COMMUNICABLE DISEASE

types of infection (based on clinical manifestations)

LOCALIZED

SYSTEMIC

infxn is located to a specific body part/one body part

CLINICAL MNFSTN: inflammation → RTCDL:

• rubor (redness)

• tumor (swelling)

• calor (heat)

• dolor (pain)

• loss of function

EX: pigsa

LOCALIZED

ifxn located to several body parts or multiple organs

• blood

• lymphatic system

CLINICAL MNFSTN: FHAMS

• fever

• headache

• anorexia

• malaise

• sore throat

SYSTEMIC

types of infection based on duration

ACUTE

CHRONIC

LIFETIME

short-term infection

days to weeks

associated with faster replication cycle

ACUTE

long-term infection

months to years

associated with slower replication cycle

CHRONIC

presence of the microorganism in the body (blood, organs, nerves) for life

LIFETIME

chronic duration of viral hepatitis

VIRAL HEPATITIS B, C, D

acute duration of viral hepatitis

A AND E

transmission of viral hpatitis b, c, d

blood borne

transmission of v. hepatitis a, e

fecal oral

management of v. hepatitis b, c, d

anti-viral

management of v. hepatitis a and e

supportive care

precautions for v. hepatitis b, c, d

standard

precautions of v.hepatitis a and e

enteric

infectious kind of hepa

V. HEPA A

serum hepa

V. HEPA B

inoculation

V. HEPA C

co-infection hepa

V. HEPA D

perinatal hepa

V. HEPA E

contaminated foods and water

FECAL-ORAL

sexual intercourse, needle sharing, mother to fetus via placenta

BLOOD-BORNE

symptom supportive; no medications

SUPPORTIVE CARE

combined alpha interferon and immunoglobulin medication

ANTI-VIRAL

chain of infection

CAUSATIVE AGENT

RESERVOIR

PORTAL OF EXIT

MODE OF TRANSMISSION

PORTAL OF ENTRY

SUSCEPTIBLE HOST

cause of the disease

CAUSATIVE AGENT

where the pathogen lives and multiply

RESERVOIR

pathway to exit

PORTAL OF EXIT

transfer of microorganism

MODE OF TRANSMISSION

pathway to enter

PORTAL OF ENTRY

client/patient

SUSCEPTIBLE HOST

created in 1980s d/t blood-borne diseases and body fluids

for hepatitis B and GRID (gay-related immunodeficiency)

hand hygiene, use of ppe, safe injection practices

UNIVERSAL PRECAUTION

reorganized in 1996

“Core” of basic practice

used in all levels of prevention and in all levels of facility

used in both communicable and non-communicable diseases

STANDARD PRECAUTION

friction during hand washing

HAND HYGIENE

use of alcohol with 60-70%; 30 seconds

HAND RUBBING

(20 seconds; WHO) with the use of soap and water

HAND WASHING

best gloves: ____

cut/chemical resistant

if w/ allergy: ____

LATEX GLOVES

NITRILE/VINYL

protection of the body

GOWN

prevents splashes to the eyes

GOGGLES

3FT, 1M, >5 microns

mask: ___

DROPLET

SURGICAL MASK

close spaced/lack of ventilation and crowded area

floaters, droplet nuclei, <5 microns

mask: ___

AIRBORNE

N(NON-RESISTANT TO OIL)-95 MASK

• 95% of all aerosolized microorganism can be filtered by this mask upto 0.3 microns

7-day measles (tigdas)

CA: Measles Virus

Transmission: Airborne

DT: RT-PCR; Specimen: Oral Swab

Incubation: 2 weeks

Period of Communicability: 4-4

• 4 days before the rash appears

• 4 days after

MEASLES (RUBEOLA)

stages of measles

PRODROMAL

EXANTHEM

CONVALESCENCE

FHAMS + 3Cs (conjunctivitis, coryza, cough) + Koplik’s spot

PRODROMAL STAGE OF MEASLES

whitish to bluish viral enanthem in buccal mucosa

KOPLIK’S SPOT

rashes (flakey and non-pruritic)

PATTERN: cephalocaudal

EXANTHEM STAGE OF MEASLES

body functions returns to normal

CONVALESCENCE STAGE OF MEASLES

complications of measles

DOPE

• DIARRHEA

• OTITIS MEDIA

• PNEUMONIA

• ENCEPHALITIS

Nursing interventions in measles

• F - Fever: ____; increase fluid intake with the use of ___; IV Therapy:____; Paracetamol PRN

• H - Headache/M - Malaise: ____

• A - Anorexia: ____, Diet: ____

• 3Cs

  • Conjunctivitis: ____

    • Bacterial Infection: ____

  • Cough and Coryza: ____, ____, ____ to loosen secretions, soothing of throat (water and milk)

• Vitamin A (Retinol) Fat-Soluble: Milk

  • Dose: 2 consecutive days only

    • <6mos: ___ IU

    • 6-11 mos: ___ IU

    • >12 mos: ___ IU

• Supplements: starts at 6 mos given every 6 mos

TSB (32C); ORS; LACTATED RINGERS/PNSS (2ND CHOICE; IF W/ ANTIBIOTICS)

BEDREST

SMALL FREQ FEEDINGS; SOFT DIET

LUBRICATING EYE DROPS

• TETRACYCLINE EYE OINTMENT

NASAL HYGIENE, VAPORIZE, HUMIDIFIER

50k

100k

200k

3-day measles (tigdas hangin) + FHAMS + 3Cs + Forscheimer Spots

CA: Rubella Virus

Transmit: Droplet

IP: 2-3 weeks

DT: RT-PCR; Oral Swab

POC: 7-7

• 7 days before the rash appears, contagious

• 7 days after ““

HIGH RISK: Pregnant on the 1st Trimester

• Congenital Rubella Syndrome

  • INFANT: deafness, cataract, heart defect

COMPLICATION IN CHILDREN: Polyarthritis

RUBELLA (GERMAN MEASLES)

DOH program for measles

LIGTAS TIGDAS PROGRAM

LIGTAS TIGDAS PROGRAM in infant

MMR Vaccine 0.5ml SC R arm 2 doses

• 1st: 9 mos

• 2nd: 12-15 mos

• Booster: Measles-Rubella Vaccine 0.5ml SC R arm 2 doses

  • 1st: Grade 1 (5-6y/o)

  • 2nd: Grade 7 (11-12y/o)

Notifiable Disease Act

• Measles: immediate notifiable (24 hrs) (Category 1)

RA 11332

red spots in the soft palate

FORSCHEIMER SPOTS

Nursing Intervention in Rubella

• droplet precaution

• same w/ measles

• CRS Triad

  • referral to OBGYN/Pediatrician

CA: MPXvirus

IP: 5-21 days

DT: RT-PCR; skin swab

POC: 1-2 days before the rash appears, until all the lesions have crusted

Transmit:

• Direct (Skin to Skin)

• Indirect (Fomite)

• Droplet (Weak)

MPOX (MONKEYPOX)

stage of mpox:

FHAMS + Lymphadenopathy

PRODROMAL STAGE OF MPOX

stage of mpox:

lesions (painful) + pruritic

PATTERN: Centrifugal (Face, genitals, Palms, soles)

STAGES: MaPa VPS

• Macule: non-elevated lesions, red or dark in color

• Papule: elevated lesions, no fluid, varies in color and sizes

• Vesicles: fluid-filled lesions, clear, no foul smell

• Pustule: pus-filled, creamy, foul-smelling

• Scabs/Crust: dried skin, blood, pus

ERUPTIVE STAGE OF MPOX

stages of MPOX

PRODROMAL

ERUPTIVE

CONVALESCENCE

Nursing interventions for MPOX

• same for FHAMS

• skin care

  • regular hygiene/bathing (warm water to promote comfort)

  • soap: hypoallergenic/oat soap

  • lotion: calamine

• 3As

  • Antipyretics for fever and pain

  • Antihistamine for pruritus

  • Antiviral

    • Tecovirimat BID 600mg for 14 days

    • JYNNEOUS Vaccine

      • 0.5ml SC 2 doses, Day 0 and Day 28

CA: Varicella Zoster Virus (VZV)

IP: 10-21 days

DT: PCR, Skin swab

Transmission: Airborne

mild FHAMS

Lesions: Pruritic Pattern: Centripetal

VARICELLA (CHICKEN POX)

Nursing Interventions for Chicken Pox

• N95 mask + contact (gloves and gown)

• 3As

• skin care

  • regular bathing with warm water

  • soap: hypoallergenic/oat soap

  • calamine lotion

  • traditional: young guava leaves

• Varicella Vaccine

  • Live Attenuated Virus

  • 0.5ml SC 2 doses

    • 1st: 12-15 mos

    • 2nd: 4-6y/o

vaccine-induced varicella “mild”

BREAKTHROUGH VARICELLA

reactivation of VZV

CA: Herpes Zoster Virus

IP: 2 weeks

DT: Viral Culture, swabbing

CLINICAL MANIFESTATIONS: FHAMS + Lesions (Painful and Pruritic)

• PAIN: radiating to the nerves (neuropathic); burning, tingling and shooting

• LESIONS: Unilateral (pattern); only one vesicle

SHINGLES (HERPES ZOSTER)

nursing interventions for shingles

• 3As

  • Antiviral - Acyclovir, Famciclovir, Valacyclovir

• wet dressing (wet gauze)

• skin care (same)

Rural

Long lifespan, Long distance flyer

NIGHT FLYING

• MALARIA

• FILARIASIS

• JAPANESES ENCEPHALITIS

CA: Anopheles Flavirostis

Time: 10pm-4am

does not bite a person in motion

lives in partially shaded streams, slow flowing

MALARIA

CA: Aedes Poecilus

Time: 10pm-12mn

lives in rock formations, swamps, banana and abaca leaves

Secondary vectors: Anopheles, Culex, Mansonia Bonae

FILARIASIS

CA: Culex Tritaeniurhyncus

Time: 6-7pm

lives in rice farms, irrigation canals

JAPANESE ENCEPHALITIS

short lifespan, short distance flyer

DAY FLYING

• DENGUE

• CHIKUNGUNYA

• ZIKA

RURAL: Aedes Albopictus

URBAN: Aedes Aegypti (tiger mosquito)

lives in stagnant water, clear, warm water

Time: 2 hrs after sunrise, 2 hrs before sunset

DENGUE

parasitic infection endemic in the PH

CA: Plasmodium

MALARIA

• most common and deadliest plasmodium

• irregular paroxysm

• IP: 1-2wks

• attacks all kinds of RBC

FALCIPARUM

• second most common plasmodium

• relapse

• every other day paroxysm

• IP: 2-3wks

• only attacks young and new RBC

VIVAX

• tertian

• relapse

• every other day paroxysm

• IP: 2-3 wks

• only attacks young and new RBC

OVALE

• quartan

• every 3 days paroxysm

• IP: 3-4 wks

• only attacks old RBCs

MALARIAE

attacks RBC and causes it to rupture

MEROZOITE

sleeping parasite, dormant

relapse after several months or years (vivax or ovale)

HYPNOZOITES

stages of malaria

COLD

HOT

SWEAT

15-60 MINUTES

chills (cold + shivering)

COLD

2h-6hrs

high fever (> 38.5)

increase bp, tachycardia, tachypnea

headache, dehydration: irritable + thirsty

WATCH OUT: Cerebral Malaria → urgent referral

• inc. ICP

• Meningeal Triad (High fever, headache, nuchal rigidity)

HOT

2-4HRS

1st sign is defervescence (from high fever to normal temp)

dehydration and profuse sweating

SWEAT

rapid testing

used during case finding

MALARIAL ANTIGEN TEST

gold standard test

MALARIAL BLOOD SMEAR/PERIPHERAL BLOOD SMEAR

• THICK BS

• THIN BS

detect low dose of parasitemia

THICK BLOOD SMEAR

detect what type of plasmodium

THIN BLOOD SMEAR

DOH program for malaria

MALARIA CONTROL PROGRAM

• ARTEMISININ COMBINATION DRUG THERAPY (flagship)

ARTEMISININ COMBINATION DRUG THERAPY

Artemether-Lumefantrine

Primaquine

pre-prophylaxis for malaria

DOXYCYCLINE

MEFLOQUINE

ATOVAQUONE PROGUANIL

malaria that can be treated in RHU

falciparum and malariae

• DOC: AL + PQ for 7 days

vivax and ovale

• DOC: AL + PQ for 14 days

UNCOMPLICATED MALARIA

malaria that needs treatment in hospital

falciparum: IV Artesunate 24 hrs + AL,PQ

Vivax: IV Artesunate 24 hrs + AL,PQ complete 14 days

COMPLICATED MALARIA

malaria is a weekly notifiable disease

friday every week

RA 11332