Communicable Diseases

Epidemiology

  • Pandemic

  • Epidemic

  • Endemic

  • Sporadic - rare

Chain of Infection (S.H.A.R.E.M.E.)

  • Susceptible Host - Human

  • Agents - Microbes

  • Reservoir - Breeding sites (note: insects are reservoir)

  • Entry

  • Mode of Transmission (only part that can be manipulated)

  • Exit

What to wear?

  • PPE (nurse) for droplet precaution use surgical mask only

  • PPE (pt) for transport, use surgical mask

Airborne

  • N95 (nurse)

  • Negative pressure

  • Private and Semiprivate (cohort) - same cases/ diseases/ causative agent

Droplet Precaution (P.I.M.P.)

  • Pertussis

  • Influenza

  • Meningitis/mumps/german measles

  • Pneumonia

Airborne Precaution (M.T.V.)

  • Measles

  • TB

  • Varicella

Contact Precaution (S.C.R.E.W.S.)

  • Superbugs (MRSA, VSA)

  • Conjunctivitis

  • Respiratory synctial

  • Enteric

  • Wound infection

  • Skin infection

Skin infections

  1. Chickenpox - centrifugal - vesiculopustular

  • acyclovir

  • antihistamine (benadryl)

  • analgesic (NSAIDS)

  • antipyretic (paracetamol)

  • avoid aspirin (to prevent reye’s syndrome or liver/brain damage)

  • azithromycin

  1. Shingles - unilateral - vesiculopustular - “same as chickenpox“

  • Anti-inflammatory (prednisone)

  1. Measles (rubeola) - cephalocaudal - maculopapular - koplik’s spot (bluish buccal)

  • ampicillin and Vit A

  • antihistamine

  • analgesics

  • antipyretics

  • Nursing management (S.P.E.E.D.):

    • Strict isolation

    • Prevent itching (cut nails/use mittens)

    • Eliminate itching (calamine lotion)

    • Enter the school (crust in 7 days)

    • Dim the lights (for photophobia) and Disinfect

  1. German measles (rubella) - confluent - maculopapular - forscheimer’s spot (small red spots soft palate)

  • Same as measles

  • Baking soda for rubella

Respiratory Infections

  1. Influenza (Droplet precaution)

  • H. Influenza A, B, C

  • annual flu vaccine

    • yes to: pregnant, elderly, immunocompromised

    • no to: 6 months & below, chicken/egg allergy, 38° fever

  1. Swine flu (Droplet precaution)

  • Hemagglutinin Neuramiridase

  • AH1N1

  1. Bird flu (Airborne precaution)

  • Hemagglutinin Neuramiridase

  • AH5N1

  • S/Sx for Both

    • Fever

    • Headache

    • Malaise

    • Cold

    • Cough

    • Coryza (runny nose)

  • Diagnostic test

    • RT PCR and Rapid Influenza D.T.

  • Management (R.I.C.E.)

    • Rest

    • Isolate

    • Vit C and Zinc

    • Encourage fluid intake to loosen secretions

  • Medication

    • Oseltamivir (tamiflu) orally taken

    • Zanamivir (relenza) IV fluids

    • Azithromycin for secondary infections (pneumonia)

  1. Tuberculosis “Koch’s disease”

  • Diagnostic tests:

    • Sputum exam: AFB smear microscopy or Gene expert MTB test

    • Chest Xray: fastest

    • Sputum culture: confirmatory

    • TT: Tuberculin (mantoux test) for exposure (2-3 days)

      • Induration - delayed hypersensitivity reaction

        • 5mm = positive (immunocompromised)

        • 10mm = positive (high risk, healthcare worker)

        • 15mm = positive (general)

  • RIPES (side effects):

    • Rifampicin/rifampin (red-orange secretions and urine)

    • Isoniazid (peripheral neuritis): advise taking VB6 (pyridoxine)

    • Pyrazinamide (high uric acid)

    • Ethambutol (visual problems)

    • Streptomycin (ototoxic, nephrotoxic, teratogenic): only given is TB relapsed

Sexually Transmitted Diseases

  1. Gonorrhea “Drip” “Clap”

  • Neisseria Gonorrhea

  • Dx: Gram staining negative

  • Women:

    • Asymptomatic

  • Men (BAD)

    • Burning sensation

    • A

    • Discharge

  • Meds 3C’s

    • Cefuroxime oral/single dose/200mg

    • Ceftriaxone

    • Ciprofloxacin

  1. Chlamydia

  • Chlamydia Trachomatis

  • Dx: NAAT (nucleic acid amplification test)

  • Women (BABY)

    • Bleeding

    • Abdominal pelvic pain (PID)

    • Burning sensation in peeing

    • Yellow discharge

  • Men:

    • rarely/asymptomatic

    • carrier

  • Meds

    • Azithromycin 1000mg 1 dose/oral (first line)

    • Doxycycline for 7 days

Prevention (ABCDEF)

  • Abstinence

  • Be monogamous

  • Contraceptives

  • Dental Dam

  • Educate (teenagers)

  • Frequent testing

Note: Never tell spouse about the result

Rabies “Lyssa”

Rhabdovirus or Lyssavirus

Affects CNS

2-8 weeks up to 5-10 years

MOT: Saliva, Bites, Scratches

  • Prodromal Stage

    • S - alivation

    • I - rritability

    • P - ain in the bite site

  • Excitement/Furious Stage (Manic phase)

    • M - anic

    • A - erophobia and Hydrophobia

    • N - uchal rigidity

  • Treatment

    • Local wound treatment (wash with soap and running water, povidone iodine)

    • Active immunization (immunovax) - Day 0, 3, 7, 14 (4-5 days)

    • Tetanus toxoid

    • Passive immunization (ERIG and HRIG)