Poliomyelitis

Definition Poliomyelitis is an acute infectious disease characterized by changes in the CNS which may result in pathologic reflexes, muscle spasms, and paresis or paralysis. It is a disease of the lower motor neurons. There is anterior horn involvement, such that is named anterior poliomyelitis. Etiologic Agent The disease is caused by a filterable virus, the polio virus (Legio debilitans). There are three strains of this virus and so far, the disease has affected man alone. 1. Brunhilde 2. Lansing 3. Leon Incubation Period The incubation period is seven to 21 days for paralytic cases, with a repeated range of three to 35 days. Period of Communicability The patient is capable of transmitting the disease during the first three days to three months of illness. The disease is most contagious during the first few days of active disease, and possibly from three to four days before the onset of symptoms. Mode of Transmission The virus is transmitted from person to person by: 1. Direct contact with infected oropharyngeal secretions and feces; 2. Person-to-person transmission through healthy carriers; and 3. Indirectly, trough flies and contaminated water, food, utensils and other articles. Predisposing Causes of Poliomyelitis 1. Age. About 60%of patients are under 10 years of age. 2. Sex. Males are more prone to the disease than females, with ratio of 3:2. Death rate is proportionately higher in males. 3. Heredity. Poliomyelitis is not hereditary. 4. Environment and hygienic condition. The rich are more often spared than the poor. Excessive work, strain and marked overexertion are also factors causing the disease.

Types of poliomyelitis 1. The abortive a) Does not invade the central nervous system b) Headache and sore throat c) Slight or moderate fever d) Occasional vomiting e) Low lumbar pain f) The patient usually recovers within 72 hours. g) Accounts for about 4 to 8% 2. Non-paralytic a) All the signs of the abortive type are observed. b) Types and spasm of the muscle of the hamstring c) Changes In the deep and superficial reflexes d) Pain in the neck, back, arms, legs and abdomen e) Inability to place the head in between the knees f) Positive Pandys test g) Transient paresis may occur h) Usually lasts for about a week, with meningeal irritation persisting for about two weeks. 3. Paralytic a) The signs and symptoms listed under the abortive and non-paralytic types are observed are present. b) Positive (+) Hoynes sign c) Paralysis occurs d) Less tendon reflexes e) Positive (+) Kernig and Brudzinski tests f) Weakness of the muscles g) Hypersinsitivity to touch h) There usually is urine retention, constipation and abdominal distension. Spinal Paralytic Paralysis occurs in muscles innervated by the motor neurons of the spinal cord. It is characterized by asymmetry and scattered flaccid paralysis on one or both lower extremities. There is autonomic involvement manifested by excessive sweating. There is respiratory difficulty. Bulbar This type of paralysis usually develops rapidly and is more serious. Motor neurons in the brainstem are attacked, affecting the medulla. This weakens the muscles supplied by the cranial nerves, especially the 9th (glossopharyngeal) and the 10th (vagus). Facial, pharyngeal and ocular muscles are paralyzed. There are cardiac irregularities and respiratory failure.

There is hypothalamic dysfunction, as manifested by impaired temperature regulation. Encephalitic manifestations, such as facial weakness, dysphagia, difficulty in chewing, inability to swallow or expel saliva, regurgitation of food through the nasal passages and dyspnea, are observed in about 30% of patients. Bulbospinal There is an involvement of the neurons both in the brainstem and the spinal cord.

Pathology 1. The organism usually enters the body through the alimentary tract and multiplies in the oropharynx and lower intestinal tract. 2. The organisms spread to the regional lymph nodes and the blood. 3. In the spinal type, there is evidence of gross inflammation in the anterior horns of the gray matter in the cord that often extend into the arachnoid membrane of the nerve roots. 4. In the cerebral type, the lesions are indistinguishable from other brain inflammations. Although there seems to be predilection for the medulla and basal ganglia. 5. There seem to be subsequent congestion, edema and necrosis in the area. 6. The lesions are found mainly in the anterior horn cells at the following sites: a) Spinal cord b) The vestibular nuclei of the medulla and the cranial nerves c) The roof and dermis of the cerebellum d) Gray matter of the midbrain e) The motor cortex Complications 1. 2. 3. 4. 5. 6. Respiratory failure Circulatory collapse Electrolyte imbalance Bacterial infection Urinary problems related to retention or paralysis of the urinary bladder Abdominal distention

Diagnostic Procedures 1. Isolation of the virus from throat washings or swab early in the disease 2. Stool culture throughout the course of the disease 3. Culture from the cerebrospinal fluid ( CSF) Modalities of Treatment 1. Analgesics are helpful in easing headaches, back pain, and leg spasms. Morphine is contraindicated because of the danger of additional respiratory suppression.

2. Moist heat application may reduce muscle spasms and pain. 3. Bed rest is necessary 4. Paralytic polio requires rehabilitation using physical therapy, braces, corrective shoes and, in some cases, orthopedic surgery

Nursing Management 1. Carry out enteric isolation 2. Observe the patient closely for signs of paralysis and other neurologic damage 3. Perform neurologic assessment at least once a day, but dont demand any vigorous muscular activity 4. Check blood pressure regularly, especially in bulbar poliomyelitis 5. Watch for signs of fecal impaction due to dehydration and immobility. To prevent this, give sufficient fluid to ensure adequate daily output 6. Prevent the occurrence of pressure sores. Provide good skin care. Reposition the patient frequently and keep the bed dry 7. To prevent the spread of the disease, wash hands after every contact with the patient 8. Apply hot packs on the affected limb to relieve the pain and muscle shortening 9. Dispose excreta and vomitus properly 10. Provide emotional support both the patient and his/her family 11. Maintain good personal hygiene, particularly oral care and skin care

Common Nursing Diagnosis 1. 2. 3. 4. 5. Impaired mobility Anxiety Pain High risk for injury Body image

Prevention and Control 1. 2. 3. 4. 5. Immunization: oral polio vaccine (OPV) Proper disposal of GIT secretions Isolation Implementation of standard precaution Sanitation of the premises and proper food handling should be strictly observed to avoid contamination by flies