College of Nursing
COMMUNICABLE DISEASES NURSING
I.
Terminology
a. Communicable diseases can be transmitted through direct, indirect, break in the skin
integrity
i. Mode of transmission
1. Horizontal Transmission
a. Direct a person to person face to face encounter
i. Kissing
ii. Sexual contact
iii. Skin to skin contact
iv. Droplet VS Airborne(Indirect)
1. Source of infection
a. D- respiratory droplet droplet nuclei- sneezing,
coughing, singing
b. A respiratory droplet also
2. Size of source of infection:
a. D- bigger it remains in a surface
b. A smaller suspended in air
3. Distance to become infected
a. Dwithin 3 feet of the patient- AH1N1,
meningococcemia
b. A no limitation with regards to distance you
cannot stop the breeze of air
i. TB, measles, chickenpox
c. Airborne is more extensive than droplet
b. Indirect with intermediary object there is a bridge that connects
you to the individual
i. Vehicle borne- linens, catheter, bed pans, urinal inanimate
objects
ii. Vector borne insects, anthropods and rodents, rats living
things, non human
c. Break in skin integrity inoculation blood transfusion,
contaminated sharp and needles
d. Airborne
2. Vertical Transmission
a. Mother to child transmission perinatal transmission /
transplacental transmission
b. Infectious diseases there is a presence of living microbes in the body which may not
be transmitted through ordinary contact
c. Contagious diseases diseases that can easily be transmitted
d. All communicable diseases are infectious but not contagious.
i. Tetanus infectious only
ii. DHF communicable and infectious
e. Three factors to consider in epidemeologic triad
i. Host either man or animals > consider the susceptibility of the host pertaining
to the degree of resistance
1. If resistance is lowered prone to infection
2. Types
a. Patient individuals who are infected with signs and symptoms
least source of infection
b. Carrier who harbors the microbes but without signs and
symptoms- with higest potential to infect others
c. Suspect- whose medical history and symptoms that he may be
developing a specific infection
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f.
iii.
iv.
v.
vi.
vii.
viii.
ix.
allergy
to
neomycin,
streptomycin
b. Encephalopathy without known cause or
convulsion within 7 days after pertussis vaccine
i. Convulsion indication of reaction in
pertussis component of drug DT vaccine
only; can cause permanent neurologic
disorder encephalopathy
ii. Encephalopathy 24 hours after DPT,
child is crying in consolably
2. Temporary resolve first the problem before giving
vaccine
a. Pregnancy
i. Cannot be given: live vaccines affect
fetal G and D MMR, OPV, BCG, Varivax
varicella vaccine; VZIG chickenpox if
with active infected house members
b. Very severe disease, severe febrile diseases
severe PNM
c. Immuno-compromised situation
i. Corticosteroids therapy
d. Recently received blood products- BT
i. Wait for 2-3 months before continuing
immunization
ii. MMR, AMV, Varivax
c. Environmental Sanitation
i. PD 856
1. Gonorrhea- 2x per month
2. Syphilis- 1x per month
ii. Proper disposal of garbage anti littering law PD 825
1. If throwing a litter- fine of2-5K and imprison from 6-12
months
d. Proper supervision of food handlers
i. Responsibility of DOH sanitary inspector inspects the
premises of food establishment
ii. FDA as of September 2009- food and drug association
2. Control there is infection; limit the spread of infection
a. Isolation separation of infected person during period of
communicability
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b.
c.
d.
e.
f.
g.
CNS Infections
a. Bacteria
i. Tetanus painful muscular spasm leg cramps
1. AKA: Lockjaw
2. CA: Clostridium tetani anaerobic soil
a. Normal habitat: intestines of herbivorous animals
b. Spore- formed when outside body should undergo sterilization
c. When in the body: transforms into a vegetative form destroyed by
oxygen
3. MOT: wound break in skin integrity any kind of wound
a. Tetanus neonatorum wound is in the stump of the UC due to
poor cord care
4. Releases toxin that will bring about systemic symptoms
a. Tetanolysin dissolves the RBC >> anemic
b. Tetanospasmin muscle spasms; acts of the myo-neural junctions
of the muscles and internuncial fibers of the spinal cord and the
brain spasm of all muscles of the person
5. Incubation period 3 days to 1 month
a. Shorter the IP, poorer prognosis
b. Initially, wound inflammation
i. Rubor, calor, dolor, tumor, FUNCTION LOSS
6. Signs and symptoms
a. Initially sigs of wound inflammation
b. Increased muscle tone near the wound
c. Tachycardia, profuse sweating
d. Low grade fever
e. Painful muscular spasms involuntary muscle contraction
f. Muscles affected:
i. Masseter muscle mastication muscle > low jaw / trismus
rigidity of jaw muscles
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0.5 cc
IM Vastus Lateralis
Expect fever to set in
Observe for convulsions within 7 days
Apply warm compress immediately vasodilation to
enhance absorption
8. After 20 minutes- cold compress VC to decrease
swelling
9. If with local tenderness, VC first then after 24 hours
hot compress
ii. Tetanus toxoid
1. 2nd trimester pregnancy
2. 2 primary doses with 1 month interval
3. Booster doses depends on mother; every time she
gets pregnant
4. IM Deltoid
5. 0.5cc
6. First dose today
7. 2nd one month after
8. 3rd 6 months
9. 4th 1 year
10.5th 1 year
11.Low risk booster dose every 10 years
12.High risk BD every 5 years
b. Proper wound care
i. Wash- soap and running water
ii. Thin dressing
iii. Band aid and Mediplast are allowed
c. Avoid wounds
b. Meninigits- inflammation of meninges
i. CA:
1. Virus CMV Cytomegalovirus not pathogenic; opportunistic infections
2. Fungus Cryptococcal Meningitis Cryptococcus Neoformans excreta of
birds opportunistic infections
3. Bacteria
a. TB meningitis inflammation of meninges caused by tubercle bacilli
b. Staphylococcus aureus secondary to skin infection
c. Pneumococcal meningitits- S. pneumonia secondary to respi
infection
d. Meningococcal meningitis meningococcemia / Spotted fever
most fatal and highly contagious- caused by: N. meningitides
i. Only type of meningitis where in vascular system is affected
>> at risk for DIC >> intravascular bleeding >> vascular
collapse >> death
ii. Only 10% are dying
iii. Signs and symptoms: waterhouse friderichsen fulminant
type of meningococcemia >> 6-24 hours, patient die;
intravascular bleeding, uncontrolled
ii. MOT: Droplet Direct
iii. IC: 2-10 days
iv. Signs and symptoms Meningococcemia - petechiae and ecchymoses
1. Nasopharynx >> URTI >> colds, cough, body malaise >> Bloodstream
>> vascular system affectation >>
Circulatory System
a. Virus DHF
b. Protozoa Malaria
c. DHF
i. Not the same as hemorrhagic fever
ii. CA: Arbovirus arthropod borne virus
1. Dengue Virus 1,2,3,4
2. Onyongyong Virus
3. Chikungunya Virus
4. West Nile
5. Flavivirus epidemic in the Philippines
iii. MOT: mosquito bite
1. Aedes Aegypti biological transmitter after 8-11 days, the mosquito can
spread the virus nagiging part na ng system ng lamok yung virus
2. Life span of mosquito: 4 months
3. Even the larva contains the virus
4. Day biting no specific time of the day
5. Clear stagnant water
6. Low flying mosquito
7. Geographical location urban areas; any part of the Philippines is a
Dengue risk area
iv. Virus >> blood stream >> multiply >> multiple lesions in blood stream
1. >> increased capillary fragility >> easy bleeding decreased
thrombocytes
2. >> increased capillary permeability >> allow fluid shift >> edema >>
ascites >> plasma leakage blood is concentrated hemoconcentration
v. Manifestations
1. Dengue without warning signs Dengue grade 1
a. High grade fever 3-5 day
i. Antipyretics RTC- decline in Temperature, gradual
b. Pain HA, retro-orbital pain behind eyes, joints and bone pains,
abdominal pain
c. Nausea and vomiting
d. Petechiae formation / Herman sign generalized redness of the
skin, generalized flushing
e. DENGUE FEVER ONLY no actual bleeding DANDY fever,
BREAKBONE fever
2. Dengue with warning signs with actual bleeding
a. Nose epistaxis, gum bleeding
b. Hematemesis, melena
c. Hematocchezia
3. Presence of severe DHF
a. Signs of circulatory failure
i. Cold clammy skin
ii. Cold extremities
iii. Prolonged capillary refill 3 seconds or more sluggish
1. Normal 1-2 seconds; less than 3 seconds
iv. VS
1. Decrease BP
2. Rapid but weak pulse thread
3. Rapid respiration
4. Dengue shock syndrome
a. Hypovolemic shock
vi. Diagnostic:
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IV.
f.
V.
f.
VI.
Presence of splenomegaly
exam
Blood culture first week only 1 week only in bloodstream
Widals Test presence of antigen
i. AgO Somatic Antigen presently infected
ii. AgH Flageller antigen has been previously been exposed
to TF; had immunizations
c. Typhidot- detects antibodies
i. IgM- present infection
ii. IgG- recovery period and some form of immunity
v. Medical Management
1. Antibiotic Therapy
a. DOC: Chloramphenicol
2. F and E replacement
vi. Nursing Care
1. Maintain F and E balance
a. I and O
b. Signs of DHN
i. Before 48 hours: #1 indicator weight loss
1. 70% of body is fluid
2. Provide adequate nutrition
a. Limit oily and fatty foods aggravate diarrhea
b. Small frequent feeding if vomiting
c. If pediatric placed on NPO 4-8 hours to rest the GI tract then
clear liquids general liquids full diet
d. No NPO for adult clients
3. Provide patient comfort measures
vii. Prevention:
1. Immunization CDT
2. Avoid the five Fs
a. Handwashing
b. Food
i. Preparation
ii. Handling
iii. Storage
c. Eradicate flies
d. Do not put anything in your mouth
g. Leptospirosis
i. AKA: Mud Fever, Canicola Fever, Swamp Fever, Pre-tibial Fever, Icterohemorrhagica Disease, Weils Disease, Swineherds Disease
ii. Farm animals dog, cats, sheep, goat, rats (not given immunizations)
iii. Source of infection: Urine of rats
iv. CA: spirochete- Leptospira
v. MOT: Skin penetration, mucous membrane no need for wound can enter
pores of the skin
vi. Organism enter blood stream affects organs of the body striated muscles,
liver and kidneys (with special affinity with kidney cells) high risk for kidney
failure
vii. Incubation period: 2 days- 4 weeks; average: 5-6 days
viii. Manifestations
1. Fever, HA, vomiting, anorexia, body malaise
2. Muscle tenderness and pain calf muscles gastrocnemius does not
like to walk nor stand up
3. Jaundice with hemorrhage orange eyes and skin
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stimulate
peristalsis
diarrhea
No bloodstreak does not
destroy the intestinal wall
Rapid DHN manifested in
skin
integrity
Washerwomans
hand:
wrinkled, poor skin turgor,
dry skin
Waten bed special bed;
with hole and pail under the
bed
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Stool exam
Rectal swab
Stool exam
Rectal swab
Medical
Manageme
nt
Antibiotics: Cotrimoxazole
ORT
Stool exam
Rectal swab
Antibiotics: Tetracycline
IVT continuous peristalsis
nothing per orem
trophozoites
(30
minutes to 1 hour)
transform into cyst
Antiamebic:
Metronidazole
or
Chloroquine
(anti
protozoan)
ORT
Nursing
Same as typhoid
Care
Prevention
Same as typhoid
i. Schistosomiasis
i. AKA: Snail fever, Bilharziasis
ii. CA: Schistosoma
1. Japonicum intestinal symptoms- affects man and animal
2. Mansoni intestine- intestina symptoms - man
3. Haematobium urinary symptoms- urinary bladder- man
iii. MOT: skin penetration / mucous membrane no need for wound
iv. Enter body of man in pairs male and female
1. Male with canal in the middle gynecoporic canal where female will
enter when they will copulate female will stay inside until she is ready
to lay her eggs after laying eggs go to portal circulation to find other
partner to lay eggs
v. Snail- intermediate host
vi. Feces with eggs rupture Larvae (Miracidium) not yet ready to infect man
or animal; 24 to 48 hours to find snail snail (incubator) Oncomelania Quadrasi;
stay in snail for 4-8 week if the microbes is now ready to infect man or animal
get out of the snail thru respiratory tract of the snail in the form of larva
(Cercariae) skin penetration / mucous membrane of man or animal
vii. Manifestation
1. Itchiness at site of entrance of the parasite
2. Fever infection
3. Calf and muscle pain
4. Dysentery-like symptoms (bacillary dysentery)
a. Mucoid
5. Emaciation payatot;
6. Abdominal distention(late sign)
a. if palpated, splenomegaly and hepatomegaly
7. lymph adenopathy
viii. Diagnostic exam
1. stool exam determine egg of parasite
2. confirmatory:
a. Blood exam
i. Circum Ova Precipitin Test COPT egg of parasite
ii. ELISA test
b. Rectal biopsy
ix. Medical Management
1. Antiblood Fluke Agent
a. Praziquantel, Fuadin
x. Nursing care: symptomatic and supportive
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j.
VII.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
xiii.
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