NCM 116 Lecture Module 2  Act as support and protection of neurons and

phagocytosis
COMMUNICABLE DISEASE NURSING

Nervous System Communicable Types:

Diseases i. Astroglia/Astrocytes

 Supply nutrients to the neurons

NERVOUS SYSTEM
 Maintain the integrity of BBB
 Coordinates all body functions

ii.. Ependymal Cells

2 Types of Cells:  Line the four small cavities in the brain (ventricles)
and choroid plexus
(1) Neurons- conducting cells
(2) Neuroglia- supportive cells
iii. Microglia

 Phagocytic cells that ingest and digest m/o and

A. NEURONS waste products
 Basic unit of the NS

 Highly specialized conductor cells that receive and iv. Oligodendroglia

transmit electrochemical impulses
 Produces myelin sheath which covers the axon of
neurons

i. Axons

 Conduct nerve impulses the cell bodies HOW NEUROTRANSMISSION OCCURS?

 Wrapped in a white, fatty, segmented covering NEUROTRANSMITTERS – potentiate, terminate, or modulate

called myelin sheath a specific action

a. Acetylcholine (Ach)- major transmitter of PNS

ii. Dendrites
b. Serotonin- controls mood and sleep; inhibits pain
 Short, thick, diffusely branched extensions of the cell
pathways
body that receive impulses from the other cells

 Conduct nerve impulses the cell body c. Dopamine- affects behaviors (attention and emotion);
fine movements

Properties d. Norepinephrine- major transmitter of SNS, affects

mood and overall activity
1. Excitability

e. Gamma-amino butyric acid (GABA)- excitatory amino

2. Conductivity
acid
3. Permanent cells
f. Enkephalin and endorphin- pleasurable sensation,
inhibits pain transmission

2 Principles Divisions of NS:

B. NEUROGLIA (glial cells)
(1) Central Nervous System (CNS)
  Includes the brain and the spinal cord  Responsible for appreciation and discrimination
of sensory impulses like PAIN, touch, heat, cold,
(2) Peripheral Nervous System and pressure (sensation originates)

 Consist of cranial nerves, spinal nerves, somatic  Interprets size, shape, distance and texture
and autonomic nervous system
v. Occipital love

vi. Insula or Island of Reil (Central Lobe)

vii. Rhinencephalon
 Controls smell

 Controls libido or sexual urge

 Controls long term memory

 Anosmia

Sulci (Creases/Fissures):

a. fissures of Silvius (Lateral Sulcus) – separates the

CENTRAL NERVOUS SYSTEM: temporal lobe from frontal and parietal\

Composition: b. Fissure of Rolando (Central sulcus) – separates the

 80% brain mass frontal lobe from parietal lobe
 10% blood
 10 CSF c. Parieto-occipital Fissure – separates the occipital lobe
from two parietal lobes

BRAIN MASS:
II. CEREBELLUM
I. CEREBRUM • Controls balance, equilibrium, gait and posture

• Controls position sense

Parts:
• Separated by
 Right Hemisphere – connected by a bridge called w/c
allows
Types of Cerebellar Test:
 Left Hemisphere – Communication between
corresponding centers in each hemisphere i. Romberg’s test

Functions:
ii. Finder to Nose Test (FTNT)
i. Sensory
*Dymetria

ii. Motor

iii. Integrative function iii. Alternate Pronation and Supination

III. DIENCEPHALON
iv. Parietal lobe  Located between the cerebrum and midbrain
  Parietal
a. Hypothalamus
 Controls BP and thermoregulation  Occipital
 Sleep and wake fullness
 Appetite
b. Meninges
 Some EMOTIONAL RESPONSES like fear, anxiety, • Fibrous connective tissues that protect, support
excitement and love and nourish the brain and spinal cord

b. Thalamus
 Relax station of ALL sensory stimuli except 3 Layers:
olfactory i. Dura mater
- outermost later that covers the brain and spinal
cord which is composed of many blood vessels and
IV. BRAIN STEM nerves
 Lies between the cerebrum
ii. Arachnoid
a. Midbrain - Middle membrane that resembles a spider web
 Act as a relay station for sight and hearing
- It has no blood supply and contains Choroid plexus
 CN III and IV originates
- With arachnoid villi which absorbs CSF
i. Size and response of pupil: (obstructions- hydrocephalus)
- Normal rxn: normal pupil size *Subarachnoid
- Isocoria: anisocoria

ii. Hearing acuity: iii. Pia mater

- Normal  Innermost membrane that hugs the brain

b. Pons
• Pneumotaxic center Blood

4 Major Arteries:
c. Medulla Oblangata
CIRCLE OF WILLS
• Controls respiration, HR, vomiting, swallowing, i. Two vertebral arteries:
hiccups, coughing, and vasomotor center  Converge to become the basilar arteries which supplies
blood to the posterior brain

V. RETICULAR ACTIVATING SYSTEM (RAS) ii. Two carotid arteries:

• Initiation and maintenance of wakefulness  Supplies anterior and posterior brain

• Interference can lead to decrease level of

consciousness
*CEREBRAL CIRCULATION receives 15% or 750ml/min of CO

Structures Protecting the Brain:

4-6 min without oxygen –
a. Skull-cranial bones:
 Frontal
>10 mins –
 Temporal CEREBROSPINAL FLUID
 • Clear, colorless fluid that cushions and acts as a  Functions independently without conscious effort
shock absorber
 Controls visceral functions
• Normal amount: 500ml/day and 125-150ml is
absorbed by the villi

• Normal CSF: clear, colorless, odorless, +CHO,

+CHON, +WBC, but -RBC

Peripheral Nervous System

 Consists of the Cranial Nerves, Spinal Nerves and ANS

I. Cranial Nerves

- 12 pairs that transmit motor or sensory or both

primarily between the brain or brainstem and the
head and the neck

II. Spinal Nerves

- 31 pairs which consist of afferent(sensory) and

efferent(motor) neurons

- consist of: CERVICAL NERVES, THORACIC NERVES,

LUMBAR NERVES, SACRAL NERVES, COCCYGEAL
NERVE

*PLEXUS-COMPLEX NETWORK OF NERVES

a. Cervical Plexus (C1-C4)

- Supply the muscle and skin of neck

- C3-C5 pass into the phrenic nerve which conduct

motor impulses to the muscle fibers of diaphragm

b. Brachial Plexus (C5-T1)

- Supply the muscle and skin of the arm, forearm, and

hand

c. Lumbosacral Plexus (T12-)

- Supply the muscle and skin of the lower abdominal

wall external genitalia, buttocks, thighs, legs, and
feet

AUTONOMIC NERVOUS SYSTEM

 Communicable Disease of The 2. Non-paralytic
- With CNS involvement but without paralysis
Nervous System
- Usually lasts for about a week, with meningeal
• BACTERIA- Tetanus, Meningitis and Botulism irritation persisting for 2 weeks

• VIRUS- Encephalitis, Polio, and Rabies

3. Paralytic
- With paralysis

Poliomyelitis/Infantile Paralysis/Heine-Medin - less tendon reflex

Disease/Acute Flaccid Paralysis - weakness of the muscles
*CA: poliovirus (Legio Debilitans) - 3 types:

*3 strains:

• Brunhilde *Diagnostic Exams:

1. Lumbar Puncture
• Lansing
- Same as encephalitis (color;clear(viral),
• Leon labs;increase CHON, increase WBC and normal
sugar)

*Reservoir: RT (nasopharyngeal) and GIT 2. Throat culture

- During 1st 4 days of infection
*MOT:

 Droplet (nasopharyngeal) 3. Stool exam

- After 4 days
 Fecal-oral route

 Vehicle transmission *Medical Management:

1. Symptomatic
*Incubation Period: 7-21 days 2. Respiratory Paralysis
- Iron-Lung Machine
• Negative pressure breathing
*Period of Communicability:

• 1st 3 days – 3mos of illness *Nursing Management:

• Most contagious during the first few days of active 1. Symptomatic and prevention
disease and 3-4 days before 2. Vaccination
- OPV-SABIN
*Stages: • 6 weeks after birth, 3 doses with 4 weeks
interval
1. Invasive or Abortive
- m/o enters the body • 2-3 gtts po

- does not invade the CNS • Careful in handling stools of vaccinated

- HA, sore throat, slight/moderate fever, person IPV-SALK
occasional vomiting, low lumbar pain • 0.5 cc IM deltoid
- Patient recovers within 72 hours
3. Avoid MOT and isolate
 4. Rehabilitation using PT, braces, corrective shoes or II. HUMANS
orthopedic surgery
Incubation Period: 10days-years (21 years in the Phil) ave: 1-3
NCM 116 lecture mos

a. Invasive – Pain, itchiness, or numbness on the site

RABIES / Hydrophobia / La Rage / of the bite, flu like sx (fever, sore throat, HA, Body
Malaise), marked insomnia, restless, irritable, and
Animal Bite apprehensive, slight photosensitivity

Rhabdovirus b. Excitement
Efferent nerves  Aerophobia
Peripheral nerves
 Hydrophobia
CNS (negri bodies) Salivary glands
 Drooling of saliva
MOT: Increase  Photophobia
concentration of virus
 Maniacal behavior

1. Contact w/ saliva of rabid (animal bites)

2. Non-bite (licking, scratching and organ transplant) c. Paralytic
3. Inhalation  Pt becomes quiet and unconscious
 Spasm stops, rapid and progressive paralysis
Incubation Period: Depends on  Death d/t respiratory paralysis

1. Distance of the bite to the brain

2. Extensive of the bite
3. Species of animal Diagnostic Exams:
4. Richness of the nerve supply in the bite area
a. Virus isolation from the patient’s saliva or throat
5. Resistance of the host
b. DFA (Direct Fluorescent Ab) Test- confirmatory test
c. Presence of negri bodies in the brain
Manifestations:
d. Observation of animals for 10 days
I. ANIMAL
e. Dog is decapitated and head is placed in an icebox
Incubation Period: 3-8 weeks then sent to laboratory for analysis
a. Dumb Stage
 Depressive or manic
Medical Management:
 Animals become withdrawn, stays in one corner
 Overly affectionate, walking to and from 1. Post-exposure Prophylaxis – Lessens chance of having
rabies
 Nerves of the head and throat paralyzed
a. Active Immunity
• Purified Verocell Vaccine (PVRV)- Verorab 0.5
b. Furious Stage cc/vial
 Easily agitate, easily bites and viscous looks
• Purified Duck Embryo (PDEV)- Lyssavac 1 cc/vial
 Drooling of saliva
• Purified Chick Embryo Cell (PCEC)- Rabipur 1
cc/vial
 Prevention:

1. Immunization for animals

2. keep away from stray animals
3. Wash wound with soap and running water for 15-20
minutes and apply antiseptic solution

ENCEPHALITIS
 Inflammation of the encephalon/brain
 Other names: brain fever
 CA: Virus-Arbovirus
b. Passive Immunity
 Coming from animal serum 1. Primary Encephalitis
 Equine Rabies Immunoglobulin (ERIg)  virus attacks the brain directly
Ex. AR serum  ex. St Louie encephalitis Japanese B encephalitis
Hyper Rab 0.2 cc/Kg BW Australian X encephalitis
Favirab Equine encephalitis (eastern, western)

 Human Rabies Immunoglobulin (HRIg)

*Mode of Transmission:
Ex. Rabuman 0.133 cc
- Mosquito bites (aedes solicitans, culex tarsalis)
Imogam (20IU)/Kg BW
- From ticks of horses from migratory birds
• Single dose
• IM ventrogluteal muscle
• Computed dosage /2 2. Secondary encephalitis
½ - ventrogluteal IM  before the brain was infected, there was a previous
½ - infiltrated wound (4 point site) infection

2. Pre-exposure Prophylaxis and Tetanus Prophylaxis  complication of certain diseases

 To susceptible hosts  Ex. Encephalitis brought about by certain diseases
a. Active Immunity – Human Diploid Vaccine or (Measles, chicken pox, mumps)
Duck Embryo Post vaccine encephalitis (after rabies vaccine)
b. Passive Immunity – Not indicated because it
gives immediate immunity
3. Total encephalitis

 caused by metal poisoning

Nursing Management:  example: (lead poisoning, mercury poisoning)
1. Symptomatic
Manifestations: behavior changes Altered level of
2. Isolate the patient
consciousness (lethargy)
3. Concurrent and terminal disinfection should be
carried out Dx Exam:

1. lumbar puncture: CSF -clear (due to virus)

Lab findings: increase WBC, increase protein, N sugar

 2. EEG: to determine the extent of brain involvement
- Medical Management: Symptomatic: (antibiotics)
- muscles affected are:
- Nursing Management:
• Masseter muscle- lock jaw is manifested
- Preventive Measures: (Trismus)
• Facial Muscle- sardonic smile (Risus Sardonicus)
DOH PROGRAM
• Muscle of the spine- arching of the back
C- Chemically treated mosquito net (Opisthotonos)

L- Larvivorous Fishes - Resp: dyspnea, heaviness of chest

E- Environmental Sanitation - GUT: urinary retention
A- Anti-mosquito soap - GIT: constipation, abdominal rigidity

N- Neem tree/Eucalyptus tree - MUSCULO-SKELTAL: stiffness of the extremity,

difficulty in extension and flexion

TETANUS / Lock-Jaw
Dx Exam:
An infectious disease characterize by painful
muscular spasms - Clinical observation and History of wound, Wound
Culture
Causative agent:

- Clostridium tetani- anerobic microorganism Medical Management: 3 objectives

- found in soil, clothing dust in spores form 1. Neutralize the toxin (ATS, TAT, Tig)

2. Kill the microorganism- Antibiotic, Daily cleansing of

Mode of transmission: the wound, use thin wound dressing
- break in skin integrity 3. Prevent and control spasm (give muscle relaxant)
- body secretions that harbor microorganisms - IV
- Tablet form
- rarely migrate to the blood stream but when it did, it
releases toxin

Tetanolysin Tetanospasmin Nursing Management:

1. Maintain airway or Ventilation

Incubation period: 2. Prevent patient from having spasm

- 3 days to 1 month shorter incubation period is poorer *Do not expose to stimuli Types of stimuli: Exteroceptive
prognosis Interoceptive Proprioceptive

3. Minimal handling of the patient

Clinical Manifestations:
*Cluster care
- initially wound inflammation
- tachycardia and excessive sweating 4. Gentle handling of the patient

- low grade fever 5. Protect patient from injury

- painful involuntary muscle contraction 6. Provide comfort measures

7. Maintain IV line
8. Monitor patient for any signs of arrythmia
 - Neuromuscular disease involving a flaccid type

Prevention:

A. Immunization (DPT) 6 weeks after birth 3 doses 4 weeks

interval

- 0.5 cc IM

1. Advise the mother to expect fever to set in

Complication: swelling and tenderness

Apply warm compress and cold compress

2. Observe the child for signs of convulsion within 7 days

*For pregnant woman: Tetanus toxoid immunization

*2 doses, 1month interval + booster doses Booster dose: 5

years for high-risk patient 10 years for the low-risk patient paralysis

*No permanent immunity - Most severe form of food poising, resulting to death

B. Proper wound care Causative Agent: Clostridium botulinum

1. Wash thoroughly with soap and water - A spore forming, a gram (+), anaerobic bacillus that
2. Apply antiseptic solution produces botulinum toxin

3. Use thin dressings - Usually lives on soil

- Can be eliminated by heating to 121C for 15 minutes
- Cannot grow and produce toxins at low pH
BOTULISM
Reservoir:
 - soil and dust
 In infant botulism, avoid giving honey to less than 1
- contaminated canned foods (optimal anaerobic
y/o
environment)
- corn syrup  in wound botulism, proper cleaning of wound with
- honey Hydrogen Peroxide and Betadine and Debridement

 Antitoxin (Equine) can be administered to prevent

the action to toxin to decrease nerve damage
 Benadryl and Epinephrine should be available
Complications: because there is secondary rate of anaphylaxis

1. Pneumonia
Prevention:
2. UTI
1. Health Education through instruction or proper
3. Pulmonary Embolism preparation of food

4. Decubitus Ulcer 2. Reheat foods

3. Bulging cans should not be opened and avoid giving

5. Flexion Contractures
honey to less than 1 y/o
6. Hypoventilation

Medical Management:
MENINGITIS
1. Symptomatic
Definition:
- Respiratory support
- Management of fluid and electrolytes - Inflammation of the meninges, the membrane
covering/surrounding for brain and spinal cord
- Monitor S/Sx of infection

Causative agent:
2. Collaboration
- Management of ABG - Cytomegalovirus, Fungi, Tubercle bacilli,
- Ventilator setting in ICU Staphylococcus, Haemophilus influenza bacilli,
Meningococcal Virus

Nursing Management: Mode of transmission:

1. Monitor RR, depth, and symmetry due to - Droplet infection

hypoventilation - Body secretions: Nasopharyngeal secretions
2. Managing fluid and electrolytes status
 IVF
 Adequate nutrition

3. Promote safety
- Avoid driving alone
- Avoid walking alone

4. Prevent complications:
 In food-borne botulism- Emetics and gastric Lavage
 Nursing Dx:

 Alteration in Body temperature

 Risk or potential for Fluid and Electrolyte imbalance

Risk for injury

Preventive Measure: No permanent Immunity

1. Immunization: Hib Vaccine

BCG

2. Proper disposal of nasopharyngeal secretion

3. Covering nose and mouth when coughing or

sneezing

4. Dispose nasopharyngeal secretions in tissue

Dx Exam:

1. Lumbar puncture- evaluate CSF upon aspiration

- contraindicated in pt with increase ICP

2. Lab analysis of CSF- increase WBC

- increase protein
- decrease sugar content

3. Culture and sensitivity

4. Counter immune Electrophoresis (CIEP)

Medical Management

1. Antimicrobial agent: Fungal-Amphotericin B

Bacterial- Ceftriaxone

2. Corticosteroid: to decrease inflammation of the

meninges

3. Osmotic diuretics: to remove excess fluid in the brain

4. Anti-convulsant: Phenytoin IV

PO

IM-contraindicated

Nursing Management:

1. Assess neurologic status of the patient

2. Monitor level of consciousness

3. Adequate nutrition and elimination

4. Symptomatic and supportive