8: INFECTIOUS DISORDERS • Chemical barriers

(VIDEO PART 1 AND 2: OVERVIEW OF ANAPHY AND INFECTIOUS PROCESS) • Cellular defenses
IMMUNITY Components:
• It is “resistance”: is the body’s specific protective response to a 1. FIRST LINE OF DEFENSE
foreign agent or organism. a. Physical surface
• Affected by a variety of factors, such as central nervous system barriers – include intact
integrity, general physical and emotional status, medications, skin, mucus
dietary patterns, and the stress of illness, trauma, or surgery. membranes, and cilia of
• Is to remove foreign antigens such as viruses and bacteria to the respiratory tract
maintain homeostasis b. Chemical barriers –
Two general types: such as mucus, acidic
a. Natural (innate) gastric secretions, enzymes in tears and saliva, and substances
b. Acquired (adaptive) in sebaceous and sweat secretions
Terms 2. SECOND LINE OF DEFENSE
• Immune memory – provides protection against harmful a. Antimicrobial substances
microbial agents. i. Complement
• Susceptibility – refers to a vulnerability or lack of resistance o a group of plasma proteins produced by
• Antigens – are membrane proteins which are cell markers that the liver that normally circulate in the
identify cells: “non-self” or “foreign” will be destroyed by blood in an inactive, non-functional form.
immune cells. o Once activated, it would
SUMMARY OF GENERAL TYPES: promote inflammation and
NATURAL ACQUIRED phagocytosis.
(aka. Innate, Non-specific) (aka. Adaptive) o Directly lyse (rupture)
TYPES: TYPES: bacterial cells
1. FIRST LINE 1. CELL-MEDIATED ii. Interferons
a. Physical surface barrier 2. ANTIBODY MEDIATED o Are proteins produced by
b. Chemical barriers cells infected with viruses
2. SECOND LINE and by T lymphocytes
a. Antimicrobial (complement o Blocks the replication or reproduction of viruses, and
and interferons) preventing them from infecting the unaffected cells.
b. Phagocytosis (neutrophils b. Phagocytosis
and macrophage) • Ingestion of microbes or other particles such as cellular debris
c. Other defense cells • Phagocytes – are specialized cells that perform phagocytosis.
(Langerhans, NK, Mast,
Basophils, Eosinophils)
d. Inflammation (local or
systemic)
OTHERS: OTHERS:
--- PROPERTIES:
• Specific
• Memory
CELLS INVOLVED:
1. Lymphocytes i. Neutrophils
• T cells o Most abundant WBC
• B cells o Their levels usually increase during acute bacterial
• NK cells infections
2. Macrophage o First to arrive at the site of invasion since they migrate
quickly, and would often die after phagocytizing a single
General Types of Immunity microorganism.
A. Innate immunity o Functions: engulf microorganisms, especially bacteria
• Other names: Natural/ Innate/ non-specific immunity and release bacteria-destroying substances (e.g.
lysozymes) into the surrounding extracellular matrix of
• Refers to defenses present at birth
the infected tissue
• Considered the first line of host defenses following antigen
o Pus – is an accumulation of fluid, dead neutrophils, and
exposure
other cells at the site of infections.
• Does not create memory. Responses are the same regardless
ii. Macrophage
of the target.
o Are monocytes that
• Primarily involves intact skin and mucus membranes, the
leave the blood, enter
inflammatory response, a number of chemicals and defensive
tissues, and enlarge
cells
about fivefold.
• Can be divided in 2 stages: o Come are given
o Immediate – generally occurring within minutes specific names, such
o Delayed – occurring within several days after exposure as dust cells in the
• Physical barriers
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 lungs, Kupffer cells in the liver, and microglia in the ii. Systemic inflammation
central nervous system. o Inflammatory response that is generally distributed
o Can ingest more and larger items than can neutrophils throughout the body.
o Macrophages usually appear in infected tissues after o Three additional features can be present:
neutrophils do. ▪ Red bone marrow produces and releases large
o Are also found in uninfected tissues numbers of neutrophils, which promote
o Phagocytes which are involved in both innate and phagocytosis
adaptive immunity ▪ Pyrogens – chemicals released by microorganisms,
c. Other defensive cells neutrophils, and other cells, stimulate fever
i. Langerhans cells production. Fever promotes the activities of the
o Cells on the skin’s epidermis which also phagocytize immune system, such as phagocytosis, and inhibits
foreign material, not merely to destroy it, but take it to a the growth of some microorganisms.
lymph node where the adaptive immunity defenses are ▪ In severe cases of systemic inflammation, vascular
then activated. permeability can increase so much that large
ii. Natural Killer (NK) cells amounts of fluid are lost from the blood into the
o Type of lymphocyte tissues. The decreased blood volume can cause
produced in red bone shock and death.
marrow which circulate B. Acquired/ Adaptive immunity
in the blood and lymph • Prior exposure to an antigen through immunization
o Non-specific (unlike the (vaccination or by contracting a disease)
T and B cells) and do not • Recognition of specific foreign antigens
exhibit a memory • Does create memory
response • Broadly divided into 2 mechanisms
o Non-phagocytic and act by making direct contact with o Cell-mediated response (involving T-cell activation)
foreign substances, and would kill them through o Effector mechanisms (involving B-cell maturation and
rupturing their membranes with chemicals. production of antibodies)
iii. Mast cells Properties of Adaptive Immunity
o Also derived from red bone 1. Specificity
marrow. Nonmotile cells in • Adaptive immunity is antigen-specific
connective tissues. 2. Memory
o Produce histamines and • The second encounter with an antigen prompts an even more
leukotrienes in response to rapid and vigorous response.
tissue damage • Example: Chicken pox
o Histamine – causes vasodilation and makes capillaries Cells involved in adaptive immunity
more permeable or “leaky” 1. Lymphocytes
o Leukotrienes – also increases capillary permeability and • Circulated in both blood and lymph and are located in
attract phagocytes to the area of tissue damage. lymphatic tissues (e.g. spleen, lymph nodes)
iv. Basophils • Smallest of the WBC. Second most abundant WBC.
o Least abundant of the WBCs
• Usually increase during acute viral infection
o Levels would increase in allergic reactions and parasitic
• Acts against an antigen
infections.
• Rejects grafts or
o Secrete histamine and heparin.
donated organs.
v. Eosinophils
Types:
o Secrete a range of highly toxic proteins and free radicals
a. T-cells/ T lymphocytes
that kill bacteria and parasites.
• Released as immature T
d. Inflammation
cells from the red bone
• A nonspecific, defensive response to the body to tissue
marrow.
damage
• They mature in the
• Main purpose is to try to contain the damage, keep it from
THYMUS.
spreading, eliminate the cause and permit tissue repair
• Provides cell-mediated
• Occurs in 3 basic stages:
immunity in which T-cells, once activated directly interact with
o Vasodilation increases blood flow and brings phagocytes
antigen-bearing cells/ agents.
and other white blood cells to the area
Specialized groups:
o Phagocytes leave the blood and enter the tissue
• Helper T cells
o Tissue repair
o Also referred to as CD4+ cells
i. Local inflammation
o When activated, helper T cells secrete cytokines, which
o Inflammatory response confined to a specific area of the
attract and activate B cells, cytotoxic T cells, NK cells,
body.
Signs of Inflammation: Mnemonics (I just placed): macrophages, and other cells of the immune system.
• Redness (rubor) • D – Dolor • Cytotoxic T cells (killer T cells)
• Pain (dolor) • O – lOss of function o Also referred to as CD8+ cells
• Heat (calor) • C – Calor o Attack the antigen directly by altering cell membrane
• Edema/ swelling (tumor) • T – tumor
• Loss of function • O – lOss of function
o Causes cell lysis (disintegration), and releasing cytolytic
• R – rubor enzymes and cytokines
2
 • Suppressor T cells CLASSES OF ANTIBODIES
o Keeps the immune response at a level that is compatible *Percentage is out of the total immunoglobulin
with health (eg. Sufficient to fight infection adequately Ig LOCATION FUNCTION Others Picture
without attacking the body’s healthy tissues) IgG Blood Provides massive Most
• Memory Cells (75%) immunity for abundant of
o Are responsible for recognizing antigens from previous Lymph newborns all
exposure and mounting an immune response. antibodies
b. B-cells/ B lymphocytes (adaptive immunity) Provides long in the blood
• Arise and mature in the bone marrow term immunity
• Provides antibody-mediated immunity in which b cells, once following The only
activated, indirectly interact with antigen-bearing cells/ recovery from class of
agents to destroy them by producing antibodies. infection or antibody to
c. Natural Killer (NK) cells (adaptive immunity) administration of cross the
vaccines. placenta
2. Macrophages IgA Secretions Provides passive ---
• Phagocytes which are involved in both innate and adaptive (15%) of all immunity for
immunity mucus breast-fed
membran newborns
• Are differentiated monocytes
es:
• Largest of the WBC.
Provides localized
• Numbers usually increase during a chronic infection
Sweat protection of
• They not only engulf foreign material, but also present
Tears mucous
fragments of the foreign materials’ antigens.
Saliva membranes
Mucus GI against bacteria
GENERAL PHASES OF ADAPTIVE IMMUNITY (because it is specific)
secretions and viruses
1. Recognition of an antigen as foreign
Breastmilk
2. Activation of cell-mediated and antibody-mediated immune
IgM Blood Produced first First
response
(10%) during an antibody to
Types of adaptive immunity:
infection (IgG be secreted
Cell-Mediated Immunity
follows) by plasma
• Does not result in the production of antibodies
cells after
• Effective against intracellular pathogens such as viruses, Are the anti-A and an initial
bacteria and fungi located inside cells Anti-B antibodies exposure to
• T cells of ABO blood any antigen
• Release of cytokines shortly after the invading antigen is group which bind
presented by the macrophages with antigens to
• Predominates during: cause
o Transplant rejection, agglutination
o Delayed hypersensitivity (eg. tuberculin reaction), during transfusion
o Graft-versus-host disease reactions
o Tumor surveillance destruction IgD Blood Serve as antigen Role is
o Intracellular infections (0.2%) receptors on the unclear
o Viral, fungal, and parasitic infections Lymph surfaces of B cells
Antibody-Mediated Immunity (particular which are
• Production of antibodies ly on the involved in its
• Is effective against extracellular pathogens such as viruses, B activation
bacteria, and fungi in the blood and body fluid lymphocyt
• B cells es)
• Predominates during: IgE Blood, Involved in Appears in
o Bacterial phagocytosis and lysis (0.004 mast cells allergic and serum
o Anaphylaxis %) and hypersensitivity
o Allergic hay fever basophils reactions Takes part in
o Asthma allergic and
o Immune complex diseases Provides some
o Bacterial and some viral infections. protection against hypersensiti
parasitic worms vity
reactions

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ANTIBODY RESPONSES An antigen is Tetanus Stimulation of
1. Primary Response deliberately toxoid an immune
• Occurs during initial exposure to the antigen introduced into an (TT), response
• B cells are activated to proliferative and begin producing individual to attenuated without the
antibody stimulate the measles severe
• However, on a person’s first exposure to the antigen, antibody immune system virus symptoms of
production is usually too slow (vaccination). The (AMV), the disease
• In the case of an antigen of a pathogen (eg. Measles virus), Artificially vaccine contains COVID-19
antibody production during the primary response is unable to acquired- weakened or killed vaccines
prevent the disease itself, and therefore diseases (eg. Clinical active pathogens like Pfizer
measles) ensures immunity (attenuated or
2. Secondary response vaccine), their Moderna
• Occurs during subsequent exposure to the antigen components (usually (mRNA
• Memory cells formed during the primary response stimulate DNA) or their vaccine)
the production of plasma cells and almost immediate rise in inactivated toxins
antibody levels occur (toxoid)
• In the case of previously-acquired disease (eg. Previous
measles), on second exposure to the pathogen, the large PASSIVE IMMUNITY
amounts of antibodies are enough to prevent a second case of Type of Mechanism Example Result
the disease Passive
• This is the reason why we develop immunity to certain diseases Immunity
and this is also the basis for protection given by vaccines Begins with Antisera are Short-term
vaccinating an available immunity
SOURCES OF IMMUNITY animal, such as a against without
1. Genetic immunity horse. After the microorganis stimulating
• Is conferred by our DNA animal’s immune m that cause an immune
• Does not involve antibodies or the immune defenses but is the system responds to disease, such response
result of our genetic makeup the antigen, as rabies, since the
• Results in certain pathogens incapable of causing disease in all antibodies are hepatitis, antibodies
human species removed from the and measles; are used or
2. Acquired immunity animal and injected bacterial eliminated by
• Involves antibodies. into the human toxins such the recipient
• natural or vaccination Artificially- requiring immunity as those that
a. Active immunity acquired Antibodies that cause Preferred
o Means that the individual produces his/ her own passive provide passive tetanus, treatment
antibodies immunity artificial immunity diphtheria, when not
o The type of immunity that stays with you for long periods are referred to by and enough time
(usually for life), as the memory cells and long-lasting the general term botulism; is available
antibodies remain with you antiserum because and venoms for the
b. Passive immunity the antibodies are from individual to
o Antibodies are form another source (from another found in serum, poisonous develop his or
person or animal) therefore “pre-made” however, the which is plasma snakes and her own
immunity it provides is fleeting minus the clotting spiders active
o Once the antibodies degrade, so does the immunity factors immunity
because there is no immune cells to produce new
antibodies. Results when Placental Short-term
antibodies are transmission immunity for
ACTIVE IMMUNITY transferred from a of antibodies newborn
Type of Mechanism Example Result mother to her child (IgG) from without
Active across the placenta mother to stimulating
Immunity before birth. fetus; an immune
Following birth, the transmission response
Exposure to live Getting Stimulation of
antibodies protect of antibodies
pathogens with sick with an immune
the baby for the in breastmilk
which you are not chickenpox response with
first few months. (IgA)
immune and symptoms of a
Naturally- Eventually, the
measles disease; there
acquired antibodies break
is recovery
passive down, and the baby
Naturally- from the
immunity must rely on its
acquired disease, with
own immune
active production of
system
immunity antibodies and
memory cells

4
 THE INFECTIOUS PROCESS Germs are the agents and they have reservoirs wherein they can live
Related terms: in people, animals, and pets. Their portal of exit can be through the
• Infectious disease – any disease caused by growth of pathogenic mouth or skin. Once they get out from the portal of exit, that is the
microbes in the body; may or may not be communicable mode of transmission which can be from droplets, hands, or toys.
(contagious) Once it is transmitted, there will be a portal of entry. The germs can
• Susceptible – not possessing immunity to a particular pathogen get in the mouth, cuts in the skin, or the eyes. Then the susceptible
• Immune – not susceptible host can be affected such as non-immunized people, elderly, or
TYPES OF INFECTION babies.
Viral infections CAUSATIVE ORGANISM/AGENT
• Smaller than bacteria; are parasitic and require a host cell in The types of microorganism that
which to carry out their life cycle cause infections are bacteria,
• Examples of viral infections: influenza, measles, rubella, rickettsiae, viruses, protozoa,
chickenpox, HPV, HIV, rabies fungi, and helminths
• Possible treatments: interventions relieving symptoms (until • Factors that influence the
immune system clears the infection) and antiviral agents ability of a microorganism
Bacterial infections to cause infection include the number of microorganisms
• Bacteria are single-celled microorganisms and can be found in all present, the potency of the microorganism, the ability of the
sorts of environments agent to enter the body, the susceptibility of the host, and
• Examples of bacterial infections: strep throat, E.coli, Salmonella, whether the organism can live in the host’s body
gonorrhea, chlamydia, TB RESERVOIR
• Possible treatments: antibiotics • Term used for any person,
Fungal infections plant, animal, substance, or
• Include yeast and molds location that provides
• Examples of fungal infections: vaginal yeast infections, athlete’s nourishment for
foot, histoplasmosis microorganisms and enables
further dispersal of the
• Possible treatments: antifungals
organisms
Parasitic infections
• Infections may be prevented
• Three types: protozoa, helminths, extoparasites (fleas, ticks, lice)
by eliminating the causative
• Examples of parasitic infections: malaria, toxoplasmosis,
organisms from the reservoir
tapeworm infection, scabies
• For example, shellfish are reservoirs for hepatitis A and the
• Possible treatments: antiparasitics
anopheles mosquito is a carrier of the malaria parasite
Prions
• Proteins that can affect normal proteins and cause them to fold
MODE OF EXIT
into abnormal shapes
The microorganism has to leave
• Can cause dementia and difficulties in walking or speaking
the reservoir to establish itself
• Are very rare; some are inherited whole some are acquired as an infection
through consuming contaminated food
• Portals of exit include the
• Examples: Creutzfeldt-Jakob disease gastrointestinal (GI) tract
• Currently no curative treatment (mouth or anus),
Health care-associated infection (HCAI) respiratory tract (nose or mouth) Genitourinary (GU) tract
• Also referred to as “nosocomial” or hospital infection (ureteral meatus or urinary diversion), blood (open wound,
• Is an infection occurring in a patient during the process of care in needle puncture site, or any break in the skin or mucous
a hospital or other health care facility which was not present or membranes), and tissue (drainage from a wound)
incubating at the time of admission ROUTE OF TRANSMISSION
• Example: central line-associated bloodstream infections, • Connects the infectious
catheter associated UTI, and ventilator-associated pneumonia, source with its new host
surgical site infections • Three methods of
THE CHAIN OF INFECTION transmission: direct,
indirect, airborne

DIFFERENT TYPES OF TRANSMISSION

Direct transmission
• Is through direct transfer from one person to another
• Can be through biting, touching, kissing, or sexual intercourse
• Sneezing, coughing, spitting, singing, or talking can also transfer
microorganisms from one person to another if the person is close
to the host and the organism is transferrable by droplet spray
into the mucous membranes of the mouth, nose, eye, or
conjunctiva
• Example: Staphylococcus aureus

5
Indirect transmission • Alcohol-based hand rubs containing 60% to 95% alcohol are the
• Can be either vehicle or vector-borne preferred method for decontaminating hands, except when
• A vehicle is anything that serves as a way to transfer a hands are visibly soiled or when a patient has infectious diarrhea
microorganism from the host to the susceptible person. • Clostridium difficile and norovirus are not affected by alcohol-
o Example: Inanimate objects (fomites) such as toys, based rubs
soiled clothes, eating utensils, handkerchiefs, surgical • Soap and water should be used in suspected or confirmed cases
instruments, or dressings, and stethoscopes can serve of infectious diarrhea
as vehicles for indirect transmission 5 moments of hand hygiene:
• Vector-borne transmission is when an animal or insect 1. Before touching a
transports the infectious agent. Transmission occurs when the patient
animal or insect either injects saliva through biting or by 2. Before
depositing feces or other materials through broken skin clean/aseptic
o Example: Aedes aegypti mosquito which causes procedure
dengue fever 3. After body fluid
Airborne transmission exposure/risk
• Can include droplets or dust 4. After touching a
• Evaporated droplets and dust particles patient
containing the infectious agent can 5. After touching
remain in the air for long periods patient
• Example: Clostridium difficile and surroundings
Mycobacterium tuberculosis and COVID-19 • The CDC recommends
PORTAL OF ENTRY scrubbing hands for at least 20 seconds, using soap, water, and
• Needed for the organism friction, and paying special attention to the areas between
to gain access to the host fingers, the backs of hands, underneath fingernails, and the
• Specific organisms may thumbs. Humming the Happy Birthday song twice or the
require specific portals of Alphabet song or Twinkle, twinkle, little star once can help count
entry for infection to occur the time
• Example: M. tuberculosis • Alcohol-based hand rubs should be rubbed into all surfaces of
does not cause disease when it settles on the skin but rather the hands until dry
through the respiratory tract PPE (PERSONAL PROTECTIVE EQUIPMENT)
• Other portals of entry: mouth, cuts in the skin, and eyes • Includes gloves, gowns, masks, respirators, and eyewear that
SUSCEPTIBLE HOST create barriers to protect skin, clothing, mucous membranes,
• Risk factors include: and the respiratory tract from infectious organisms
o Age (very • The item selected depends on the infectious agent, the type of
young and interaction, and the method of microorganism transmission
very old) • Knowing how to put on and remove PPE can help prevent cross-
o Immune contamination
suppression treatment for cancer or organ transplant Types of PPE
o Immune deficiency conditions • Gloves: should be worn when touching blood, body fluids,
o Chronic disorders such as COPD and end-stage renal nonintact skin, mucous membranes, and contaminated items,
disease, and disorders that require and for any activities involving vascular access
immunosuppressive therapy such as rheumatoid • Face shield or mask and goggles: should be worn if you
arthritis, Crohn disease, and multiple sclerosis anticipate a splash or spray of blood or body fluids that might
• Note: expect that any hospitalized patient is at risk for infection come in contact with your nose, eyes, or mouth
because of the physical stress of illness or surgery and the • Gown: if you expect your skin or clothing might be exposed to
prevalence of microorganisms, including HAI body fluids or blood
TAKING PRECAUTIONS DONNING PPE
• Include standard precautions and transmission-based 1. Identify and gather the proper PPE to don
precautions 2. Perform hand hygiene using hand sanitizer
STANDARD PRECAUTIONS 3. Put on isolation gown
• Are guidelines that were established to break the chain of 4. Put on NIOSH-approved N95 filtering facepiece respirator
infection and reduce risk of pathogen transmission in hospitals or higher (use a facemask if a respirator is not available)
• Apply to blood and body fluids, secretions and excretions (except 5. Put on face shield or goggles
sweat), nonintact skin, and mucous membranes 6. Put on gloves
• Premise: ALL PATIENTS are colonized or infected with 7. Healthcare personnel may now enter patient room
microorganisms, whether or not there are signs or symptoms, DOFFING PPE
and that a uniform level of caution should be used in the care of 1. Remove gloves
all patients 2. Remove gown
HAND HYGIENE 3. Healthcare personnel may now exit patient room
• Is the number one weapon in preventing the spread of 4. Perform hand hygiene
microorganisms 5. Remove face shield or goggles
• Includes alcohol-based hand rubs and hand washing with soap 6. Remove and discard respirator (or facemask if used instead
and water of respirator)
6
 7. Perform hand hygiene after removing the o Remove gloves before leaving patient room
respirator/facemask and before putting it on again if your • Hand hygiene
workplace is practicing reuse o According to standard precautions
• Facilities implementing reuse or extended use of PPE • Gowns
will need to adjust their donning and doffing o Don gown upon entry into the room or cubicle
procedures to accommodate those practices o Remove gown and observe hand hygiene before leaving
the patient care environment
• Patient transport
o Limit transport of patients to medically necessary
purposes
o Ensure that infected or colonized areas of the patient’s
body are contained and covered
o Remove and dispose of contaminated PPE and perform
hand hygiene prior to transporting patients on Contact
Precautions
o Don clean PPE to handle the patient at the transport
destination
• Patient-Care Equipment
o Use disposable noncritical patient-care equipment or
implement patient-dedicated use of such equipment
• Are used when caring for patients with known or suspected
PROMOTING INJECTION SAFETY diseases that are spread by direct or indirect contact
• Gloves should be worn when • Include gloving and gowning when in contact with the patient,
administering injections objects, and surfaces within the patient’s environment
• Puncture-proof disposal systems are • All reusable items should be cleaned and disinfected according
recommended to dispose of uncapped to organizational policy, and disposable items should be thrown
needles and sharps away immediately after being used
• Never recap needles following • Sample situation: E. coli, Hep A, Cellulitis, Pressure ulcers,
administration of medication to reduce Scabies
your risk of being stuck with an unclean DROPLET PRECAUTIONS
needle
• For all staff:
• Engage a needle safety device immediately after performing an o Before entering room: perform hand hygiene and put on
injection to avoid getting a needle stick injury surgical mask
ENVIRONMENTAL CLEANING o On leaving room: dispose of mask and perform hand
• Includes medical equipment and environmental surfaces hygiene
• Any reusable equipment, including stethoscopes, bandage • Require the use of a surgical mask when withing 3ft (6ft for
scissors, and hemostats, used on multiple patients must be smallpox) of a patient known to have or suspected of having a
cleaned between each patient contact, following organizational disease spread by droplets
policy, with a broad-spectrum antimicrobial agent such as • Observe droplet precautions when examining a patient with
chlorhexidine respiratory symptoms, especially if the patient has a fever. These
• Nursing staff should work closely with environmental services to precautions should remain in effect until it is determined that
ensure that rooms are thoroughly cleaned and disinfected the symptoms are not caused by an infection that requires
between patients to prevent the spread of infection through droplet precautions
inanimate objects • Sample situations: influenza, pertussis, pneumonia, and
RESPIRATORY HYGEINE & COUGH ETIQUETTE meningococcal disease
• Patients with signs and symptoms of a respiratory infection AIRBORNE PRECAUTIONS
should be taught to cover their mouth and nose with a tissue • EVERYONE MUST:
when coughing or sneezing and dispose of the tissue in the o Clean hands when entering and leaving the room
nearest trash container as soon as possible
• DOCTORS AND STAFF must:
• These patients should also perform hand hygiene with alcohol- o Wear CAPR/PAPR or fitted N95 mask prior to entering the
based rubs, soap and water, or an antiseptic hand wash after room
being exposed to respiratory secretions or contaminated
• Patient placement:
materials or objects
o Airborne Infection Isolation Room required (negative
TRANSMISSION-BASED PRECAUTIONS
pressure)
• Use transmission-based precautions in addition to standard o Keep door closed
precautions
• Are used when in contact with patients with known or suspected
• Three-types: contact, droplet, and airborne diseases spread by fine particles transmitted by air currents such
CONTACT PRECAUTIONS as tuberculosis, measles, and severe acuter respiratory
• Stop visitors: report to nurse before entering syndrome
• Gloves: • Must wear a National Institute for Occupational Safety and
o Don gloves upon entry into the room or cubicle Health certified, fit-tested N-95 respirator just before entry into
o Wear gloves whenever touching the patient’s intact skin an area shared with a patient suspected or known to have one
or surfaces and articles in close proximity to the patient of these diseases
7
• If eye protection is needed, wear goggles, or a face shield during
all contact with the patient, not just if you predict splashes or
sprays
• Sample situations: Measles, Varicella, TB
STAGES OF INFECTIOUS PROCESS
I. Incubation Period
• Occurs in an acute disease after the initial entry of the pathogen
into the host
• It is during this time the pathogen begins multiplying in the host.
However, there are insufficient numbers of pathogen particles
(cells or viruses) present to cause signs and symptoms of disease
• Can vary from a day or two in acute disease to months or years
in chronic disease
• Factors involved in determining the length of the incubation
period can include strength of the pathogen, strength of the host
immune defenses, site of infection, type of infection, and the size
infectious dose received
II. Prodromal Period
• The pathogen continues to multiply and the host begins to
experience general signs and symptoms of illness, which typically
result from activation of the immune system, such as fever, pain,
soreness, swelling, or inflammation
• Interval from onset of nonspecific s/sx to more specific
symptoms
III. Interval period/Acme/Fastigium
• During which the signs and symptoms of disease are most
obvious and severe and more specific to the type of infection
IV. Recovery/Convalescent Period
• When the acute symptoms of infection disappear and the body
tries to replenish resources and return to a state of homeostasis
• Some diseases may inflict permanent damage that the body
cannot fully repair

8
PART 3: INFECTION CONTROL AND PREVENTION • WHO Collaborating Centre for Reference and Research in AMR,
Organizations involved in infection prevention Public Health England
• Principal agencies involved in setting guidelines about infection • World Surgical Infection Society
prevention. PREVENTION OF INFECITON IN THE COMMUNITY
• Health care – associated infections (HAIs) in health care setting. 1. Recommended Adult Immunization Schedule for ages 19 years
INFECTION PREVENTION AND CONTROL (IPC) or older
• Practical evidenced- based approach- prevents patients and
health workers from being harmed by avoidable infections.
• Preventing health-care associated infections (HAI); reduces
spread of antimicrobial resistance (AMR); high quality,
integrated, people-centered services.
• WHO’s IPC Global Unit- new approach to strengthen national
and international capacity improve practice and behavior for
healthcare safer and free from avoidable infections.
• In collaboration with other member states → vision of protecting
the lives of pxs and health workers
• WORK: Hand hygiene, surgical site infections, core components
of IPC, injection safety, focus in AMR, other health care
intervention
GLOBAL INFECTION PREVENTION AND CONTROL NETWORK (GIPC How to use the Adult Immunization Schedule
NETWORK) STEP 1: Determine recommended vaccinations by age (TABLE 1)
• administered by the WHO’s Service Delivery and Safety STEP 2: Assess need for additional recommended vaccinations by
Department, under the auspices of the Infection Prevention and medical condition and other indications (TABLE 2)
Control (IPC) global unit. STEP 3: Review vaccine types, frequencies, and intervals &
• aim is to enhance local, national (Member States) and considerations for special situations (Notes)
international coordination and collaboration in the field of
infection prevention and control (IPC) and to support WHO’s and
Member States’ efforts on IPC
• GOAL: reduction of health care-associated infection and address
the global burden of antimicrobial resistance (AMR) in support
of all Member States and WHO priorities
GIPCN PARTICIPATING ORGANIZATIONS (FROM 2017)
• American University of Beirut Medical Centre
• Asia Pacific Society of Infection Control (APSIC)
• Association for Professionals in Infection Control and
Epidemiology (APIC)
• Baltic Antibiotic Resistance collaborative Network (BARN)
• Centers for Disease Control and Prevention (CDC), USA
• National IPC programme, Ministry of Health, Chile
• European Committee on Infection Control (EUCIC) and European
Society of Clinical Microbiology and Infectious Diseases (ESCMID)
• European Network to Promote Infection Prevention for Patient
Safety (EUNETIPS)
• Infection Control Africa Network (ICAN)
• Institute of Epidemiology, Disease Control and Research (IEDCR),
Bangladesh
• International Federation of Infection Control (IFIC)
• Jhpiego-an affiliate of Johns Hopkins University, USA
• Médecins Sans Frontières (MSF)
• Ministry of Health, Kingdom of Saudi Arabia
• National Centre for Infectious Diseases, Tan Tock Seng Hospital,
Singapore
• North Western State Medical University, Russian Federation
• Public Health Agency of Canada
• Society for Healthcare Epidemiology America (SHEA)
• School of Nursing, University of Sao Paulo, Brazil
• WHO Collaborating Centre for Infectious Disease Epidemiology
and Control, China
• WHO Collaborating Centre for IPC and AMR, Ministry of National
Guard Health Affairs, Kingdom of Saudi Arabia
• WHO Collaborating Centre of Patient Safety, University Hospitals
of Geneva, Switzerland

9
 f. Cerebrovascular Disease (Stroke)
g. Chronic Obstructive Pulmonary Disease (COPD)
h. Coronary Artery Disease
i. Heat stroke
j. High blood pressure or hypertension
k. Obesity and Overweight
l. Diabetes
m. Depressive Disorders
n. Substance Abuse: Alcohol
o. Substance Abuse: Ecstasy
Objectives:
a. To raise the priority accorded to the prevention and control of
non-communicable diseases in national, regional and local
health and development plans
b. To strengthen leadership, governance, and multisectoral actions
for the prevention and control of noncommunicable diseases
c. To reduce modifiable risk factors for non-communicable
diseases and underlying social determinants through creation of
health-promoting environments
d. To strengthen health systems and increase access to quality
medicines, products and services, especially at the primary
health care level, towards attainment of universal health
coverage
e. To promote and support research and development for the
prevention and control of non-communicable diseases
f. To monitor the trends and determinants of non-communicable
diseases and evaluate progress in their prevention and control
Program Components
a. Cardiovascular Disease
b. Diabetes mellitus
c. Cancer
d. Chronic Respiratory Disease
Policies and Laws
a. AO No. 2011-0003 or The National policy on Strengthening the
Prevention and Control of Chronic Lifestyle Related
Noncommunicable Diseases
b. AO No. 2012-0029 or The Implementing Guidelines on the
Institutionalization of Philippine Package of Essential NCD
Interventions (PhilPEN) on the Integrated Management of
Hypertension and Diabetes for Primary Health Care Facilities
2. Non-Communicable Disease Programs c. AO No. 2013 – 0005 or The National Policy on the Unified
• Non-communicable diseases (NCDs) are considered as Registry Systems of the Department of Health (Chronic
lifestyle related and is mostly the result of unhealthy habits. Noncommunicable Diseases, Injury Related Cases, Persons with
Behavioral and modifiable risk factors like smoking, alcohol Disabilities, and Violence Against Women and Children Registry
abuse, consuming too much fat, salt and sugar and physical Systems)
inactivity have sparked an epidemic of these NCDs which pose d. AO 2015-0052: “National Policy on Palliative & Hospice Care in
a public threat and economic burden the Philippines
• Vision: A Philippines free from the avoidable burden of NCDs e. AO 2016-0001: “Revised Policy on Cancer Prevention and Control
• Mission: Ensure sustainable health promoting environments Program
and accessible, cost-effective, comprehensive, equitable and f. AO 2016 – 0014 - Implementing Guidelines on the Organization
quality health care services for the prevention and control of of Health Clubs for Patients with Hypertension and Diabetes in
NCDs, and guided by the principle of “Health in All, Health by Health Facilities
All, Health for All” whereas Health in All refers to Health CONCEPTUAL FRAMEWORK (Administrative Order-2011-0003
• in All Policies, Health by All involves the whole-of-government National Policy On Strengthening the Prevention and Control of
and the whole-of-society and the Health for Chronic Lifestyle Related Non-Communicable Diseases)
1. Environmental Interventions (macroeconomic and policy
• All captures the KP (Kalusugan Pangkalahatan) or the
change)
Universal Health Care (UHC).
List of Non-Communicable Diseases • Governance
a. Alzheimer’s Disease • Policy and legislation
b. Cancer • Creating supportive environments
c. Epilepsy 2. Lifestyle Interventions
d. Osteoarthritis • Behavioral interventions
e. Osteoporosis • Health promotion
10
 • Information and education International Thyroid Awareness
• Improving the built environment Week
3. Clinical Interventions Health Justice Philippines Philippine Thyroid Association
WHO Philippines Philippine College of Chest
• Clinical preventive services
National Nutrition Council Physicians
• Risk factor detection (screening) and control Philippine Society of Endocrinology, Philippine Society of Nuclear
• Acute care Diabetes and Medicine
• Chronic care and rehabilitation Metabolism UP College of Public Health
• Palliative Care Philippine Heart Association UP National Institutes of Health
4. Advocacy Philippine Academy of Family UP Philippine General Hospital
Physicians Philippine Coalition for the
5. Research, Surveillance and Evaluation
Philippine Cancer Society, Inc. Prevention and Control of Non
6. “Whole-of-government’ and Whole-of-society response Communicable Diseases
• Leadership ROLE OF INFECTION CONTROL NURSE
• Multisectoral partnership What is an infection control nurse?
• Community mobilization • specialize in preventing the spread of infectious agents such as
7. Health sector response that of viruses and bacteria.
• Primary health care • prevent dangerous outbreaks from occurring in a hospital
• Chronic care management setting
• Health systems strengthening • to perform and educate others on how to prevent and contain
RELEVANT STATISTICS outbreaks and to prevent further incidents from occurring.
• National Nutrition Survey Where do infection control nurses work?
• Food and Nutrition Research Institute (20years old and above): • Hospitals
• Prevalence of Hypertension (2015): 23.9 • Long term care facilities
• Prevalence of High Fasting Glucose (2013): 5.6 • Home Care
• Prevalence of High total Cholesterol: 18.6 • Ambulatory Care
• Prevalence of Binge Drinking (2015): Males: 58.8, Female: 41.9 • Hospices
• Prevalence of Insufficiently Physically Active Adults (2015): 42.5 • Emergency Preparedness
• Prevalence of Overweight and Obese and Adult (2013): Males: • Public Health
27.6, Females: 34.4 • Behavioral Health
Program Accomplishments/Status What are the roles and duties of an Infection Control Nurse?
1. Finalization of the Philippine Multi sectoral Strategic Plan for the • The responsibilities of an infection control nurse include:
Prevention and Control of NCDs (2017 - 2025) • Gathering and analyzing infection data, facts and trends to
2. The Philippine Package of Essential NCD Intervention for the other healthcare personnel.
integrated management of hypertension and diabetes is being • Providing training and education to other medical professionals
implemented nationwide. This is being supplemented by and civilians on prevention techniques.
developing the DOH Hypertension and Diabetes Health Clubs in
• Develop plans to prevent patients from spreading diseases
primary health care facilities which will ensure continuity of care
throughout the hospital or other patient
and provision of NCD drugs. A registry of hypertensives and
• care facilities.
diabetics was also developed and is maintained by the
• Often acting as a coordinator or leader of an Infection
department.
Prevention and Control (IPC) Program.
3. Training on Diabetes management using Insulin for Regional
• Reinforcing the implementation of infection control practices as
Offices and LGUs
provided in the guidelines of the CDC (Center for Disease Control
4. Provision of NCD drugs through the Medicine Access Programs
and Prevention
(Breast Cancer, Childhood Cancer, Colon and Rectum Cancer,
Insulin, NCD maintenance medicines for hypertension and • Bringing rates of infection down within a facility.
diabetes) • Determining the origin of a particular pathogen by studying the
5. Training on cervical cancer screening using visual inspection makeup and composition of it.
using acetic acid (VIA) among health care workers started in 2013 • Working side by side with scientists and doctors to develop
and on going. Monitoring of trained institutions started in 2014. treatments for other infectious diseases
6. NCD indicators are integrated in existing DOH current MOST BASIC STRATEGIES RESULTING IN POSITIVE OUTCOMES:
performance reporting systems like Field Health Service • the practice and promotion of hand hygiene
Information System, Local Government Unit scorecard • consistent use of aseptic technique
7. DOH support for proposed legislative bills focusing on addressing • cleaning and disinfection practices
the harmful effects of alcohol consumption, and integrating • use of standard precautions
palliative and hospice care into the health care system • patient assessment and additional precautions
CALENDAR OF ACTIVITIES • patient education
Goiter Awareness Week World No Tobacco Day • use of safety devices
National Cancer Consciousness National No Smoking Month • removal of unnecessary invasive devices
Week Nutrition Month • use of bundle strategies for infection prevention
Philippine Heart Month Thyroid Cancer Awareness Week
International Childhood Cancer Day Obesity Awareness and Prevention
• fit for duty
Hypertension Awareness Month Week
Cervical Cancer Consciousness Breast Cancer Awareness Month
Month World Diabetes Day

11
PART 4: NURSING CARE OF CLIENTS WITH INFECTIOUS DISORDERS medications do you use? Have you taken antibiotic agents
A. Health History and Physical Assessment recently or long term?
• Are you being treated with corticosteroids, immunosuppressive
agents, or chemotherapy? Have you been treated for other
infectious diseases in the past? Have you been hospitalized for
infectious diseases? What was the immunization or
antimicrobial prophylaxis used for protection while you were
traveling? What is your occupation? What are your recreational
activities?
PHYSICAL ASSESSMENT
• Vital signs, including heart rate, respiratory rate, and blood
SAMPLE pressure, should be measured and compared with normal for
Symptoms: Patient’s chief What’s wrong? indication of underlying illness or disease
complaints What brought you to the • Careful respiratory examination should be performed,
hospital particularly in individuals with pulmonary I signs or symptoms
Allergies: Seeking to know what Are you allergic to anything? • The abdominal examination should be include careful
type of allergic reaction they What happens to you when you assessment for hepatic and splenic enlargement, conditions that
experience use something that you’re can be associated with a wide variety of conditions
allergic to? • A full lymph node exam should also be performed through
Medications: Prescribed, OTC Are you taking any palpation
drugs, herbal medicines, etc. medications? • Nutritional status is also assessed
What are you taking the B. DIAGNOSTIC TESTS
medications for? 1. COMPLETE BLOOD COUNT AND DIFFERENTIAL
When did you last take your • Series of tests used to evaluate the composition and
medications? concentration of the cellular components of the blood
Past Medical History: Have you had this problem • It measures the following:
Something to know the before? o The number of Red Blood Cells (RBCs); the number of White
previous state of health, and Do you have other medical Blood Cells (WBCs); the total amount of hemoglobin in the
previous illnesses problems? blood; the fraction of the blood composed of red blood cells
Last oral intake: Seeking what Where did you last eat or drink (hematocrit); the mean corpuscular volume (MCV) – the
are the last oral intakes of the anything? size of the red blood cells
client What was it that you last ate? CBC also includes information about the red blood cells that is
Events: Events leading up to the Injury: How did you get hurt? calculated from the other measurements:
illness of injury Illness: What led to this • MCH (mean corpuscular hemoglobin); MCHC (mean corpuscular
problem? hemoglobin concentration)
I SIGN, HYM SYMPTOMS (Signs VS Symptoms) • The platelet count is also usually included in the CBC
SIGN Purpose
• Something I can detect even if patient is conscious • As a preoperative test to ensure both adequate oxygen carrying
SYMPTOM capacity and hemostasis
• Is something only HYM knows about • To identify persons who may have an infection
Obtaining History • Identify acute and chronic illness, bleeding tendencies, and
• Current symptoms, past medical problems, medications, white blood cell disorders such as leukemia
allergies, social/family history Process
• Prior hospitalizations, episodes of severe illness, chronic • No preparation needed
conditions, previous injuries, surgeries (including dental • Blood is drawn from a vein: inside of the elbow or back of the
procedures and blood transfusions) hand
• Vaccination history • Puncture site cleaned up with antiseptic; elastic band or the
• A medication history should include nonprescription (over-the- tourniquet placed around the upper arm to cause the vein to
counter medications), as well as an inquiry about the use of swell with blood
traditional and / or herbal remedies and therapies a. White blood cell count (WBC): presence of infection
Assessing for Infectious Disease b. Differential white blood cell count: specific patterns of WBC
• Do you have a history of previous or recurrent infections? Have c. Red blood cell count (RBC): carries oxygen and carbon dioxide
you had fever? How high has your temperature been? Is your from lungs to tissue and vice versa
temperature constant, or does it rise and fall? Has fever been d. Hematocrit (Hct): measures RBC mass
associated with chills? Have you taken any medication to relieve e. Hemoglobin (Hgb): Main component of RBC
fever? f. Red blood cell indices: calculated values of size and Hgb content
• Have you taken medications that could have induced the rash? of RBCs, important in anemia evaluation
Have you been exposed to another person with an identified g. Platelet count: Necessary for clotting and control of bleeding
infectious disease or rash? What is your vaccination history? Are h. Red blood cell distribution width (RDW): indicates degree
your immunizations up to date? Have you had an insect or variability and abnormal cell size
animal bite? Have you had an animal scratch or other exposure i. Mean platelet volume (MPV): index of platelet production
to pets, darm animals, or experimental animals? What Red Blood Cells

12
• Transport oxygen from the lungs to the bodily tissues. RBCs are o Hemoglobinopathy
produced in the red bone marrow, can survive in the peripheral o Hemolytic reaction
blood for 120 days, and are removed from the blood through the o Hemorrhage
bone marrow, liver, and spleen o Hyperthyroidism
• Normal values for red blood cell count: o Leukemia
o Male adult: 4.5 to 6.2 million/mm3 o Liver cirrhosis
o Female adult: 4.5 to 5.0 million/mm3 o Malnutrition
• Indication of RBC count o Multiple myelomas
o Helps in diagnosing anemia and blood dyscrasia (pathologic o Normal pregnancy
condition of blood) o Nutritional deficiency
Hemoglobin (Hgb) o Rheumatoid arthritis
• Protein component of red blood cells that serve as a vehicle for White Blood Cells (WBC)
oxygen and carbon dioxide transport. • Act as the body’s first line of defense against foreign bodies,
• It is composed of a pigment (heme) which carries iron, and a tissues, and other substances. WBC count assesses the total
protein (globin) number of WBC in a cubic millimeter of blood. White blood cell
• Normal values chart for hemoglobin count: differential provides specific information on white blood cell
o Male adult: 14 to 16.5 g/dL types:
o Female adult: 12 to 16 g/dL o Neutrophils are the most common type of WBC and serve
• Indications of Hemoglobin count: as the primary defense against infection
o Hemoglobin count is indicated to help measure the severity o Lymphocytes play a big role in response to inflammation or
of anemia (low hemoglobin) or polycythemia (high infection
hemoglobin) o Monocytes are cells that respond to infection,
• Monitor the effectiveness of a therapeutic regimen inflammation, and foreign bodies by killing and digesting
• Increased HGB levels the foreign organism (phagocytosis)
o Chronic obstructive pulmonary disease (COPD) o Eosinophils respond during an allergic reaction and
o Congenital heart disease parasitic infections
o Dehydration o Basophils are involved during an allergic reaction,
o Hemoconcentration of the blood inflammation, and autoimmune diseases
o High altitudes o Bands are immature WBCs that are first released from the
o Polycythemia vera bone marrow into the blood
o Severe burns • Normal lab values for white blood cell count and WBC
• Decreased HGB levels differential:
o Anemia o WBC count: 4,500 to 11,000 cells/mm3
o Cancer o Neutrophils: 55 to 70% or 1,800 to 7,800 cells/mm
o Chronic hemorrhage o Lymphocytes: 20 to 40% or 1,000 to 4,800 cells/mm
o Hemolysis o Monocytes: 2 to 8% or 0.0 to 800 cells/mm
o Kidney disease (due to low Erythropoietin) o Eosinophils: 1 to 4% or 0.0 to 450 cells/mm
o Lymphoma o Bands: 0 to 2% or 0.0 to 700 cells/mm
o Neoplasia (new uncontrolled growth of cells) • Increased WBC counts (Leukocytosis)
o Nutritional deficiency o Inflammation
o Sarcoidosis o Infection
o Severe hemorrhage o Leukemic neoplasia
o Sickle cell anemia o Stress
o Splenomegaly o Tissue necrosis
o Systemic lupus erythematosus o Trauma
Hematocrit (Hct) • Decreased WBC count (Leukopenia)
• Or packed cell volume represents the percentage of the total o Autoimmune disease
blood volume that is made of the red blood cell (RBC) o Bone marrow failure
• Normal values for hematocrit count: o Bone marrow infiltration (ex: myelofibrosis)
o Male adult: 42 to 52% o Congenital marrow aplasia
o Female adult: 35 to 47% o Drug toxicity (ex: chloramphenicol)
• Increased HCT levels o Nutritional deficiency
o Burns o Severe infection
o Chronic obstructive pulmonary disease Platelets (PLT)
o Congenital heart disease • Are produced in the bone marrow and play a role in the
o Dehydration hemostasis. Platelets function in hemostatic plug formation, clot
o Eclampsia retraction, and coagulation factor activation
o Erythrocytosis • Normal values for platelet count: 150,000 to 400,000 cells/mm3
o Polycythemia vera • Increased platelet count (thrombocytosis)
o Severe dehydration o Iron deficiency anemia
• Decreased HCT levels o Malignant disorder
o Anemia o Polycythemia vera
o Bone marrow failure o Post splenectomy syndrome
o Rheumatoid arthritis
13
• Decreased platelet count (thrombocytopenia) • What does the test result mean?
o Cancer o Susceptible: likely, but not guaranteed to inhibit the
o Chemotherapy pathogenic microbe; may be an appropriate choice for the
o Disseminated intravascular coagulation treatment
o Hemolytic anemia o Intermediate: may be effective at a higher dosage, or more
o Hemorrhage frequent dosage, or effective only in the specific body sites
o Hypersplenism where the antibiotic penetrates to provide adequate
o Immune thrombocytopenia concentrations
o Infection o Resistant: not effective at inhibiting the growth of the
o Inherited thrombocytopenia disorders such as Bernard- organism in a laboratory test; may not be an appropriate
Soullier, Wiskott-Aldrich, or Zieve syndromes choice for the treatment
o Pernicious anemia • A sample culture and susceptibility testing should be collected
o Leukemia and other myelofibrosis disorders before the start of any treatment with an antimicrobial drug,
o Systemic lupus erythematosus unless the test is used to monitor the effectiveness of treatment
o Thrombotic thrombocytopenia • When to get results?
2. ERYTHROCYTE SEDIMENTATION RATE (ESR) o 24 to 48 hours for bacterial cultures; 6 to 8 weeks for fungal
• Measurement of the rate at which erythrocytes settle in a blood culture and tuberculosis
sample within one hour • Results
• Normal lab values for erythrocyte sedimentation rate: 0 to 30 o ✓ Susceptible — likely, but not guaranteed to inhibit the
mm/hour (value may vary depending on age) pathogenic microbe; may be an appropriate choice for
• Indication for Erythrocyte Sedimentation Rate: diagnosis of treatment
conditions related to acute and chronic infection, inflammation, o ✓ Intermediate — may be effective at a higher dosage, or
and tissue necrosis or infarction more frequent dosage, or effective only in specific body
• Increased ESR levels sites where the antibiotic penetrates to provide adequate
o Infection concentrations
o Rheumatoid arthritis o ✓ Resistant — not effective at inhibiting the growth of the
o Rheumatic fever organism in a laboratory test; may not be an appropriate
o Vascular disease choice for treatment
o Inflammatory bowel disease • Microbes and resistance to antimicrobial drugs
o Heart disease o the most susceptible microbes are the ones that are killed
o Kidney disease first. If treatment is stopped before all of the pathogens are
o Certain Cancers killed, the survivors may develop a resistance to that
• Decreased ESR levels particular antimicrobial drug
o Polycythemia vera o Resistance can spread when resistant microbes share their
o Sickle cell anemia genetic material with susceptible ones. This may occur
o Leukocytosis, an abnormal increase in white blood cells more frequently in a healthcare setting, where many
• Nursing Considerations patients are treated with antimicrobial drugs. For instance,
a. Explain test procedure. Slight discomfort may be felt when resistant strains of bacteria, such as methicillin resistant
the skin is punctured. Staphylococcus aureus (MRSA), have been a problem in
b. Encourage to avoid stress if possible because altered hospitals for decades and are increasingly common in the
physiologic status influences and changes normal community.
hematologic values Principles in Specimen Collection
c. Fasting is not necessary. However, fatty meals may alter 1. Contaminated and improperly collected specimens will
some test results as a result of lipidemia produce false results which will adversely affect in the
d. Apply manual pressure and dressings over the puncture site diagnosis and treatment of clients.
e. Monitor the puncture site for oozing or hematoma 2. Specimens allowed to stand at the room temperature for a
formation long time will give a false result Blood chemistry is not uniform
f. Instruct to resume normal activities and diet throughout the day, it varies with the food intake.
3. ANTIBIOTIC SUSCEPTIBILITY TESTING 3. The accuracy and reliability of findings depend upon the
• To determine the likelihood that a particular antibiotic or correct method of collection, transportation of the specimens
antifungal drug will be effective in stopping the growth the of the to the laboratory and recording of reports. Inaccurate results
bacteria or fungi causing your infection may mislead the physician in the diagnosis and treatment of
• Sample: eg. Wound, urine, blood, sputum clients
• No preparation 4. Specimens serve as a media for transmission of disease
• Susceptibility testing is performed on bacteria or fungi causing producing organisms to the personnel who handle them
an individual’s infection after they have been recovered in a carelessly.
culture of the specimen; determine potential effectiveness of C. ANALYSIS/NURSING DIAGNOSES
specific antibiotics or if bacteria developed resistance to certain 1. Risk for infection related to impaired immunity.
antibiotic 2. Risk for infection related to tissue damage.
• Helps select drug/s that is most effective for treatment 3. Risk for injury related to impaired immunity.
• When is it ordered? 4. Impaired skin integrity related to interruption of circulation
o When the culture is positive for one or more pathogens 5. Imbalanced nutrition less than body requirements related to
o When an infection does not respond to treatment poor dietary habits
14
 6. Imbalanced nutrition less than body requirements related to ✓ Drug duration. The nurse should emphasize the importance of
GI dysfunction. finishing the prescribed duration (correct number of times each
D. PLANNING FOR HEALTH PROMOTION, RESTORATION, AND day for the full number of days) of anti-infective therapy to
MAINTENANCE ensure that microbes are completely eliminated and are not
given the chance to grow and develop resistant strains.
General objective for interventions: 2. Nutrition and Diet Therapy
• Prevention of exposure to infectious organisms. ✓ Vitamin C- is an important physiological antioxidant and may
• Monitor and reduce the spread of infection. even help regenerate other antioxidants in your body.
• Maintain resistance to infection E.g. Guavas, citrus fruits. Red bell pepper, strawberries,
• Clients and families learn about infection control papaya, kale
E. IMPLEMENTATION ✓ Vitamin E – has antioxidant properties can protect your cells
1. Pharmacologic Agents (including Nursing Considerations) from oxidation and thereby contribute to preventing problems
- Anti-infective agents are drugs utilized to exert effect on from infection. This nutrient may also have an effect on
invading foreign organisms on the body, especially those which respiratory tract infections. E.g. Sunflower seeds and almonds,
can cause infection spinach, avocados, squash, olive oil
- Drug resistance remains to be the major challenge in the use of ✓ Carotenoids- include beta-carotene and lycopene, are also
anti-infectives against infections. Emergent strains are rapidly important for maintaining your immune system.
adapting to repel the effects of anti-infectives. E.g. Sweet potatoes, carrots, dark leafy greens, squash,
DRUG MECHANISM OF ACTION cantaloupe, red bell peppers
penicillins Interferes with the biosynthesis of the ✓ Zinc- is a cofactor for many enzymes required for cell
pathogen cell wall membrane repair, the production of collagen, protein
sulfonamides Inhibits invading organisms from using synthesis and cell proliferation, all of which are essential for
Antimycobacterial substances essential to their growth and tissue regeneration
Trimethoprim- development E.g. Oysters, red meat poultry, seafood, beans, nuts
sulfamethoxazole ✓ Antibacterial Herbs and Spices- contain antimicrobial and
Aminoglycosides Interferes with steps involving in protein antibacterial compounds that help fight infection.
macrolides synthesis thereby rendering cell division E.g. Ginger, Oregano, thyme, cinnamon
Chloramphenicol non-functional 3. Client Education
Fluoroquinolones Interferes with DNA synthesis leading to a. Be aware of healthcare-associated infections (HAIs).
inability to divide and ultimately, cell b. Feel empowered to speak up for their care.
death c. Know to clean their hands often.
Antifungals Alteration of cell membrane permeability d. Understand the basics of safe injection practices.
Antiprotozoals leading to leakage of essential cellular
e. Know to monitor the cleanliness of their area.
Other antibiotics components and cell death
f. Be prepared to ask questions about their medications.
RESISTANCE
g. Know how to practice good post-surgical care.
Ways that microorganisms can develop resistance:
h. Understand how to care for their devices.
✓ Enzyme production. Strains of bacteria that were once
i. Have a plan to stay up to date with their vaccinations.
susceptible to penicillin can now produce an enzyme called
j. Know that they can always ask to speak with an infection
penicillinase which inactivates penicillins before they can exert
preventionist (IP).
their effect to the bacteria.
✓ Cell membrane permeability alteration. This prevents the drug
from entering the cell. Some bacteria alter transport systems to
prevent the drug from being transported actively into the cell.
✓ Binding site alteration. Prevents the drug from being accepted
into the cell.
✓ Chemical production. Acts as antagonist to the drug.
✓ Vancomycin (Vancocin, Vancoled) is an antibiotic that interferes
with cell wall synthesis in susceptible bacteria; used for patients
who are allergic to penicillin and cephalosporins; staphylococcal
infections resistant to penicillins and/or cephalosporins. It is
highly-toxic that it is reserved only for certain situations as it can
cause renal failure, ototoxicity, superinfections, and red man
syndrome (sudden and severe hypotension, fever, chills,
paresthesia, and erythema or redness of the neck and back).
Prevention of Resistance
✓ Drug dosing. The nurse may collaborate with the physician for
around-the-clock dosing to eliminate the peaks and valleys in
drug concentration. This also helps maintain a constant
therapeutic level to prevent the emergence of resistant
microbes during times of low concentration.
15
PART 5: INFECTIOUS DISORDERS • between the third and fifth symptomatic day:
1. EBOLA o the patient often develops severe diarrhea, abdominal
• deadly disease which most commonly affects people and pain, and vomiting
nonhuman primates (such as monkeys, gorillas, and o great risk of severe dehydration (over 5L of liquid stool per
chimpanzees) day)
• genus Ebolavirus (e.g.: Ebola, Sudan, Tai Forest, and Bundibugyo o This stage can persist for a week or more, and many
viruses) patients develop hemodynamic shock because of severe
• was first discovered in 1976 near the Ebola River in what is now dehydration
the Democratic Republic of Congo. o may show increasing neurologic symptoms such as
• incubation period (from exposure to first symptoms): 2 to 21 confusion, agitation, delirium, or encephalitis
days o 5% will develop bleeding or hemorrhage, a very poor
• If there are no symptoms by 21 days after exposure, there is prognostic indicator
essentially no risk of developing Ebola. Patients are not Assessment and Diagnostic Findings
contagious to others before symptoms occur. • “dry” symptoms initially (such as fever, aches and pains, and
• Scientists do not know where Ebola virus comes from. Based on fatigue), and “wet” symptoms (such as diarrhea and vomiting0
similar viruses, they believe EVD is animal-borne, with bats or as the person becomes sicker
nonhuman primates being the most likely source. Infected • combination of symptoms suggestive of EVD and a possible
animals carrying the virus can transmit it to other animals, like exposure to EVD within 21 days before the onset of symptoms
apes, monkeys, duikers and humans. • Blood samples from the patient should be collected and tested
to confirm infection (only detected in blood after the patient
becomes symptomatic and viral levels rise significantly as the
disease progresses)
• Polymerase chain reaction (PCR)
• is once of the most commonly used diagnostic methods
• can detect the presence of a few virus particles in small amounts
of blood
• the ability to detect the virus increases a s the amount of virus
increases during an active infection
• When the virus is no longer present in great enough numbers in
a patient’s blood, PCR methods will no longer be effective.

Medical Management
• is largely supportive maintenance of the circulatory system and
respiratory systems
• providing fluids and electrolytes through infusion intravenously
• mode of transmission: direct contact • offering oxygen therapy to maintain oxygen status
• It is NOT spread through an air, water, or insect bite. • using medication to support blood pressure, reduce vomiting
• blood or body fluids ((urine, vomit, feces, saliva, sweat, semen, and diarrhea and to manage fever and pain
and breast milk) from infected person • antiviral drugs regeneron (REGN-Eb3) and mAb114 currently
• objects (such as clothes, bedding, needles, and medical remain in use for patients with confirmed Ebola
equipment) • December 19, 2019 - The U.S. Food and Drug Administration
• infected fruit bats or nonhuman primates (such as apes and (FDA) approved the Ebola vaccine rVSVΔG-ZEBOV-GP Ebola
monkeys) vaccine (tradename “Ervebo”). This is a single dose vaccine
• semen from a man who recovered from EVD (through oral, regimen that has been found to be safe and protective against
vaginal, or anal sex) only the Zaire ebolavirus species of Ebola virus. this is the first
Pathophysiology FDA approval of a vaccine for Ebola.
a) Ebola virus enters the patient and infects many cell types • Another investigational vaccine was developed and introduces
including monocytes, macrophages, dendritic cells, endothelial under a research protocol in 2019 to combat an Ebola outbreak
cells, fibroblasts, hepatocytes, adrenal cortical cells, and in the Democratic Republic of Congo. This vaccine requires two
epithelial cells doses with an initial dose followed by a second “booster” dose
b) Ebola virus migrates from the initial infection site to regional 56 days later. The second vaccine is also designed to protect
lymph nodes and subsequently to the liver, spleen, and adrenal against only the Zaire ebolavirus species of Ebola.
gland Nursing Management
c) Hepatocellular necrosis occurs and is associated with • Supportive care for a patient with such a devastating disease
dysregulation of clotting factors and subsequent coagulopathy. requires psychological support for the patient and family.
d) Adrenocortical necrosis also can be found and is associated with • Patients must be promptly isolated in a private room
hypotension and impaired steroid synthesis • observe standard and transmission-based protocols
e) Ebola virus appears to trigger a release of pro-inflammatory • health care workers should correctly wear complete PPE.
cytokines with subsequent vascular leak and impairment clotting • Equipment used for the patient with
ultimately resulting in multiorgan failure and shock • Ebola virus should be used solely for that patient and should be
Clinical Manifestations disposed after use. If equipment must be reused, it should be
• the initial clinical manifestations include high fever, muscle sterilized or scrupulously cleaned with a bleach-based solution
aches, and fatigue before reuse.
16
• Visitors should be restricted. Exceptions may be considered on decrease amount of lymphocytes which are B cells, T cells, and
an individual basis, and then visitors should be trained and a natural killer cells in the blood; during an infection your WBC
logbook kept of all who enter the room attack and attach to induce production and secretion of
2. CORONAVIRSUSES chemicals that would help fight the virus)
• Numerous coronaviruses, first discovered in domestic poultry in Clinical Manifestations
the 1930s, cause respiratory, gastrointestinal, liver, and • flu-like symptoms, including fever, chills, rhinorrhea, mostly
neurologic diseases in animals. Only 7 coronaviruses are known clear pulmonary findings, including hypoxemia, ronchi, and rales
to cause diseases in humans (some patients may have a normal auscultation), tachycardia,
• Four of the 7 coronaviruses most frequently cause symptoms of cough, SOB
the common cold • hypotension may occur with severe illness, reflecting systemic
• Coronaviruses that cause severe respiratory infection are inflammatory response syndrome
zoonotic pathogens, meaning they begin in animals and are • diarrhea and nausea/vomiting
transmitted between animals and people (e.g. SARS-CoV-2 • more severe complications followed, such as pneumonia and
which has a significant person-person transmission) kidney failure
• Three of the 7 coronaviruses cause much more severe, and • most of the people who died had a pre-existing medical
sometimes fatal, respiratory infection in humans than other condition that weakened their immune system
coronaviruses and have caused major outbreaks of deadly • some infected people had mild symptoms (such as cold-like
pneumonia in the 21st century symptoms) or no symptoms at all
a. SARS-Cov was identified in 2003 as the cause of an outbreak Assessment and Diagnostic Findings
of severe acute respiratory syndrome (SARS) that began in a) rRt-PCR assay - FDA issued an Emergency Use Authorization
China near the end of 2002 (EUA) on June 5, 2013, to authorize use of CDC’s 2012 real-time
b. MERS-CoV was identified in 2012 as the cause of the Middle reverse transcription–PCR assay to test for MERS-CoV in clinical
East respiratory syndrome (MERS) respiratory, serum, and stool specimens.
c. SARS-CoV-2 is a novel coronavirus identified as the cause of b) Serology – Serologic testing for MERS-CoV is available as a
coronavirus disease 2019 (COVID-19) that began in Wuhan, research/surveillance test from the CDC; it is not considered a
China in late 2019 and spread worldwide diagnostic test but may offer valuable epidemiologic data
c) Laboratory studies – Laboratory findings at presentation may
Middle East Respiratory Syndrome (MERS) include leukopenia, lymphopenia, thrombocytopenia, and
• MERS is an illness caused by a virus (a coronavirus) called Middle elevated lactate dehydrogenase levels; these are most likely with
East Respiratory Syndrome Coronavirus (MERS-CoV) increasing severity of illness
• The origins of the virus are not fully understood but, according d) Imaging studies – Chest imaging findings are abnormal in more
to the analysis of different virus genomes, it is believed that it than 80% of MERS cases
may have originated in bats and was transmitted to camels Medical Management
sometime in the distant past. • there is no specific antiviral treatment recommended for MERS-
• Most MERS patients developed severe respiratory illness with CoV infection
symptoms of fever, cough and shortness of breath. About 3 or 4 • supportive: this include hydration, antipyretic, analgesics,
out of every 10 patients reported with MERS have died respiratory support, and antibiotics if needed for bacterial
• Through first reported in Saudi Arabia, it was later discovered superinfection
that the first known case of MERS occurred in Jordan in April • Acetaminophen or a nonsteroidal anti-inflammatory drug
2012 (NSAID) such as ibuprofen are given to relieve fever and muscle
• A large MERS outbreak occurred in the Republic of South Korea aches
linked to a traveler form the Arabian Peninsula in 2015 • the patient should be placed in an airborne infection isolation
Transmission room
• like other coronaviruses, likely spreads from an infected person’s • for severe cases, current treatment includes care to support vital
respiratory secretions, such as through coughing. However, we organ functions
don’t fully understand the precise ways that it spreads. MERS- Prevention
CoV has spread from ill people to others through close contact, • Handwashing
such as caring for or living with an infected person. • Cover your nose and mouth with a tissue when you cough or
• The symptoms of MERS start to appear about 5 or 6 days after a sneeze, with proper disposal of tissue
person is exposed, but can range from 2 to 14 days. • Avoid touching your eyes, nose, and mouth with unwashed
Pathophysiology hands.
• Compared with severe acute respiratory syndrome coronavirus • Avoid personal contact, such as kissing, or sharing cups or eating
(SARS-Cov), MERS-CoV can establish infection in monocyte- utensils, with sick people.
derived macrophages (MDMs) and macrophages. • Clean and disinfect frequently touched surfaces and objects,
• The virus induces release of proinflammatory cytokines, leading such as doorknobs.
to severe inflammation and tissue damage, which may manifest • Avoid touching animals when travelling
clinically as severe pneumonia and respiratory failure. Treatment
• Vascular endothelial cells located in the pulmonary interstitium • There is no specific antiviral treatment recommended for MERS-
may also be infected by MERS-CoV, and, because MERS-CoV CoV infection. Individuals with MERS often receive medical care
receptor DPP4 is expressed in different human cells and tissues, to help relieve symptoms
dissemination of the infection may occur • No MERS-CoV vaccine is commercially available
• lymphopenia has been noted in most patients infected with • Clinical trials are needed to establish any benefit from ribavirin
MERS-CoV, as was noted in SARS infections. (lymphopenia- and/or interferon alfa
17
Nursing Management likely when people are in close contact with one another (within
• History – keys to the case definition of MERS is a history of about 6 feet).
residence or travel in the Arabian Peninsula, in countries where • it may be possible to get COVID-19 by touching a surface or
MERS-CoV is known to be circulating in dromedary camels, or object that has the virus on it and then touching one’s own
where human infections have recently occurred and exposure mouth, nose, or eyes
within the incubation period of 14 days. Transmission
• monitor the patient’s temperature and respiratory rate
• there are procedures that can aerosolize the virus resulting in
• include the patient and family in creating the teaching plan,
airborne transmission of the virus. These procedures include, but
beginning with establishing objectives and goals for learning at
are not limited to positive pressure ventilation, endotracheal
the beginning of the session
• Ensure patent airway (proper breathing and coughing, place intubation or extubation, bronchoscopy, airway suction,
patient in upright position when tolerated) ventilator care, tracheostomy care, Chest PT, nebulizer
• Patients may require nebulized medications and sometimes treatment, and sputum induction.
intubation (since virus may become airborne for sometime in the • can be transmitted by people before they exhibit symptoms and
environment) even by people who are infected but never develop symptoms
• To avoid further transmission, patients should be in negative
pressure environments during nebulization and intubation
• for nausea and diarrhea – infectious waste and laundry must be
handled in a way to avoid further infections
• Dehydration, diarrhea, the need for isolation and immobility due
to general weakness all contribute to the patient’s increased risk
of developing wounds. Nurses increased their vigilance for
wound prevention and care during the epidemic
• Reduce increase in temperature. Adjust and monitor
environmental factors like room temperature and bed linens as
indicated; encourage ample fluid intake by mouth; eliminates
excess clothing and covers, and give antipyretic medications as
prescribed.
• Encourage patient to increase fluid intake to 3 liters per day Prevention
within the limits of cardiac reserve and renal function
• handwashing, alcohol/sanitizers
• Reduce patient anxiety
• cough and sneeze into the elbow
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 ) • dispose of used tissues immediately
• is a disease caused by a new strain of coronavirus called Severe • social distancing (at least 1 meter)
Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 ) • avoid crowds and public gatherings
• was first reported in late 2019 in Wuhan, China and has since • avoid touching your face
spread extensively worldwide • clean all shared surfaces frequently
• has an incubation period that ranges 2-14days, with symptoms • avoid all nonessential travel
appearing on average around day 5 following exposure • call ahead before going to a clinic or hospital
• SARS-CoV-2 virus primarily affects the respiratory system, • isolate yourself if sick or at risk of complications
although other organ systems are also involved • work from home if possible
• The risk of serious disease and death in people with COVID-19 • wear a mask if you are sick, have COVID-19, or are caring for
increases with age and in people with other serious medical someone with it
disorders, such as heart, lung, kidney, or liver disease, diabetes, • People with COVID-19 should receive supportive care to relieve
obesity, or immunocompromising disorders symptoms. For severe cases, treatment should include to
Causes support the vital organ functions
• they get their name, “corona,” from the many crown-like spikes Epidemiology
on the surface of the virus. • Following the outbreak in China, SARS-CoV-2 has spread
• there are four main sub-grouping of coronaviruses, known as worldwide. As of early April 2020, the reported numbers of
alpha, beta, gamma, and delta COVID19 patients is highest in the US followed by Spain, Italy,
• Human coronaviruses were first identified in the mid-1960s Germany, France, and China
• the seven coronaviruses that can infect people are 229E (alpha • more men than women suffered from severe disease and died
coronavirus), NL63 (alpha coronavirus), OC43 (beta coronavirus), (more women were linked with using hygienic practices more
HKUI (beta coronavirus) often than men)
• Other human coronaviruses are MERS-CoV, SARS-CoV, and • The situation in the Philippines has also rapidly evolved, with a
COVID-19 single case identified last January 30, 2020, to over 200 cases by
Transmission March 16, 2020. Sustained community transmission led to the
• spread mainly from person to person via respiratory droplets implementation of intensified quarantine measures in March
produced when an infected person coughs, sneezes, or talks. 2020. Cases plateaued in May which led to the relaxation of
These droplets can land in the mouths or noses of people who quarantine measures. however, by mid-June, there has been a
are nearby or possibly be inhaled into the lungs. Spread is more resurgence of cases within the National Capital Region and in
18
 Cebu. As of July 2020, the country has more than 60,000 decisions (i.e., duration of isolation, clearance for work,
reported cases with more than 1,000 deaths. clearance for medical or surgical procedures)
Clinical Manifestations COVID-19 Molecular Diagnostic Test through RT-PCR
• respiratory symptoms of COVID-19 are extremely heterogenous, • To increase likelihood of detection, CDC recommends collection
ranging from minimal symptoms to significant hypoxia with of 3 specimen types: lower respiratory, upper respiratory, serum
ARDS specimens for testing
• The most common are fever, dry, cough, and fatigue
Other symptoms:
• SOB or difficulty breathing
• muscle or body aches
• headaches
• new loss of taste or smell
• sore throat
• congestion or runny nose
• nausea or vomiting
• diarrhea
• discoloration of fingers or toes
Emergency warning signs:
• difficulty breathing
• persistent pain or pressure in the chest
• new confusion
• inability to wake or stay awake
• bluish lips or face
Other serious complication include:
• heart disorders including arrhythmias, heart muscle disorders,
and acute heart injury
• coagulation disorders including blood clots in small and large
blood vessels and well as bleeding
Assessment and Diagnostic Findings
• Travel history. Health care providers should obtain a detailed
travel history for patients being evaluated with fever and acute
respiratory illness
• Physical examination. Patients who have fever, cough, and SOB
and who has traveled to Wuhan, China recently must be placed
under isolation immediately
A. Real-time reverse transcription-polymerase chain reaction (RT-
PCR) assay
• currently recommended test to confirm COVID-19 infection
which detects viral RNA
• using this assay, SARS CoV-2 can be detected in nasal or
pharyngeal samples (most common), sputum, bronchoalveolar B. Rapid Diagnostic Tests Based on Antigen Detection
lavage fluid, and other bodily fluids, including feces and blood • Rapid antigen test detects the presence of viral proteins
• False negative results of RT-PCR assays may be due to (antigens) expressed by the COVID-19 virus in a sample form the
inadequate sample and inappropriate timing of ample collection respiratory tract of a person
in relation to symptom onset • If the target antigen is present in sufficient concentrations in the
• All symptomatic individuals suspected of having COVID-19 sample, it will bind to specific antibodies fixed to a paper strip
patients should undergo SARS CoV-2 RT-PCR assay testing to enclosed in a plastic casing and generate a visually detectable
diagnose COVID-19 infection signal, typically within 30 minutes
• Nasopharyngeal specimens rather than oropharyngeal or saliva • The antigen(s) detected are expressed only when the virus is
specimens are preferred for swab-based SARS-CoV-2 testing. actively replicating: therefore, such tests are best used to
• Specimens from sputum, endotracheal aspirates, and identify acute or early infection
bronchoalveolar lavage among hospitalized patients may also be • However, several factors affect the performance of the test
sent directly to the microbiology laboratory for processing including:
• The qualitative reporting of results of SARS-CoV-2 RT-PCR as o time from onset of illness
positive or negative is sufficient for DIAGNOSIS but may be o the concentration of virus in the specimen
supplemented by a CYCLE THRESHOLD report, a semi- o the quality of the specimen collected from a person and
quantitative value, correlated with timing of symptom onset to how it is processed
guide infection control, public health and occupational health o the precise formulation of the reagents in the test kits

19
• base on antigen-based RDTs for other respiratory diseases such • Sputum, endotracheal aspirate (ETA), or bronchoalveolar lavage
as influenza, the sensitivity of these tests might be expected to fluid culture and sensitivity
vary from 34 % to 80% • Chest x-ray
Recommendations: • High resolution chest CT scan plain
• Rapid antigen tests can potentially be used as an alternative to • ECG
RT-PCR assay for the diagnosis of COVID-19 among symptomatic Medical Management
patients during the first week of illness a) Supportive care
• these include antipyretics for fever; oral fluids for hydration,
• Negative results form an antigen test should be confirmed with
isolation at home or in temporary treatment and monitoring
an RT-PCR test prior to making treatment decisions to prevent
facilities
undue transmission. Results should always be correlated with • Routine antibiotics and routine anti-influenza drugs are NOT
clinical and epidemiologic parameters. recommended for mild COVID-19 disease.
Drugs with anti-SARS CoV-2 activity:
C. Rapid Tests Based on Antibody Production a) Remdesivir
• aka Serology testing • binds to the viral RNA-dependent RNA polymerase, inhibiting
• detects past and current infection of COVID-19 viral replication through premature termination of RNA
• Blood sample by a finger prick or drawing blood from the arm transcription
• Lack of evidence if you are protected from antibodies against • FDA emergency use authorization in hospitalized pediatric
reinfection with COVID-19 patients weighing 3.5kg to less than 40kg and 12 y/o above
• Timing and type of antibody affects accuracy • This drug should be administered in the hospital or healthcare
setting that can provide similar level of care to an in-patient
• Provides qualitative detection of IgG and/or IgM from human
hospital
serum
• Remdesivir has been studied in several clinical trials for the
• When foreign body (antigen) enters the body, our body will fight treatment of COVID-19. The recommendations from the COVID-
against it through our antibodies or immunoglobulins. This test 19 Treatment Guideline Panel (the Panel) are based on the
will determine if there is a recent or previous infection because results of these studies.
of the presence of IgM and/or IgG • Adverse effects: GI symptoms, elevated transaminase levels,
o IgM- & IgG- = no infection increase prothrombin time (PT), hypersensitivity reactions
o IgM+ & IgG- = RECENT infection • Liver function tests and prothrombin time should be obtained in
o IgM- & IgG+ = PREVIOUS infection all patients before remdesivir is administered and during
o IgM+ & IgG+ = RECENT infection treatment as clinically indicated.
• Remdesivir may need to be discontinued if alanine transaminase
(ALT) levels increase to >10 times the upper limit of normal and
should be discontinued if an increase in ALT level and signs or
symptoms of liver inflammation are observed.
• not recommended for patients with impaired renal function
• Drug-drug interaction: may decrease antiviral activity when
given with hydrochloroquine; coadministration of these drugs is
not recommended.
Recommendations: b) Chloroquine or Hydroxychloroquine
• Rapid point-of-care lateral flow immunoassay antibody tests are • CQ is used mainly as an anti-malarial agent that (developed in
not recommended as stand-alone tests for the diagnosis of 1934), while HCQ (analogue of chloroquine, was developed in
COVID-19. These tests are also not recommended for mass 1946) is used for autoimmune diseases such as systemic lupus
testing and clearance for work of asymptomatic people due to erythematosus (SLE) and rheumatoid arthritis
• CQ and HCQ appear to block viral entry and transport of SARS-
its low sensitivity and high false negative rates
CoV-2 into cells, possibly preventing the release of the viral
• Laboratory based immunoassays such as chemiluminescence
genome
assay (CLIA) and enzyme-linked immunosorbent assay (ELISA)
• Both chloroquine and hydroxychloroquine also have
are the preferred tests for antibody determination. This is best immunomodulatory effects, which have been hypothesized to
done on the third week onwards form the onset of symptoms. be another potential mechanism of action for the treatment of
COVID-19.
D. Ancillary Tests • the clinical safety profile of hydroxychloroquine is better than
The following diagnostics are recommended when COVID-19 is that of chloroquine during long term use, allows higher daily doe
suspected to guide management: and has fewer side effects
• Complete Blood Count (CBC) • Chloroquine and hydroxychloroquine have similar toxicity
• Metabolic panel: creatinine, LFTs, sodium, potassium, profiles, although hydroxychloroquine is better tolerated and
magnesium, calcium, albumin has a lower incidence of toxicity than chloroquine.
• Inflammatory markers: lactate dehydrogenase (LDH), Ferritin, C- Recommendations:
reactive protein (CRP), and procalcitonin • CQ or HCQ or in combination with a macrolide (e.g.,
• Prothrombin and D-Dimer azithromycin) or an antiviral agent (lopinavir-ritonavir,
• Arterial blood gas (ABG) measurement favipiravir) is NOT recommended for hospitalized patients with
• Blood cultures if contaminant bacterial infection is suspected probable or confirmed COVID-19 pneumonia
• Respiratory tract specimen for influenza testing
20
• CQ or HCQ is NOT recommended for outpatients with early or
mild COVID-19 disease except in the context of a clinical trial
• CQ or HCQ is NOT recommended for prophylaxis or prevention
of COVID-19 except in the context of a clinical trial (strong c) Convalescent Plasma (CP)
recommendation, low quality of evidence) - refers to the administration
• Adverse effects: Cardiac adverse events include: QTc of antibodies against SARS-
prolongation, Torsades de Pointes, ventricular arrythmia, and CoV-2 with the use of
cardiac deaths. plasma from recovered
c) Azithromycin COVID-19 patients
• antiviral and anti-inflammatory properties - It is a means of antibody
• when in combination with hydrochloroquine= synergistic effect transfer to provide passive
on SARS-CoV-2 in vitro and molecular modeling studies immunity until the
• neither HCQ + azithromycin nor HCQ alone can reduce upper and individual can develop an active immune response, with the
lower RT viral overloads hope that clinical outcomes can be improved in the recipient
• Adverse effects: QTc prolongation and cardiac adverse events - This mode of passive antibody therapy had been previously used
(higher risk in combination with HCQ) to provide immediate immunity to susceptible individuals
Recommendations: against pandemic viruses such as SARS, MERS, A(H1N1) influenza
• Azithromycin + HCQ is NOT recommended for COVID-19 and Ebola
d) Favipiravir - There is insufficient evidence to support the routine use of
• selectively inhibits the RNA-dependent RNA polymerase, halting convalescent plasma for critically ill COVID19 patients except in
viral replication the context of a clinical trial or for compassionate use
d) Intravenous Immunoglobulin G
• There is insufficient evidence to recommend the routine use of
- is a mixture of polyclonal immunoglobulin and proteins pooled
favipiravir in the treatment of COVID-19 except in the context of
from healthy donors
a clinical trial or for compassionate use among patients with
- Its mechanism of action is twofold – one, as a neutralizing
moderate COVID19 disease
antibody and second as an anti-inflammatory or
immunomodulator of the cytokine response
Immunomodulating Agents
- There is insufficient evidence to support the use of intravenous
a) Corticosteroid Therapy (Dexamethatsone)
immunoglobulin (IVIg) for the management of COVID-19 among
• Corticosteroids inhibit multiple inflammatory cytokines
severe hospitalized patients except in the context of a clinical
resulting in decreased edema, capillary leakage, and migration
trial
of inflammatory cells, thereby globally suppressing the
e) Hemoperfusion
inflammatory response
- Cytokine release syndrome is prevalent in severe cases of COVID-
• is recommended as adjunctive treatment for COVID-19 patients
19. Hemoperfusion devices or extracorporeal blood purification
requiring oxygen support and for patients on mechanical
has been proven to effectively remove the released
ventilation
inflammatory cytokines
- There is insufficient evidence to support the routine use of
Recommendations:
hemoperfusion as adjunctive management for severe COVID-19
• Corticosteroid therapy (dexamethasone) is not recommended
patients suspected to have cytokine storm except for
for COVID-19 patients who do not require oxygen support (mild
compassionate use.
to moderate disease severity). [Strong recommendation,
moderate quality of evidence]
Adjunctive Therapy
• Inhaled steroids are NOT recommended for the treatment of a) Vitamin C and Zinc
COVID-19 pending the results of ongoing studies. - Vitamin C is a water-soluble vitamin with antioxidant properties.
• Oral, inhaled or IV steroids are NOT recommended for In in –animal studies, it is thought to attenuate organ induced
prophylaxis or prevention of COVID-19 injury. Zinc is an essential mineral used to boost the immune
b) Tocilizumab system
• Interlukin-6 (IL-6) receptor inhibitor - There is insufficient evidence to support the use of vitamin C and
• used alone ore in combination with corticosteroids, or other zinc as adjunctive treatment for COVID19.
medications Vaccination
• Rheumatoid arthritis (attacks own joints causing pain, swelling - As of December 2020, there are over 200 vaccine candidates for
loss of function), giant cell arthritis (swelling of blood vessel COVID-19 being developed. Of these, at least 52 candidates are
especially at scalp and head esp. adults), systemic sclerosis- in human trials (only 1 out 5 is successful)
associated interstitial lung disease - The more vaccine in development the better the chances of a
• Polyarticular juvenile idiopathic arthritis & Systemic JIA successful vaccine
(childhood arthritis that affects 5 or more joints during first 6 3 main approaches to making a
months of the condition causing pain, swelling loss of function of vaccine:
children 2 y/o or older) 1. Using a whole virus or
• Cytokine release syndrome (severe over-reactive immune bacterium
system on adults or children 2yrs above) 2. Parts that trigger the
• Side effects: headache, runny nose or sneezing, redness, itching, immune system
rash flushing, difficulty breathing and swallowing, fever, yellow 3. Just the material
eyes or skin The Whole-microbe approach:
- Inactivated vaccine
21
- Live attenuated vaccine
- Viral vector vaccine
a) Inactivated vaccine
- The first way to make a vaccine is to take the disease-carrying
virus or bacterium, or one very similar to it, and inactivate or kill
it using chemicals, heat or radiation.
- This approach uses technology that’s been proven to work in
people – this is the way the flu and polio vaccines are made –
and vaccines can be manufactured on a reasonable scale.
- However, it requires special laboratory facilities to grow the virus
or bacterium safely, can have a relatively long production time,
and will likely require two or three doses to be administered.
The subunit approach
- A subunit vaccine is one that only uses the
very specific parts (the subunits) of a virus
or bacterium that the immune system
needs to recognize. It doesn't contain the
whole microbe or use a safe virus as a
vector. The subunits may be proteins or
sugars. Most of the vaccines on the
childhood schedule are subunit vaccines,
protecting people from diseases such as whooping cough,
tetanus, diphtheria and meningococcal meningitis.
- E.x. Novavax
b) Attenuated vaccine
The genetic approach (nucleic acid vaccine)
- A live-attenuated vaccine uses a living but weakened version of
- Unlike vaccine approaches that use either a weakened or dead
the virus or one that’s very similar. The measles, mumps and
whole microbe or parts of one, a nucleic acid vaccine just uses a
rubella (MMR) vaccine and the chickenpox and shingles vaccine
section of genetic material that provides the instructions for
are examples of this type of vaccine.
specific proteins, not the whole microbe. DNA and RNA are the
- This approach uses similar technology to the inactivated vaccine
instructions our cells use to make proteins. In our cells, DNA is
and can be manufactured at scale. However, vaccines like this
first turned into messenger RNA, which is then used as the
may not be suitable for people with compromised immune
blueprint to make specific proteins.
systems.
- A nucleic acid vaccine delivers a specific set of instructions to our
cells, either as DNA or mRNA, for them to make the specific
protein that we want our immune system to recognize and
respond to.
- The nucleic acid approach is a new way of developing vaccines.
Before the COVID-19 pandemic, none had yet been through the
full approvals process for use in humans, though some DNA
vaccines, including for particular cancers, were undergoing
human trials. Because of the pandemic, research in this area has
progressed very fast and some mRNA vaccines for COVID-19 are
getting emergency use authorization, which means they can now
be given to people beyond using them only in clinical trials.
- E.x. Pfizer-BioNtech and the Moderna
c) Viral Vector vaccine
- This type of vaccine uses a safe virus to deliver specific sub-parts
– called proteins – of the germ of interest so that it can trigger
an immune response without causing disease.
- To do this, the instructions for making particular parts of the
pathogen of interest are inserted into a safe virus. The safe virus
then serves as a platform or vector to deliver the protein into the
body.
- The protein triggers the immune response. The Ebola vaccine is
a viral vector vaccine and this type can be developed rapidly.

22
 - Avoid touching N95 respirator, facemask, eye goggles, and face
shield if wearing during extended use.
- Wash hands before donning all PPE. When doffing PPE, wash
hands before doffing your goggles, N95 respirator, and face
shield, and again after all PPE is doffed
- Doff PPE before breaking for meals and taking trips to the rest
room.
- Eat meals in non-clinical areas.
- Disinfect cell phone frequently, and place cellphone in a clear
sealable bag that serves as a barrier, discard the bag before going
home, disinfect the cell phone before entering home
- Change scrubs and shoes if possible before returning home
Evaluation
Nursing Diagnosis: Nursing goals are met as evidenced by:
Based on the assessment data, the major nursing diagnosis for a - The patient successfully prevented the spread of infection to
patient with covid-19 are: family, the community, or to healthcare staff
- Infection related to failure to avoid pathogen secondary to - The patient learned more about COVID-19 and its management
exposure to COVID-19. - The patient had improved body temperature levels
- Deficient Knowledge related to unfamiliarity with disease - Restoration to normal breathing patterns
transmission information. - Reduced anxiety
- Hyperthermia related to increase in metabolic rate. Documentation Guidelines:
- Impaired breathing pattern related to shortness of breath. Documentation guidelines for COVID-19 patients include:
- Anxiety related to unknown etiology of the disease. - Individual findings, including any external factors affecting the
Nursing Care Planning and Goals: patient’s illness, interactions, nature of social exchanges, and
The following are the major nursing care planning goals for COVID-19: specifics patient behaviors
- Prevent the spread of infection - Cultural and religious beliefs expressed by the patient
- Learn more about the disease and its management - Patient expectations
- Improve body temperature levels - Care plan
- Restore breathing pattern back to normal - Teaching plan
- Reduce anxiety - Responses to nursing interventions, education, and
Nursing Management: information, and nursing actions performed
- Follow established occupational safety and health procedures, - Attainment of, or progress toward, the desired clinical outcome
avoid exposing others to health and safety risks and participate and fulfillment of patient expectation.
in employer-provided occupational safety and health training
- Use provided protocols to assess, triage and treat patients 2. HEPATITIS
- Treat patients with respect, compassion, and dignity Refers to an inflammatory condition of the liver. It’s commonly
- Maintain patient confidentiality caused by a viral infection, but there are other possible causes of
- Swiftly follow established public health reporting procedures of hepatitis. These include non-viral hepatitis that occurs as a secondary
suspected and confirmed cases result of mediations, drugs, toxins and alcohol.
- Self-monitor for signs of illness and self-isolate or report the Liver is located in the right upper area of the abdomen.
illness to managers, if it occurs Functions of liver:
- Advise management if you are experiencing signs of undue stress • bile production, which is essential to digestion
or mental health challenges that require support interventions • filtering of toxins from your body
- Monitor the patient’s temperature; and monitor the respiratory • excretion of bilirubin (a product of broken-down red blood cells),
rate of the patient as shortness of breath is another common cholesterol, hormones, and drugs
symptom. • breakdown of carbohydrates, fats, and proteins
- Monitor the patient’s O2 saturation because respiratory • activation of enzymes, which are specialized proteins essential
compromise results in hypoxia. to body functions
- Maintain respiratory isolation. Keep tissues at the patient’s • storage of glycogen (a form of sugar), menials and vitamins (A, D
bedside; dispose secretions properly; intsruct the patient to E, and K)
cover mouth when coughing or sneezing; use masks, and advise • synthesis of blood proteins, such as albumin
those entering the room to wear masks as well; place respiratory • synthesis of clotting factors
stickers on chart, linens, and so on. How is Hepatitis is Diagnosed?
- Enforce strict hand hygiene. Teach the patient and folks to wash • HISTORY AND PHYSICAL EXAM - Determine risk factors
hands after coughing to reduce or prevent the transmission of (infectious or noninfectious hepatitis): palpation of abdomen for
the virus. pain and tenderness (enlarged liver), eyes and skin are yellow
- Manage hyperthermia. Use appropriate therapy for elevated • LIVER FUNCTION TESTS and Other blood tests – use of blood
temperature to maintain normothermia and reduce metabolic samples to determine how efficiently the liver works. Abnormal
needs. results of this test may be the first indication that there is a
- Educate the patient and family. Provide information on disease problem especially if you don’t show any signs on the physical
transmission, diagnostic testing, disease process, complications, exam of liver disease; presence of high liver enzymes levels may
and protection from the virus indicate that the liver is stressed, damaged or not functioning
- Adhere to the standards for donning and doffing PPE when properly; check for virus that cause hepatitis
caring for COVID-19 patients.
23
• HEPATITIS TESTING – for specific hepatitis virus markers to • Anorexia – early symptom (often severe). Results from the
determine type of hepatitis such as Radioimmunoassay, enzyme release of a toxin by the damaged liver or from failure of the
linked immunosorbent assay (ELISA), and microparticle enzyme damaged liver cells to detoxify an abnormal product
immunoassay • Jaundice and dark urine (later signs) may become apparent
o Can check the viruses that causes hepatitis. Can also • Indigestion is also present in varying degrees – mark by vague
be used to check for antibodies that are common in epigastric distress, nausea, heartburn and flatulence. Also, the
conditions like autoimmune hepatitis. patient may develop a strong aversion to the taste of cigarettes
• ABDOMINAL UNLTRASOUND – allows to view liver and nearby or the presence of cigarette smoke and other strong odors
organs that may reveal fluid in abdomen, liver • Jaundice – tend to clear as soon as the jaundice reaches its peak
damage/enlargement; liver tumors or abnormalities of perhaps 10 days after its initial appearance
gallbladder. And sometimes the pancreas would also show up in o Symptoms may be mild in children and in adult they
the ultrasound images as well. may be more severe, and the course of the disease
o This uses ultrasound waves to create an image of the may be prolonged.
organs within your abdomen. Assessment and Diagnostic Findings
• LIVER BIOPSY – invasive procedure from the liver and can be • Enlarged liver and spleen few days after onset
done through the skin with a needle and does not require • HAV antigen – present in stool 7-10 days before illness and 2-3
surgery. Typically, it guides the doctor when taking the biopsy weeks after symptoms appear
sample; sample tissue of liver through needle, determine • Antibodies are detectable in the serum although usually not until
infection and inflammation; areas of liver that appear abnormal the symptoms appear
VIRAL HEPATITIS • Analysis of subclasses of immunoglobulins can help determine
• Systematic viral infection in which necrosis and inflammation of whether antibody is acute or past infection
the liver cells produce a characteristic cluster of clinical, Prevention
biochemical and cellular changes. • Encourage patients and the family to follow genre precautions
• 5 types that causes liver disease: Hepatitis A, B, C, D, and E that would prevent the transmission of the virus. Teach them:
• Hep. A and E (fecal-oral route) • Scrupulous hand hygiene, safe water supplies, and proper
o Similar in mode of transmission control of sewage disposal are just a few of these prevention
• Hep. B, C and D – share many other characteristics strategies
Hepatitis is easily transmitted and cause high morbidity and • Recommended two-dose vaccine: be given to adults >18 years
prolonged time from school or employment old, 2nd dose given 6 to 12 months after the first. (Protection
HEPATITIS A VIRUS against HAV develops within several weeks after the first dose of
• Former name: Infectious hepatitis the vaccine)
• Caused by RNA virus of the enterovirus family • Three doses: children and adolescents (1-18 yrs old), 2nd dose
• Fecal-oral route – ingestion of foods or liquids infected by virus given 1 month after the 1st dose, and 3rd dose after 6-12 months.
• More prevalent in countries with overcrowding and poor • Hep A. virus routine immunization of young children has proved
sanitation to be effective in reducing disease incidence and maintaining
• Found in stool of infected patients before the onset of symptoms very low incidence level among vaccine recipients and across all
and during the first few days of illness. Typically, a child or young age groups in many settings. As a result of effectiveness in
adult acquires the infection at the school through poor hygiene decreasing the virus, the Hap A. vaccinations recommendations
hand to mouth contact, sewage contaminated waters. The virus have been expanded to include all children at 1 year of age
is carried home where half-hazard sanitary habit spread it to the • Recommended for people travelling (unsatisfactory sanitation
family. An infected food handler can also spread the disease and and hygiene places); high risk groups: men to men sex, people
people can contract it by consuming water or shellfish from the who also use IV or injection drugs, staff of daycare centers as
sewage contaminated waters. There are outbreaks that have well as the healthcare personnel and those who work with virus
occurred in daycare centers and institutions as a result of poor in research or animal care settings.
hygiene among people with developmental disabilities. • Vaccine for community – wide outbreaks
• Can be transmitted during sexual activity (oral-anal contact or • Combined HAV and HBV vaccine (Twinrix) has been available for
oral intercourse with multiple sex partners) vaccination of people 18 years of age or older with indications of
• Hep A. is not transmitted by blood transfusions both hep A. and hep B
• INCUBATION PERIOD: between 2 and 6 weeks (approx. 4 weeks o Vaccinations would consist 3 doses, given on the same
according to CBC guideline) schedule as that use for single antigen HBV vaccine
• Illness: 4 to 8 weeks • IM Hepatitis immune globulin: for people who have not been
• More severe >40 years old previously vaccinated; given during incubation period, within 2
• Most pxs. recover from Hep A and rarely progresses to acute weeks or exposure. (This bolsters the person’s antibodies
liver necrosis resulting in cirrhosis in the liver or death production and provides 6-8 weeks passive immunity; Immune
• Mortality rate of hepatitis A is approximately 0.5% for those globulin may suppress overt symptoms of disease thus resulting
younger than 40 years and 1% to 2% for older adults to subclinical case of HAV that would produce immunity to
• Morbidity and mortality increase with underlying chronic liver subsequent episodes of the virus)
disease. o Susceptible: Same household with patient, sex
Clinical Manifestations: contacts of people w/ HAV
• Anicteric (without jaundice) & symptomless. • Pre-exposure prophylaxis of Hepatitis A vaccine: recommended
• When symptoms would appear, they resembled those of a Mild to people travelling to developing countries/ poor sanitation
flu-like, Upper Respiratory Tract Infection (URTI) with low grade (insufficient time to acquire protection)
fever
24
Medical Management - Major worldwide cause of cirrhosis and hepatocellular
- Bed rest during an acute stage carcinoma (high mortality rate), approximately 15% from chronic
- Nutritious diet (important aspect of treatment) Hep B (adulthood); 25% chronic infection (childhood)
- During the period of anorexia, patient must receive small Clinical Manifestations
frequent feedings; supplemented if necessary, by IV fluids with - Incubation period: 1 to 6 months
glucose because the patient often has an aversion to food, gentle - s/s: insidious and variable
persistence and creativity may require to stimulate appetite. - There is a fever and respiratory symptoms are rare, some has
- Optimal food and fluid levels are necessary to counteract weight rushes
loss and speed recovery - Loss of appetite, dyspepsia, abdominal pain, generalized aching,
- Gradual but progressive ambulation – hastens recovery with malaise and weakness.
periods of rest after activity; and does not participate in activities - Jaundice (may or may not be evident); presence of light-colored
to the point of fatigue stools and dark urine is evident (if with jaundice) because of the
Nursing Management inability of the liver to produce bile and giving it a normal brown
This would usually occur in home unless symptoms is severe. stool color and excess bilirubin build up due to the inability of
Therefore… the liver to breakdown normally
- Assist px and family in coping with temporary disability and - Tender and enlarged liver (12 cm to 14 cm vertically)
fatigue that are common w/ HAV; Educate them to seek - Palpable and enlarged spleen (few patients)- causes increased
additional healthcare if symptoms persist or worsen vascular pressure from liver disease
- Diet, rest, follow-up blood work, no alcohol as well as sanitation - Posterior cervical lymph nodes may be enlarged
and hygiene measures (particularly hand hygiene) to prevent (inflammatory/immunological response to host)
spread of disease to family members.
- There is a specific education for patients and family about
reducing the risks of contracting this virus that would include
Good personal hygiene, stressing careful hand hygiene (after
bowel movements and before eating). And;
- Environmental sanitation – safe food and water supply, effective
sewage disposal
Health Promotion
- Safe practices for preparing and dispensing food
- Conscientious individual hygiene
- Proper community health education programs: vaccination to
interrupt community-wide outbreaks
- Recommended pre-exposure vaccination for all children 12-23
months of age. Continue existing immunization programs for - Through direct blood to blood contact
children 1-18 years of age - Direct contact with sexual fluids
- Recommended vaccination for travelers to developing countries, - Mother to child during birth
illegal drug users (injection and noninjective drug users), men - Sharing of hygiene equipment such as razors, toothbrushes,
who have sex with men, people with chronic liver disease, earrings
people who work with HAV-infected animals or work with HAV - Unsterile healthcare practices
in research facilities and recipients (e.g., hemophiliacs) of pooled - Tattoos, piercings, barbers, scarification, circumcision
plasma products for clotting factor disorders. practices
- Support effective health supervision of schools, dormitories, Risk Factors
extended care facilities, barracks and camps. - Close contact with carrier of hepatitis B virus
HEPATITIS B VIRUS - Frequent exposure to blood, blood products, or other body fluids
- Transmitted primarily through blood (percutaneous and - Health care workers: hemodialysis staff, oncology and
permucosal routes) chemotherapy nurses, personnel at risk for needlesticks,
- Found in blood, saliva, semen and vaginal secretions and can be operating room staff, respiratory therapists, surgeons, dentists
transmitted through mucous membranes and breaks in the skin - Hemodialysis
- Carrier mothers to their infants, especially in areas with a high - IV/injection drug use
incidence (e.g., Southeast Asia). The infection usually is not - Male homosexual and bisexual activity
transmitted via the umbilical vein but from mother at the time - Mother-to-child transmission Multiple sexual partners Receipt
of birth and during close contact afterward of blood or blood products (e.g., clotting factor concentrate)
- Has a long incubation period. It replicates in the liver and - Recent history of sexually transmitted infection
remains in the serum for relatively long periods, allowing - Tattooing
transmission of the virus. - Travel to or residence in area with uncertain sanitary conditions
- Screening of blood donors has greatly reduced the occurrence of Assessment and Diagnostic Findings
HBV after blood transfusion. - Presence of HBsAg 1-10 weeks after exposure: 80%-90%
- Most people (more than 90%) who contract HBV infection infected individuals;
develop antibodies and recover spontaneously in 6 months. o 2-8 weeks before onset of symptoms or ↑ in
- Mortality rate: 1 % for acute HBV, 10% Carrier state or chronic transferase (enzyme in liver) levels.
hepatitis w/ persistent HBV infection, hepatocellular injury and o 6 months or longer after acute infection: HbsAg (Hep
inflammation. B surface Antigen) carriers

25
- HBeAg (Hep B e Antigen): usually appears in serum within 1 ✓ All meds are avoided if vomiting occurs
week of the appearance of HBsAg, before changes in ✓ Hospitalization and fluid therapy → if vomiting persists
aminotransferase levels; disappears from serum within 2 weeks ✓ Is also evaluated for HIV infection (due to mode of transmission)
- HBV DNA: detected by PCR testing (+) serum; same time with Nursing Management
HBeAg ✓ 3 to 4 months or longer: Convalescent period w/ complete
- HBcAg (hep B core antigen): not always detected in serum (does symptomatic recovery
not circulate in significant quantity of blood) ✓ Gradual resumption of physical activity after jaundice has
o Core protein antigen of Hep B virus present inside resolved
complete variants ✓ Psychosocial issues: separation from family and friends during
o Also, indicator of active viral replication. But In these acute and infective stages.
diagnostic findings it is not always detected in serum ✓ Plan: includes family to reduce their fears and anxieties about
because this does not circulate in significant quantity spread of disease
of blood ✓ Promoting home, Community-Based and Transitional Care,
HBV is a deoxyribonucleic acid (DNA) virus composed of the following Educating patients about self-care.
antigenic particles: ➢ provision of adequate rest and nutrition
➢ HBcAg—hepatitis B core antigen (antigenic material in an ➢ educating about risks of contracting HBV, early signs and
inner core) modes of transmission; avoidance of drinking alcohol.
➢ HBsAg—hepatitis B surface antigen (antigenic material on ✓ Continuance and Transitional Care
the viral surface, a marker of active replication and ➢ Follow-up visits for px progess and assessment; emphasizes
infection) its importance, health promotion activities and
➢ HBeAg—an independent protein circulating in the blood recommended screenings
➢ HBxAg—gene product of X gene of HBV DNA Diet Management
Each antigen elicits its specific antibody and is a marker for different ✓ Avoid substances (medications, herbs, illicit drugs and toxins)
stages of the disease process: that may affect liver function
➢ anti-HBc—antibody to core antigen of HBV; persists during ✓ Enteral feedings: anorexia, nausea and vomiting persist
the acute phase of illness; may indicate continuing HBV in ✓ Monitoring of fluid balance
the liver ✓ Abstinence of alcohol during acute illness (6 months after
➢ anti-HBs—antibody to surface determinants on HBV; recovery)
detected during late convalescence; usually indicates ✓ Provide intake of 25-30kcal/day: CHON intake of 1.2-1.5g/kg/day
recovery and development of immunity ✓ Small frequent meals; minimize periods without food intake
➢ anti-HBe—antibody to hepatitis B e-antigen; usually Prevention
signifies reduced infectivity Would require multi positive approach including public health
➢ anti-HBxAg—antibody to the hepatitis B x-antigen; may interventions and education as well as programs
indicate ongoing replication of HBV ✓ Immunization. Very important against virulent virus in an effort
Medical Management to reduce the disease burden
✓ Alpha-interferon: ✓ Avoidance of risk behaviors (sharing of needles, multiple sex
➢ single modality of therapy; a regimen of 5 million U daily or partners)
10 million U, 3x weekly for 16 to 24 weeks (remission of ✓ Screening of blood donors (presence of HBAg): lowers risk by
disease in approx. 1/3 of pxs); given via injection blood transfusion
➢ S/E: Fever, chills, anorexia, nausea, myalgias, and fatigue. ✓ Use of disposable syringe, needles, lancets and NEEDELESS IV
➢ The delay side effects are more serious and may necessitate sets
dosage production or discontinuation. This includes bone ✓ Disinfection of work areas (clinical laboratory and hemodialysis
marrow suppression, thyroid dysfunction, alopecia and unit)
bacterial infections (delayed S/E) ✓ Use of gloves in handling blood or body fluids/secretions
➢ Pegylated interferon or peginterferon (peginterferon alfa- ✓ No eating in the laboratory or other areas exposed to secretions
2a [Pegasys]): once-weekly dosing and blood.
✓ Entecavir (ETV) and Tenovir (TDF) – antivirals treatment ✓ Patient education
➢ oral nucleoside analogs; for chronic Hep B in US.; for HBV- ✓ STANDARD PRECAUTION in clinical care
related decompensated cirrhosis & decompensated liver ✓ Avoid multidose vials in patient settings
cirrhosis awaiting liver transplantation (recommended); ✓ Clean, disinfect and sterilization of reusable devices in px care
either can be used in combination with peginterferon. settings
➢ loss of detectable virus, improved liver function and ✓ Active immunization
reduced progression to cirrhosis ➢ for high risk people exposed (e.g., health care personnel,
➢ these agents can also be used to patients who have patients undergoing hemodialysis, hx of STI, multiple sex
decompensated cirrhosis who are waiting for liver partners, sexually active (men to men), drug users); people
transplantation with hepatitis C virus and other chronic liver diseases.
✓ Bed rest until symptoms subside ✓ Recombivax HB (yeast- recombinant vaccine)
✓ Restrict activities until hepatic enlargement, level of serum ➢ active immunity; >90% in healthy people
bilirubin & liver enzymes decreased. Gradually increased activity ➢ Booster doses of Hep. B vaccine: immunocompromised
is then allowed. ➢ Both forms of Hep. B vaccine: given in 3 doses; 2nd and 3rd
✓ Maintain adequate nutrition: Protein intake 1.2 to 1.5g/kg/day dose given 1 month and 6 months after the 1st dose.
(no restriction of CHON) ➢ (3rd dose: important; prolonged immunity)
✓ Antacids and antiemetic agents for dyspeptic symptoms and ➢ given IM deltoid
general malaise
26
 ➢ however, does not provide protection to people exposed • Common among those who use IV or injection drugs, patients
with HBV nor types of viral hepatitis undergoing hemodialysis, and recipients of multiple blood
✓ Universal vaccination of all infants; catch-up vaccination for transfusions.
children, prepubertal adolescents up to age 19 (not been • Sexual contact with those who have hepatitis B is considered to
previously immunized) be an important mode of transmission of hepatitis B and D
✓ Passive Immunity: Hepatitis B Immune Globulin (HBIG); • Incubation period: varies between 30 and 150 days
➢ exposed to HBV, never had Hep B, and never received Hep • Symptoms: similar with Hepatitis B; except that patients are
B vaccine. (post exposure vaccine) more likely to develop fulminant hepatic failure and to progress
➢ Specific indications: (1) percutaneous (needlestick) or to chronic active hepatitis and cirrhosis
transmucosal (splashes in contact with mucous membrane) • Treatment: similar to other forms of hepatitis
routes, (2) sexual contact with people positive for HBAg, o Interferon alfa: only licensed drug available for treatment
and (3) perinatal exposure – does infants born with HPV (high-dose, long-duration therapy for at least a year is
infected mothers should receive the immunoglobulin recommended)
within 12 hours after delivery. HBIG is prepared from HEPATITIS E VIRUS
plasma selected for high titers of antiHBs • Is a waterborne disease caused by the hepatitis E virus (HEV)
o There must be prompt immunization with the HBIG • Hepatitis E is mainly found in areas with poor sanitation and
within hours to a few days after exposure of the Hep B typically results from ingesting fecal matter that contaminates
because this increases the likelihood of the infection. the water supply
o Both active and passive immunization are • Fecal-oral route; resembles Hepatitis A
recommended for people who have been exposed to • Incubation period: variable, ranges between 15 and 65 days
hep B virus through sexual contact or through the
• Presence of jaundice
percutaneous or transmucosal routes.
• Same management with Hep A
o If HBIG and Hep B vaccine are given at the same time,
o Importance of good hygiene
there must be separate sites and separate syringes that
• Self-limited course with an abrupt onset
must be use.
• Chronic forms do not develop
o HBIG is considered very safe and there has been no
NONVIRAL HEPATITIS
evidence that infectious diseases have been
Toxic Hepatitis
transmitted due to its administration
HEPATITIS C VIRUS • Resembles viral hepatitis
- Transmitted through direct contact with infected body fluids, • Hx of exposure to hepatotoxic chemicals (carbon tetrachloride
typically through injection drug use and sexual contact. and phosphorus: true hepatotoxic agents), medications
- Clinical course: similar to HCV; symptoms are mild or absent (isoniazid, halothane, acetaminophen, methyldopa) or certain
- Incubation period: variable and may range 15 to 160 days antibiotics, antimetabolites, and anesthetic agents; botanical
- ↑ risk for chronic liver disease, cirrhosis after HCV, High agents (would assist in early treatment and removal of the
prevalence rates (e.g., born in certain countries or regions) causative agent)
- Alcohol and medications that affect liver should be avoided • Symptoms: fever, anorexia, nausea, and vomiting; jaundice and
Risk Factor hepatomegaly are noted on physical assessment
- Children born to women infected with hepatitis C virus o Vomiting (if persistent) with emesis containing blood;
- Health care and public safety workers after needlestick injuries clotting abnormalities (severe), hemorrhages under the
or mucosal exposure to blood skin
- Multiple contacts with a hepatitis C virus–infected person o Severe GI symptoms may lead to vascular collapse,
- Multiple sex partners, history of sexually transmitted infection, delirium, coma, and seizures
unprotected sex • Recovery from the acute toxic hepatitis is rapid if the
- Past/current illicit IV/injection drug use hepatotoxin is identified early or if exposure to the agent is
- Recipient of blood products or organ transplant before 1992 or limited
clotting factor concentrates before 1987 • Recovery is unlikely if there is a prolonged period of exposure
Medical Management and onset of symptoms
- Peginterferon and Ribavirin (Rebetol): used in combination of 2 • A few px recover from acute toxic hepatitis only to develop
antiviral agents; effective and produces improvement in Hep C chronic liver disease
and treating relapses (2001) (this treatment is no longer o If liver heals, there may be scarring followed by post
employed because of the new recommened antiviral agents) necrotic cirrhosis
- Simeprevir (Olysio) plus sofosbuvir (Sovaldi), • Treatment: liver transplantation, restoring and maintaining fluid
ledipasvirsofosbuvir (Harvoni) and ombitasvirparitaprevir- and electrolyte imbalance, blood replacement; comfort and
ritonavir packaged with dasabuvir (Viekira Pak): few side effects: supportive measures
short treatment durations and higher cure rates than the Drug-induced Hepatitis
previously recommended antiviral agents. • Most common cause of acute liver failure
HEPATITIS D VIRUS • Manifestations of sensitivity to a medication may occur on the
• Also called delta hepatitis first day of its use or not until several months later
• Is a serious liver disease caused by hepatitis D virus (HDV) o Onset is abrupt: chills, fever, rash, pruritus, arthralgia,
• HDV is contracted through direct contact with infected blood anorexia, and nausea
• Hepatitis D is a rare form of hepatitis that only occurs in o Later: may be jaundice, dark urine; enlarged and tender
conjunction with hepatitis B infection. The hepatitis D virus can’t liver
multiply without the presence of hepatitis B

27
 o After the offending medication is withdrawn, the symptoms • Progresses to peak severity within 2 weeks and no longer than 4
may gradually subside. However, the reactions can be weeks
severe or even fatal even if the medication is stopped. • If the progression is longer, the px is classified to have Chronic
• STOP IMMEDIATELY IF: fever, rash, or pruritus occurs from any inflammatory Demyelination Polyneuropathy: if progression is
medication no longer
• Use of acetaminophen (OTC drug used to treat fever and pain): • Cranial nerve demyelination:
leading cause of acute liver failure o Optic nerve – blindness
• Causes associated w/ liver injury: anesthetic agents, meds for o Glossopharyngeal and vagus nerves – bulbar muscle
rheumatic and musculoskeletal dse, antidepressants, weakness (difficulty swallowing or clear secretions),
psychotropic meds, anticonvulsants, and antiTB agents autonomic dysfunction in CV system – tachycardia,
• Treatment: short course of high dose corticosteroids may be bradycardia, hypertension, or orthostatic hypotension
used in px with severe hypersensitivity reactions even though its ▪ Symptoms of autonomic occur and would resolve
efficacy is uncertain; liver transplantation (optional) but rapidly
outcomes may not be as successful as with other causes of liver • GBS does not affect cognitive function or the level of
failure consciousness
Autoimmune Hepatitis • Classic clinical features: areflexia (muscles don’t respond to
• Occurs when your body makes antibodies against your liver stimuli) and ascending weakness
tissue • Miller-Fisher variant: atypical axonal destruction (sensory
• Treatment: Azothioprine (Imuran), a drug that suppresses the progressive symptoms)
immune system is often included in treatment. It can be used o Paralysis of the ocular muscles
with or without steroids. o Ataxia (lack of muscle control or coordination of voluntary
o Other immune suppressing drugs like mycophenolate movements)
(CellCept), tacrolimus (Prograf), and cyclosporine (Neoral) o Areflexia
can also be used as alternatives to azathioprine for
treatment
GUILLAIN-BARRE SYNDROME (GBS)
• Known as acute idiopathic polyneuritis
• Autoimmune attack on the peripheral nerve myelin → acute,
rapid segmental demyelination of peripheral nerves and some
cranial nerves
• Would produce ascending weakness with dyskinesia (inability to
execute voluntary movements)
• Hyporeflexia and paresthesia – numbness, tingling / pins and
Assessment and Diagnostic Findings
needles sensation
• Symmetric weakness, diminished reflexes, and upward
• Antecedent event: most often a viral infection precipitates
progression of motor weakness
clinical presentation in approximately 60-70% of the cases
• Hx of a viral illness in the previous few weeks to help with dx
• Most common infectious agents: Campylobacter jejuni (24% to
50% cases); Cytomegalovirus, Epstein barr virus, Mycoplasma • Changes in vital capacity and negative inspiratory force
pneumoniae, H. influenzae, and HIV o in order to identify impending neuromuscular
Pathophysiology respiratory failure
• Result of cell-mediated and humoral immune attack on • Elevated protein levels are detected in CSF evaluation, without
peripheral nerve myelin proteins that causes inflammatory an increase in other cells
demyelination • Evoked potential studies demonstrate a progressive loss of nerve
• Molecular mimicry: infections organism contains an amino acid conduction velocity
that mimics the peripheral nerve myelin protein
• Immune system: unable to distinguish between 2 proteins and
destroys peripheral nerve myelin
• Influx of macrophages and other immune-mediated agents that
attack myelin and cause inflammation and destruction,
interruption of nerve conduction, and axonal loss
Clinical Manifestations
• Muscle weakness; diminished reflexes of lower extremities
• Hyporeflexia → tetraplegia (known as quadriplegia)
o Paralysis caused by illness or injury that results in the
partial or total loss of function of the 4 limbs or torso Medical Management
• Demyelination of the nerves that innervate the diaphragm and • Because of the possibility of rapid progression and respiratory
intercostal muscles would result to neuromuscular and failure, GBS is a medical emergency that may require
respiratory failure management in an intensive care unit
• Sensory symptoms: Paresthesia of hands and feet o After baseline values are identified, assessment of
o Also pain r/t the demyelination of sensory fibers changes in the muscle strength and respiratory function,
alert the physician to the physical and respiratory needs of
• Antecedent event: 1 to 3 weeks before symptoms begin
the patient
• Weakness usually begins in legs and may progress UPWARD

28
• Respiratory therapy or mechanical ventilation may be necessary o Intubation and mechanical ventilation would result in less
to support pulmonary function and adequate oxygenation anxiety if they are initiated on a non-emergency basis to a
• Elective intubation before the onset of extreme respiratory px who has been well informed
muscle fatigue • Suctioning: to maintain a clear airway because of impaired
o Emergent intubation may result in autonomic dysfunction ability to swallow and clear secretions
and mechanical intubation / ventilation may be required o is done because of the bulbar weakness that impairs the
for an extensive period ability to swallow and clear secretions
o Px is weaned from the mechanical ventilation after the o this is another factor in the development of respiratory
respiratory muscles can support spontaneous respiration failure
again and maintain adequate tissue oxygenation • BP and heart rate are assessed (to identify autonomic
• Other interventions are aimed at preventing complications of dysfunction) so interventions can be initiated quickly when
immobility needed
• Anticoagulant agents and sequential compression boots – o Medications are given or temporary pacemakers placed
prevent venous embolism, DVT and pulmonary embolism for the clinically significant bradycardia
• Therapeutic Plasma Exchange (TPE) and Intravenous • Enhancing physical mobility – key to the function and survival
immunoglobulin (IVIG) – directly affect the peripheral nerve • Paralyzed extremities are supported in functional positions, and
myelin antibody level passive range-of-motion exercises are performed at least twice
o Decrease circulating antibody levels and reduce the daily
amount of time the patient is immobilized and dependent • DVT and PE are threats to a px who is paralyzed. Nursing
on mechanical ventilation interventions are aimed at enhancing venous thromboembolism
• Continuous ECG monitoring – cardiovascular risk by autonomic • ROM exercises, position changes, anticoagulation, use of
dysfunction embolic / antiembolism stockings, sequential compression
• Alpha-adrenergic blocking agents – tachycardia and boots, and adequate hydration would decrease risk of venous
hypertension thromboembolism
o Short-acting medications is important because the • Padding over bony prominences (elbow and heels): to reduce
autonomic dysfunction is very labile or easily altered risk of pressure ulcers
• Increasing the amount of IV fluid administered – for hypotension • Provide adequate nutrition
Nursing Process o Paralytic ileus may result from insufficient
Assessment parasympathetic activity
• Ongoing assessment for the disease progression is critical o Administer IV fluids and parenteral nutrition
• Monitored for life-threatening complications (respiratory o Gastronomy tube may be placed (due to bulbar paralysis)
failure, cardiac dysrhythmias, VTE including DVT or PE) so to administer nutrients
appropriate interventions can be initiated o Monitor return of gag reflex and bowel sounds
• Patient and family’s ability to cope and use coping strategies • Decreasing fear and anxiety
because the disease is life-threatening o Provide information about the condition;
Diagnosis o Emphasizing a positive appraisal of coping resources
• Ineffective breathing pattern o Provide instruction about relaxation exercises and
• Impaired gas exchange distraction techniques
o Both are r/t rapidly increasing weakness and impending o The positive attitude and atmosphere of the
respiratory failure multidisciplinary team are important to promote a sense
• Impaired bed and physical mobility of wellbeing
o r/t paralysis o Diversional activities to decrease loneliness and isolation
• Imbalanced nutrition: less than body requirements o Encouraging visitors to alleviate px’s sense of isolation
o r/t the inability to swallow • Monitoring and managing potential complications
• Impaired verbal communication • There should be a thorough assessment of respiratory function
o r/t cranial nerve dysfunction at regular and frequent intervals respiratory insufficiency and
• Fear and anxiety subsequent failure due to weakness or paralysis of the
o r/t loss of control and paralysis intercostal muscles and diaphragm may develop quickly
Nursing Interventions • Respiratory failure is the major cause of mortality. S/S would
• Maintaining respiratory function – incentive spirometry and include:
chest physiotherapy o Breathlessness while speaking
• Monitor changes in vital capacity and negative inspiratory force o Shallow and irregular breathing
which are the keys to early intervention for neuromuscular o The use of accessory muscles
respiratory failure o Tachycardia, weak cough, and changes in respiratory
• Mechanical ventilation is required if the vital capacity falls, function
making spontaneous breathing impossible and tissue • Other complications include
oxygenation inadequate (may be required for a long period) o cardiac dysrhythmias (which necessitate ECG monitoring)
o Potential need for mechanical ventilation should be o transient hypertension
discussed to the px and the family upon admission in order o orthostatic hypotension
for them to have time for psychological preparation and o DVT and PE
decision-making o Urinary retention
o And other threats to any px who is immobilized and
paralyzed

29
• Requires monitoring and attention to prevent them and to have • Type 2 – greatly affected by coronavirus which produces
prompt treatment if indicated surfactant since it is a lipoprotein that decreases tension
Promoting home, community-base, and transitional care – family in the alveolar surface
members and other home care providers are educated about care of ▪ If there is an increase in alveolar tension, it can lead
the patients and their role in the rehabilitation process to collapse or atelectasis
• Preparation for discharge is an interdisciplinary effort requiring • Alveolar dust cells – considered to be a wandering
family or caregiver education by all team members, including the macrophage which clear debris in the alveolar cell
nurse, physician, occupational and physical therapists, speech • The type 2 cell’s membrane has a receptor called angiotensin
therapist, and respiratory therapist converting enzyme 2 receptor (ACE-2 receptor) which plays a
Evaluation vital role for the virus to get into the cell
1. Maintains effective respirations and airway clearance • Since COVID-19 has projections called “spike”. Inside the virus is
a. Has clear breath sounds on auscultation a single stranded RNA
b. Demonstrates gradual improvement in respiratory • When the virus gets into the body via the mucous membrane to
function your throat then to your lungs all the way to the alveoli, it affects
c. Breathes spontaneously the type 2 cell
d. Has vital capacity within normal range • When the spike attaches to the ACE-2 receptor, the cell opens
e. Exhibits arterial blood gases and pulse oximetry within and allows the virus to get into the cell
normal limits • Once inside the cell, a typical viral infection would need to get
2. Shows increasing mobility inside the nucleus for replication to happen BUT covid-19 does
a. Regains use of extremities not need to get inside the nucleus to multiply
b. Participates in rehabilitation program • Instead s ingle stranded RFNA is released in the cytoplasm of the
c. Demonstrates no contractures and minimal muscle cell. This RNA will be desynthesized by the ribosomes (organelles
atrophy responsible for protein synthesis). They synthesize the single
3. Receives adequate nutrition and hydration stranded RNA into small proteins.
a. Consumes diet adequate to meet nutritional needs • Once small proteins are there, an enzyme called proteinase or
b. Swallows without aspiration proteolytic enzyme will act on the proteins and dissect and
4. Demonstrates recovery of speech transform them into different small proteins needed for viral or
a. Communicates needs through alternative strategies virus replication
b. Practices exercises recommended by the speech therapist • This set of SSRNA from the virus will be acted by another enzyme
5. Shows lessening of fear and anxiety called RNA-dependent RNA polymerase which will copy SSRNA
6. Has absence of complications • If there is a sufficient number of SSRNA and proteinase for viral
a. Maintains intact skin integrity replication, they will clump together and go to the underlying
b. Does not develop VTE membrane of cell and get out of the cell and form a new virus
c. Voids without difficulty
• IN SUMMARY: the COVID-19 virus will get inside the cell, it will
use the cell to produce more virus
SUPPLEMENTARY VIDEOS
• The daughter cells or “baby viruses” are now ready to infect the
COVID-19 SIMPLIFIED PATHOPHYSIOLOGY
other cells
People at risk for COVID-19 is divided into two factors:
• Question: can we do something about this process?
1. Precipitating factor: CORONA VIRUS- 19
• There are trial drugs right now being used in the clinical
o The virus’ structure has projections outside that look like
set-up
a crown “corona”, 19 since it was discovered in
December 2019 • Remember that the ACE-2 receptor will facilitate entry of the
2. Predisposing factors: virus when the spike adheres to the receptor
• Poor hygiene (do not wash hands or take a bath) • There is a drug that would prevent entry of the virus into
the cell. It is an anti-malarial drug called “chloroquine”
• It can be spread via fecal-oral route
• There is another drug that inhibits the enzyme proteinase
• Poor social distancing
called ritonavir (proteinase or proteolytic enzyme
• Observe self-quarantine to protect yourself and others
inhibitor)
• Inadequate or misused PPE
• The RNA-dependent RNA polymerase enzyme can also be
• One of the main protection not to get exposed to the virus
inhibited by “remdesivir”
itself
• Since the type 2 cell sustains injury or is damaged. This releases
• Immunocompromised individuals
inflammatory mediators which activate macrophages. Once
• Immune system cannot fight off efficiently
these are activated, they release cytokines specifically
• Comorbidities: conditions that occur simultaneously with Interleukin 1 (IL-1), Interleukin 6 (IL-6) and Tumor Necrotic
other conditions Factor alpha (TNF-α)
▪ Example: a patient with heart problems has COVID-19,
• Pay attention to IL-6 that is greatly associated with systemic
the comorbidity is the heart problem which increases
inflammation. These cytokines cause vasodilation or causes
the chance of mortality
blood vessels to dilate
• Frequent travels
• Vasodilation will increase capillary permeability. If blood vessels
• If you go to places with higher rates of COVID-19 cases are permeable, it will be easier for the fluid to shift out. This is
• This type of virus primarily affects the throat and lungs called fluid shifting. Since the movement of fluid will be from
• The alveoli has 3 common cells: intravascular to extravascular or from plasma to interstitial.
• Type 1 – responsible for gas exchange • When fluid gets out of the vascular compartment, that fluid
surrounds the alveolar wall which restricts the normal
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 movement of inflation and deflation processes. Some fluid will immune response can be generated to the antigen without the
also get inside the alveolar wall which fills the alveolar sac with virus causing disease.
fluid. This affects gas exchange which makes the patient hypoxic. • When the immune system comes into contact with the
• With the presence of cytokines, it attracts neutrophils to get weakened virus, these defenses such as antibodies and T cells,
inside the alveolar area since they destroy or kill the virus. But it attack the virus or infected cells.
will also affect or damage the normal cells like the type 1 cell and • In the process, the specialized memory cells take note of the
other cells in the alveolar cells specific antigen and prime the immune system to produce cells
• This aggravates impaired gas exchange. Due to cellular damage, and antibodies that will quickly target these proteins.
debris will accumulate in the alveolar cell. The X-ray or CT scan • So, the next time that person is exposed to the same virus, the
will show ground-glass opacities or consolidation which are immune system is ready to fight it off.
prominent for patients with COVID-19
• Neutrophils will affect type 1 and 2 cells. It affects gas exchange PROTEIN SUBUNIT VACCINES
and surfactant. Since surfactant is affected, it increases alveolar • Instead of using the whole virus, another way to trigger
tension leading to collapse of the alveolar cell or atelectasis immunity involves using just fragments of it, like the spike
• Patients with COVID-19 need to be mechanically ventilated if proteins.
need • These subunit vaccines have the advantage of being relatively
• Mechanical ventilation can promote or enhance oxygenation of easy and cheap to produce and are incapable of causing disease
the patient. The goal is to prevent the collapse of the alveolar because these fragments are not able to infect host cells.
cell. Mechanical ventilation will increase the positive end • However, they are less likely to be recognized by immune cells
expiratory pressure or PEEP aimed at attacking infected cells which means they may trigger
• If not controlled or treated, too much cytokines (especially IL-6) a weaker immune response.
will enter systemic circulation causing systemic inflammation • Because of this, subunit vaccines often include chemical agents
• To know that there is systemic inflammation: called adjuvants which are designed to stimulate a stronger
• Fever immune response and booster shots may also be required.
• Elevation of ESR (erythrocyte sedimentation rate)
• Due to systemic inflammation, it will result to systemic • Not all vaccines are designed to introduce antigens to the body.
vasodilation. Systemic vasodilation causes increased fluid Some work by using cells in a patient’s body to produce the
shifting and decreases blood volume. This will result to antigens themselves. Examples include viral vector vaccines and
decreased tissue perfusion. If there is not enough perfusion to mRNA vaccines.
the brain, heart, lungs, and kidneys, it will cause multi-system • In both cases, the goal is to get a short fragment of genetic code
organ failure taken from the target pathogen, in this case the SARS-CoV-2
• If perfusion is affected, not enough blood may go to the brain. virus that causes COVID-19, into the patient’s cells.
Cerebral hypoxia may happen. • By hijacking the cellular mechanisms, these kinds of vaccines
• Early signs of Cerebral hypoxia include: mimic the way viruses normally reproduce during natural
• Altered LOC infection. But rather than creating copies of the virus, the cells
• Irritable only produce large amounts of antigen that then usually trigger
• Confusion a strong immune response
• Restlessness
• If not enough perfusion goes to the heart, if affects the VIRAL VECTOR VACCINES
myocardial cells and they start die causing myocardial tissue or • Viral vector vaccines achieve this by inserting the generic code
muscle death for the antigen into a harmless virus, which effectively acts like a
• Elevation of cardiac enzyme (CK-MB or creatine kinase- delivery system to get the code into the cells, without causing
MB) disease.
• Troponin • Vector-based vaccines can be complex to develop but they can
• Contractility is affected and affects the cardiac output trigger strong immune responses without the need for
• Ultimately leading to cardiac arrest adjuvants.
• If not enough tissue perfusion happens, not enough blood goes • And in theory, one type of vector can be used to deliver code for
to the liver causing liver injury or damage a range of different antigens, which can speed up vaccine
• Elevation of liver enzymes (AST and ALT) development.
• Since it is a systemic injury, expect an elevation in D-Dimer test
• Due to perfusion problems, renal failure or dysfunction NUCLEIC ACID VACCINES
happens wherein nitrogenous wastes cannot be filtered • Like mRNA and DNA vaccines, also involve inserting genetic code
out. into cells, to produce antigens
• Elevation of BUN and creatinine • But instead of using viruses to deliver the code, these vaccines
take a more direct approach that involves inserting code directly
4 TYPES OF COVID-19 VACCINES into cells either by attaching to a molecule or by forcing into cells
All COVID-19 vaccines being developed aim to produce immunity to using a gene gun
the SARS-CoV-2 virus by stimulating an immune response to an • These vaccines can be quick and cheap to develop but are a
antigen, usually the characteristic spike protein found on the surface relatively new technology
of the virus • With hundreds of COVID- 19 vaccines now in development, it is
WHOLE VIRUS VACCINES likely that a mixture of different approaches will be needed to
• Some traditional vaccines achieve this by modifying the virus to stop to global spread of coronavirus and end the pandemic.
weaken or disable it. So that when introduced to the body, an
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