NCM 104CARE of CLIENTS with PROBLEMS in INFLAMMATORY
& IMMUNOLOGIC RESPONSE
COMMUNICABLE & INFECTIOUS DISEASES
In general, COMMUNICABLE DISEASE is an illness due to an
infectious agent or its toxic products w/c is transmitted directly or
indirectly to a susceptible person or animal or through an
agency of an intermediate animal host, vector or the inanimate
environment.
CONTAGIOUS vs. INFECTIOUS CONTAGIOUS
applied to disease that are easily spread directly transmitted
from person-to-person
INFECTIOUS are those disease not transmitted by ordinary
contact, but require a direct inoculation through a break in the
previously intact skin or mucous membrane
INFECTIOUS AGENTS
Agents that produce infections can consist of
bacteria,viruses,fungi,protozoa,rickettsia,chlamydia
The ability of a microorganism to infect a client is related to:
Pathogenicity-ability to cause disease
Virulence-disease severity
Invasiveness-ability to enter and move through the tissue
Infective Dose-number of organisms needed to initiate infection
Organism Specificity-host preferenceSusceptibility of the Host
INFECTIOUS AGENTS are pathogenic microorganisms
producing disease.
Bacteria- a simple, one-celled microbe with double cell
membrane that protect them from harm. They reproduce rapidly
and considered as the most common cause of fatal infectious
diseases. They are classified according to: Shape- cocci, bacilli,
spirillae Need for O2- aerobic, anaerobicResponse to staining-
gram +, gram – or acid fastMotility- motile, non motileTendency
to capsulate- encapsulated, capsulatedCapacity to form spore-
spore forming, non spore forming
Rickettsiae- small, gram (–) bacteria-like microbe that can
induce life-threatening infections. Like viruses, they require a
host’ cell for replication. These are usually transmitted through
bite of arthropod carrier like flea, ticks, lice as well as through
waste products.
Spirochete- are bacteria with flexible, slender, undulating spiral
rods that possess cell wall. (treponema, leptospira, borilla)
Viruses- the smallest known microbe. They can’t replicate
independently in the host’s cells and stimulate it to participate in
the formation of additional viruses.Chlamydia- smaller than
rickettsiae but larger than viruses.
Fungi- found almost everywhere on earth. They live in soil,
water or animals and plants. They also live inside or outside
human body.
Protozoa- much larger than bacteria. The simplest single-celled
organism of animal kingdom. Parasitic protozoa absorb nutrients
from the body of the host. (amoeba)
Parasite- live on or within other organisms, live on the expenses
of others. They don’t kill the host but take the nutrients they
need. (tapeworms, hair/body lice, skin mites)
SOURCE or RESERVOIR the environment and objects on which
an organism can survive or multiply.
HUMAN RESERVOIR
FRANK CASES- very ill
SUB-CLINICAL – ambulatory
CARRIER
INCUBATORY CARRIER- one who is incubating the illness
CONVALESCENT CARRIER- the recovery stage of illness but
continue to shed the pathogenic microorganism
INTERMITTENT CARRIER-occasionally shed the microbes
CHRONIC/SUSTAINED CARRIER- always has the microbes in
his system.
ANIMAL RESERVOIRNON-LIVING
MODE OF TRANSMISSION
Route of Transmission Contact TransmissionAirborne
TransmissionVehicle RouteVector-borne Transmission
Contact Transmission
Direct contact-person to personIndirect contact-usually an
inanimate object
Droplet contact-from coughing, sneezing, or talking by an
infected person
Vehicle Route food-salmonellosis water- shigellosis,
legionellosis drugs- bacteremia resulting from infusion of a
contaminated infusion product blood- hepatitis B, or non-A non-
B hepatitis
Airborne Transmission Droplet nuclei-dried residue formed by
evaporation of droplets cough or sneezed Organisms shed into
environment from-skin-hair-wounds or -perineal areaDust
particles-air containing the infectious agent
Vector Transmission-via contaminated or infected arthropods
such as: flies, mosquitoes, ticks, etc.
Mode of Escape from Reservoir
Respiratory tract,GI tract,GU tract, Open lesion Mechanical
escape - bites from insects, Blood
Mode of Entry into Human Body
Respiratory tract, GI tract, GU tract, Mucous membrane or skin,
Placenta
Susceptible Host
A person with a reduced immune response has increased
susceptibility.The immune response is the body’s natural
defense against infection.
ESSENTIAL ELEMENTS IN C.D.
HOST, AGENT & ENVIRONMENT
Factors Influencing Production of an Infectious Disease Age,
Heredity, Stress, Surgery, Nutrition Health Status
Four Stages of Infection
Incubation,Prodroma, lIllness, Convalescence
DEFENSE MECHANISM OF THE BODY
Normal Defense Mechanisms
Non-specific immune defenses
Specific immune defenses
Nonspecific Defense Mechanisms
-Protect the host from all microorganisms-Not dependent on
prior exposure to the antigen
Skin and Normal FloraTearing Reflexes Elimination Acidic
Environment Mucous Membranes Sneeze, Cough Reflexes
Inflammatory Response
Skin Intact skin is the body’s first line of defense against
infection. Sebum is produced by the skin and contains fatty
acids that kill some bacteria.
Normal Flora Normal flora residing on the skin compete with
pathogenic flora for food and inhibit their
multiplication.Inappropriate antibiotic use may disrupt the
balance of normal flora.
Mucous Membranes Mucus entraps infectious agents and
contains substances that inhibit bacterial growth. Cilia trap and
propel mucus and microorganisms away from the lungs.
Sneeze and Cough Reflexes Physically expel mucus and
microorganisms from the respiratory tract and oral cavity with
force
Tearing Reflex Protects the eyes by continually flushing away
microorganisms
Elimination Patterns and Acidic Environment Resident flora of
the large intestines Mechanical process of defecation Flushing
action of urination Acidic environment of urine and vagina
Inflammatory Response Tissue injury caused by bacteria,
trauma, chemicals, heat, or any other phenomenonRelease of
substances that produce secondary changes in the tissue
Specific Immune Defense (The Immune Responses) Immunity
is a specific defense mechanism that creates an immune
response to a specific invading antigen. Immune Responses:
Active immunityPassive immunity Natural immunity Artificial
immunity
Active immunity results from the development within the body of
antibodies that neutralize the infective agent.Passive immunity is
acquired by the introduction of preformed antibodies.Acquired
immunity results either from exposure to an antigen or from the
passive injection of immunoglobulins.Natural immunity refers to
the genetically determined response of protection within a
specific species.Artificial immunity is produced following a
vaccine.
The Humoral Immune Response - B lymphocytes recognize the
antigen as an enemy.Immunoglobulins are plasma protein cells
that produce five different classes of antibodies (IgG, IgA, IgM,
IgE, and IgD).GAMED Immunoglobulins circulate throughout the
bloodstream for the purpose of destroying antigens.
Cell-Mediated ImmunityFights pathogens that survive inside
cells.Antigen stimulates the release of activated T cells.-T-helper
cells-T-suppressor cells-T-cytotoxic cells
PERSONAL PROTECTIVE EQUIPMENTS (3G,MC) GLOVES
GOWNS GOGGLES MASK CAP
Reduce/Eliminate Infectious Agents
CLEANSING –removal of soil or organic material from
instruments & equipment used in providing care using water.
DISINFECTION -elimination of pathogens, except spores, from
inanimate objects by the use of germicides and antiseptics.
STERILIZATION- a method for the total elimination of all
microorganisms including spores.
COMMUNITY REACTION
SPORADIC- intermittent occurrence of particular disease in a
particular/ specific area ( Tetanus, salmonelliosis)
ENDEMIC- the habitual presence of a disease in a certain
locality (Cholera, Typhoid)
EPIDEMIC- the occurrence of cases of similar nature in human
population in particular area in excess of usual incidence
(Dengue, meningococcemia)
PANDEMIC- the occurrence of a disease in several countries or
continents (SARS, Bird’s flu, AIDS)
PREVENTION AND CONTROL
PRIMARY PREVENTION-is done pre-pathogenesis by
promoting general optimum health care and specific protection.-
HEALTH PROMOTION-SPECIFIC PROTECTIONSECONDARY
PREVENTION- early diagnosis and treatment (as soon as
disease is detectable early in pathogenesis)TERTIARY
PREVENTION- corrective therapy (rehabilitation, disability
limitation)
Role of Health Care Personnel and Health Agencies in
Infection Control
Reinforce adherence to isolation.
Post signs indicating type of isolation.
Provide necessary supplies.
Place clients in a private room with adequate ventilation.
Use disposable supplies and equipment.
Labeling of all articles leaving the room
Use of impermeable bags or double bagging
Client and family instruction
Alert to psychological discomfort
ROLE OF FAMILY & COMMUNITY IN PREVENTION & CONTROL
OF C.D.
FAMILY PROVIDES
Adequate nutrition
Finances for periodic examination
Means for children’s immunization
Personal hygiene for children
Sanitary environment
COMMUNITY PROVIDES
Health care facilities
Recreational facilities
Housing facilities
NATIONAL AND INTERNATIONAL CONTROL PROGRAMS
DOH Maternal & Child health care programs including Family
Planning
TB Control Program
Control of Diarrheal Diseases
Malaria Control Program
Schistosomiasis Control Program
Legislation of Sanitation
CodeEPI (Expanded Program on Immunization)
WHO Maternal & Child health programs
EPI Primary Health Care
Control of CD
Biologic standards for vaccines and other products
SPECIFIC DISEASES
INFLUENZA (LA GRIPPE, FLU)
An acute, highly contagious infection affecting respiratory
tractCausative Agent: RNA containing myxovirus
influenzaeType A viruses –strikes q year; most common H1N1
→ hemaglutinin (H) and the neuraminidase (N). H2N2 H3N3
Type B Type C
May be sporadic or endemicRemarkable features of Flu:
capacity for Antigenic Variation: A. Antigenic drift- yearly or
every few yearsB. Antigenic shift- changes that lead to
pandemics
INCUBATION PERIOD 1-5 Days
PERIOD OF COMMUNICABILITY 3-5 daysUp to 7 days in
children
PREVENTION Avoid crowded places Personal hygiene Flu
vaccine
SIGNS AND SYMPTOMS HeadacheLoss of appetite Malaise
Coryza Cough Fever Weakness Sore throat Myalgia
LABORATORY WBC usually normal but with increase WBC-
bacterial infection
RESERVOIR: Man
MODE OF TRANSMISSION May persist for hour in mucus
Airborne Direct through droplet
TREATMENT
Acetamenophen for fever, headache and myalgia Cough syrup
for dry hacking coughAmantidine or Rimantadine- reduces
symptoms and virus titers in respiratory secretions
NURSING MANAGEMENT
IsolationRestIncrease fluid intakeProper nutritionUse vaporizer
to reduce respiratory irritation
COMPLICATIONS
Hemorrhagic pneumoniaEncephalitisMyocarditisSudden infant
death syndrome Otitis media Sinusitis Pneumonia
PULMONARY TUBERCULOSIS
An acute or chronic infection
Causative agents: Mycobacterium tuberculosis from humans;
M. bovis/africanum from cattle
Types: Extrapulmonary Pulmonary
Modes of Transmission Airborne Direct contact - kissing
Incubation Period 4-12 weeks
Period of Communicability As long as live microorg are present
in sputumAntimicrobial drug therapy reduces communicability
within days after initiation of treatment
Pathogenesis
1. Droplet nuclei- sneezing/coughing
2. Cavity lesions-produce 1 million to 100 million tubercle bacilli
per ml
3. Once inhaled, bacilli settles in alveolus causing infectionCell-
mediated immunity-may arrest the disease (3-6wks)
4. If infection reactivates, body’s response leads to caseation
5. The caseum may localize, undergo fibrosis, or excavate and
form cavities- the walls are studded with multiplying tubercle
bacilli
6. Infected caseous debris may spread throughout the lungs
Signs & SymptomsNon-specific symptoms:Fatigue Weakness
Anorexia Weight loss Night sweats Low-grade fever
Reactivation:Cough- Mucopurulent sputum Hemoptysis Chest
pains
Diagnostic Tests Chest x-ray- nodular lesions, patchy infiltrates,
scar formationTuberculin Skin Test/Mantoux Test- 5-15 mm
induration is positive reactionSputum smears/culture- shows
heat-sensitive, nonmotile, anaerobic, acid-fast bacilli
Only contraindication for SPUTUM EXAM: massive hemoptysis
Direct sputum smear exam :is the principal diagnostic method
adapted by the NTP because of the ff reasons: Microscopy
center in remote areas Economical Definitive diagnosis of active
TBSimple procedure
TREATMENT
Anti-TB drugsIsoniazid (INH)Rifampicin (RIF)Pyrazinamide
(PZA)Ethambutol (etham)Drug-resistant
TBStreptomycinQuinolone drugsAmikacin
Gen objective of Case Finding: early identification & diagnosis of
TB casesCase finding refers to the activities that aim to
find/discover TB casesThe main activities of Case finding are
sputum exam and chest x-ray
Nursing managementMaintain respiratory isolation until patient
responds to treatment or until the patient is no longer
contagious.Administer medicines as ordered.Always check
sputum for blood or purulent expectoration.Encourage
questions and conversations so that the patient can air her
feelings.Teach or educate the patient all about PTB.Encourage
to stop smokingTeach to cough or sneeze into tissue paper and
dispose secretions properly.Advise patient to have plenty of rest
and eat balance meals.Be alert of signs of drug
reaction.Emphasize the importance of regular follow up
examinations and instruct the patient and his family about the
signs & symptoms of recurring TB.
Why is this new H1N1 virus sometimes called “swine flu”?This
virus was originally referred to as “swine flu” because laboratory
testing showed that many of the genes in this new virus were
very similar to influenza viruses that normally occur in pigs in
North America. But further study has shown that this new virus
is very different from what normally circulates in North American
pigs. It has two genes from flu viruses that normally circulate in
pigs in Europe and Asia and avian genes and human genes.
Scientists call this a "quadruple reassortant" virus
What are the signs and symptoms of this virus in people?similar
to the symptoms of seasonal flu and include:fever, cough, sore
throat, runny or stuffy nose, body aches, headache, chills and
fatigue. A significant number of people reported diarrhea and
vomiting. Also, like seasonal flu, severe illnesses and death has
occurred as a result of illness associated with this virus. Take
these everyday steps to protect your health:Cover your nose
and mouth with a tissue when you cough or sneeze. Throw the
tissue in the trash after you use it. Wash your hands often with
soap and water, especially after you cough or sneeze. Alcohol-
based hand cleaners are also effective. Avoid touching your
eyes, nose or mouth. Germs spread this way. Try to avoid close
contact with sick people. Stay home if you are sick for 7 days
after your symptoms begin or until you have been symptom-free
for 24 hours, whichever is longer.
Are there medicines to treat infection with this new virus?
Yes. CDC recommends the use of oseltamivir or zanamivir for
the treatment and/or prevention of infection with the new H1N1
flu virus. Antiviral drugs are prescription medicines (pills, liquid
or an inhaler) that fight against the flu by keeping flu viruses
from reproducing in your body.

PNEUMONIA
An acute infection of the lung parenchyma; impairs gas
exchange
Etiology: Microbiologic- viral, bacterial, fungal, protozoal,
mycobacterial, mycoplasmal, rickettsial
Location: Bronchopneumonia- distal airways and alveoli Lobular
Pneumonia- part of a lobe Lobar Pneumonia-
entire lobe
CAUSATIVE AGENTS :STREPTOCOCCUS
PNEUMONIAESTAPHYLOCOCCUS AUREUSHEMOPHILUS
INFLUENZAEKLEBSIELA PNEUMONIAE (FRIEDLANDER’S
BACILLI)
Types:
Primary Pneumonia- inhalation or aspiration of
pathogenSecondary Peumonia- follows initial lung damage from
chemical or superinfection
PREDISPOSING FACTORS
BACTERIAL/VIRAL Chronic illness/debilitationCancerAbdominal
& Thoracic surgeryAtelectasisCommon colds/ viral respiratory
infectionsCOPDInfluenzaMalnutritionSmoking
ASPIRATION PNEUMONIA Old age Debilitation NGT feedings
Impaired Gag reflex Poor oral hygiene Decreased LOC
CLINICAL MANIFESTATIONS
CARDINAL SYMPTOMS:CoughingSputum production –rusty
sputum (PS)Chest painShaking chills Fever
COMPLICATIONS:Hypoxemia Respiratory failure Pleural
effusion Bacteremia
DIAGNOSIS
Sputum exam Chest X-ray Clinical features
TREATMENT: Antimicrobial therapy- varies with CA Supportive
therapy Bed rest
NURSING CONSIDERATIONS: Maintain patent airway
Measure ABG as ordered Deep breathing exercises Coughing
exercises Adequate nutrition If on mechanical ventilator-
suctionBed rest

What is H1N1 (swine flu)?

H1N1 (referred to as “swine flu” early on) is a new influenza
virus causing illness in people. This new virus was first detected
in people in the United States in April 2009. Other countries,
including Mexico and Canada, have reported people sick with
this new virus. This virus is spreading from person-to-person,
probably in much the same way that regular seasonal influenza
viruses spread.