.

DIFFERENCE BETWEEN ENDEMIC,

PHASES OF ILLNESS EPIDEMIC, PANDEMIC
Incubation Period ENDEMIC
● Initial phase of the disease process ● Transmission occurs, but the number of
before symptoms become apparent cases remains constant.
● The pathogen is actively replicating. EPIDEMIC
Prodromal Period ● Number of cases increases.
● Numbers of the infectious agents start PANDEMIC
increasing ● When an epidemic occur on several
● The immune system starts reacting continents –global epidemic.
● Disease symptoms first become
apparent.
Period Of Illness
● Active replication or multiplication of
the pathogen.
● Its numbers peak exponentially, quite
often in a very short period of time.
● Symptoms are specific to the organ
affected.
ISOLATION SYSTEM
Period Of Decline
● Number of pathogen particles begins to ● Techniques used to prevent the spread
decrease of infection.
● Signs & symptoms of illness begin to ● Isolation precautions should be followed
decline according to illness.
Period Of Convalescence 3 Types Of Isolation System
● Patient recovers gradually 1. Standard Precaution
● “Universal Precautions” applied to all
clients in any health care setting,

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

regardless of their presumed infection B. Droplet Precaution

diagnosis. ● Transmission of droplets
PRECAUTIONS APPLY whenever there is ● (>5 - 10 μm in diameter) containing
potential possibility of contact with: microorganism
● A. Blood ● Drop within 3 feet (1 meter)
● B. Body fluids, secretions & excretions ● Use standard precautions to patients
(except sweat) known suspected to have the illness.
● C. Mucous membrane Ex. Covid 19, Diphtheria, Meningococcal
● D. Breaks in skin (Non-intact skin) infections, Herpes Zoster
2. Transmission Based Precautions
● Additional infection control precautions
● Applied for patients who are known
suspected to be infected or colonized
with infectious agents.
A. Contact Precautions
Direct Contact - direct contact between body-
surface to body-surface.
Indirect Contact - contact with a
contaminated intermediate object. Usually
inanimate, such as contaminated instruments ,
needles & contaminated hands.

C. Airborne Precautions
● Many airborne diseases with clinical
importance include bacteria, viruses, &
fungi
● Spread through sneezing, coughing,
spraying of liquids, spread of dust.
● Transmitted by small particle droplets
that can remain suspended & become
widely dispersed by air currents.
Ex. Mycobacterium tuberculosis, Rubeola,
Varicella
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

a period of time equivalent to the

longest incubation period of that
disease.
Community Quarantine
● Strict isolation imposed to prevent the
spread of disease by separation of
people reasonably believed to have
been exposed to a communicable
disease but not yet symptomatic.
● Others who have not been exposed, to
prevent possible spread of a
communicable disease.
EX: Epidemic/ Pandemic
Gastrointestinal Tract
3. Protective Precaution Infections
● Reduce the risk of infection for CHOLERA
immunocompromised patient CA Vibrio coma, Vibrio Cholerae,
● Prevent infection for people whose Vibrio El Tor (Bacteria)
resistance to infection & body defenses
are lowered or compromised. MOT Fecal - Oral, Ingestion of
contaminated food or water
Ex. extensive skin loss due to burns or trauma.
Patient Placement – Can be placed in any ICP Few hours to 4 days
room with general hospital ventilation & the
● Rice watery stool with fishy odor
door should be closed.
● Washerwoman’s appearance
ISOLATION PRECAUTIONS ● Oliguria to anuria
● Measures to implement infection control ● Dehydration
through isolation ● Aphonia
● Prevent contagious diseases from Deficits
avoiding contact with a patient's body ● Severe Dehydration
fluids, by means of wearing PPE. ● Metabolic Acidosis
➢ Strict Isolation ● Possible Hypokalemia During Treatment
➢ Blood & Body Fluid Precautions Diagnosis: Stool Exam
➢ Reverse Isolation (Protective)
Treatment Of Choice
➢ Contact Isolation
● Oral Fluids
➢ Respiratory Isolation
● Tetracycline (DOC)
➢ Enteric Isolation
● Co-trimoxazole
Quarantine
● Chloramphenicol
● Limitation of the freedom of movement ● Enteric precautions
of persons or animals which have been
exposed to a communicable disease for

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

DYSENTERY Pathophysiology
Synonyms Bacillary dysentery,
(Shigellosis), amoebic
dysentery

CA [Link] (fatal), s. Flexneri

(common in the Philippines) s.
boyd il , S. Sonnei

MOT Fecal - oral, Food - borne

ICP IP: 1-7 Days

PC: 1-4 weeks
● Watery mucoid, bloody
with pus feces
● Vomiting
● Fever
● Colicky or cramping
abdominal pain
● Tenesmus = rectal prolapse
Diagnostic Tests
● Stool Exam
● Rectal Swab Culture
Management Stages Of Infection
● F&E therapy ● 1st week step ladder (BLOOD)
● Antipyretic ● 2nd week rose spot and fastidial
● Potassium supplements (if required) ➢ typhoid psychosis (URINE &
● Chloramphenicol, Tetracycline STOOL)
TYPHOID FEVER ● 3rd week (complications) intestinal
bleeding,
Synonyms Enteric fever, bilious fever,
➢ perforation, peritonitis,
yellow jack
encephalitis,
CA Salmonella Typhi ● 4th week (lysis) decreasing S/SX
● 5th week (convalescent)
MOT 5F’s
Manifestations
ICP IP: 1-3 weeks ONSET
● Step ladder fever to fastidial (peak of
fever) typhoid psychosis
● Peyer’s patches of Small Intestine
● May stay in the gallbladder (hiding
area)

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Headache, chilly sensation and aching HEPATITIS C

all over the body
Typhoid Fever Manifestations
●Nausea, vomiting and
diarrhea
● Rose spot (abdominal
rashes)
TYPHOID STATE
● Coma vigil: patient seems to be staring HEPATITIS D
blankly
● Tongue becomes dry and brown
● Subsultus tendinum: twitching of the
tendons, especially at the wrist
● There is a constant tendency for the
patient to slip down to the foot part of
the bed
Diagnosis
HEPATITIS E
● Blood culture (typhidot) -1st week after
● Stool and urine culture - 2nd week after
Treatment Of Choice
● Chloramphenicol (DOC)
● Cotrimoxazole (added for severe cases)
● Fluids
● Plasma expander (blood loss)
HEPATITIS
HEPATITIS A Stages Of Manifestations
PRE-ICTERIC
● Fever, RUQ pain, fatigability, weight
loss, anorexia, N/V
ICTERIC
● Jaundice, itchiness/pruritis-bile salts in
skin, tea colored urine,
stools-clay-colored, hepatomegaly
POST-ICTERIC STAGE
HEPATITIS B
● Jaundice subsides
Diagnostic Tests
● Liver function Test - determine extent of
liver damage
● ALT/SGPT - Alanine Aminotransferase
● Hepatitis Profile

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

Treatment Incubatio Average incubation period is

● Symptomatic and supportive n period 10-12 days
● Antiviral: lamivudine- OD x 1 yr Some cases - shortest at 8
● Interferon – 3x a week for 6 months days, longest at 20 days
Nursing & Preventive Care
Characteristics
Nursing Care:
● CBR ● Rashes: Maculopapular cephalocaudal
● Nutrition: inc. CHO in diet ● Hairline and behind the ears to trunk
Preventive: and limbs
● Immunization ● Confluent, desquamation, pruritus
● Universal precaution
Preventive Care (Hepa)
Handwashing
Environmental sanitation
● Safe water supplies
● Proper control of sewage disposal
Prepare foods SAFELY
Assist in HE Signs and Symptoms
● Mandatory reporting Pre-Eruptive Phase (3-4 days)
● Vaccine ● High fever
● 18 y/o and above (2 doses) ● Highly communicable
● 2nd dose 6 – 12 months after ● 3C’s (cough, colds, conjunctivitis) plus
● Below 18 (3 doses) 0, 1, 6 - 12 photophobia
RESPIRATORY INFECTIONS ● PS: Koplik’s spots
MEASLES
● Acute, highly contagious
exanthematous, vaccine preventable
disease usually affecting children
● Also known as “tigdas”
Causative Measles virus or measles
Agent morbillivirus a single stranded, - Grayish or whitish spot on the
enveloped RNA virus with I inner aspect of the cheek
serotype. It is classified as a opposite of the second molar
member of the genus - PATHOGNOMONIC SIGN OF
Morbillivirus in the MEASLES
Paramyxoviridae family ● Stimson Line - puffiness of the eyelid
with linear congestion of the lower
Mode of Droplet transmission
conjunctiva (red horizontal line)
transmissi Indirect transmission with
on freshly contaminated fomites

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Encephalitis: Sub Sclerosing

Panencephalitis (SSPE)
● Diarrhea
● Otitis media
Nursing Management
● Bed rest
● Relief of symptoms
Eruptive Phase ● Vaporizers and warm environment help
● Maculopapular rashes, reddish, and reduce respiratory irritation
blotchy “morbilliform rash” ➢ Health teaching
● after appearance of koplik’s spot, ➢ Proper disposal of discharges
rashes will appear that is characterized ● Concurrent and terminal disinfection
as maculopapular, reddish in color and ● Droplet and airborne precaution
blotchy in appearance (“pantal”) that’s ● Protect eyes of patient from glare of
why it is also called Little Disease strong light
● First appear on the hairline or behind ● Keep patient warm and dry to prevent
the ears patient from exposure to draft
● Cephalocaudal distribution, rashes (“hamog”, “huwag malamigan”)
appear on the third day because this may lead to colds and
of illness, within 2-3 cough which is a good medium for
days the entire body is growth of microorganism in the
completely covered respiratory area due to increase
● Exanthem - a skin respiratory mucous secretion leading to
eruption or rash pneumonia or respiratory distress (a
common complication of measles) and
Post-eruptive Phase encephalitis
● “Branny desquamation” from red color Preventive Management
rashes, it will fade to brown then it peels ● Immunization, this targets 3% of the
off excluding the skin population
● Proper disposal of nasopharyngeal
secretion
● Covering of nose and mouth when
coughing or sneezing
GERMAN MEASLES
● “Rubella”
● A severe form known as black measles ● A contagious viral infection best known
● Hemorrhagic rashes, epistaxis, melena by its distinctive red rash
and marked toxicity may occur Synonyms Rubella, Rotheln disease, 3 day
Complications Measles
● Pneumonia
Causative RNA rubella virus
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

agent

MOT Droplets and airborne

Incubatio 14-21 days

n period Period of communicability: 5
days before and 5 days after Drug treatment
rash ● Aspirin for fever and joint pain
Signs and Symptoms ● No topical or systemic medications
● Rashes: Maculopapular, diffuse/not ● Diversionary activities
confluent, no desquamation, spreads ● Pregnant women should not receive
from the face downwards rubella active immunization
Preventive Management
● Immunization
● Proper disposal of nasopharyngeal
secretion
● Covering of nose and mouth when
coughing or sneezing
CHICKENPOX
● PS: forscheimer’s (red lesion on the ● Maculopapular Vesicular (covered
buccal cavity or soft palate areas)
● Cervical lymphadenopathy ● Centrifugal, starts on face and trunk
and spreads to entire body
● Leaves a pitted scar (pockmark)

● Fever: low grade fever

Complications
● Pneumonia
● Meningoencephalitis
● Thrombocytopenia
● Sinusitis
● Otitis media Synonyms varicella
● Fetal Complications Causative Herpes zoster virus, varicella
➢ 1st tri: congenital anomalies agent zoster virus
➢ 2nd tri: abortion
➢ 3rd tri: premature delivery MOT Droplets and airborne
➢ Mental retardation
IP 10-21 days
➢ Cataracts Period of communicability: one
➢ Blueberry-muffin skin day before rash and 6 days
after first crop of vesicles

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

Complications MOT Droplet, contact with

● Furunculosis - simultaneous occurrence nasopharyngeal secretions
of a no. of furuncles (boil)
Incubation 1-5 days
period

● Erysipelas - skin infection that often

follows strep throat

● Meningoencephalitis Surface Antigens

● Dormant: remain at the dorsal root ● Hemagglutinin (HA or H)
ganglion and may recur as shingles ● Neuraminidase (NA or N)
● The older one gets, the more susceptible ● Influenza virions possess two major
he becomes to the complications of surface antigens, hemagglutinin (HA or
chickenpox H) and neuraminidase (NA or N), that
are both capable of eliciting a
Drug Treatment protective antibody response against
● Oral acyclovir 800 mg 3x/day for 5 days influenza virus infections
● Strict isolation Avian Influenza
● Local or systemic antipruritic Synonym Bird flu, AI
● Cool bicarbonate of soda baths
● Calamine lotion CA Influenza A, H4NI virus
● antihistamine
MOT Direct contact with droppings
Preventive Management of infected bird
● Immunization
● Proper disposal of nasopharyngeal S/Sx Fever, body weakness or
secretion muscle pain, cough, sore throat,
sore eyes, DOB
● Covering of nose and mouth when
coughing or sneezing Mgt Same as influenza
INFLUENZA
Preventio No vaccine available yet, avoid
Synonyms flu n migratory birds, through
cooking of poultry meat
Causative Myxovirus, influenza virus A, B,
C
Signs and Symptoms of Influenza
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Chills
● Temperature ranging from 38-40 C
● Headache, myalgia, non-productive
● Occasional: laryngitis, hoarseness,
conjunctivitis, rhinitis, and rhinorrhea
● Symptoms subsides in 3 to 5 days
● GI manifestations: N and V
Diagnostic Tests
● Nose culture
● Viral culture Preventive Management
● Viral serology ● Immunization
Drug Treatment ● Proper disposal of nasopharyngeal
● Symptomatic secretion
● Amantadine ● Covering of nose and mouth when
➢ a drug administered orally esp. in coughing or sneezing
the form of its hydrochloride COVID 19
C10H17NHCl to treat infection (as Synonyms NCOV
by the virus causing influenza A)
by interfering with virus CA Myxovirus, influenza virus A,
penetration into host cells B, C
● Zanamivir MOT Droplet; airborne
➢ an antiviral drug C12H20N4O7
administered by oral inhalation in Incubation 21 days
the treatment of influenza A and period
B Severe Acute Respiratory Syndrome
● Isolation synonyms SARS
● Bed rest
● AVOID ASPIRIN!! CA CoronaVirus
➢ Reye’s Syndrome The exact
MOT Airborne; respiratory droplet
cause of Reye's syndrome is
and direct contact with body
unknown, but it most commonly fluid of a person with SARS.
affects children and young adults Oro-fecal, fomites
recovering from a viral infection
– for example a cold, flu or Incubation 2-7 days
period
chickenpox. In most cases,
aspirin has been used to treat
their symptoms, so aspirin may Signs and Symptoms
trigger Reye's syndrome ● Intermittent fever
● Chills
● Headache
● Body aches
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Dry productive cough with hypoxemia

conditions that would normally
(respiratory acidosis) require life-sustaining
● Dyspnea related to loss of aerating therapies, such as mechanical
surface ventilation (invasive or
● Loss of smell, loss of state non-invasive) or vasopressor
Diagnostic Tests therapy.
● Nucleic acid amplification tests (NAAT),
such as reverse transcriptase Clinical Syndrome
polymerase chain reaction (RT-PCR)
Diagnostic Imaging Mild 1. No signs of severe
pneumonia pneumonia
● “Ground-glass” opacification is often
2. Children: cough or DOB +
indicative of viral pneumonia
fast breathing
2. Fast breathing is defined as:
● <2 months old, ≥60
● 2–11 months old, ≥50
● 1–5 years old, ≥40 and
no signs of severe
pneumonia

Severe 1. Adolescent/adult: fever or

pneumonia suspected respiratory
● Radiologic abnormalities caused by infection, plus one of RR>30
COVID 19 are more likely to be bilateral, breaths/min, severe
have a peripheral distribution and respiratory distress, or SpO2
involve the lowers lobes <90% on room air.
2. Children: cough or difficulty
Clinical Severity
breathing, plus at least one of
None- Defined as the absence of any the following:
sever covid signs of severe or critical ● central cyanosis or
19 COVID 19 infection SpO2 <90% on room air
● severe respiratory
Severe Defined by: distress (e.g. grunting,
covid- 19 ➢ O2 sat of <90% on room severe chest indrawing)
air ● signs of pneumonia with
➢ RR > 30 bpm in adults a general danger sign
and > 5 years old; (inability to breastfeed
age-based respiratory or drink, lethargy or
guidelines for children unconsciousness, or
<5 years old convulsions)
➢ Signs of severe ● Other signs of
respiratory distress pneumonia: fast
breathing
Critical Acute respiratory distress ● The diagnosis is clinical,
covid 19 syndrome (ARDS), sepsis, and imaging is not
septic shock or other required; chest imaging
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

can exclude Medication for symptom relief

complications. ● Paracetamol (acetaminophen) can be
used to treat fever or pain
● Non-steroidal anti-inflammatory drugs
Nursing Care
(NSAIDs) may be used as second line
● Supplemental oxygen should be given
agents for pain or fever if paracetamol
to all patients with Severe Acute
is not effective or not available.
Respiratory Infection (SARI) and
● Nasal decongestants such as
respiratory distress, hypoxemia, or
pseudoephedrine can be used to reduce
shock
congestion and rhinorrhea.
● COVID-19 awake repositioning/proning
● Honey has been shown to reduce
protocols (CARP)
symptoms of cough and sore throat
● Intravenous fluid should generally be
(only for children >2 years of age)
reserved for patients with evidence of
● Empiric antibiotics are not
reduced perfusion to end organs
recommended
(shock)
Preventive Management
Drug Treatment
● Immunization
● Empiric antimicrobials are NOT
● Proper disposal of nasopharyngeal
recommended for all patients with
secretion
suspected or confirmed mild/moderate
● Covering of nose and mouth when
COVID-19.
coughing or sneezing
● Empiric therapy should include
● Get vaccinated when a vaccine is
treatment with a neuraminidase
available to you
inhibitor to cover for influenza if there is
● Stay at least 1 meter apart from others,
known local circulation of the virus or
even if they don’t appear to be sick
other risk factors present.
● Wear a properly fitted mask when
Homecare Management
physical distancing is not possible or
● Place the patient in a well-ventilated
when poorly ventilated settings
single room (i.e., open windows and an
● Choose open, well-ventilated spaces
open door)
over closed ones. Open window of
● Limit patient movement around the
indoors
house
● Wash your hands regularly with soap
● Minimize time spent in shared spaces,
and water or clean them with
ensure that those spaces are well
alcohol-based hand rub.
ventilated
● Cover your mouth and nose whe
● Household members should stay in
coughing or sneezing
different room or maintain distance of
● If you feel unwell, stay home and
at least 1 meter - no shared beds
self-isolate until you recover.
● Limit the number of caregivers
PULMONARY TUBERCULOSIS
● Visitors should not be allowed until the
An infectious disease that primarily affects the
patient has completely recovered
lung parenchyma
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

Synonym Koch’s disease, phthisis,

galloping consumption, tb

CA Mycobacterium tuberculosis,
Mycobacterium Bovis

MOT Droplet infection, cow’s milk

containing M. Bovis

Incubatio 4-12 weeks (2-10 weeks in

n period some)

Pathophysiology Classification
Minimal
● Small lesions without demonstrable
excavation that are confined to a small
part of one or both lungs
Moderately advanced
● One or both lungs
● Total diameter of the cavities should not
exceed 4cm
Advanced
● Lesions that are more extensive than
moderate
Signs and Symptoms
● Cough
● Afternoon fever
● Weight loss
● Blood stained sputum
● Night sweats
Diagnostic Tests
● AFB SMEAR - Sputum culture
● Chest X- Ray - to determine lung
involvement
● Tuberculin Tests - to determine exposure
to TB Drug Treatment (RIPES)
● Mantoux Test ● Directly Observed Treatment Short
➢ 0.1 cc PPD read after 48-72 hours Course (DOTS)
➢ Check for induration ● The patient is required to take the
anti-TB drugs in the presence of a HCP
to ensure compliance to treatment
regimen
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● RIPES: Rifampicin, Isoniazid,

Side Effects ● Optic Neuritis
Pyrazinamide, Ethambutol,
Streptomycin Nursing ● Give aspirin or NSAID
● 2-4 weeks after intake of drugs, patient Implications
is no longer contagious
● Second-line drugs used for resistant Nursing Management
patients ● Diet: if with anorexia- small, frequent
➢ Capreomycin feedings; high protein
➢ Kanamycin ● Drug-strict compliance
➢ Para-aminosalicylic acid ● Rest
➢ cycloserine ● AVOID CHEST CLAPPING AS THIS
● Chemoprophylaxis STIMULATES HEMOPTYSIS
➢ Isoniazid & Vitamin B6 Preventive Management
RIFAMPICIN ● Immunization
➢ BCG at birth 1 dose @right
Side Effects ● Heartburn, anorexia, deltoid
N/V, cramps, diarrhea,
● Proper disposal of nasopharyngeal
headache, dizziness,
confusion, visual secretion
disturbances ● Covering of nose and mouth when
● Presence of coughing or sneezing
reddish-orange PNEUMONIA
secretion (urine, stool) ● Inflammation of the alveoli and
terminal airspaces in response to
Nursing ● Give drug before meals
Implication or at bedtime invasion by an infectious agent that is
● Avoid taking alcohol introduced into the lungs through
hematogenous spread or inhalation

INH; Isoniazid Synonyms N/A

Side effects ● Tingling and numbness CA ● Mycoplasma

pneumoniae
of hands and feet
● jaundice ● Enterobacter species
● E-coli, H-Influenzae,
Nursing ● Administer in an klebsiella species,
Implication empty stomach proteus, Serraria
● Vit.B6 to counteract marcescens,
peripheral pseudomonas
neuropathies aeruginosa, MRSA S.
● Avoid taking alcohol pneumoniae

MOT Droplet infection and

indirect contact
Ethambutol
Incubation 1-3 days
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Inflammation in the small airways leads

period
to crackles
● Wheezing is less common than in viral
Risk Factors infections
● Intubation, tracheostomy, impaired ● Inflammation and pulmonary edema
cough reflex, or aspiration causes the lungs to become stiff and
● Ciliary dyskinesia, bronchial obstruction, less distensible, thereby decreasing tidal
viral infections, smoking, or certain volume
chemical agents ● The patient must increase his
● Anatomic abnormalities, gastric fluid respiratory rate to maintain adequate
aspiration, altered pulmonary blood ventilation resulting in
flow, and pulmonary edema ventilation/perfusion mismatch &
● Immunodeficiency or hypoxemia
immunosuppression Clinical manifestations
● Fever
● Productive cough
● Rusty or prune juice sputum -
Classification: PATHOGNOMONIC SIGN
1. Community Acquired (CAP): pneumonia ● Dyspnea
occurring in the community ≥48 hours of ● Increase RR, Shallow
hospital admission ● Stabbing chest pain when coughing
2. Health care-associated (HCAP): Non ● cyanosis
hospitalized client with extensive healthcare In children:
contact acute care facility, nursing homes, ● Nasal flaring
antibiotic therapy within 30 days, ● Chest retraction
hemodialysis, home infusion therapy, family ● Chest pain aggravated by coughing
member with MDRS Diagnostic Tests
3. Hospital-acquired (HAP): ≥ 48 hrs after
1. Sputum culture
hospital admission that did not appear to be
2. Bronchoscopy
incubating at the time of admission
➢ Flexible fiberoptic
4. Ventilator-Associated (VAP): Develops ≥ 48
bronchoscopy is
hours after endotracheal tube intubation
occasionally useful to
Pathophysiology obtain lower airway
secretions for culture
or cytology
➢ Most useful in immunocompromised
patients believed to have unusual
organisms (Pneumocystis, other fungi)
or patients who are severely ill
3. Radiography

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

➢ Viral pneumonias are associted with a ● Group A strep, pneumococal and

patchy perihilar infiltrate, staphylococcal secondary infections are
hyperinfaltion, and atelectasis on a all relatively common
chest x-ray Management
➢ In bacterial pneumonia, typical findings Category 1
include a lobar consolidation with air ● <60 y/0
bronchograms occasionally ● w/0 co-existing illness
accompanied by a pleural effusion ● Treated as out-patient
➢ primary imaging study used to confirm 1. Amoxicillin 500mg cap TID
the diagnosis of pneumonia 2. Erythromycin 500 mg cap QID
➢ indicated in an infant or toddler who Category II
presents with fever and any of the ● > 60 y/o
following: tachypnea, nasal flaring, ● With co-existing illness
retractions, grunting, rales, decreased ● Treated as out-patient
breath sounds, or respiratory distress 1. Cefuroxime 250-500 mg tab BID
2. Co-amoxiclav 375 mg tab TID +/-
eryhthromycin
Newborn Category III
● Bacterial pneumonia with group B ● Hospitalized patient but not needing
Streptococcus, Listeria monocytogenes, ICU
or gram-negative rods (eg, E. coli, K. 1. Cefuroxime 750 mg IV TID
pneumoniae) are a common cause 2. Co-amoxiclav 600 mg-gm IV TID
● These pathogens can be acquired in 3. Ceftazidime 1g IV TID +/- erythromycin
utero, via aspiration of organisms Category IV
present in the birth canal or by ● Patient needing ICU care
postnatal contact with other people or 1. Ceftazidine IV or Cefoperazone IV
contaminated equipment 2. Imipinem 500 mg IV TID +
● The most commonly isolated virus is Erythromycin or +/- aminoglycosides
respiratory syncytial virus (RSV) (amikacin/gentamicin)
● School-aged children
School-Aged children
● Mycoplasma pneumoniae is the most
common cause of community-acquired
pneumonia
Adults
● Viral pneumonias are occasionally
severe and can rapidly progress to
respiratory failure, either as a primary
manifestation of viral infection or as a
consequence of subsequent bacterial
infection
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

Signs and Symptoms

Pseudomembrane(PATHOGNOMONIC SIGN)
● dirty gray-white rubbery membrane
over tonsils and back of the throat as an
inflammatory response to a powerful
necrotizing exotoxin

Nursing Management
1. Maintenance of Proper airway
● Proper positioning
● Increase fluid intake Classification
● Chest physiotherapy 1. Nasopharyngeal/facial type
● Deep breathing and coughing exercises ● Affects pharynx and
● Suctioning as ordered tonsils
● Inhalation treatment as ordered ● Cervical lymph nodes
2. Relieve chest pain are swollen/marked
● Splinting of the chest when couging degree of toxemia
3. Adequate nutrition ● Sore
4. Prevent spread of infection by disposing throat-dysphagia
secretions properly ● Pseudomembrane- soft palate walls of
Preventive Management tonsils
● Proper disposal of nasopharyngeal ● Bull neck appearance due to
secretions inflammation and enlargement of
● Covering of nose and mouth when cervical lymph nodes
sneezing and coughing (cough 2. Nasal
manners) ● Sero-sanguinous
● Pneumococcal vaccination secretion with a foul
DIPHTHERIA mousy odor
Acute pharyngitis, acute nasopharyngitis or ● Pseudomembrane on
acute laryngitis characterized by the the nasal septum
information of pseudomembrane 3. Laryngeal
● Most severe and
Synonyms Whooping cough fatal
CA Corynebacterium diphtheriae ● Usually affects
or the klebs-loeffler bacillus infants/children
2-5 y/0
MOT Respiratory droplet ● Affects larynx and
Incubation 2-5 days tonsils
period
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Hoarseness of voice, loss of voice 3. Moloney’s test - test for hypersensitivity to

(aphonia) diphtheria antitoxin
● Brassy metallic cough; dry, husky cough Clinical Management
(croup) ● Neutralize toxin
Pathophysiology ➢ Anti-diphtheria (skin testing
needed)
➢ If hypersensitivity - fractional
dose (antidote: epinephrine,
corticosteroids)
● Antibiotics- penicillin
● Tracheostomy - to prevent respiratory
obstruction
Nursing Management
Complications ● Place the patient in CBR until 2 weeks
● Myocarditis after recovery (to prevent complication:
● Bronchopneumonia myocarditis)
● Polyneuritis - paralysis of soft palate, ● Maintenance of proper airway
ciliary muscles of eyes, pharynx, larynx ● Small frequent feedings (soft)
and extremities ● Use ice collar to relieve pain of sore
throat
Diagnostic Tests
Preventive Management
1. Nose and throat swab/culture - to identify
the microorganisms ● Immunization - DPT at 6 weeks after
2. Shick test - to determine immunity or birth at one month interval
susceptibility ● Cover of nose and mouth when sneezing
The schick and coughing
test works by ● Never kiss the patient
injecting a small PERTUSSIS
amount of Synonyms Whooping cough
specially-prepared
CA Haemophilus pertussis,
diphtheria toxin
Bordetella pertussis
beneath the skin.
If the MOT Nasopharyngeal secretion;
person is droplet
susceptible to the
Incubation 7 to 21 days
disease, a red
period
swollen rash
appears around
the injection area.
Vaccine may then
be used to protect the person form diphtheria.

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

Pathophysiology ➢ NPO during spasmodic attack of

cough
● Application of abdominal binder
Preventive Management
● Immunization - DPT
● Proper disposal of naso-pharyngeal
secretions
MUMPS
synonyms Viral parotitis, epidemic
parotitis and infectious
parotitis

CA Paramyxovirus

MOT Respiratory droplets indirect

contact with objects
Signs and Symptoms contaminated with secretions
Catarrhal
Incubation 14 to 25 days
● Patient is highly contagious colds,
cough at night, fever, listless
Pathophysiology
Spasmodic/paroxysmal
● Whooping cough
● Vomiting
● Teary red eyes and protrusion of
eyeballs
● convulsion
Convalescence
● Signs and symptoms subside and
patient can recover
Diagnostic tests
● Bordet - gengou agar plate: Specimen=
Naso-pharyngeal Secretion
Drug Treatment Pathognomonic Sign
● Erythromycin, Penicillin ● Swollen salivary glands
Nursing Management
● Complete bed rest to conserve energy
● Prevent aspiration through:
➢ Proper feeding
➢ Small holes of nipple for bottle
feeding
➢ Feed with medicine dropper
Clinical manifestations
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Pain in the swollen salivary glands on RESPIRATORY MANAGEMENT

one or both sides of the face Thoracentesis
● Pain while chewing or swallowing Insertion of a needle into pleural space to
● Low-grade fever remove fluid that has accumulated and
● Headache decrease pressure on lung tissue; may also be
● Earache used to diagnose potential causes of pleural
● Muscle aches effusion
● Loss of appetite Indications
● dysphagia ● Removal of fluid (and rarely air) in the
Diagnostic Tests pleural space
● Viral isolation ● Aspiration of pleural fluid for analysis
● Blood exam ● Pleural biopsy
● Viral serology ● Instillation of medication into the
● Serum amylase determination test pleural space
Complications Nursing care BEFORE the procedure
● Orchitis which is the ● Chest x-ray or ultrasound
most dreaded ● Consent
complication in ● Client education
makes Nursing care DURING the procedure
● Oophoritis which is ● Position the patient
most dreaded in comfortably with
females adequate support
● Mastitis ● Sitting on the edge of the
● Pancreatitis bed with the feet
● Myocarditis supported and arms
● Hearing loss padded over-the-bed-table
Drug Treatment ● Straddling a chair with arms
● No specific treatment and head resting in back of
● Palliative management the chair
➢ Analgesic ● Lying on the unaffected
➢ Antipyretic side with the head
➢ Moist heat and cold application elevated 30-45 degrees if
Nursing Management unable to assume a sitting
● Rest as much as possible position
● Ease symptoms with cold compresses ● Assist and reassure the
and over-the-counter pain relivers client
Preventive Management ● Ask the client to avoid coughing and
● Measles-mump-rubella (MMR) vaccine any unnecessary movements
● Anesthetic will be injected
● Needle may be inserted in the 2nd or
3rd midclavicular line
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Advise the client to deep breath and ● Restoration of negative intrathoracic

hum during the removal of the needle pressure
● Put a small, airtight sterile dressing over ● Promotes lung expansion
the site (some may indicate vaselinized Mediastinum
gauze) ● Drain blood after chest surgeries
Nursing care AFTER the procedure Materials
● Observe and measure the amount of 1. Chest Tube/Chest Catheters
aspirated fluid and document. Take note ● Small bore catheter (7 fr- 12 fr) contains
of its color and consistency a one-way valve that prevents air from
● Monitor RR, asymmetry in respiratory moving back into the chest
movements, dyspnea, diminished breath ● Large bore catheter (may range up to
sounds, anxiety or restlessness, chest 40 Fr) – collection of fluid and monitors
tightness, uncontrollable cough, air leaks
blood-tinged frothy mucus, rapid pulse 2. Bottle system/Chest drainage system
and signs of hypoxemia ● Suction source, collection chamber and
Complications a mechanism to prevent air from
● Pneumothorax re-entering the chest with inhalation.
● Tension pneumothorax Chest Drainage systems works by combining
● SQ emphysema the following three efforts:
● Pyogenic infection ● Expiratory positive pressure from the
● Pulmonary edema patient helps push air and fluid out of
● Cardiac stress the chest (eg, cough, Valsalva
Chest tube Thoracostomy maneuver)
Indications ● Gravity helps fluid drain as long as the
● Pneumothorax: open or closed; simple chest drainage system is placed below
or tension the level of the patient’s chest
● Hemothorax ● Suction can improve the speed at which
● Hemopneumothorax air and fluid are pulled from the chest
● Hydrothorax Three Components
● Chylothorax ● Collection chamber, Trap bottle or
● Empyema reservoir chamber
● Pleural effusion ● Underwater seal chamber, water-seal
● Patients with penetrating chest wall chamber
injury who are intubated or about to be ● Suction regulator chamber,
intubated suction-control chamber
● Considered for those about to undergo Nursing Care
air transport who are at risk for Collection chamber
pneumothorax ● Mark the drainage with tape on the
Purpose outside at an hourly/daily increments
Right and left pleural spaces
● Drainage of air, blood or other fluids
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Ensure that the drainage tubing does ● Dry suction chest drainage
not kink, loop, or interfere with the ● Easiest to set up
patient’s movement ● Ideal for ambulatory patients
● Always place below the level of the ● Best used for clients with uncomplicated
lungs pneumothorax
● If collecting blood, gently milk the Two-Way bottle system
tubing in the direction of the drainage
chamber as needed, to avoid
obstruction by clots and fibrin
● Drains are clamped only in the following
situations:
● When the draining tubes and
underwater seal bottle are to be
changed
Three-way bottle system
● Just before tube removal, as a trial of
clamping for 4-6 hours to confirm that
the air leak has stopped
● When it is necessary to reconnect an
accidentally disconnected tube that
resulted in loss of the underwater seal
Water-Seal Chamber
Observe fluctuations or “tidaling”. Fluctuations
will stop when:
● The lung has re-expanded
Nursing Care
● The tubing is obstructed by blood clots,
Removal
fibrin or kinks
● Instruct the client to hold breath during
● A loop of tubing hangs below the rest of
the removal of the tube
the tubing
● Apply sterile Vaseline gauze and
● If connected to suction, suction motor is
provide pressure bandage over the site.
not working properly
SEXUALLY TRANSMITTED INFECTIONS
Observe for intermittent bubbling. Continuous
bubbling may indicate air leaks. GONORRHEA
One-way bottle system Synonym Gonococcus (GC), Gonoclap,
s Jack, Gleet, Morning Drop

CA Neisseria gonorrhea (bacteria)

MOT Direct contact with exudate via

sexual contact or transmission
to the neonate during the
passage through the birth canal

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

ICP 2-7 days (Contagious as long as Treatment of Choice

gonococci are present in the ● Tetracycline 500mg QID for 7 days
patient) ● Ceftriaxone is the drug of choice for
pregnant women
● Penicillin
MALE ● Other treatment schedules are used for
● purulent discharge (inc. in am) patients with co-existing chlamydial
● burning sensation upon urination infection
● redness and edema of urinary meatus Nursing Care
● abscess formation in the prostate gland ● Prophylactic antibiotic treatment for
● chronic-scar in epididymis gonorrhea eye infection in the neonate
● obstruct flow of sperms- sterility (ophthalmia neonatorum
FEMALE ● Encourage follow up cultures in 4 to 7
● burning sensation upon urination if days after treatment and again at 6
urinary meatus is involved months
● (+/-) of purulent discharge ● Teach importance of abstinence from
● abscess formation in Bartholins/Skene’s sexual intercourse until cultures are
glands negative
● If untreated, may result to PID- when ● Urge the client to inform sexual partner
the gonococcus spread through uterine so that he/she may be treated for
and fallopian tubes infection
● sterility/ectopic pregnancy ● Importance to take full course of
OPHTHALMIA NEONATORUM antibiotics
Preventive Care
● No artificial or acquired immunity for
gonorrhea and syphilis. A person can
get gonorrhea and syphilis again and
again
● Safe sex,
● Monogamous relationship
OPHTHALMIA NEONATORUM SYPHILIS

Synonyms Pox, Lues, Bad Blood Disease

CA Treponema pallidum (bacteria)

MOT Sexual contact, blood

Diagnostic Tests transfusion, placental
● Positive gram stain smear of discharge transmission(5th mo of
or secretion gestation)
● Positive culture
ICP 10-90 days, average of 21 days
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

Diagnostic Tests
● VDRL
● Wasserman Test
● Fluorescent Treponemal Antibody
Absorption Test (FTA-ABS)

Treatment of Choice
Penicillin G
● Newborn = 100,000 units/kg single IM
dose
● Adult = 2.4 million units IM single dose
● Jarish Herxheimer Reaction
➢ May occur in patient given large
doses of penicillin
➢ Flu-like symptoms subsiding
within 24 hours
➢ Management:
STAGES OF INFECTION
Primary Bed rest and aspirin
● chancre – painless, papular lesions that Warn the patient that this
reaction may be expected
heal spontaneously w/ or w/o tx (4-6
weeks) CANDIDIASIS
Secondary : 6-8weeks Synonyms Moniliasis
● Dermatitis – condyloma lata dry hard
wart-like lesions fused together found CA Candida albicans (yeast)
under breasts or on the genitalia
MOT DIRECT CONTACT (Sexual
● Mucous patches – mouth, throat, cervix
contact)
● Changes in hair growth – patchy
alopecia moth eaten appearance
ICP Variable (Communicable for
● Iritis
duration of lesions)
● Arthritic and bone pain
Latent stage – 1-2 yrs. ● Itching, beefy red irritation,
inflammation of the vaginal epithelium
● White, cheese-like, odorless discharge
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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

● Patches of curdlike, cheesy material Nursing Intervention

that adhere to the vaginal mucosa ● Urge client to have sexual partner
● Increased risk in women with diabetes treated
and women taking birth control pills, ● Emphasize the importance of long term
during pregnancy and after treatment drug therapy because of the pathogens
with antibiotics unique life cycle, which make it difficult
to eliminate
● Antibiotics: doxycycline and
azithromycin are the primary antibiotic
for treatment
● Penicillin and its derivatives are not
effective against these organisms. This
explains the persistence of infection in
clients who are treated for gonorrhea
and do not respond.
TRICHOMONIASIS

CA Trichomonas vaginalis (protozoa)

MOT SEXUAL CONTACT

Treatment of Choice
★ nystatin vaginal suppository twice a ICP 4-20 days
day for 7-14 days ● Yellow green frothy vaginal discharge
★ vaginal douche of 2 tsp ordinary baking ● Burning and pruritus of vagina
powder dissolved in 1 quart of warm ● Dysuria, dyspareunia
water ● Usually asymptomatic in men
★ application of gentian violet to the
vagina and perineum to prevent
staining of undergarments
CHLAMYDIAL INFECTIONS

CA Chlamydia trachomatis
(bacteria)

MOT SEXUAL CONTACT

Management
ICP 2-35 days ● Metronidazole (Flagyl) 250mg TID for 1
● Pruritus in the genital week. Do not give during the first
● Burning sensation in the genital trimester of pregnancy
● Painful intercourse ● Sitz bath may relieve symptoms
● Acid douches (1 tablespoon of vinegar
in 1L of water) to counteract the

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CMPA 411 | COMMUNICABLE DISEASES
Respiratory Infections & Diseases | GI infection | STI Transes by: Garduque,Justiza,Macaspag

alkaline environment that favors the ➢ Azidothymidine

growth of T. vaginalis ➢ Zidovudine
ACQUIRED IMMUNODEFICIENCY ➢ Lamivudine
SYNDROME (AIDS) ➢ Retrovir
● Non- MNRTI
CA Human immunodeficiency
➢ Dideoxyinosine (Didanosine)
virus
➢ Dideixycytidine ( Zalcitabine)
MOT Blood, sexual contact ● Protease inhibitors
➢ Saquinavir
ICP 6 weeks – 6 months ➢ Indanavir
➢ Ritonavir
Major Symptoms
➢ Nelfinavir
● Persistent fever – 1 month
Nursing & Preventive Care
● Chronic diarrhea
● Nursing Care: Symptomatic and
● 10% wt. Loss ( stunted growth)
supportive Counseling
Minor Symptoms
● Prevention
● Persistent cough ➢ A abstinence
● Persistent generalized ➢ B be faithful
lymphadenopathy ➢ C condom
● Generalized pruritic dermatitis ➢ D don’t use drug
● Pharyngeal candidiasis
● Recurrent herpes zoster
● Progressive disseminated herpes
simplex
OPPORTUNISTIC INFECTIONS
● Tb (Mycobacterium
avium-intracellulare)
● P. carinii pneumonia
● Cryptococcal meningitis
● Infectious mononucleosis
● Cancer – Kaposi sarcoma – malignancy
of the vascular endothelium
➔ pink, purple, painless, spot in skin
( leopard look)
Diagnostic Tests
● ELISA – screening test
● Western blot – confirmatory test
● CD4 – T cell count
Treatment
● Mononucleoside Reverse Transcriptase
Inhibitors
28