Communicable Disease Nursing

ARLENE D. LATORRE RN MAN

Host and Microbial Interaction
INTRODUCTION

Although most microorganisms

live in harmony with the human
body, some—called pathogens—
can infect the body and cause
disease. Infectious diseases
range from mild illnesses, such
as a cold, to fatal illnesses,
such as AIDS.
We occasionally come into
contact with people or animals
that are infected and thus
expose ourselves to the
pathogens of their diseases. In
fact, our environment is such
that everyday we live with
some risk of exposure to
diseases.
Communicable Disease
= any disease that spreads from one host to
another, either directly or indirectly to a well person
thru an agency, vector, or an inanimate object.
Contagious Disease
= disease that easily spreads directly from one
person to another thru direct or indirect means
Infectious Disease
= disease not transmitted by ordinary
contact but require a direct inoculation through a
break in a previously intact mucous membrane. On
the other hand, all contagious diseases are
infectious.
• Examples of communicable diseases include
herpes, malaria, mumps, HIV/AIDS, influenza,
chicken pox, ringworm, and whooping cough.
• Cancer, on the other hand, is not a
communicable disease.
• Disinfection -is the destruction of
pathogenic microorganism outside the
body by directly applying physical or
chemical means
• Habitat = is a place where an
organism lives or where an organism is
usually found.
• Host = is a person, animal or plant on
which a parasite depends for its survival
• Isolation = is the separation from other
persons of an individual suffering from a
communicable disease

• Quarantine = is the limitation of freedom of

movement of persons or animals which have
been exposed to communicable disease/s for
a period of time equivalent to the longest
incubation period of that disease.
• Reservoir = is composed of one or more
species of animal or plant in which an
infectious agent lives and multiplies for
survival and reproduces itself in such a
manner that it can be transmitted to man

• Surveillance = is the act of watching.

• Carrier – is an individual who harbors the
organism and is capable of transmitting
it to a susceptible host without showing
manifestations of the disease.
• Contact - is any person or animal who is
in close association with an infected
person, animal, or freshly soiled
material
 Disease
• Caused by an infectious agent from an
infected individual and transmitted to
susceptible host either by direct/ indirect
contact or through inoculation into a
broken skin.
2 major types of communicable diseases
1. Infectious
2. Contagious
ALL COMMUNICABLE DISEASES ARE
INFECTIOUS BUT NOT CONTAGIOUS
Infection - Is defined as the invasion and
multiplication of microorganisms on the
tissues of the host resulting to sign and
symptoms as well as immunologic response

• Carrier – is an individual who harbors the

organism and is capable of transmitting it to
a susceptible host without showing
manifestations of the disease.
Classification of Infectious Diseases:
• Based on Occurrence of Disease:
1. Sporadic Disease
= disease that occurs only occasionally &
irregularly with no specific pattern
i.e. botulism, tetanus
2. Endemic Disease
= constantly present in a population,
country or community
i.e. Pulmonary Tuberculosis; malaria
3. Epidemic Disease
= patient acquire the disease in a relatively
short period of time ; greater than normal
number of cases in an area within a short
period of time
i.e, cholera; typhoid
4. Pandemic Disease
= epidemic disease that occurs worldwide
i.e. HIV infection; SARS
• Based on Severity or Duration of Disease
1. Acute Disease
= develops rapidly (rapid onset) but
lasts only a short time
i.e. measles, mumps, influenza
2. Chronic Disease
= develops more slowly (insidious onset)
disease likely to be continual or recurrent for
long periods
i.e. TB, Leprosy
3. Subacute Disease
= intermediate between acute and chronic
i.e. bacterial endocarditis
4. Latent Disease
= causative agent remains inactive for a time but
then becomes active to produce symptoms of
the disease
i.e. chickenpox → shingles (zoster); amoebiasis
• Based on Extent of Affected Host’s Body
1. Local Infection
= microbes invade a relatively small area
of the body
2. Generalized (Systemic) Infection
= spread throughout the body by blood
or lymph
i.e. measles
3. Focal Infection
= local infection that spread but are
confined to specific areas of the body
• Based on State of Host Resistance:

1. Primary Infection
= acute infection that causes the initial illness
2. Secondary Infection
= one caused by an opportunistic pathogen
after primary infection has weakened the body’s
defenses
3. Subclinical (Inapparent Infection)
= does not cause any noticeable illness
 Reason why infection occur
1. Some bacteria develop resistance to
antibiotics.
2. Some microbes such as influenza have so
many different strains that a single vaccine
cannot protect against all of them
3. Most viruses resist antiviral drugs
4. New infectious agents occasionally arise
such as HIV and corona viruses
5. Some microbes localize in areas of the body
that make treatment difficult
( e.g., bones , CNS )
6. Opportunistic organisms can cause
infection in immunocompromised patients.
7. Most people have not received
immunization
8. Increased air travel can cause the spread of
the virulent organism to a heavily
populated area in hours
9. Use of biological warfare and bioterrorism
with organisms such as Anthrax and plaque
is an increasing threat to public health and
safety throughout the world
10. The expanded use of immunosuppressive
drugs and invasive procedures increases the
risk of infection.
The nurse responsibilities extend beyond the immediate care of
the patient. He/she must be knowledgeable of the following :

1. The nature of the specific microorganism

and its capacity for survival both within and
outside the body.
2. The most effective method of destruction of
the specific organism
3. How the organism invades the host and its
route of escape from the body.
4. The incubation period, prodrome, and the
length of communicability
5. How a specific drugs alters the clinical
signs and the infections course of the
disease.
6. The most recent methods and concepts of
prophylaxis for communicable disease
7. The rationale and control measures,
including isolation techniques
 Stages of Disease
• Incubation Period
- time interval between the initial infection and the 1st
appearance of any s/sx
- patient is not yet aware of the disease
• Prodromal Period
- early, mild appearance of symptoms of the disease
• Period of Illness
– Time of greatest symptomatic experience ( pt. is
sick)
- overt s/sx of disease
WBC may increase or decrease
can result to death if immune response or medical
intervention fails
• Period of Decline
s/sx subside
pathogen replication is brought under control
vulnerable to secondary infection

• Period of Convalescence
– Replication of pathogenic organisms is
stopped
regains strength and the body returns to its
pre diseased state
= recovery has occurred
 Nurse Alert!!!!

• Note that in the case of acquired immunity against

a pathogen the progress of disease may end during
the prodromal period as a consequence of the
rapid immune system response to the infection.
• For example, acquired immunity might be as a
consequence of vaccination or previous natural
exposure to the pathogen.
 MICROBES against HUMAN
Definitions:
• Symptoms
subjective evidence of disease that is experienced or
perceived
subjective changes in body function noted by
patient but not apparent to an observer
• Signs
objective evidence of a disease the physician can
observe and measure
• Syndrome
a specific group of signs and symptoms that
accompany a particular disease
• Incidence
the number of people in a population who
develop a disease during a particular time
period
• Prevalence
= the number of people in a population who
develop a disease, regardless of when it
appeared
= refers to both old and new cases
• INFECTION
- condition caused by the entry and
multiplication of pathogenic
microorganisms within the host body
 CONDITIONS THAT AFFECT INFECTION DEVELOPMENT

• Pathogenicity – ability to cause disease

• Infective dose (sufficient number of microorganisms
needed to initiate infection)
• Virulence ( disease severity) and Invasiveness of
microorganisms ( ability to enter and move through
tissue)
• Organisms specificity ( host preference)
• Resistance of the host
• Immunity of the host
**Cycle of infection must be completed**
Chain of Infection
 Chain of Infection

The chain begins with the

existence of a specific
pathogenic microorganism

The second link is the

reservoir, an environment
where the pathogen can
survive.
CHAIN OF INFECTION

Causative agent

• Is any microbe capable of producing a disease

1. Bacteria
2. Spirochete
3. Viruses
4. Rickettsia
5. Chlamydiae
6. Fungi
7. Protozoa
8. Parasites
 CHAIN OF INFECTION
Reservoir
of
Infection

• Reservoir of Infection- Refers to the

environment and objects on which an
organism survives and multiplies.
1. Human Reservoir
2. Animal
3. Non-living things
Inanimate (Non Living) Reservoirs
air, soil, food, milk, water, fomites

Fomites
articles that are easily contaminated by
pathogens from the respiratory, intestinal
tract and skin

Air
droplets of respiratory tract secretions
dust particles
 Chain of Infection

The third link is the means

of escape from the
reservoir. ( Mode of Exit )

The fourth link is the

mode of transmission
from the reservoir to
the host.
CHAIN OF INFECTION

Portal of exit

• Is the path or way in which the organism leaves the

reservoir. This is where the organism grows.
• Common portal entry IS THE PORTAL OF EXIT
1. Respiratory system
2. GUT
3. GIT
4. Skin and mucous membrane
5. Placenta ( in transplacental transmission)
CHAIN OF INFECTION

MOT

• Infectious agent passes through from the

portal of exit of the reservoir to the
susceptible host.
• 4 modes by which the infectious agent
an be transmitted:
1. Contact transmission
2. Airborne
3. Vehicle transmission
4. Vector- borne transmission
CHAIN OF INFECTION
MOT
Horizontal transmission

1. Contact transmission-
1. Direct contact – person to person
2. Indirect contact – inanimate objects or personal things
3. Droplet contact- contact with discharges from coughing, sneezing or
talking with an infected person.
2. Airborne Transmission
– Droplet nuclei – within 3 feet from the source
– Dust particles in the air
3. Vehicle transmission
– transmitted through items or inanimate object like food, water and
contaminated infusion products and equipments
4. Vector- borne transmission
– Transmitted with the aid of contaminated or infected arthropods such as
flies, mosquitoes and ticks
Type of Contact Transmission

• Direct Contact Transmission

i.e. kissing, touching, sexual contact

Source → Susceptible Host

• Indirect Contact Transmission

reservoir to a susceptible host by means of a
non living object (fomites)
Source → Non Living Object → Susceptible Host

• Droplet Transmission
Microbes spread in droplet nuclei that travel only
short distances (< 1 meter)
i.e. coughing, sneezing, laughing or talking
 Chain of Infection

The fifth link is

the means of
entry into the
host ( Mode of
entry)

And the last link is the

host's susceptibility to
the pathogenic
microorganism
CHAIN OF INFECTION
Portal
Of
entry

• Is the venue where organism gains

entrance into the susceptible host.
• The infective microbes use the same
avenues when they exit from the
reservoir
CHAIN OF INFECTION

Susceptible host

• Human body has many defenses against

the entry and multiplication of organism.
• Defenses are good no infection will
take place
• Weakened host  microbes will launch
an infectious diseases
 Susceptible Host

• Recognition of high risk patients

• Immunocompromised
• DM
• Surgery
• Burns
• Elderly
Treatment of underlying
Diseases Rapid accurate
Causative agent
Susceptible
Recognition of Identification
host
High risk Of organism
patient

X
Employee health
Reservoir
Environmental sanitation
Disinfection/sterilization
CHAIN OF INFECTION
Aseptic technique
Portal of entry
Catheter care
Wound care

Hand hygiene Portal

Hand hygiene
Sterilization Of & secretion
Mode Control of excretion
Standard precaution Trash andexit
waste disposal
AirflowOfcontrol
transmission
Food handling
isolation
 Infection control: 1st line of defense

• Hand hygiene, first line of defense and the

most important practice in preventing
infection.

• Handwashing – single most important way of

preventing transfer of microorganisms
 Preventing the Spread of Communicable Disease

• Community vs. Nosocomial

• Community Acquired Infection

• = infection present or incubating at the time
of consultation
• Nosocomial Infection
• = infection that develop during the course of
hospital stay was not evident at time of admission
 Factors for Nosocomial Infection

Microorganism/Hospital Environment
• Most common cause
Staph aureus, Coag Neg Staph Enterococci
E. coli, Pseudomonas, Enterobacter, Klebsiella
Clostridium Difficile
Fungi ( C. Albicans)
Other ( Gram (-) bacteria)
• 70% are drug resistant bacteria

Compromised Host
• One whose resistance to infection is impaired by
broken skin, mucous membranes and a
suppressed immune system
Skin and Mucous Membrane
physical barrier
i.e. burns, surgical wounds, trauma, IV site
invasive procedures
Suppressed Immune System
i.e. drugs, radiation, steroids, DM, AIDS

Chain of Transmission
• Direct Contact Transmission
Hospital staff to patient
Patient to patient
• Indirect Contact Transmission
Fomites - inanimate objects or substances capable of
absorbing or transmitting a pathogen
i.e. clothing, bed linens, towels, eating utensils

• Hospital Ventilation System

Airborne transmission
Handling of Food and Eating Utensils
Organisms
Staphylococcus (skin /dust)

Clostridium Botulinum ( dust/dirt)

Clostridium Perfringens ( dust/dirt/hand)

Salmonella, Shigella, Camphylobacter,

Proteus
( feces/hands/flies/pets)

Pseudomonas Sp (dirt/hand/contaminated
equipment)
General Control Measures
Prevention of Airborne Contamination

• Cover mouth and nose ( coughing or

sneezing)
• Limit number of persons in a room
• Removal of dirt and dust
• Open room to fresh air and sunlight
• Roll linens together
• Remove bacteria from the air (air filters)
• Use high quality foods
• Proper refrigeration and storage of food
• Proper washing, preparing, and cooking of food
• Proper disposal of uneaten food
• Proper hand washing
• Proper disposal of oral and nasal secretion
• Cover hair and wear clean clothes and apron
• Provide periodic health exam for kitchen workers
• Keep cutting boards clean
• Prohibit anyone with respiratory or GIT disease from
handling food
• Rinse and wash utensils with a temperature above
80°C
Handling of Fomites

• Use disposable equipments

• Sterilize or disinfect equipment
• Use individual equipment for each patient
• Use single use thermometers
• Empty bedpans and urinals properly and wash
with hot water, store in dry ,clean area or
storage
• Place used linens and personal care equipments,
and soiled laundry in a bag
 IMMUNITY
- is the condition of being secure against any
particular disease, particularly the power
which a living organism possesses to resist and
overcome infection
- is the resistance that an individual has against
disease
• IMMUNE SYSTEM

• PROTECTION AGAINST INFECTIVE OR ALLERGIC

DISEASES BY A SYSTEM OF ANTIBODIES,
IMMUNOGLOBULINS AND RELATED RESISTANCE
FACTORS.

• ANTIBODY

• - a specific immune substance produced by the

lymphocytes of the blood of tissue juices of man or
animal in response to the introduction into the
body of an antigen
• ANTIGEN
TRIGGERING AGENT OF THE IMMUNE SYSTEM;
FOREIGN SUBSTANCE INTRODUCED INTO THE
BODY causing the body to produce antibodies
TYPES OF ANTIGENS:
1. INACTIVATED ( KILLED ORGANISM)
1. Not long lasting
2. Multiple doses needed
3. Booster dose needed
2. ATTENUATED ( LIVE WEAKENED ORGANISM)
1. single dose needed
2. long lasting immunity
** all vaccines lose their potency after a certain time.
 TYPES OF IMMUNITY
• NATURAL =innate; within the HOST;
Immune System
a. Natural
a.1. Natural Active
a.2. Natural Passive
• ACQUIRED = outside the HOST
a.1. artificial Active
b.2. artificial passive
Types of Immunity

A. NATURAL :
1. Natural active – through exposure or
diseases; had the disease & recovered
2. Natural Passive – maternal antibodies;
acquired through placental transfer
B. ARTIFICIAL ( Laboratory )
1. Artificial active – introduction of antigen
Ex. Vaccines ; toxoids
( No exposure yet; preventive measure)
= gives long immunity – months to years
2. Artificial passive- introduction of antibodies
Ex. Antitoxins; immunoglobulin
( gammaglobulin), antiserum, convalescent
serum
Ex. TAT ( tetanus antitoxin)
( w/ exposure to the causative agent)
= gives short immunity – 3-4 weeks
 Immunity

NATURAL ACQUIRED
- INHERENT BODY TISSUES
Outside the host

1. NATURAL 2. ARTIFICIAL
( HUMAN) ( LABORATORY)

A. ACTIVE B. PASSIVE A. ACTIVE B. PASSIVE

-HAD THE DISEASE & - MATERNAL - VACCINES - ANTITOXINS
-RECOVERED ANTIBODIES - TOXOIDS - IG’S
 Infection control and prevention

• Immunization
• Active
• Passive
 IMMUNIZATION
- is the induction or introduction of specific
protective antibodies in a susceptible person or
animal, or the production of cellular immunity
in such a person or animal.

- A PROCESS BY WHICH RESISTANCE TO AN

INFECTIOUS DISEASE IS INDUCED OR
AUGMENTED.
 Active Immunization
1. BCG
2. DPT
3. OPV/IPV
4. Measles
5. MMR
6. Hepatitis B
7. Varicella
8. Hemophilus influenzae B (Hib)
 Active immunization not routinely given

1. Cholera vaccine
2. Rabies
3. Typhoid
4. Influenza A & B
5. Meningococcal
6. Pneumococcal vaccine
7. HPV vaccine
 Passive immunization
1. Diphtheria antitoxin
2. Hepatitis B immunoglobulin (HBIG)
3. Measles immunoglobulin
4. Varicella immunoglobulin (VZIG)
5. Rabies Human immunoglobulin (RIG)
6. Tetanus human immunoglobulin (TIG)
7. Tetanus Toxin ( ATS)
 NURSE ALERT !!!

ALL VACCINEs LOSE THEIR POTENCY

AFTER A CERTAIN TIME.
EXPIRY DATE SHOULD BE NOTED ON THE LABEL
 What
damages
vaccine ??
Heat and sunlight damages vaccine
Esp. LIVE VACCINE

Freezing damages the KILLED vaccine

And TOXOID
 Use water only in cleaning the
refrigerator
Or freezer.
( antiseptics, disinfectants and
detergents
Or alcohol lessen potency of
vaccine )

Cold Chain System

KEEP VACCINES IN CORRECT COLD TEMPERATURE
(0-8 c)
 Cold Chain System
• Starts from the manufacturer >>> Airport
>>>Central Vaccine Store ?>>> Regional Store
>>> District Hospital >>> Health Center or
Outreach Service
>>>Dispensary>>Immunizing Staff or Mother
& Child
 Immunization
• EPI : PPD 996
• GOAL : Universal Child Immunization
( Proc. No. 6)
• Common Goal to Prevent childhood diseases
covered by the EPI ( expanded program immunization)
1. Tb (BCG)
2. Measles
3. Diphtheria, Pertusiss
4. Polio ,
5. Tetanus
6. Hepatitis B
 IMMUNOGLOBULINS
( IG’S)
• IgG
MOST PREVALENT ANTIBODY 80%, PRODUCED LATER IN THE IMMUNE
RESPONSE, ONLY Ig THAT CAN CROSS PLACENTA
• IgA
FOUND IN COLOSTRUM, TEARS, SALIVA, SWEAT
• IgM
PRINCIPAL ANTIBODY OF BLOOD, QUICKLY PRODUCED IN
RESPONSE TO AN ANTIGEN, RESPONDS TO ARTIFICIAL
IMMUNIZATION
• IgE
RESPONDS TO ALLERGIC REACTION
• IgD
UNKNOWN, ANTIGEN RECEPTOR, FOUND IN THE SURFACE OF B CELLS
 Expanded Program of Immunization

BCG At birth ID Once None, mild fever, local rxn

DPT 6 weeks IM 3 x (4weeks int) Local rxn, acute

encephalopathy
MMR 15 mos

OPV 6 weeks oral 3 x (4wks int) None

Measles 9 mos SQ Once Fever

Hep B At birth IM 3 x ( 2,4,6 ) Mild local rxn

 Special-use Vaccine
Meningoccocal Epidemic areas SQ None

Rabies Exposures ID/IM Local rxn

Typhoid travellers IM Local rxn

Japanese encep travellers SC Anaphylactic

Pneumococcal immunocompro IM/SQ Local rxn

 Contraindications when giving
immunizations:

• Severe febrile illness

• Live virus vaccine are generally not
administered with altered immune system
• Allergic reaction
 Permanent ContraIndication
• Allergy
• Encephalopathy without known cause
• Convulsion within 7 days after Pertussis
vaccine
 Temporary C.I
• Pregnancy
• Immunocompromised
• Very severe disease
• Previously received blood product/transfusion
 EPIDEMIOLOGY AND DISEASE TRANSMISSION

Reservoirs of Infection:
= any site where the pathogen can multiply or merely
survive until it is transferred to the host
• Human Reservoir
= principal living reservoir of human disease
1. Direct Transmission
= usually associated with signs and symptoms
2. Carriers
= harbor the pathogen without associated signs
and symptoms
 Types of Carriers:

Incubatory Carrier
- capable of transmitting pathogens during the
incubation period
Convalescent Carrier
- transmit disease during convalescence or
recovery period
Active Carrier
- completely recovered from disease but
continue to harbor the pathogen indefinitely
Passive Carrier
- carry the pathogen without ever having the
disease
 INFECTIOUS DISEASES
CLASSIFIED AS
• Blood/ vector borne
• Enteric diseases
• Respiratory diseases
• Eruptive Fever
• CNS infection
• Diarrheal Diseases
• STD
• EMERGING DISEASES
 INFECTIOUS DISEASES
CLASSIFIED AS
1. Respiratory diseases
a. Diphtheria
b. Pertussis
c. PTB
d. Mumps
e. Meningococcemia
2. Eruptive fever
a. Measles (Rubeola)
b. Varicella
c. German Measles ( Rubella)
d. Small pox
 INFECTIOUS DISEASES
CLASSIFIED AS
3. Blood/ vector borne
a. DHF
b. Malaria
c. Leptospirosis
d. Filiariasis
4. Enteric diseases
a. Typhoid fever
b. Viral Hepatitis
c. Schistosomiasis
INFECTIOUS DISEASE
Respiratory Diseases
 Diphtheria

• - characterized by the formation of

pseudomembrane commonly in the
faucal area & tonsils and the elaboration
of a powerful EXOTOXIN affecting the
important viscera of the heart & kidneys
& the peripheral nervous system
• CA: Corynebacterium diphtheriae, gram
(+)
( Klebs Loeffler’s Bacillus)
• IP: 2-5 days
• Period of Communicability: 2-4 wks if
untreated, 1-2 days if treated
• Active (DPT) and
Passive Immunization
(Diphtheria antitoxin)
• Source: Discharges of the nose, pharynx, eyes, or
lesion of other parts of the body infected
• More severe in unimmunized and partially
immunized

MOT: Direct/indirect contact = Airborne/droplet,

fomites
Respiratory type of Diphtheria:
1. Faucial & Pharayngeal ( tonsilar, uvular, palatar)- low
grade fever, malaise, headache, sore throat & slight
cervical lymphadenopathy)
- w/in 24 hrs, small yellowish spots appear on the
reddened tonsils & form the adherent
PSEUDOMEMBRANE (pathognomonic)
- Dysphagia & noisy breathing
- “ Bullneck appearance” – due to massive
enlargement of the lymph nodes
- Death may occur from bronchopneumonia or toxic
myocarditis
-
2 Laryngotracheal – ( trachea, bronchial)
- Extension of the pharyngeal type ( more
common in infants)
- Hoarseness with a barking cough & noisy
breathing
3. Nasal =( anterior, posterior)
- occurs mostly during the 1st 3 yrs of life
- benign, subacute or chronic if it does not
extend downward
S/sx: sore throat, fever,
“Bull-neck appearance”(
CHARACTERISTIC
SIGN) ,Pseudomembran
e-( PATHOGNOMONIC
SIGN) gray exudate, foul
breath, massive swelling
of tonsils and uvula,
cervical
lymphadenopathy,
swelling of
submandibular and
anterior neck),
obstruction of
respiratory tract
Diagnostics:
1.Schick test – ID
injection to determine
susceptibility to
diphtheria toxin
2. Moloney – ID injection
to determine sensitivity
to diphtheria toxoid
3. Nose &Throat swab –
swab is streaked on
fresh blood tellurite &
examined after 8-24 hrs
((-) results does not rule
out diphtheria)
 Treatment
• Neutralize the toxins – antidiptheria serum
• Kill the microorganism – penicillin,
erythromycin, rifampicin, clindamycin
• Considered non contagious after 3 negative
throat cultures
• Prevent respiratory obstruction –
tracheostomy, intubation
• CBR up to 2 weeks to prevent myocarditis
• Strict isolation
 Nursing Interventions
• 1. REST
– Pt. should be confined to bed for at least 2
weeks, not permitted to feed himself, to bathe or
to make exertions.
– Pt. is apt to be restless, esp. with the dyspnea of
laryngeal diphtheria therefore warm fresh air
must be insured
– In very severe cases, baths & even making bed
shl. be omitted to conserve the pt’s strength
– Small frequent feedings rather than larger ones
– Prevent straining on defecation
2. Care of the nose and Throat
– Gentle swabbing must be done to prevent
bleeding
– Liquid albolene is very soothing to the mucous
membrane after cleansing & it prevents dryness
and excoriation caused by discharges from the
lesions
– The whole room or unit must have a very moist
atmosphere, with the humidity very carefully
regulated in order to lessen irritability to nose &
throat
3. Ice collar
– More effective than heat application in reducing
pain of the sore throat
– To be effective, the collar must be kept around
the neck as intended and not permitted to slip
down on the chest
– The rubber collar must me placed in a cloth or
wrapped in gauze to protect the pt’s skin & to
prevent condensation from wetting the pt’s
clothing
4. Diet
– Soft foods are more easily swallowed bec of sore
throat
– Small amounts are given frequently
– Fruit juices helps to maintain alkalinity of the
blood
– Creamed soups, purees, soft eggs, jellies,
custards, broths, & buttermilk shl. provide a
balanced ration if a sufficient amount is
swallowed
 Pre exposure prophylaxis for Diphtheria,
Pertussis, Tetanus
• DPT- 0.5 ml IM
1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
1st booster – 18 mos
2nd booster – 4-6 yo
subsequent booster – every 10 yrs thereafter
• Household contacts
(+) primary immunization and (-) culture - booster dose
(+) culture and (-) immunization – treated as a case of
Diphtheria
 Complications
1. Due to Toxemia:
• Toxic Myocarditis – most common ( due to the
action of the toxin on the heart muscles)
• Polyneuritis – caused by the absorption of toxins on
the nerves
- paralysis of the soft palate, paralysis of the
ciliary muscle of the eye, pharynx, larynx, or
extremities
• Acute Bronchopneumonia – secretions tend to
stagnate due to paralysis of the diaphragm (Airway
obstruction can lead to death through asphyxiation)
 Pertussis/ Whooping Cough
• Bordetella pertussis, B. parapertussis, B.
bronchiseptica, gram (-)
“ Bordet Gengou Bacillus”
• Common in Infants and young children & fatal
to toddlers
IP: 7-14 days
MOT: airborne/droplet; direct contact ( nose &
throat secretions); indirect contact ( articles)
 Pertussis/ Whooping Cough
• Characterized by repeated attacks of
spasmodic coughing which consists of a series
of explosive expirations, typically ending in a
long drawn force inspiration, which produces
the characteristic crowing sound called the
WHOOP & usually followed by vomiting.
Period of communicability: from 7 days after
exposure to 3 weeks after typical paroxysms
MOT: airborne/droplet; direct contact ( nose &
throat secretions); indirect contact ( articles)
S/sx:
1. Catarrhal stage (1-2 wks; highly contagious) – sneezing, runny
nose,tearing lacrimation, mild cough, low grade fever
2. Paroxysmal stage (2-4 wks) - Clusters of cough that ends with a
whoop, vomiting, exhaustion
3. Convalescent stage (4-6 wks) – less frequent cough

Dx: WHO - >21 days cough + close contact w/ pertussis px + (+) culture OR
rise in Ab to FHA or pertussis toxin
* throat culture w/ Bordet gengou agar
Complications: ( common in infants)
1. Otitis media – caused by secondary invading
organisms
2. Bronchopneumonia
3. Spontaneous pneumothorax, bronchiectasis,
atelectasis, rectal prolapse, umbilical hernia,
strangulation of inguinal hernia due to straining
4. Convulsions - serious complication due to brain
damage

Prognosis: greatest danger is when the disease is

acquired during infancy because of the
complications such as bronchopneumonia &
convulsions due to encephalopathy brought about
by asphyxia
Nursing Management:
• liquefy thick secretions with Ferrous
iodide
• Supportive measures:
- CBR when paroxysms are severe
- Warm fresh air is better than cold air
w/c induces vomiting
- Do not bring pt outdoors
- Hydration and nutrition
- Avoid excitement, dust, smoke, &
sudden changes in temp
• Isolation = 4 wks after coughing
begins & continued for 7 days after
the onset of antibiotic therapy
Medical Management:
1. Erythromycin shorten the period of
communicability if given at a dose of 50
mg/kg/day for 7 days
2. Ampicillin
3. Hyperimmune pertusis gamma globulin
4. Control of the cough paroxysms may be
attempted w/ sedatives or narcotics
5. Children w/ pertussis under 2 yrs of age
should be hospitalized
6. IV therapy in serious cases
Pre exposure prophylaxis for Diphtheria,
Pertussis, Tetanus
• DPT- 0.5 ml IM
1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
1st booster – 18 mos
2nd booster – 4-6 yo
subsequent booster – every 10 yrs thereafter
• Household contacts
(+) primary immunization and (-) culture - booster
dose
(+) culture and (-) immunization – treated as a case
of Diphtheria
 Pulmonary Tuberculosis( Koch’s
Disease/Pthisis/Consumption disease)
• CA: Mycobacterium tuberculosis ( bacteria), acid
fast bacilli
• The organism multiplies slowly & is characterized
as acid fast aerobic organism which can be killed
by heat, sunshine, drying & ultraviolet light.
• Sputum of persons with TB is the most common
source of the organism spread through droplet
( airborne)
- Is a chronic, or subacute or acute respiratory
disease commonly affecting the lungs characterized
by formation of tubercles in the tissues which tend
to undergo caseation, necrosis and calcification.
IP: 2 – 10 weeks
Mode of Transmission:
• Direct: droplet ( sneezing, coughing)
• Indirect: continuous exposure to infected persons
within the family
Source of Infection: sputum, blood from hemoptysis,
nasal discharges and saliva
• Classification :
– Minimal – slight lesion
– Moderately advanced – one or both lung may be
involved
– Far advanced- more extensive
• Clinical classification:
– 1. inactive TB
• Symptoms absent
• Sputum negative
• CXR – no evidence of cavity
– 2. Active
• Tuberculin test positive
• CXR – progressive
• (+) of symptoms
• Sputum (+)
– 3. Activity not determined
• Clinical manifestations:
– Afternoon rise of temperature for 1 mo. or more
– Night sweating
– Body malaise, weight loss
– Cough, dry to productive
– Dyspnea, hoarseness of voice
– Hemoptysis – pathognomonic
– Occasional chest pain
– (+) sputum for AFB
Etiologic Factors that contribute heavily to the
high Incidence & high mortality rate of TB:
• Poverty / Overcrowded homes
• Protein undernutrition
• Deficiencies in Vit A,D,C
• Children below 5 years old – prone to
infection due to inadequate levels of
immunity
 DX
• 1. Case Finding:
A. Sputum Microscopy ( cheapest & confirmatory )
– Results take about 3 weeks to confirm
– Sputum sample shld be taken 1st thing in the
morning upon arising
3 specimens:
– 1st – on the spot = HC
– 2nd- upon arising = Home
– 3rd – on the spot = HC
• 2. Sputum Culture & Sensitivity
• 3. Chest X-ray – cavitary lesion
• 4. Tuberculin Test
– 1. PPD – Purified Protein Derivative
A Purified Protein Derivative (PPD) of tubercle
bacilli (any rod-shaped bacteria) called tuberculin is
introduced into the skin by scratch, puncture or
intradermal injection.
A screening test to detect exposure to M.
tuberculosis
Result offers LIMITED information
• HEAF TEST (multiple puncture test
• PIRQUET’S TEST (scratching of tuberculin in the skin)
• TINE TEST (multiple sharp prongs penetrate the skin and
inject tuberculin)
• A negative result does not necessarily exclude a diagnosis
of tuberculosis because of variations in sensitivity and
strength of tuberculin administered.
• Reading is from 48-72 hours after the test.

Mantoux Test- intradermal test (more reliable) = ID

injection of tuberculin extract into the inner aspect of
forearm to detect infection/exposure to CA.
Localized reaction- detected in 48 to 72 hours
(+) induration of 10 mm or above
• Advise the client not to scratch the test site, to
prevent infection and abscess formation
• Instruct the client to avoid washing the test
site
• Assess the test site for the amount of
induration (hard swelling) in millimeters and
the presence of erythema and vesicles
(small blister-like elevations).
 PPD – ID
macrophages in skin take up
Ag and deliver it to T cells

T cells move to skin site,

release lymphokines

activate macrophages and

in 48-72 hrs, skin becomes
indurated

- > 10 mm is (+)
20-mm INDURATION
Tuberculin test. Erythema and induration at site of intradermal injection
of 5 tuberculin units in a child with primary tuberculosis. This is an
unusually severe reaction. Mantoux method.
Dx:
Chest xray - cavitary
lesion
Sputum exam
sputum culture
 Classification of TB
Class I TB exposure – (+) exposure
Class II TB Infection – (+) exposure and PPD
Class III TB disease – active TB or 3 or more of
criteria
Exposure, s/sx, (+)tuberculin
test, xray, sputum
exam, culture
Class IV TB inactive – (+/-) hx of prev TB,
(+/-) prev hx of
chemotherapy,
(+)xray evidence of
healed lesion and
(+) PPD
Tx: Intensive:
INH, Rifampicin, PZA x
2 mos (ETM, STREP)
Maintenance :
INH, Rifampicin x 4 mos
 CATEGORIES OF TB
• category I (new PTB) - (+) sputum(+) chest xray

• category II (PTB relapse not less than 6 mos)

• category III (active PTB case) - (-) sputum chest x-

ray, regression of infiltrates
• Category 1V – partially treated; poor compliance to
DOTS
• Category V – PTB suspect ( (+) skin test; (+) family
member with PTB
Mgmt:
• short course – 6-9 months
• long course – 9-12 months
• DOTS- direct observe treatment short course
• Case finding
• Home meds (members of the family)
• Referrals
• Follow-up

* 2 wks after medications – non communicable

3 successive (-) sputum - non communicable
rifampicin - prophylactic
 TREATMENT:

• CATEGORY 1 - NEW PTB, (+) SPUTUM

GIVE RIPE 2 MONTHS, MAINTENANCE OF RI 4 MONTHS

• CATEGORY 2 - PREVIOUSLY TREATED WITH RELAPSES

GIVE RIPES 1ST 2 MONTHS, RIPS 1 MONTH, MAINTENANCE RIE 5
MONTHS

• CATEGORY 3 - NEW PTB (-) SPUTUM FOR 3X

GIVE RIP 2 MONTHS, MAINTENACE RI 2 MONTHS

* IF RESISTANT TO DRUGS GIVE ADDITIONAL MONTH/S AS PRESCRIBED

 Primary Anti TB Drugs

1. Rifampicin = Oral ( R)
Dose: 10-20mg/kg/day – empty stomach
Duration: 6 mos
Action: Antimycobacterial activity & most
effective anti-TB drug discovery after INH
Rapid response, induces resolution of the
desiminated foci up to complete
disappearance of the lesions
SE = orange colored urine, GI upset, Jaundice,
Renal failure, thrombocytopenia
• 2. Isoniazid (INH) = Oral ( H)
• Dose: 10-20mg/kg/day in 2-3 doses or once
daily not to exceed 500mg
- ( Bacteriostatic) inhibits
• ( Bactericidal ) kills
• Used prophylactically to patients (+) of PPD
• SE = Rashes (give anti-histamine); Peripheral
neuritis ( Give Vit B6- Pyridoxine)50 mg;
Jaundice; Psychosis
3. Pyrazinamide ( PZA) ( Z)
• SE = Hyperuricemia ( inc uric acid)
• Mx: Inc fluid intake
4. Ethambutol = Oral 15-20mg/day ( E )
• SE = Optic neuritis ( dec visual acuity)
• Give Vit. B6(Pyrdoxine)
5. Streptomycin= IM ( S )
- skin testing imp. Before administration of
the drug
• SE = Ototoxicity, 8th cranial nerve damage
– ( Tinnitus, dizziness, N&V)
MDT side effects
• r-orange urine
• i-neuritis and hepatitis
• p-hyperuricemia
• e-impairment of vision
• s-8th cranial nerve damage
PTB- NURSING MANAGEMENT
1. MAINTAIN REPIRATORY ISOLATION
2. Administer medicine as ordered
3. Always check sputum for blood or purulent
expectoration
4. Encourage questions and conversation so that the
patient can air his or her feelings
5. Teach or educate the patient all about PTB
6. Encourage patient to stop smoking
7. Teach how to dispose secretion properly
8. Advised to have plenty of rest and eat balanced diet
9. Be alert of drug reaction
10. Emphasize the importance of follow-up
 PULMONARY TUBERCULOSIS
( Koch’s Disease/Phthisis/ consumption Disease)
PREVENTION:
1. Submit all babies for BCG immunization
2. Avoid overcrowding
3. Improve nutritional and health status
4. Advise persons who have been exposed to
infected persons to receive tuberculin test if
necessary CXR and prophylactic isoniazid.
 Mumps ( Epidemic Parotitis); Infectious
Parotitis
• -Acute VIRAL disease of the salivary gland.
Characteristic feature is swelling of one or both of the
parotid glands
• RNA, Mumps virus ; paromyxovirus of the Varicella
family( found in the saliva
• MMR – 15 mos ( lifetime immunity)
IP: 14-25 days, usually 18 days
Incidence: 5-15 y/o, cold weather, common in men. Adults
less likely to be attacked ( If so, causes sterility)
MOT: droplet, fomites, saliva
S/sx: Pain at the angle of the jaw (Unilateral or
bilateral) PATHOGNOMONIC SIGN
parotitis, Orchitis - sterility if bilateral,
Period of communicability: 6 days before swelling ;
until 9 days after swelling subsides ( 7th – 9th day)
** highest communicability – 48 hrs after onset
of swelling
Dx: serologic testing, ELISA
Mgmt: supportive
Supporter for orchitis
Analgesics Antipyretic, cold compress, steroids
• Diet : soft. Don’t give sour foods
Promotive:
 Proper disposal of nasal & throat secretions
 Bed rest
 Acute Meningococcemia

• CA : Neisseria meningitides ( bacteria) gram

(-)diplococci
MOT: Droplets (urti) to blood stream to CNS

IP: 1-2 days ( even faster)

• High risk: immunocompromised
S/sx:
1. Meningococcemia – usually starts as nasopharyngitis,
followed by sudden onset of high fever, chills,nausea,
vomiting, headache and arthralgia & rapid deterioration
of clinical condition within 24 hours.
2. Bacteria is carried by circulation & when it reaches the
meninges of the brain, BLEEDING occurs & petechial,
purpuric or ecchymotic hemorrhage is scattered in the
entire body surface appear.
3. Histologically, the skin lesions is the result of acute
vasculitis in the small vessels followed by suppurative
necrosis and hemorrhage into the dermal connective
tissue
S/sx:

n The combination of meningococcemia and

adrenal medullary hemorrhage is known as
WATERHOUSE FRIEDRICHSEN SYNDROME
n Fulminant Meningococcemia (Waterhouse
Friedrichsen) – is the rapid development of the
petechiae to purpuric and ecchymotic spots in
association with shock
S/Sx: of septic shock; hypotension, tachycardia,
enlarging petecchial rash, adrenal insufficiency
 Meningococcal Septicemia
Waterhouse-friedrichsen Syndrome
 Treatment:
• antimicrobial
– Benzyl Penicillin 250-400000 u/kg/day ( current drug of
choice)
– Chloramphenicol 100mg/kg/day( considered as
alternative choice for Pen allergic patients)

• Symptomatic and supportive

– fever
– seizures
– hydration
– respiratory function
• Chemoprophylaxis
– Rifampicin 300-600mg q 12hrs x 4 doses
– Ofloxacin 400mg single dose
– Ceftriaxone 125-250mg IM single dose ( Ciprobay)