Communicable Diseases • from a pregnant woman to fetus, or

• Communicable disease are most often the leading cause from a mother to her infant during
of illness in our country today childbirth
• Knowing what type of communicable disease could • Three Primary routes (Contact, droplet and airborne)
prevent a health care provider from acquiring or • Two lesser routes ( Vehicle and vector)
harboring the disease
Primary Routes
COMMON TERMS • A. Contact- most frequent source of nosocomial infection
• Epidemiology – science that study the patterns of • 1. Direct contact- transmission body to body and physical
health and disease, its occurrence & distribution for the transmisssion (sexual intercourse, kissing or touching)
prevention and control of disease. • 2. Indirect contact- contact with contaminated
• Sporadic – occasional or intermittent occurrence of intermediate object ( needle, dressing or dirty hands)
disease with no specific pattern • B. Droplet- transmission of large particle droplets ( larger
• Endemic - constant or continuous occurrence of disease the 5 microns) Diphtheria, pertusis, pnuemonia, etc.
• Epidemic – sudden increase in # of cases in short • C. Airborne- transmission of small particle droplets or
period of time, an outbreak residue of 5 microns ( measles, varicella, TB)
• Pandemic – worldwide epidemic
• Attack rate Two lesser routes
• is the number of cases developing in a group • Common Vehicle: transmission by contaminated items
people who were exposed to the infectious such as food, water or devices.
agent INFECTIOUS DISEASE PROCESS or CHAIN OF INFECTION • Vector borne: Mosquitoes, fleas, rats, etc.
• Morbidity rate • Infectious Agent 5. Portal of entry
• calculated as the number of cases of illness • Reservior • Mucous membrane, gastrointestinal (GI) tract,
given time period divided by the population at • Portal of Exit Genitourinary (GU) tract, Respiratory tract, Nonintact
risk. • Route of Transmission of MO skin
• Mortality rate • Portal of Entry 6. Susceptibility of the host
• the percentage of population that dies from • Susceptible Host • A host who is immunosuppressed, fatigue,
disease malnourished, weakened by other diseases, elderly,
• incidence Six links form the chain of infection stressed, or hospitalized with wounds, IV’s and catheters
• described as the number new cases in a are at high risk.
specific time period in a given population risk 1. Infectious agent (Microorganism): Bacteria, virus, fungi, etc.
• way of measuring the risk of an individual • A. Capability of producing an infection depends on: TRIAD OF DISEASE CAUSATION –
contracting the disease • i. Virulence and number of organisms present Epidemiologic Triad
• Prevalence • ii. Susceptibility of the host. 1. Host (suscepibility)
• reflects the number of total existing cases (both • iii. Existence of portal of entry - intrinsic or extrinsic characteristics
old and new) • iv. Affinity of host to harbor MO 2. Agent
• useful to assess the overall impact of the 2. Reservoir: Provide survival for organism 3. Environment
diseases on society • People, equipment, water, etc. - Medium for culture of MO and MOT
• Outbreak • A. Appropriate environment for growth and multiplication
• generally implies a cluster of cases occurring of microorganism must be present. Characteristics of an Agent
during a brief time interval and affecting a • B. Reservoir include respiratory, gastrointestinal, • Infectious dose – number of causative agent
specific population reproductive and urinary tracts, and the blood
3. Portal of exit
• Pathogenecity – ability to cause the disease
• Allows the microorganism to move from reservoir to host • Virulence / Potency – extent/severity of toxin quality
The Infectious Process • Antigenecity – ability to stimulate an anti-body response
• For an infection to occur a process involving six links or ( includes excretions, secretions, skin, droplets)
steps must be present 4. Route of transmission of MO (five routes)
• Types of transmission of pathogens: Viruses
• A. if any of the links are missing, the infection will not
– Horizontal transmission • can only multiply in living things as its reservoir
occur
• from one person to another through • can pass through the filters of the body, Blood
• B. Infection control measures can interrupt the process
contact, ingestion of food or water, or Brain Barrier & Placenta Barrier
by eliminating one or more of the steps.
via a living agent such as insect. • self limiting
– Vertical transmission • lasts for a specific length of time with or without
treatment,
 • Reverse Isolation – protecting the patient • Airborne Precaution – use of respiratory protection such – death is usually due to complications (pneumonia)
wherein MO will be away from the patient as use of special types of mask = ultra filter mask or
particulate mask – affects children < 2y/o, malnourished

2 Revised Isolation Precaution to be practiced • Droplet Precaution – use ordinary mask and goggles CA: Paramyxovirus – rubeola virus

1. Standard Precaution • Contact Precaution – use of gloves and gowns MOT: Droplet spread or direct contact in some instances it is
Airborne
2. Transmission Based Precaution • B. Quarantine – limitation of freedom of movement of a
well person during the longest incubation period; Incubation period- 10 days from exposure
1. Standard Precaution – the primary strategy for preventing
nosocomial infection - quarantine of person with no disease but were 1. Pre-eruptive Stage – highly contagious stage
exposed.
• applies to all pts regardless of their dx - high grade fever – 3-4 days
• C. Disinfection – killing/destruction of pathogen by - 3 C’s – cough, colds, conjunctivitis
• applies to all body fluids, secretions and excretions mechanical or chemical
except sweat
- (+)Stimson sign / measle eye – puffiness of
the eyelid with linear congestion of the lower conjunctiva
• applies to non intact skin and mucous membrane
2 Ways of Attaining Disinfection: - Photosensitivity
Elements of Standard Precaution
CDC
• Concurrent – done when a person is still the - (+) enathem, fine red spot (grayish pecks) at the center
Centers for Disease Control and Prevention
source of infection found in the inner cheek just opposite the molars
• Handwashing - (Koplik’s spot) –pathognomonic
• Terminal – done when the patient is no longer the source
• Wear gloves if there is a possibility of direct contact with of infection 2. Eruptive Stage
blood or bodily secretions
• Sterilization - killing of all MO including spores – Rashes appear on the 3rd day - maculopapular,
• Gloves must be worn when in contact with items or
reddish, and blochy
surfaces soiled with blood or body fluids • Disinfestation - destruction of MO, insects, rodents or
• Removal of false fingernails
animals that are living in the human habitat that can – cephalo-caudal in distribution
transmit disease to man.
• Protect clothing with gowns or plastic aprons if there is 3. Post-eruptive Stage
possibility of being splashed or direct contact with • Fumigation – killing of arthropods and rodents using
contaminated material gaseous agents – fine, branny desquamation – peeling off

• Wear mask and/or goggles or face shields to avoid being D. Medical Asepsis from red color rashes, it will fade to brown then peel off excluding
splashed, suctioning, irrigations, during OR and skin
deliveries • Hand washing – the no. 1 principle

• Do not break needles into receptacles; rather discard • Use of protective barrier (PPE)
them intact and uncapped into containers
• Placarding – no smoking sign
• 2. Transmission Based Precaution – is instituted to
patients with highly transmissible infections. Precautions Integumentary System
are beyond the set for the standard precautions.
Measles
3 Ways to Practice Transmission Based Precaution:
-aka RUBEOLA, Morbilli, Little Red Disease, 7 day measles, 9
day measles, Hard measles of First Disease
2. Eruptive Stage  Immunization using Varicella vaccine (Viravax) given 12 • B- Bactericidal ---decrease chance of skin infection
months old, 0.5cc SQ deltoid
 begins as a macule, 5-10 crops → papule • Oxidizing ---deodorizes the rashes
→vesicle → pastule  If <13 y/o – single dose ; if > 13y/o – 2 doses, 1 month
interval • analgesic for pain
 rashes are classified as vesiculo-pastular
 Proper disposal of nasopharyngeal secretions
• Zovirax can also be given
 rashes have generalized distribution all over the
body (trunk and scalp 1st)  Cover mouth and nose when sneezing and coughing
• Nursing Care and Preventive Measures: same as
Herpes Zoster Chicken pox
 contagious from the time rashes appear until
the last rash have dried or crusted Nervous System
• aka SHINGLES, Zona, Acute Posterior Ganglionitis
 centrifugal in spread of rash Tetanus
• adults are usually affected
3. Post-Eruptive Stage – rashes starts to dry/crust and peel off by • aka Lock Jaw
itself • CA: inactive or dormant type of chicken pox

• MOT: Airborne or droplet

• CA: Clostridium tetani – anaerobic, non-motile, spore-
forming
• Duration of Illness – 2 weeks
• Normal habitat: intestines of plant eating animal
Signs and Symtoms
• Break in the skin
• (+) vesiculo-papular rashes- painful rather than itchy bec
it affects nerve endings and that pain persists within 2
• MO stays in the wound à releases toxins à travel to the
blood à produces s/sx
months even if patient had recovered.

Management • unilateral distribution of rashes • New born – umbilical cord (tetanus

neonatorum)
 Diagnostic Examination: by clinical observation and • period of communicability is the same as chicken pox
physical examination when all rashes have dried • Children – dental caries

 Medical: • Adult – any king of wound

 treated symptomatically • Toxins released by MO are:

 Anti-viral agent – Zovirax (Acyclovir) • Tetanolysin – dissolves RBC causing anemia

 Anti-histamine • Tetanoplasmin – brings about the muscle spasm

affecting the myonueral junction and internuncial fibers of
 Nursing Care the brain

 skin care to prevent infection • Immunity: No permanent immunity

Management
 increase resistance and adequate rest and s/Sx:
• Diagnostic Examination: Clinical observations and
nutrition to prevent encephalitis physical examination
– Trismus – lock jaw
 Immunity: Gives permanent immunity
• Potassium Permanganate (KMNO4) with 3 Fold EffectS:
– Risus sardonicus- sarcastic smile
 Avoid MOT
• A- Astringent ---dries rashes
– Opisthotonus- arching of the back
 • Factors to consider in observing the animal: • inflammation of the meninges • AbN reflexes – (+) kernig’s sign, (+)
brudzinki’s sign (pathognomonic sign)
• Site of the bite • CA:
• ↓
• Extent of the bite Viruses – CytoMegaloVirus – viral meningitis
• Incresed ICP -----CsF in subarachnoid space
• Reason for the bite Fungus – Cryptococccal meningitis

Medical Management • ↓
Bacteria – common cause

1. Vaccine – post exposure prophylaxis only • severe HA

TB meningitis, streptococcal meningitis, hemophilus
influenza B • projectile vomiting
• Active form of Vaccine
Meningococcal Meningits
a. Purified Duck Embryo Vaccine (PDEV) – Lyssavac Spotted fever / Meningococcemia • altered VS:increase temp, decrease PR, decrease RR,
increase systolic but N diastolic
b. Purified Vero Cell Vaccine (PVCV) – Verorab • highly fatal and highly contagious type of meningitis
• convulsions
with in 24 hours • vascular system is affected resulting to vascular collapse
(DIC) • diplopia – optic nerve/disc
c. Purified Chick Embryo Cell Vaccine – (PCEV)
• Waterhouse Friedrichsen Syndrome – caused by • tinnitus, difficulty of hearing/deafness, loss of balance,
• 2 Ways of Administration: IM or ID vertigo
massive invasion of blood by meningococcus infection
• Passive form of Vaccine resulting in organ failure, coma or even death, unless
effective antibiotic or tx is quickly rendered • altered LOC
a. Equine Rabies Immunoglobulin (ERIg) – from animal
• Rifampicin 450 mg once/day x 3 days • Others/sx: anorexia, gen body malaise and loss of
serum
apetite
b. Human rabies Immunoglobulin – human serum • Ciprobay 500 mg once/day x 3 days
Diagnostic exams:
Nursing Care • CA: Neisseria Meningitides • Lumbar Puncture (L3 & L4) – tap or aspirate CSF to
• Wash wound with running water • Incubation Period: 2-10 days a. Color: yellowish, turbid/cloudy
• Seek consultattion asap. • Portal of Entry: Respiratory system via the nasopharynx b. increased CHON, increased WBC, decreased sugar
• Place patient in dim and quiet room • Neisseria Meningitides à Nasopharynx à Blood stream c. C & S – to determine CA and specific drug to kill the
MO
• Room of patient should be away from sub-utility room
•
↓ d. Counter Immuno Electrophoresis (CIE) – if clear CSF
• Wear complete protective barriers when entering the either viral or protozoa
room
• Vascular changes (petechiae,
echymossis)
• Blood culture – done if lumbar puncture cant be done
Preventive Measures:
yet bec MO travels to the blood stream
• Keep away from stray dogs • ↓
• Antimicrobial drugs
• Keep animal caged or chained • Meningeal irritation manifested by: a. Viral – supportive
• If bitten – wash with soap and running water, use strong • nuchal rigidity/stiffneck (1 sign of
st
b. Fungus – antifungal
antiseptic solution and observe the dog meningitis)
c. Bacteria – antibiotic
Meningitis
Circulatory System a. fever – 3-5 days • Release the cuff, check and count the petechial
formation per one square inch (>20 petechial formation =
Dengue b. HA; periorbital, abdominal, joint and bone pains (+) tourniquet test

• CA: Arbovirus-Dengue virus c. N/V • Platelet Count - ↓ in DHF – definitive test

West Nile virus d. pathological vascular changes: petechiae and • Hematocrit (Hct) determination - ↑ in DHF due to
Herman sign (generalized flusing/redness of the skin hemoconcentration
Flavivirus
e. diagnosed as Dengue Fever or Dandy Fever or • Symptomatic treatment
• MOT: biological transmitter – Aedes Aegypti Breakbone Fever
• Antipyretic – but never give Acetyl Salicylic or Aspirin
mechanical transmitter – Celux fatigan • Grade 2 (ASA)

• day biting and low flying mosquito a. persistence of s/sx of Grade 1 + Bleeding • Reye’s Syndrome – a neurologic d/o associated with
viral infection (<12y/o)
• breed in clear stagnant water
b. bleeding from: 1. nose – epistaxis • Vit K (Aquamephyton, Phytomenadion, Synkavit and
• urban area Konakion)
• white stripes on legs, gray wings 2. gum - gum bleeding
• Vit C
3. stomach -
• Blood Transfusion
Mosquito (Aedes Aegypti) 4. hematemesis, melena,
hematochezia • 1. To prevent and control bleeding
↓
• Grade 3 a. Epistaxis
Bloodstream
a. persistence of s/sx of Grade 2 + Circulatory Failure b. Gum Bleeding
↓
b. cold clammy skin c. Hematemesis
Creates multiple lesions in the bloodstream
c. check for capillary refill d. Melena
----------------------------------------------------
d. hypotension, very rapid weak pulse and rapid • Supportive & Symptomatic
↓ respiration
• Increase body resistance – proper nutrition and
↓
• Grade 4 adequate rest
↑ capillary fragility ↑ capillary permeability
a. persistence of s/sx of Grade 3 + Hypovolemic Shock • Preventive Measures:
( easily bleeds ) (allows shifting of fluid fr 1 → Death
CLEAN Program of DOH
comp to another)
• Torniquet Test or Rumpel Leede Test - presumptive
C- hemically treated mosquito net
↓
↓ • Test for capillary fragility
L- arva eating fish
Thrombocytopenia edema, ascites, and • 3 Criteria before performing Torniquet test
E- nvironmental Sanitation
hemoconcentration
1. 6 months or older
A- nti mosquito soap/off lotion
2. fever > 3 days
N- atural mosquito repelant trees
• Grade 1
3. (-) signs of DHF- fever of 3 days
 • 3. Chest X-ray - not definite test, tells only the extent of c. Pyrazinamide (P)– causes hyperurecemia Diphtheria
involvement of the lungs
d. Ethambutol (E)– causes irreversible optic neuritis that • acute contagious dse char by generalized toxaemia
• According to extent of disease based on cavitations brings about blindness coming from a localized inflammatory process known as
within the lungs PSEUDOMEMBRANE.
• 2. Standard Regimen(SR) – Streptomycin, Isoniazid &
a. Minimal Ethambutol (SIE) • CA: Corynebacterium diphtheria or Klebs-Loeffler
bacillus
b. Moderately advanced a. Streptomycin (S)
• MOT: Droplet (direct contact) – affects all ages
c. Advanced – (+) of cavitations within the lungs Side Effects: 1. Nephrotoxicity
• Nasal
• According to clinical manifestations 2. Ototoxicity – CN8
(tinnitus/vertigo) - dryness, excoriation of upper lip and nares
a. Active PTB
• 3. Directly Observed Treatment Short Course (DOTS) - (+) of pseudomembrane in the nasal
b. Inactive PTB WHO- “tutuk gamutan” turbinate– pathognomonic sign
• According to American Pulmonary Society 5 Elements: - grayish-white membrane with
leathery consistency
a. TB 0 – (-) exposure (-) infection (-) tuberculin testing 1. Political will to support the program
b. TB I- (+) exposure (-) infection (-) tuberculin testing • Pharyngeal – (+) bullneck appearance (enlargement of
2. Microscopic availability the cervical lymphnode)
c. TB II – (+) exposure (+) infection (+) tuberculin testing 3. Steady supply of medicine
(-) s/sx • Laryngeal – (+) respiratory distress
4. Personnel – RN and midwife - (+) hoarseness/aponia
d. TB III – (+) exposure (+) infection (+) tuberculin testing
(+) s/sx 5. Documentation and recording - (+) laryngeal stridor – brassy metallic cough
• Short Course Chemo therapy – Rifampicin, Isoniazid, D – iet - small frequent nutritious foods
Pyrazinamide Ethambutol (RIPE) • Nose and Troat Culture
D – rugs - adequate drugs and emphasize
a. Isoniazid (INH) – mainstay drug importance of compliance • Shick’s Test – to determine resistance or susceptibility to
diphtheria
- 6mons for carrier & inactive adult patient R – est - conserve energy
• Moloney’s Test – to determine hypersensitivity to
- 9mons for children • Contraindicated Nursing Care: Do not do chest diphtheria
physiotherapy
- 12mons for immunocompromised patients *Removal of the pseudomembrane is not encouraged à facilitate
• Avoid MOT bleeding and fast regrowth
Side Effects: 1. Peripheral neuropathies/neuritis
• Immunization with BCG immediately after birth 0.5cc ID • Neutralize toxin
a. Foods rich in Vit B6 ® deltoid area
(pyroxidine) ADS – IM,IV ANST; if (+) give in fractional
Instruction to mothers: don’t massage the dose – desensitization
2. Hepatotoxicity – (+) jaundice area, (+) fever, (+) abscess formation on
the site of injection →scar IV fluid to dilute toxin
a. Monitor liver enzymes
• Proper disposal of nasopharyngeal secretions • Antibiotic – Penicillin
b. Avoid alcohol
• Covering of mouth when sneezing • Supportive – O2 inhalation, tracheostomy
b. Rifampicin (R) – causes orange color of tears, urine
and stool • Immunization : Gives temporary immunity • Strict Isolation – highly contagious
 d. sabsultus tendinum – involuntary twitching of • CA: • 2. Give Penicillin to patient allergic to tetracycline
tendon
1. Leptospira (spirochete) – bacteria • - give 1hr before meals or 2hrs after meals or empty
3. Defervescence Stage – (+) ulcer formation àintestinal stomach
perforation à bleeding àspillage in peritoneal cavity 2. Leptospira canicola
• Nursing Care: Symptomatic
S/Sx of Peritonitis: 3. Leptospira hemorrhagica
1. Provide eye care
1. sudden and severe abd pain 4. Leptospira enterogans – common in Phils.
2. Warm compress for muscle pain
2. persistence of fever • MOT: Skin penetration
3. I/O,consistency, frequency & amt
3. board-like rigid abd • Incubation Period: 2 dyas to 4 weeks
• Preventive Measures:
4. Convalescent /Lysis Stage – s/sx starts to subside • People at risk: sewage workers, farmers, miners, people
living in Manila areas 1. Environmental sanitation by eradication of rats
still have to observe for relapse
• Incidence: rainy seasons • 2. Avoid walking through floods
1. Blood Culture
• striated muscles Hepatitis
a. Widal Test
• inflammation of the liver
Antigen O (AG O) or Somatic Antigen = presently infected • liver
Hepa A Hepa B Hepa C
Antigen H (Ag H) or Flagellar Antigen = previously exposed to TF • kidneys
1. Infectiuos Serum Hepa, Post-
or has had an immunization Synonym Hepa, Homologous Hepa, transfusion
• fever, HA, vomiting
Catarrhal Viral Hepa Hepa
b. Thypi dot – uses blood specimen where it Jaundice,
identifies antibodies • myalgia and myositesàcalf muscles Epidemic
Hepa
• 2. Stool and Urine Exams • jaundice with hemorrhages on skin & mucous membrane 2. Source Feces Blood,semen,cervic Blood
icter-hemorrhagic à yellow and red orange skin, orange of Infection al secretions
• Medical: eyes à pathognomonic sign 3. HAV or RNA HBV of DNA HCV
Causative cointaining containing virus
• Antibiotic – Chloramphenicol • Diagnostic Examination: agent virus
4. MOT Fecal-oral Person-person, percutaneou
• Nursing Care: • 1. Blood culture Leptospira agglutination test (LAT) parenteral/ s
percutaneous,
1. Fluid and Electrolyte Management • Leptospira antigen-antibody test (LAAT) placental
5.Incubatio 2-7 wks 6wks-6mons 5wks-7-8
2. Provide adequate nutrition – (+) vomiting-small,freq • Microscopic agglutination test (MAT) n Period wks/12wks
meals; (+)diarrhea-(x) fatty food 6. Risk Crowding, Multiple sex Blood
• Medical Management: homosexual partners, members recipients
3. Provide comfort measures s, food of medical team,
handlers, blood, drug addicts
Leptospirosis
• 1. Antibiotics – Tetracyline à drug of choice
poor
sanitation,
• aka Mud fever, Swamp fever, Canicola fever, Pre-tibial
• - not given to a. child <8y/o àstaining of teeth unsafe water
fever, Weil dse, Swineherd dse and Ictero-Hemorrhagica supply,
dse • b. pregnant women – teratogenic effect àbone children
defect
7. Carrier No No Yes
• Source of infection: Excreta of rats particularly urine
• - never give tetracycline with calcium rich food, antacid state
and iron prep & milk
 – (+) narrowing of fallopian tube à sterility • Medical :

• If pregnant, it will cause: ectopic pregnancy or opthalmia Antibiotic: Benzathine Penicillin G

neonatorum (Penadur)

• Nursing Care & Preventive Management: same as

gonorrhea

HIV infection means one is infected with AIDS Virus

• AIDS = infected by virus + incompetent immuno-

response
2. Secondary Stage: highly infectious & contagious
• CA: Human Immuno-Deficiency Virus (HIV) retrovirus
a. fever & malaise

b.skin rashes & dermatitis: dry, hard, wart like

• MOT: BT, sexual contact,
lesions à Condyloma lata
exposure to infected blood, products or
• C&S by mucosal scrapping tissuesvertical (mother-child) or
c. Oral mucous patches
Perinatal (pregnancy,delivery&breastfeeding)
• Pap Smear or Vaginal Smear
d. alopecia – patchy, polka dot or moth eaten
appearance of hair and thinning of pubic hair sharing needles
• Medical Management: Antibiotic
• Incubation Period: 6 mons – 7 years
a. Ceftriaxone (Rocephin)

b. Doxycycline (Tetracycline)
MOà detected by macrophageàalert T Cells
• Psychological aspect of care – low self-esteem

• Health education: - safe sex, monogamous relationship, ↓

masturbation
HIV ← Antibodies ← stimulate B cells
use of condom, behaviour modification
• fever with night sweats without a cause
Syphilis 3. Tertiary Stage –
• enlargement of the lymph nodes without a cause
• aka Pox, Lues, SY, and Bad Blood Disease a. Gumma – infiltrating lesion found on deeper tissues &
body organs such as skin, bone and liver • fatigability
• CA: Treponema Pallidum – a spirochete that passes to
the placental barrier during the 16th week of pregnancy b. aortitis & aneurysm • weight loss
(2nd & 3rd trimester)
c. paresthesia, abnormal reflexes, dementia and • altered sleeping patterns
• MOT: Sexual contact, vertical transmission psychosis
• temporary memory loss
• Incubation period: 10-90 days • C&S by mucosal scrapping
• altered gait
• 1. Primary Stage • Dark Field Microscope

• a. Chancre, a painless popular lesion on face, • Serologic Test

lips, tongue, under the breast, fingers and genitals Adults: 2 Major sxs and 1 Minor sx
• Flourescent Treponema Antibody Absorption Test –
Children: 2 Major sxs and 2 Minor sxs
• b. Regional lymphadenopathy confirmatory test