Chickenpox

(varicella)

Definition
Chicken pox is an acute and highly contagious disease of viral etiology that
is characterized by vesicular eruptions on the skin and mucous membrane with
mild constitutional symptoms.

Clinical Manifestations
1. Pre-eruptive manifestations are mild fever and malaise.
2. Eruptive stage
a. Rash starts from the trunk (unexposed area), then spread to other
parts of the body.
b. Initial lesions are distinctively red papules where contents become
milky and pus-like within four days.
c. In adult and bigger children, the lesions are more widespread and
more severe.
d. There is a rapid progression so that transition is completed in six to
eight hours.
e. Vesicular lesions are very pruritic.
f. All stages are present simultaneously before all are covered with
scabs, known as “Celestial map”.
g. All lesions appear in different stages at one time or it will pass
through the following stages: macule, papule, vesicles, pustule, crust.
 Macule is a lesion that is not elevated above the skin
surface.
 Papule is a lesion that is elevated above the skin surface
with a diameter of about 3 mm.
 Vesicle is a pop-like eruption filled with fluid. The
thin-walled vesicle easily bursts and dries up in three to five
days.
 Pustule is a vesicle that is infected or filled with pus. If the
lesion becomes infected the scar may be big and wide.
 Crust is a scab or eschar. This is a secondary lesion caused by the
secretion of vesicle drying on the skin. The scars are superficial, depigmented
and take time to fade out.
 Diagnostic Test
1. Determination of V-Z virus through Complement Fixation Test
2. Determination of V-Z virus through Electron Microscopic examination of
vesicular fluid

Treatment Modalities
1. Zoverax 500mg/tablet, 1 tab 2x a day for seven days must be administered.
2. Oral acyclovir 800 mg 3x a day for five days must also be given.
3. Oral antihistamine can be taken to symptomatic pruritus.
4. Calamine lotion will ease itchness.
5. Salicylates must not be given.
6. Antipyretic might be given for fever.

Nursing Management
1. Respiratory isolation is a must until all vesicles have crusted.
2. Prevent secondary infection of the skin lesion through hygienic care of the
patient.
3. Attention should be given to nasopharyngeal secretions and discharges.
Linens must be disinfected under the sunlight or through boiling.
4. Cu finger nails short and wash hands more often to minimize bacterial
infections that may be introduced by scratching.
5. A child must wear mittens.
6. Provide activities to keep child occupied to lessen pruritus.

Filariasis
(elephantiasis)

Definition

Filariasis is a parasitic disease caused by an African eye worm, a

microscopic thread-like worm. The adult worm can only live in human
lymphatic system. This is an extremely debilitating and stigmatizing disease
caused by parasitic worms affecting men, women, and children. It affects the
poor in both rural and urban areas. The disease is rarely fatal, however, it causes
extensive disability, gross disfigurement, and untold suffering of millions of
men, women and children.
Symptoms

1. Symptoms vary, depending on the type of parasitic worm that caused the
infection, but all infections usually begin with chills, headache, and fever
between three months and one year after the insect bite.
2. There may also be swelling, redness, and pain in the arms, legs, or
scrotum.
3. Areas of abscesses may appear as a result of dying worms or a secondary
bacterial infection.

Diagnostic Procedures
1. Circulating Filarial Antigen (CFA) test is performed on a finger-
prick blood droplet taken any time of the day and gives result in a few
minutes.
2. The larvae can also be found in the blood, but mosquitoes which
spread the disease are active at night, the larvae are usually found between
about 10:00 pm to 2:00 am.
3. Patient’s history must be taken and pattern of inflammation and
signs of lymphatic obstruction must be observed.

Modalities of Treatment
1. I nvermectin, albendazole, or diethylcarbamazine (DEC) are used to
treat by:
 eliminating the larvae,
 impairing the adult worm’ ability to reproduce, and
 by actually killing the adult worms.
The above medications are started at low doses to prevent reactions
caused by large numbers of dying parasites.
2. Surgery maybe used to remove surplus tissue and provide a way to drain
the fluid around the damaged lymphatic vessels. Surgery may also be used to
minimize massive enlargement of the scrotum.

Nursing Management
1. Elephantiasis of the legs can also be eased up by elevating the legs and
providing support with elastic bandages.
2. DEC-fortified salt is helpful.
 Leptospirosis
(weil’s disease)

Definition
Leptospirosis is a zoonotic infectious bacterial disease carried by animals,
both domestic and wild, whose urine contaminates water or food which is
ingested through the skin.

Clinical Manifestations
1. The symptoms range from severity to asymptomatic fatal outcome.
2. Clinical course is generally biphasic and the majority of the cases
is unicteric.
3. Three septic stages can be recognized:

a) Septic stage This stage is marked with febrile lasting for four to
seven days. There is an abrupt onset of remittent fever, chills,
headache, anorexia, abdominal pain, and severe prostration. There
is also respiratory distress and fever subsides by lysis.
b) Immune or toxic stage – This stage can be with or without jaundice,
and lasts for 4 to 30 days.
• Iritis, headache, meningeal manifestations like disorientation,
convulsions, with CSF findngs of aseptic meningitis
• Oliguria and anuria with progressive renal failure
• Shock, coma, and congestive heart failure are also seen in
severe cases. Death may occur between the 9th to 16th day.

c) Convalescence – At this stage, relapse may occur during the 4th to 5th
week.

Medical Management
1. Penicillin G Na
2. Tetracycline
3. Peritoneal dialysis
4. Administration of fluid and electrolyte and blood as indicated
Nursing Management
1. Isolate the patient, urine must be properly disposed of.
2. Keep patient under close surveillance.
3. For home care, dirty places, pools and stagnant water must be cleaned.
4. Eradicate rats and rodents.

Measles
(Rubeola/Morbilli)

Definition
Measles is an acute, contagious and exanthematous disease that usually
affects children which are susceptible to Upper Respiratory Tract Infection
(URTI). This maybe one of the most common and most serious of all childhood
diseases.

Clinical Manifestations
clinical manifestations come in three stages:

1. Pre-eruptive stage
a) Fever
b) Catarrhal symptoms (rhinitis, conjunctivitis, photophobia, coryza)
c) Respiratory symptoms start from common colds to persistent
coughing.
d) Enanthema sign (Koplik’s spot, Stimson’s line)

2. Eruptive stage

a) The rash is usually seen late on the 4th day

b) High grade fever come on and off
c) Anorexia and irritability
3. Stage of Convalescence
a) Rashes fade away
b) Fever subsides
c) Desquamation begins
 Diagnostic Procedures

1. Nose and throat swab

2. Urinalysis
3. Blood exams (CBC, leucopenia,leukocytopenia)

Modalities of Treatment

1. Anti-viral drugs(Isoprenisone)
2. Antibiotics if with complication
3. Supportive therapy(oxygen inhalation, IV fluids)

Nursing Management

1. Isolation of the patient is necessary

2. Control the patient’s high temperature
3. skin care is utmost
4. oral and nasal hygiene is very important aspect of nursing care
5. care of the eyes is necessary
6. care of the ears is also important
7. patient’s position should be changed every three to four hour’s

Tuberculosis
(Koch’s Disease)

Definition
Tuberculosis is a chronic sub-acute or respiratory disease commonly
affecting the lungs characterized by the formation of tubercles in the tissues
which tend to undergo caseation,necrosis and calcification.

Clinical manifestations

1. Afternoon rise of temperature

2. Night sweating
3. Body malaise and weight loss
4. Cough, dry to productive
5. Dyspnea, hoarseness of voice
 6. Hemoptysis – considered pathognomonic to the disease

Diagnostic procedures

1. Sputum analysis for AFB – confirmatory

2. Chest x-ray
3. Tuberculin testing
a. mantaux test
b. tine test
c. heaf test

Modalities of treatment

1. Short course chemotherapy may be given through a six-month treatment

with isoniazid (INH), Rifampicin , Pyrazinamide (PZA), and Ethambutol.
2. Patients with drug resistance may be given with second line drugs such
as capreomycin , streptomycin , cycloserine , amikacin, and quinolone
drugs.

Nursing Management

1. Maintain respiratory isolation until patient responds to treatment or until the

patient is no longer contagious.
2. Administer medicines as ordered.
3. Always check sputum for blood or purulent expectoration.
4. Teach or educate the patient all about PTB.
5. Encourage the patient to stop smoking.
6. Teach the patient to cough or sneeze into a tissue paper and dispose
secretions properly.
7. Advise patient to have plenty of rest and eat balanced meals.