IMCI

FEVER
A. Malarial risk
Classification Signs and symptoms Management

VERY SEVERE Any general danger sign •First line AB

FEBRILE DISEASE/ + stiff neck =CHLOROQUINE
MALARIA •Paracetamol for fever
•refer
MALARIA Blood smear (+) oRal antimalarial (5days)
Paracetamol for fever
FEVER: MALARIA Blood smear(-) Paracetamol for fever
UNLIKELY Runny nose (+) Treat other causes of fever
Measles (+)
Fever (+)
B. NO MALARIAL RISK
Classification Signs and symptoms Management
VERY SEVERE FEBRILE Danger signs + FEVER •IST LINE AB
DISEASE •Paracetamol for fever
•refer
FEVER: NO MALARIA No signs of very severe Home care
febrile disease
C. MEASLES
Classification Signs and symptoms Management
SEVERE COMPLICATED ANY DANGER SIGN + •Give VIT. A and AB
MEASLES corneal discharge, deep or •Apply Tetracycline if PUS is
extensive mouth ulcers draining from the eye
•REFER
MEASLES WITH EYE OR PUS draining from the eye Give VIT. A
MOUTH COMPLICATIONS Mouth ulcers Apply Tetracycline if PUS is
draining from the eye
MEASLES Measles now or from the Give VIT. A
last 3 months
D. DHF
CLASSIFICATION SIGNS AND SYMPTOMS MANAGEMENT
SEVERE DENGUE •Tourniquet test (+) •Fluids
HEMORRHAGIC FEVER •BLEEDING- melena, •ORS
hematemesis, hematochezia, •DO NOT GIVE ASPIRIN
easy bruising •REFER URGENTLY
•SHOCK-LIKE manifestations

FEVER: DENGUE NO SIGNS OF SEVERE DENGUE •Follow up in 2 days

HEMORRHAGIC FEVER HEMORRHAGIC FEVER •DO NOT GIVE ASPIRIN
UNLIKELY
ANEMIA
CLASSIFICATION SIGNS AND MANAGEMENT
SYMPTOMS
SEVERE •Severe palmar pallor •GIVE VIT. A
MALNUTRITION/ •Visible severe •REFER URGENTLY
SEVERE ANEMIA wasting
•Edema of both feet
ANEMIA/VERY LOW •VERY LOW WEIGHT Give iron, VIT A
WEIGHT FOR AGE GIVE Mebendazole/albendazole
•Some palmar pallor RHU: Feeding program

NO ANEMIA AND NOT Not very low weight 5 days follow-up

VERY LOW WEIGHT for age and no other
signs of malnutrition
 COMMUNICABLE DISEASE
- Caused by an infectious agent from an
infected individual and transmitted to a
susceptible host either by direct or indirect
contact
2 MAJOR TYES OF COMMUNICABLE DISEASE:
Contagious- transmitted easily from one person
to another by direct or indirect contact
Infectious- not easily transmitted by ordinary
contact but requires a direct inoculation
 Classification of Infectious Diseases:
• Based on Occurrence of Disease:
1. Sporadic Disease
= disease that occurs only occasionally &
irregularly with no specific pattern
i.e. botulism, tetanus
2. Endemic Disease
= constantly present in a population, country or
community
i.e. Pulmonary Tuberculosis; malaria
3. Epidemic Disease
= patient acquire the disease in a relatively
short period of time ; greater than normal
number of cases in an area within a short period
of time
i.e, cholera; typhoid
4. Pandemic Disease
= epidemic disease that occurs worldwide
i.e. HIV infection; SARS
• Based on Severity or Duration of Disease
1. Acute Disease
= develops rapidly (rapid onset) but
lasts only a short time
i.e. measles, mumps, influenza
2. Chronic Disease
= develops more slowly (insidious onset)
disease likely to be continual or recurrent for
long periods
i.e. TB, Leprosy
3. Subacute Disease
= intermediate between acute and chronic
i.e. bacterial endocarditis
4. Latent Disease
= causative agent remains inactive for a time but
then becomes active to produce symptoms of
the disease
i.e. chickenpox → shingles (zoster); amoebiasis
• Based on State of Host Resistance:

1. Primary Infection
= acute infection that causes the initial illness
2. Secondary Infection
= one caused by an opportunistic pathogen
after primary infection has weakened the body’s
defenses
3. Subclinical (Inapparent Infection)
= does not cause any noticeable illness
 IMMUNITY

- is the condition of being secure against any

particular disease, particularly the power
which a living organism possesses to resist
and overcome infection
- is the resistance that an individual has
against disease
• IMMUNE SYSTEM

• PROTECTION AGAINST INFECTIVE OR ALLERGIC

DISEASES BY A SYSTEM OF ANTIBODIES,
IMMUNOGLOBULINS AND RELATED RESISTANCE
FACTORS.

• ANTIBODY

• - a specific immune substance produced by the

lymphocytes of the blood of tissue juices of man or
animal in response to the introduction into the body
of an antigen
• ANTIGEN
TRIGGERING AGENT OF THE IMMUNE SYSTEM;
FOREIGN SUBSTANCE INTRODUCED INTO THE
BODY causing the body to produce antibodies
TYPES OF ANTIGENS:
1. INACTIVATED ( KILLED ORGANISM)
1. Not long lasting
2. Multiple doses needed
3. Booster dose needed
2. ATTENUATED ( LIVE WEAKENED ORGANISM)
1. single dose needed
2. long lasting immunity
** all vaccines lose their potency after a certain time.
 TRIAD OF DISEASE CAUSATION
1. Agent
Infectivity
Pathogenicity
Virulence
Antigenicity
2. Environment
3. HOST
 CHAIN OF INFECTION
I. Causative Agent
II. Reservoir/Source of infection
III. Portal of exit
IV. MODE OF TRANSMISSION
2 TYPES OF MOT:
Vertical- mother to child transmission through
placental transfer
Horizontal- Contact, Airborne, Vector, Vehicle
1. Contact transmission
a. Direct contact- person to person transfer of
organism
b. Indirect contact- occurs when susceptible
person comes in contact with a
contaminated object
c. Droplet spread- transmission thru contact
with respiratory secretions when infected
person coughs, sneezes, or talks up to 3 feet.
2. Airborne- occurs when fine microbial particles
or dust particles containing microbes remain
suspended in the air for a prolonged period,
droplet nuclei.
3. Vehicle transmission- thru articles or substance
that harbor the organism until it is ingested
into the host
4. Vector-borne transmission- occurs when
intermediate carriers: fleas, flies, mosquitoes
transfer the microbes to another living
organism.
V. Portal f Entry
VI. Susceptible host

QUARANTINE VS. ISOLATION

DISINFECTION VS. STERILIZATION
TYPES OF ISOLATION TECHNIQUES:
1. UNIVERSAL PRECAUTION- intended to
prevent parenteral, mucous membrane, and
non-intact skin exposure of health care
workers to blood-borne pathogens.
2. TRANSMISSON-BASED PRECAUTION
a. CONTACT PRECAUTIONS- prevent spread of
infection by close or direct contact
b. AIRBORNE PRECAUTION- for diseases
transmitted via airborne transmission; N95
mask required.
3. REVERSE ISOLATION/PROTECTIVE ISOLATION
- Protects the patient.

ASEPSIS:
1.Medical- clean technique
2. Surgical technique- sterile technique
INFECTIOUS
DISEASE
Respiratory Diseases
 Mumps ( Epidemic Parotitis);
Infectious Parotitis
• Acute contagious VIRAL disease. Characteristic feature
is swelling of one or both of the parotid glands
• RNA, Mumps virus ; paromyxovirus of the Varicella
family( found in the saliva)
• Mumps vaccine - > 1yo
• MMR – 15 mos
• Lifetime Immunity
IP: 14-25 days, usually 18 days
Incidence: 5-15 y/o, cold weather, common in men. Adults
less likely to be attacked ( If so, causes sterility)
MOT: droplet, fomites, saliva
S/sx: Pain at the angle of the jaw (Unilateral or
bilateral) PATHOGNOMONIC SIGN
parotitis, Orchitis - sterility if bilateral,
Period of communicability: 6 days before swelling ;
until 9 days after swelling subsides ( 7th – 9th day)
** highest communicability – 48 hrs after onset
of swelling
Dx: serologic testing, ELISA
Mgmt: supportive
Supporter for orchitis
Analgesics Antipyretic, cold compress, steroids
Diet : soft. Don’t give sour foods
Promotive:
 Proper disposal of nasal & throat secretions
 Bed rest
Preventive: MMR vaccine ( 15 mos.)
= LIFETIME IMMUNITY
 Diphtheria
• CA: Corynebacterium diphtheriae, gram (+)
( Klebs Loeffler’s Bacillus)
• IP: 2-5 days
• Period of Communicability: 2-4 wks if untreated, 1-2 days
if treated
• Active (DPT) and
Passive Immunization
(Diphtheria antitoxin)
• Source: Discharges of the nose, pharynx, eyes, or lesion of
other parts of the body infected
• More severe in unimmunized and partially immunized

MOT: Direct/indirect contact = Airborne/droplet, fomites

Toxin – producing organism = EXOTOXIN
1. Nasal – invades nose by extension from
pharynx
2. Tonsillar – low fatality rate
3. NasoPharygeal- more severe type
- sore throat causing dysphagia
- Pseudomembrane in uvula, tonsils, soft palate
– gray exudate
-
Bullneck – inflammation of cervical LN; neck
tissues are edematous
- increasing hoarseness until aphonia
- wheezing on expiration
- dyspnea
• 4. Cutaneous diphtheria affect mucous
membrane & any break on the skin
Diphtheria BULLNECK with
pharyngeal diphtheria
skin lesion
S/sx: sore throat, fever,
“Bull-neck appearance”(
CHARACTERISTIC
SIGN)
,Pseudomembrane-
( PATHOGNOMONIC
SIGN) gray exudate, foul
breath, massive swelling
of tonsils and uvula,
thick speech, cervical
lymphadenopathy,
swelling of
submandibular and
anterior neck),
obstruction of
respiratory tract
Dx: 1.Schick test -
susceptibility to
diphtheria toxin
2. Moloney -
sensitivity to diphtheria
toxoid
3. Throat swab (K
tellurite and Loeffler’s
coagulated blood serum
 Treatment
• Neutralize the toxins – antidiptheria serum
• Kill the microorganism – penicillin,
erythromycin, rifampicin, clindamycin
• Considered cured after 3 negative throat
cultures
• Prevent respiratory obstruction –
tracheostomy, intubation
• CBR up to 2 weeks to prevent myocarditis
• Strict isolation
 Nursing intervention
• Strict isolation of the hospitalized child
• Administer anti-toxin
• Supportive
– Maintenance of adequate nutrition
• Encouraged drinks rich in vitamin C
– Maintenance of adequate fluid and electrolytes
– Bed rest – for at least 2 weeks
• Avoid exertion
• Ice collar must be applied to the neck
• Nose and throat must be taken care of
• Administer antibiotics as prescribed
– Penicillin – effective for respiratory diphtheria
Pre exposure prophylaxis for Diphtheria,
Pertussis, Tetanus
• DPT- 0.5 ml IM
1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
1st booster – 18 mos
2nd booster – 4-6 yo
subsequent booster – every 10 yrs thereafter
• Household contacts
(+) primary immunization and (-) culture - booster dose
(+) culture and (-) immunization – treated as a case of
Diptheria
 PERTUSSIS
Other names: 100 day cough, Tuspirina
CA: Haemophilus pertussis; Bordetella pertussis;
pertussis bacilli
MOT: Direct spread through respiratory and
salivary contacts; crowding facilitates spread
DX EXAM:
• Direct fluorescent Antibody
• Nasopharyngeal culture: Bordet-Gengou (Agar
plate)
S/SX:
Catarrhal stage- most
contagious
Paroxysmal stage
Convalescent stage-
recovery phase
DOC: Penicillin
 SARS- Severe acute respiratory syndrome
Causative Agent: SARS-
associated coronavirus
MOT:
• respiratory droplets (droplet
spread) produced when an
infected person coughs or
sneezes
• direct contact with respiratory
secretions or body fluids of a
patient with SARS.
Signs and symptoms:
PRODROMAL Phase
Fever > 38 C, chills, headache, malaise
RESPIRATORY phase
• Dry non-productive cough with or without respi
distress
• Physical examination- hypoxia and crackles or
rales, dullness on percussion
Treatment: Supportive treatment as needed (e.g.
oxygen, fluids). Empiric broad spectrum
antibiotics also given against community-
acquired pneumonia and atypical pneumonia
 INFLUENZA
CA: ORTHOMYXOVIRUS influenza virus (A,B ,C)
H1N1, which caused Spanish flu in 1918, and the
2009 flu pandemic
H2N2, which caused Asian Flu in 1957
H3N2, which caused Hong Kong Flu in 1968
H1N2, endemic in humans and pigs
MOT:
• person to person via small particle aerosols
• Fomites
Signs and symptoms:
Fever
Chills
Abdominal pain
Respi tract infection
• Prevention
Vaccination- influenza vaccine
 Meningococcemia

• CA : Neisseria meningitides ( bacteria) gram

(-)diplococci
• May also be caused by H. Influenzae and S.
Pneumoniae
MOT: Droplets (urti) to blood stream to CNS

IP: 1-2 days ( even faster)

• High risk: immunocompromised
S/sx:
1. Meningococcemia – usually starts as nasopharyngitis,
followed by sudden onset of spiking fever, chills,
arthralgia. Bacteria is carried by circulation & when it
reaches the meninges of the brain, BLEEDING occurs
into the medulla which extends to the cortex &
petechial, purpuric or ecchymotic hemorrhage is
scattered in the entire body surface appear.
2. Fulminant Meningococcemia (Waterhouse
Friedrichsen) – septic shock; hypotension, tachycardia,
enlarging petecchial rash, adrenal insufficiency
• Clinical Manifestation
– sudden onset of high grade fever, rash and rapid
deterioration of clinical condition within 24 hours
 Meningococcal Septicemia
Waterhouse-friedrichsen Syndrome
 Treatment:
• antimicrobial
– Benzyl Penicillin 250-400000 u/kg/day ( drug of choice)
– Chloramphenicol 100mg/kg/day

• Symptomatic and supportive

– fever
– seizures
– hydration
– respiratory function
• Chemoprophylaxis
– Rifampicin 300-600mg q 12hrs x 4 doses
– Ofloxacin 400mg single dose
– Ceftriaxone 125-250mg IM single dose ( Ciprobay)
Nursing Intervention
1. To prevent the occurrence of further
complications
• -maintain strict surgical aseptic technique when
doing dressings or lumbar puncture in order to
prevent the spread of microorganism
• -administer O2 inhalation to prevent respiratory
distress and to maintain a clear open airway
• -TSB for fever to prevent convulsions
• -observe signs and symptoms of increase
intracranial pressure
• -change positions at least every 2 hours to
prevent pressure sore
• -protect the eyes from bright lights and noise
• 2. Maintain normal amount of fluid and
electrolyte balance
• 3. Prevent spread of the disease, prophylaxis
for close contacts ( Rifampicin )
• 4. Ensure the patients full comfort, prevent
stress provoking factors that may retard
convalescence and to prevent from injury
• 5. Prevent the spread of infection,
microorganisms and contamination some
precautions should be carried out
• 6. Maintain personal hygiene and cleanliness
and avoid microorganisms to harbor in the
patients body
• 7. Maintain proper elimination of waste
product of metabolism
• 8. Nutritional intake
CIRCULATORY CD
 MALARIA (Ague)
King of Tropical Disease
Causative agent : Protozoa of genus Plasmodia
4 species of Protozoa:
1. Plasmodium falciparum ( malignant tertian)
Most fatal ; common in the Philippines
2. Plasmodium vivax ( Benign tertian)
Non-life threatening except for the very young &
old ; manifest chills q48H on the 3rd day onward if
untreated
3. Plasmodium malariae (Quartan)
Less frequently seen ; non life threatening , fever
& chills usually occur q72H usually on the 4th day
after the onset
4. Plasmodium ovale
rare
Vector – Female Anopheles mosquito
Vector: (night biting)
• Female anopheles mosquito
or minimus flavirustris
= infectious but not contagious
= thrives in clear, free flowing shaded streams
usually in the mountains
= bigger in size than the ordinary mosquito
= brown in color, usually does not bite a person
in motion
= assumes a 36 degree position when it alights
on walls, trees, curtains and the like
Pathology
– the most characteristic pathology of
malaria is destruction of red blood cells,
hypertrophy of the spleen and liver and
pigmentation of organs.
– The pigmentation is due to the
phagocytocis of malarial pigments
released into the blood stream upon
rupture of red cells
• Clinical manifestations :
1. Cold stage
– Chilling sensation of the body ( 10-15 mins)
– Chattering of lips, shakes
» Keep the patient warm
» Hot water bath
» Expose to heat
» Warm drinks
– Last about 10-15min
2. . Hot stage (3-4Hrs)
– Recurring high grade fever , headache , abdominal
pain and vomiting
» TSB , cold compress
» Light clothing,
 III. Wet stage
– Profuse sweating
» Keep patient comfortable
» Keep them warm and dry
» Increase fluid intake
Diagnostics:
1. Malarial smear - Peripheral blood extraction (extract blood
at the height of fever or 2 hrs before chilling ( AGUE)
2. Rapid diagnostic test ( RDT) – blood test for malaria
conducted outside the lab & in the field- result is within 10-
15 mins. This is done to detect malarial parasite antigen in
the blood.
Medical Mgmt:
A. IVF’s
B. Anti- Malarial Drugs
Chloroquine ( less toxic);
Premaquine
For chloroquine resistant plasmodium – quinine
• Prophylaxis – chloroquine or mefloquine,
pyrimethamine/sulfadoxine (fansidar)
C. Erythrocyte exchange transfusion for rapid
production of high levels of parasites in the
blood.
 Nursing Considerations
• If entering an endemic area, travellers are
advised to take chloroquine from 1-2 weeks at
weekly interval. Protection is good for 1 year
• Patient must be closely monitored
• Soaking of mosquito nets in an insecticide
solution
• Bio pond for fish
• On stream clearing – cut vegetation overhanging
stream banks to expose the breeding stream to
sunlight
• Vectors peak biting is at night (9pm-3am)
• Planting of neem tree ( repellant effect)
• Zooprophylaxis ( deviate mosquito bite from
man to animals
• Wear long sleeves/ pants/Socks
• Apply insect repellant on skin
• Screening of houses

Notes:
• Malaria stricken mother can still breastfeed
• Chloroquine ca be given to a pregnant woman
• If there is drug resistance, give quinine SO4
-BT in anemia
-Dialysis in renal failure
-Decreased fluids in cerebral edema
-No meds to destroy sporozoites

Prevention and Control:

• Malaria cases should be reported.
• A thorough screening of all infected persons from
mosquitoes is important.
• Mosquito breeding places must be destroyed.
• Homes should be sprayed with effective
insecticides which have residual actions on the
walls.
• Mosquito nets should be used especially when
in infected areas.
• Insect repellents must be applied to the
exposed portion of the body.
• People living in malaria-infested areas should
not donate blood for at least 3 years.
• Blood donors should be properly screened.
 DENGUE FEVER
Other names: ( H-Fever, Dandy
Fever, Breakbone Fever, Phil
Hemorrhagic fever)
 CA: Arbovirus/flavivirus/chikungunya virus, dengue
virus type 1-4
VECTOR: Aedes aegypti

Day biting mosquito ( they appear 2 hours after sunrise and 2 hours before sunset.
Low flying ( Tiger mosquito – white stripes, gray wings )
- Breeds on clear stagnant water
IP: 3 – 14 days; commonly 7 – 10 days
PERIOD OF COMMUNICABILITY:
• Patients are usually infective to mosquito
from a day before the febrile period to the
end of it.
• The mosquito becomes infective from day 8 to
12 after the blood meal and remains infective
all throughout life.
 PATHOPHYSIOLOGY
Dengue Fever
DHF
DHF
Vector caries virus (AEDES aegypti)
Febrile phase
2-7 days
Bite host ( IP 3-10d)

First 2 days s/sx : Fever , headache, myalgia ,anorexia

Vascular injury Vomiting, sorethroat, rashes
Plasma leakage
(+) petechiae , (+) TT
IMPROVE
3rd day WBC, PLT Ct , Hct >20% (+) Pleural effussion

Circulatory failure
Dengue progress -hypotension death
-narrow pulse pressure
,20mm Hg (shock)
 DX EXAMS:
• Platelet count - ( decreased) – confirmatory test
• Hemoconcentration – an increase of at least
20% in hematocrit or steady rise in hematocrit
• Tourniquet test (Rumpel Leads test) - screening
test, done by occluding the arm veins for about 5
minutes to detect capillary fragility.
– Keep cuff inflated for 6 – 10 minutes ( child);
10-15 minutes ( adults)
– Count the petechiae formation 1 square inch (
20 petechiae/sq.in)(+)TT
 CRITERIA FOR DIAGNOSIS:

– Fever ,acute, high continous, lasting for 2-7

days
• Positive torniquet test
• Spontaneous bleeding

(petechiae,purpura,ecchymoses,pistaxis,gum
bleeding, hematemesis, melena)
• Laboratory: thrombocytopenia </= 100,000mm3,
hemoconcentration- an increase of at least 20%
in the hematocrit or its steady rise
 CLASSIFICATIONS:
GRADE 1- fever accompanied with non-specific
constitutional symptoms and the only
hemorrhagic manifestation is positive in
tourniquet test.
GRADE 2- All signs of Grade I plus spontaneous
bleeding from the nose, gums, GIT are present.
GRADE 3- presence of circulatory failure as
manifested by weak pulse, narrow pulse
pressure, hypotension, cold clammy skin and
restlessness.
GRADE 4- profound shock, undetectable blood
pressure, and pulse.
 Treatment Modalities
1. Analgesic drugs other than aspirin may be required for
relief of headache, ocular pain, and myalgia.
2. Initial phase may require intravenous infusion to
prevent dehydration and replacement of plasma.
3. Blood transfusion is indicated in patient with severe
bleeding.
4. Oxygen therapy is indicated to all patients in shock.
5. Sedatives maybe needed to allay anxiety and
apprehension.
 Nursing Management
a. Patient should be kept in mosquito-free
environment to avoid further transmission of
infection.
b. Keep patient at rest during bleeding episodes.
c. Vital signs must be promptly monitored.
d. For nose bleeding, maintain patient’s position in
elevated trunk, apply ice bag to the bridge of
nose and to the forehead.
e. Observe signs of shock, such as slow pulse, cold
clammy skin, prostration, and fall of blood
pressure.
 Dengue hemorrhagic Fever
• PREVENTION : DOH 1995 Program
• C- hemically treated Mosquito Net
• L – arvae eating fish – Gold fish
• E – nvironmental Sanitation – 4 0’ clock habit
• A – antimosquito soap – lanzones peeling
• N – atural mosquito repellant – Neem tree ,
eucalyptus , oregano
FILARIASIS
CA: Helminths
• Wuchereria bancrofti ( african eye worm)
Only live in lymphatic system
• Brugia malayi
• Brugia timori
MOT: Bites of Aedes poecilius (night biting)
DX TEST: Nocturnal blood smear
Demonstration of microfiliaria in fresh blood obtained
between 10:00 to 2:00 am
Patient ‘s history must be taken and pattern of
inflammation and signs of lymphatic obstruction must
be observed
• Immunochromatographic test- done in the
morning
• DOC: Diethylcarbamazepine citrate (Beltrazan,
Hetrazan)
» Eliminate the larvae
» Impairing the adult worm’s ability to
reproduce
» Kill the adult worm
 Filariasis ( elephantiasis )

Mosquito bites
Aedes poiculus , culex
faligans and Person infected – bitten by mosquito
anopheles flavirostris Transmitted to another person

Bites a person with lymphatic filariasis Larvae migrate to LN, reach

& infect the mosquito Sexual maturity & cycle is
completed

Microscopic worms pass from mosquito

Through the human skin, travel to LN , grow as adult
Note: a person needs
Note: a person needs
Many mosquito bite
Many mosquito bite
Adult worm lives for 7 yrs in lymph vessels Over several months- years to get
Over several months- years to get
Mate release into blood stream- microfilaria Filariasis
Filariasis
• Organs affected : kidney & lymph system
– Fluid collects and causes swelling in the
arms, breast, legs and for men  genitalia
– Swelling decrease function of lymph system
• Susceptible to bacterial infection
– Skin harden and thicken  ELEPHANTIASIS
– Conjuctival filariasis  worm migrate eye
 cause blindness if untreated known as
Onchoceriasis.
S/SX:
ACUTE: CHRONIC:
• Chills, headache Hydrocele
and fever between Lymphedema
3 months and 1
year after the
Elephantiasis
insect bite
• Lymphadenitis
• Lympangitis
Mgmt: Environmental sanitation
Personal Hygiene
Provide mosquito nets
Long sleeves, long pants & socks
Mosquito repellant
Take yearly dose of medicine that kills worms
circulating in the blood
Screening of houses
NERVOUS SYSTEM CD
RABIES
CA: Rhabdovirus (Lyssa virus)
MOT: bite of an infected animal, scratch
DIAGNOSTIC TEST: Brain tissue (dog);
Fluorescent antibody staining
CLINICAL MANIFESTATIONS:
– PRODROMAL- numbness at the bite site,
salivation, tingling sensation, low grade
fever, sore throat
 Rabies Virus
The rabies virus is usually transmitted to humans by a bite from an
infected dog, but the bite of any animal (wild or domestic) is suspect in an
area where rabies is present. Symptoms of the disease appear after an
incubation period of ten days to one year and include fever, breathing
difficulties, and muscle spasms in the throat that make drinking painful.
Death almost invariably occurs within three days to three weeks of the
onset of symptoms. For this reason, the emphasis of treatment is on
prevention. In the United States, veterinarians recommend regular
vaccination of domestic dogs.
• Clinical Manifestation
– pain or numbness at the site of bite
– fear of water
– fear of air

4 STAGES
1. prodrome - fever, headache, paresthesia,
2. encephalitic – excessive motor activity,
hypersensitivity to bright light, loud noise,
hypersalivation, dilated pupils
3. brainstem dysfunction – dysphagia,
hydrophobia, apnea
4. death
 Pathophysiology
Bite/wound

Local wound replication

CNS encephalitis

ANS

Salivary glands, adrenal medulla, kidney, lungs, skeletal

muscles, skin, heart
 Postexposure prophylaxis
Category I Observe the dog for 14 days
Licking of intact skin

Category II Active vaccine

Abrasion, laceration, punctured Observe dog for 14 days
wound on the lower extremities

Category III
Abrasion, laceration on upper Active
extremities, head and neck Passive
Dog is killed, lost, died
 SNAKEBITE

Neurotoxic Slow swelling Ptosis, Cobra

then necrosis respiratory
paralysis,
cardiac
problems

Myotoxic None Myalgia on Sea snake

moving
paresis

Vasculotoxic Rapid swelling Bleeding Vipers

abnormalities
 Management
• Lie the victim flat
• ice compress and constrictive materials are
contraindicated
• Transport the patient to the nearest hospital
• Antivenim administration in patient’s with
signs of envenomation
• It is never too late to give anti-venim
• Antivenim is given thru intravenous
infusion, which is the safest and most
effective route. 2-5 ampules plus D5W to
run over 1-2 hours every 2 hours
• Antimicrobial therapy
• sulbactam/Ampicillin or co-amoxiclav
• Substitute
• Prostigmine IVinfusion, 50-100ug/kg/dose
q 8hrs
• Atropine
 Tetanus/Lockjaw/Trismus
CA:
• Clostridium tetani (gram (+), spore forming,
anaerobic ( survives w/o air) non-motile,
vegetative( ability to grow)
• Produces potent exotoxin
• Tetanus spores are introduced into the wound
contaminated with soil
• IP: 4-21 days
• Tetanus neonatorum - umbilical cord
 Pathophysiology
Clostridium tetani in puncture wound

Release of Neurotoxin (Tetanospasmin)

Hemolysin ( tetanolysin

attack PNS and CNS

GABA and Glycine inhibited

Tetanic spasm
 Clinical manifestations

• Difficulty of opening the mouth

(trismus or lockjaw)
• Risus sardonicus ( sneering grin) – “ngiting aso”
• Dysphagia
• Generalized muscle rigidity
• Opisthotonus ( severe arching of the back)
• Localized or generalized muscle spasm
• Respiratory paralysis to death
S/Sx:
Neonatal tetanus - Poor sucking, irritability,
excessive crying, grimaces, intense rigidity, and
opisthotonus
Criteria Stage I Stage II Stage III

Incubation Period > 11 days 8-10 days <7days

Trismus mild moderate Severe

Muscle rigidity mild Pronounced Severe, boardlike

Spasm absent Mild, short Frequent,

prolonged

Dyspnea, absent absent Present

cyanosis
Dx: history, leukocytosis, serum antitoxin
levels

Mgmt:
Anticonvulsant, muscle relaxants, antibiotics,
wound cleansing and debridement
Active-DPT and tetanus toxoid
Passive-TIG and TAT, placental immunity
 Tetanus
Treatment:
1. Specific :
-within 72 hours after punctured wound 
received ATS,TAT or TIG espicially if no previous
immunization
- Pen G to control infection
- muscle relaxant to decrease muscle rigidity.
2. Non-specific
- oxygen inhalation
anti-toxin Treatment:
• Tetanus Anti-Toxin (TAT)
Adult,children,infant 40,000 IU ½ IM,1/2 IV
Neonatal Tetanus 20000 IU, 1/2IM, ½ IV
• TIG
Neonates 1000 IU, IV drip or IM
Adult, infant, children 3000 IU, IV drip or IM
 Pre exposure prophylaxis
• DPT- 0.5 ml IM
1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
1st booster – 18 mos
2nd booster – 4-6 yo
subsequent booster – every 10 yrs thereafter
• TT – 0.5 ml IM
TT1 6 months within preg
TT2 one month after TT1
TT3 to TT5 every succeeding preg or every year
Antimicrobial Therapy
Penicillin !-3 mil units q 4hours
Pedia 500000 – 2mil units q 4 hrs
Neonatal 200000 units IVP q 12hrs or
q8hrs
 3 types of patients w/ skin wounds
post exposure prophylaxis

1. (+) immunization as a child w/ boosters but

last shot > 10 yrs – give TT + TIG/TAT
2. (-) immunization - TT + TIG/TAT

3. (+) tetanus – TIG/TAT + TT + Abx + wound

cleansing + supportive therapy
Control of spasms
• diazepam
• chlorpromazine
 LEPROSY
CA: Mycobacterium leprae/ Hansen’s bacillus
MOT: Prolonged skin to skin contact
Dx Exam: Slit skin smear/ Lepromin test
Symptoms:
• MILD- skin patches, loss of sensation
• SEVERE- acute orchitis, paralysis
• LATE- madarosis, lagopthalmus
TX: Multi-drug therapy
MONOTHERAPY: Dapsone
PAUCIBACILLARY: Rifampicin + Dapsone
MULTIBACILLARY: Rifampicin + Dapsone +
Lamprin
S/E:
Dapsone- increase lesions
Lamprin- skin discoloration, dryness and
flakiness
Rifampicin- orange-colored secretions
 Leprosy/Hansen’s disease
• Chronic communicable disease of the skin & the
peripheral nerves
• Causative Agent: Mycobacterium Leprae, acid fast
bacilli
• MOT: may be due to prolonged
skin-skin contact or droplets
• IP - years to decades

• Active immunization (BCG)

TYPES:
PAUCIBACILLARY
1. Early/Indeterminate – hypopigmented /
hyperpigmented anesthetic
macules/plaques
2. Tuberculoid – solitary hypopigmened
hypoesthetic macule, neuritic pain,
contractures of hand and foot, ulcers, eye
involvement ie keratitis
MULTIBACILLARY
1. Lepromatous – inability to close eyelids
“unblinking eyes” ( lagophthalmos)
multiple lesions, Loss of lateral portion of
eyebrows (madarosis), corugated skin
(leonine facies), septal collapse
(saddlenose) clawing of fingers & toes,
loss of digits, enlargement of male breasts
( gynecomastia)
2. Borderline – between lepromatous and
tuberculoid
•
Mgt:
Domiciliary home treatment ( RA 4073)
• Multi Drug Therapy ( MDT) – use of 2 or more
drugs for the tx of leprosy. Proven effective
cure for leprosy & renders patients non-
infectious a week after starting treatment.
• Paucibacillary- Rifampicin and Dapsone
• Multibacillary-Rifam,Dapsone,Clofazimine
• Diaminodiphenylsulfone DDS( Dapsone)
• Rifampicin
• Clofazimine (lamprene)
• Treatment is from 9 mos to 18 mos(2 years )
 INTEGUMENTARY CD
SCABIES
CA: Sarcoptes scabiei/itch mite/dog mite
MOT: discharge of infected individual; indirect
contact (beddings)
Diagnostic exam: Scraping from its burrow with
hypodermic needle or currete
Pathognomonic sign: “weeping itch” linear lesions
with serosanguineous exudates
TX: Benzyl benzoate emulsion
Kwell ointment
 PEDICULOSIS
CA: Pediculosis humanis DX TEST:
Nits in hair
Pediculosis capitis- head lice
follicles
Pthirus pubis- pubic lice
Pediculosis corporis- body lice
S/sx: head scratching, itching,
excoriation, rashes, oval-white
nits on hair shafts
TX: PEDICULOSIDE
• Kwell shampoo
• Vinegar solution (1:2 sol)
 PEDICULOSIS

a. Feed on human blood & lay their eggs in

body hair & clothing fibers.
b. After the nits hatch, the lice must feed
within 24 hours otherwise it will die.
c. They mature in about 2 – 3 weeks.
d. It injects toxin into the skin that produces
mild irritation & a purpuric spot.
 Clinical Manifestations Treatment
Head a. more common in female than a. dusting the scalp with 1%
louse in male. Infects more malathion powder is a
children than adults. reliable & convenient
b.Itching is the first & method
predominant symptom. b. massage with gamma
c. irritation, excoriation & crusting benzene hexachloride
& foul smelling mass shampoo in the scalp for
consisting of matted hair, 4 minutes, then rinse.
nits, ova, pus, crusts, &
pediculi results (plica
polonica)
Body a. initial lesions are minute red a. laundry (dry clean) or boil the
louse spots clothing & beddings
b. spot swells & secondary crust b. good body hygiene must be
& excoriation is formed on the observed always.
surrounding skin as a result of
scratching.
 Clinical Manifestations Treatment
Crab lice a. unusual, persistent a. apply Kwell or Gamene
itching in the pubic region (Lindane) cream or lotion
b. Maculae caeruleae – b. Rub crotaminon (Eurax,
grayish pigmented spots Geigy) into the affected area.
c. repeat the application of
– found in the surface of crotaminon after 1 week.
the inner thighs or the d. simultaneously treat the
abdomen, pea-size to a person who had sexual
small coin. contact with the patient
e. remove remaining nits
mechanically.
 Chicken Pox, Varicella
• Acute & highly contagious disease of viral etiology
• Childhood disease & adolescents (adults – more
severe) Not common in infancy
• Locally called “ Bulutong”
• Human beings are the only source of infection
• CA = Varicella Zoster virus, Herpes virus
• IP – 10-21 days
• MOT: droplet spread
> nose & throat secretions
> Vesicles ( contagious in early stage of
eruption
> Airborne
• Prodromal period: headache , vomiting, fever
• Papulovesicular rashes appear on trunk 
spreading to face and extremties ( centrifugal)

• Macules papules vesicles with clear fluid

inside crusting and scar formation

• The disease is communicable until the last

crust disappear ( D1 before D6 after
appearance of rashes)
Period of Communicability – 5 days before rashes & 5
days after rashes – crusting - dry
Rashes:
Maculopapulovesicular
(covered areas),
Centrifugal rash
distribution, starts on
face and trunk and
spreads to entire body

• Leaves a pitted scar

(pockmark)
CX = secondary bacterial infection, furunculosis,
pneumonia, meningoencephalitis ( rare)

• Dormant: remain at the dorsal root ganglion

and may recur as shingles (VZV)
 Curative & Nursing Considerations:
• If it feels itchy, give oral antihistamine or local
antihistamine
• Avoid rupture of lesions
• Cut nails short
• Pay attention to nasopharyngeal secretions/
discharges
• Disinfection of linen ( sunlight or boiling)
• Prophylactic antibiotics
Tepid water and wet compresses for pruritus
Soothing Baths, cool baths
Treatment:
a. oral acyclovir
b. Tepid water and wet compresses for pruritus
c. Potassium Permanganate (ABO)
a. Astringent effect
b. Bactericidal effect
c. Oxidizing effect (deodorize the rash)
• Exclusion from school for 1 week after
eruption appears
• An attack gives lifetime immunity. Second
attack is rare
• Immunoglobulins can be given ( 12 mos)
• Drug of choice: Acyclovir ( Zovirax ) – topical
cream applied to crusts
• Preventive measures
– Active immunization with LIVE ATTENUATED
VARICELLA VACCINE
• Start at 1 yr old ( 1 dose )
• booster – 4-12y
• If >13 yrs = 2 doses
• Given SC
– Avoid exposure as much as possible to infected
person
 HERPES ZOSTER/SHINGLES
CA: Herpes zoster virus
MOT: Droplet, discharge with secretions from
vesicles
S/SX:
Painful vesiculo-papular lesion confined to a
dermatome
Primary goal of supportive tx:
1.Relieve itching and neuralgic pain
2.Potassium manganate
 Measles, Rubeola, Morbili, 7 Day
Fever, Hard Red Measles,
• RNA, Paramyxoviridae
• Measles virus is rapidly inactivated by heat, UV light,
& extreme degrees of acidity & alkalinity
• Active immunity (MMR and Measles vaccine)
• Passive immunity (Measles immune globulin)
• Lifetime Immunity
IP: 8-12 days
MOT: Direct ( droplets, airborne); Indirect ( fomites)
*Contagious 1-2 days before rash and 4 days after the
appearance of rash
• Sources of Infection:
– Patient’s blood
– Secretions from the eyes, nose & throat
Diagnostics:
– Nose & throat swab
– Urinalysis
– Blood exams ( CBC, leukopenia, leukocytosis)
Rashes: maculopapaular,
cephalocaudal (hairline and
behind the ears to trunk
and limbs), confluent,
desquamation, pruritus)
 Clinical manifestations:
1. Pre-eruptive stage:
(2-4 days) - malaise, cough, conjunctivitis, , fever,
kopliks spots ( PATHOGNOMONIC SIGN) (1-2
mm blue white spots on red background along 2nd
molars), stimsons ( puffiness of eyelid)
photophobia
2. Eruptive stage:
Rash is usually seen late on the 4th day
Maculo-papular rash
3. Stage of convalescence:
Rashes fade away, desquamation begins,fever
subsides
Cx: pneumonia, meningitis,
 MEASLES

– Fever persist  means (+) complication

• Bronchopneumonia- most common
• Otitis media, reactivation of previous TB
• Bronchitis, laryngitis, exacerbation
malnutrition
• Encephalitis
 MEASLES
• Diagnostic procedure
• Physical examination
• Nose and throat swab
• Urinalysis
• CBC ( leukopenia & leukocytosis)
• Complement fixation or hemogglutinin
test

Eruptive fever
• MANAGEMENT
1. Supportive
2. Hydration
3. Proper nutrition
4. Vitamin A
5. Antibiotics – if w/
secondary bacterial
infection
6. Vaccine- measles
vaccine @ 9 mos and
MMR @ 15 mos
7. Anti viral drugs
( Isoprenosine)
Observe respiratory
Isolation
 Nursing Care
• Isolation of the patient if necessary
• TSB for fever
• Skin care is of utmost importance. The pt.
should have a daily cleansing bed bath.
• Oral & nasal hygiene is a very important aspect
of nursing care of patients with measles
• Restrict to quiet environment
• Dim light if photophobia is present; care of the
eyes is necessary
• Administer antipyretic
• Use cool mist vaporizer for cough
 German Measles, Rubella, Rotheln
Disease, 3 Day Measles
• = contagious viral disease characterized by fever,
URTI, arthralgia, DIFFUSED fine red maculopapular
rash)
• CA - RNA, rubella virus ( Togaviridae)
• Immunity: Active natural ( permanent or lifetime)
• Active immunity - rubella vaccine and MMR
• Passive immunity - gammaglobulin
• Period of communicability – contagious 7 days
before & 7 days after appearance of rash & probably
during the catarrhal stage
German Measles, Rubella, Rotheln Disease,
3 Day Measles

IP: 14-21 days

MOT: Direct contact: droplets spread through
the nasopharynx
Indirect contact: transplacental

** Highly
communicable infant may shed virus
for months after birth**
Rashes: Maculopapular,
Diffuse/not confluent,
No desquamation,
spreads from the face
downwards
Clinical Manifestations:
> FORSCHEIMER’S SPOTS (petecchial lesion on
buccal cavity or soft palate)
> oval, rose red papule about the size of pin head
> cervical lymphadenopathy,
> low grade fever
Dx: clinical
CX: rare; pneumonia, meningoencephalitis
CX to pregnant women:
• 1st tri-congenital anomalies ( microcephaly, heart
defects, cataracts, deafness
• 2nd tri-abortion or bleeding
• 3rd tri-pre mature delivery
Nursing Considerations:
• MMR immunization
• Use of immunoglobulins ( IG’s)- ppost
exposure prophylaxis – 72 hrs after exxposure
• Prevention of congenital measles
• Avoid exposure
 Roseola Infantum,
Exanthem Subitum, Sixth disease
• Human herpes virus 6
• 3mos-4 yo, peak 6-24 mos
MOT: probably respiratory secretions

S/sx: Spiking fever w/c subsides 2-3 days, Face and

trunk rashes appear after fever subsides, Mild
pharyngitis and lymph node enlargement
Mgmt: symptomatic
 SCARLET FEVER/SCARLATINA
CA: Group A beta hemolytic
streptococcus
MOT: droplet
DX TEST: DOC:
•Erythromycin,
Dick’s test- susceptibility
Penicillin
Schultz-charlton-
hypersensitivity
S/SX: Prodromal phase
Eruptive phase:
• Fever •Circumoral pallor
• Flushed face •Rashes
• Slapped cheek appearance •Strawberry tongue
 IMPETIGO
CA: Group A beta hemolytic
streptococcus
MOT: Direct or indirect
contact
S/SX: Vesiculo-papular lesions
with thick honeycombed
crust n the face, around the
mouth , neck and hands
DOC: antibiotics
• IMPETIGO
A disease causing skin lesions
Most common in children
May but rarely affects adults
May follow an URTI
Also occurs as a result of breaks in skin
• AREAS AFFECTED
• Face
• Lips
• Arms
• Legs
• Other Areas
SYMPTOMS
• Skin Rash
• Begins as tiny fluid filled vesicles
• Fluid is yellow or honey coloured
• Vesicles will burst causing brown/yellow
• crusting
• Rash is itchy
Diagnosis & Treatment
• • Diagnosis is usually made on appearance
• of skin lesion
• • Culture of infecting bacteria will confirm
• Staphylococcal or Streptococcal infection
• • Aim of treatment is to cure infection
• • Cure rate 100%
• • Recurrence common in children
• Treatment
• • Application of topical antibiotics
• • Wash several time a day with antibacterial
• soap to remove crusts
• • Prevent spread of infection
• • Wash clothing/bed sheets etc.
• • Use clean towel and flannel each time
• • Do not share towels/razors etc. with other
• people
GASTROINTESTINAL CD
 Cholera / El Tor
• Causative agent: Vibrio coma (inaba, ogawa,
hikojima), vibrio cholerae, vibrio el tor; gram
(-)
• Curved rod or coma shaped organism; motile
• Habitat: small intestine
• Can survive longer in refrigerated foods
IP: few hours to 5 days
MOT: oral fecal route ( by contaminated food,
water, shellfish)
 Cholera
Sigmoidoscopic view of colonic mucosa
Fatal case of infection
Rice Watery Stool in Cholera
Cholera Cot and Bucket
 Nursing Mx:
• Replacement of lost F & E
– Administer D5LR ( more in Na) DLR ( more in K)
– Enteric Isolation
– All patients should be isolated until rectal swab
shows (-) result
– All water & milk should be boiled for 15 minutes
– Food must be protected from flies
– Prepare food properly
– Proper disposal of excreta
– Good environmental sanitation
 SCHISTOSOMIASIS
also known as bilharzia, bilharziosis or snail fever
CA: Species of Schistosoma that can infect humans:
Schistosoma mansoni– can cause intestinal
schistosomiasis
Schistosoma haematobium-causes urinary
schistosomiasis
Schistosoma japonicum and Schistosoma mekongi
cause Asian intestinal schistosomiasis
VECTOR: Oncmelania quadrasi
MOT: Waterborne transmission occurs via
penetration of larval cercariae in
contaminated bodies of fresh water.
S/SX: SWIMMER’S ITCH
1.Itchy red pustule @ point of entry of
cercariae
2.Diarrhea
3.Abdominal pain
4.hepatosplenomegaly
 TREATMENT
• Praziquantel - effective in the treatment of all
forms of schistosomiasis, with virtually no side
effects
• Oxamniquine - used exclusively to treat
intestinal schistosomiasis in Africa and South
America
• Metrifonate - effective for the treatment of
urinary schistosomiasis
 Typhoid Fever
• Salmonella typhosa, gram (-)
• Carried only by humans
Bacterial infection transmitted by contaminated
water, milk, shellfish ( oyster ) & other foods
Infection of the GIT affecting the lymphoid tissue
( payer’s patches) of the small intestine
Most severe form of salmonellosis caused by
salmonella typhi
MOT: oral fecal route
5 F’s : Fingers, Fomites, Flies, Feces, Food & Fluids
 Pathophysiology
Oral ingestion

Bloodstream

Reticuloendothelial system (lymph node, spleen, liver)

Bloodstream

Gallbladder

Peyer’s patches of SI necrosis and ulceration

 Typhoid Fever
Ulceration of the Peyer's Patches
 Typhoid Fever
Clinical Manifestations:
Incubation Period: 1-2 weeks
1. Prodromal – 1st week: Step ladder fever 40-41
deg, headache, abdominal pain, GI manifestations
3 cardinal signs of pyrexial stage:
1.ROSE SPOTS ( irregular rashes found on the
chest, abdomen, back
2. Remittent fever ( ladder like)
3. Spleenomegaly
Typhoid Fever
Rose Spots
• 2. Fastidial = 2nd week ( Typhoid)
• a. High fever, typhoid psychosis w/
hallucination, confusion, delirium
– Drug of choice: Antibiotics
• 1. Chloramphenicol
• 2. Ampicillin
• 3. Cotrimoxazole

b. Severe abdominal pain

c Sordes typhoid state
1st week step ladder fever (BLOOD)
2nd week rose spot and fastidial
• typhoid psychosis (URINE & STOOL)
3rd week (complications) intestinal bleeding,
perforation, peritonitis, encephalitis,
4th week (lysis) decreasing S/SX
5th week (convalescence)
Dx: Blood culture (typhi dot) 1st week
Stool and urine culture 2nd week
Widal test
Mgmt: Chloramphenicol, Amoxicillin,
Sulfonamides, Ciprofloxacin, Ceftriaxone
** Observe standard precaution until 3 negative
stool culture**
Nursing Interventions
• Environmental
Sanitation
• Food handlers
sanitation permit
• Supportive therapy
• Assessment of
complications
(occuring on the 2nd to
3rd week of infection )
- typhoid psychosis,
typhoid meningitis
- typhoid ileitis
Intestinal

Parasitism
 INTESTINAL PARASITISM
• are parasites that populate the gastro-
intestinal tract.
• MOT : they are often spread by poor hygiene
related to feces
– contact with animals, or poorly cooked food
containing parasites.
• Two main types of intestinal parasites:
– A. Helminths
• Tapeworms, pinworms, and roundworms are among
the most common helminths
– B. Protozoa.
 Cause of intestinal Parasitism
• high risk for getting intestinal parasites:
– Living in or visiting an area known to have
parasites
– Poor sanitation (for both food and water)
– Poor hygiene
– Age -- children are more likely to get infected
– Exposure to child and institutional care centers
 INTESTINAL PARASITISM
• Some asymptomatic
• S/SX:
– Diarrhea
– Nausea or vomiting
– Gas or bloating
– Dysentery (loose stools containing blood and mucus)
– Rash or itching around the rectum or vulva
– Stomach pain or tenderness
– Feeling tired
– Weight loss
– Passing a worm in your stool
– Anemia
• Fecal testing (stool exam) can identify both
helminths and protozoa..

• The "Scotch tape" test identifies pinworm by

touching tape to the anus. Then the tape is
examine under a microscope for eggs
 Ascariasis (Roundworm)
CA: Ascaris Lumbricoides
IP: weeks to months
MOT: transmitted through contaminated fingers into
the mouth; ingestion of food and drinks
contaminated by embryonated eggs
Affects 4-12 years old

Dx: stool for ova

Mgmt: Mebendazole,/ Albendazole/ Pyrantel

Pamoate
MOT: ingestion of food
contaminated by ascaris eggs
larvae in large intestine
penetrate wall lung
where larvae grow and coughed
up intestine
larvae mature and passed
out in feces
 Ascariasis ( roundworm infection)
• Nursing Intervention:
– Isolation is not needed
– Preventive measures in each home and in the community
should be enforced
– Wash hands before handling food
– Wash all fruits and vegetable thoroughly
– Availability of toilet facilities must be ensured
– Importance of personal hygiene should be explained
– Proper waste disposal.
 Ascariasis ( roundworm infection)
• Prevention:
– Improved sanitation and hygienic practices
– Improved nutrition
– Deworming may be advised
 Complications
• Migration of the worm to different parts of
the body Ex. Ears, mouth,nose
• Loefflers Pneumonia
 Tapeworm (Flatworms)
• CA: Taenia Saginata (cattle), Taenia Solium (pigs)
MOT: fecal oral route
(ingestion of uncooked, infected meat )
IP: 2-3 mos - years
Dx: Stool Exam
Mgmt: Praziquantel, Niclosamide
ISOLATION OF HOSPITALIZED
PATIENTS. STANDARS PRECAUTIONS
RECOMMENDED
 Pinworm
• Enterobius Vermicularis
MOT: fecal oral route
S/sx: Itchiness at the anal area d/t eggs of the
agent
Dx: tape test at night time
(agents release their eggs during night time)
Mgmt: Pyrantel Pamoate, Mebendazole
Enterobius vermicularis (PIN WORM)
The pinworm lives in
the lower part of the
small intestine and
the upper part of the
colon
Human the only
natural host
IP : 1-2 months or
longer
MOT : indirectly by
Isolation is not needed contaminated fomites
-shared toys, toilet
seat and bath
 Nursing Intervention
• Promote hygiene
• Environmental Sanitation
• Proper waste and sewage disposal
• Antihelmintic medications repeated after 2
weeks (entire family)
 Hookworm (Roundworm)
• CA: Necator Americanus, Ancylostoma
Duodenale
• IP - few weeks to months to years
S/sx: Ground itch or dew itch at site of entry of
filariform larvae involving the feet/legs, abd’l
cramps, diarrhea, abd’l distention, anemia,
perforation to peritonitis to septicemia
** Isolation is not necessary **
Dx: microscopic exam (stool exam)
Mgmt: Pyrantel Pamoate and
Mebendazole
• don’t give drug without (+) stool
exam
• members of the family must be
examined and treated also
Nsg. Intervention:
1. Proper disposal of excreta
2. Avoid walking or playing barefooted
3. Periodic deworming of school age
group
 Amoebiasis ( Amoebic Dysentery)
• Protozoal infection of human beings initially involving
the colon, but may spread to soft tissues, most
commonly to the liver or lungs.
• CA: Entamoeba Hystolitica, protozoa
– Prevalent in unsanitary areas
– Common in warm climate
– Acquired by swallowing
– Cyst survives a few days after outside of the body
– Cyst passes to the large intestine & hatch into
TROPHOZOITES. It passes into the mesenteric veins, to the
portal vein, to the liver thereby forming AMOEBIC LIVER
ABSCESS.
• Entomoeba histolytica has two developmental
stages:

• 1. Trophozoites/vegetative form
– Trophozoites are facultative parasites that may
invade the tissues or may be found in the parasites
tissues and liquid colonic contents.
2. Cyst
a. Cyst is passed out with formed or semi-formed
stools and are resistant to environmental conditions.
 b. This is considered as the infective stage in the life
cycle of E. histolytica

Pathology
When the cyst is swallowed, it passes through the
stomach unharmed and shows no activity while in an
acidic environment. When it reaches the alkaline
medium of the intestine, the metacyst begins to move
within the cyst wall, which rapidly weakens and tears.
The quadrinucleate amoeba emerges and divides into
amebulas that are swept down into the cecum. This is
the first opportunity of the organism to colonize, and its
success depends on one or more metacystic
trophozoites making contact with the mucosa.
Mature cyst in the large intestines leaves the
host in great numbers (the host remains
asymptomatic). The cyst can remain viable
and infective in moist and cool environment
for at least 12 days, and in water for 30 days.
The cysts are resistant to levels of chlorine
normally used for water purification. They are
rapidly killed by desiccation, and
temperatures below 5 and above 40 degrees.
MOT: Ingestion of cysts from fecally
contaminated sources (Oral fecal route)
oral and anal sexual practices
• Extraintestinal amoebiasis- genitalia, spleen,
liver, anal, lungs and meninges
lifecycle
s/sx: Blood streaked, watery mucoid diarrhea,
abdominal cramps
Dx: microscopic stool exam - trophozoites
• Pd of Communicability: the microorganism is
communicable for the entire duration of the illness
Mgmt:
• Tetracycline 250 mg every 6 hours
• Ampicillin, Quinolones, sulfadiazine
• Metronidazole (Flagyl) 800 mg TID x 5 days
• Strptomycin SO4, Chloramphenicol
• F&E balance
 Nsg. Mx
• Observe isolation & enteric precaution
• Provide health education & instruct patient to:
– Boil water for drinking or use purified water
– Avoid washing food from open drum or pail
– Cover leftover food
– Wash hands after defecation or before eating
– Avoid ground vegetables ( lettuce, carrots, etc)
 Prevention:

• Health education
• Sanitary disposal of feces
• Protect, chlorinate & purify drinking water
• Observe scrupulous cleanliness in food
preparation & food handling
• Detection & tx of carriers
• Fly control ( they can serve as vectors)
 GENITO-URINARY CD
GONORRHEA
Other names: GC, Clap. Drip
CA: Neisseria gonorrhoeae
MOT: sexual intercourse with infected partner
DX TEST: culture and sensitivity of urethral
discharge
S/SX:
Male- yellowish, thick purulent urethral
discharge; burning sensation upon urination
Female- 80% asymptomatic
COMPLICATION:
sterility, Disseminated
gonococcal infection
(DGI), PID

TREATMENT:
DOC: Penicillin,
Amoxycillin,
Doxycycline Disseminated gonococcal
infection
 CHLAMYDIA
CA: Chlamydia trachomatis
MOT: sexual contact; infants during vaginal delivery
of an infected mother
DX TEST: Culture and sensitivity test of the
discharge
S/SX: MALES- discharge from penis; burning and
itching of urethral opening; burning sensation
during urination
FEMALES- slight vaginal discharge; itching and
burning of vagina; painful intercourse
TREATMENT: Azithromycin, doxycycline
 TRICHOMONIASIS
CA: Protozoa- Trichomonas vaginalis
MOT: Direct sexual contact
DX TEST: examination of vaginal secretion by
wet slide treated with Potassium hydroxide
S/SX: initially asymptomatic-malodorous
discharge
TREATMENT:
DOC- Metronidazole
 CANDIDIASIS/MONILIASIS
CA: Candida albicans
MOT: sexual contact; prolonged use of broad
spectrum antibiotics
DX TEST: clinical picture
S/SX: creamy, cheese-like vaginal discharge,
itchiness, redness at the vulva
DOC: Nystatin
Health teachings: Swab nystatin on the oral mucosa
of an infant with thrush
Instruct pt. to swish nystatin solution around his
mouth for several minutes before swallowing
 Gonorrhea
(Clap/Flores Blancas/Gleet)
- sexually transmitted bacterial disease
involving the mucosal lining of the genito-
urinary tract, the rectum, and pharynx.

Causative Agent: Neisseria gonorrhoeae

Incubation Period: 3-21 days
average: 3-5 days
 Mode of Transmission
1. Bacteria is transmitted by contact with
exudates from the mucous membrane of
infected persons.
2. Through direct contact with contaminated
vaginal secretions of the mother as the baby
comes out of the birth canal.
3. May also be transmitted through fomites.
 Clinical Manifestations
1. In females
a. Burning sensation and frequent urination.
b. Yellowish purulent vaginal discharge
c. Redness and swelling of the genitals
d. Burning sensation and itching of vaginal
area
e. Urinary frequency and pain on urination
f. Urethritis or cervicitis occurs initially a few
days after exposure
g. Pregnant women with gonorrhea may infect
the eye of her baby during the passage
through the birth canal.
2. In males
a. Dysuria with purulent discharge from the urethra 2
– 7 days after exposure.
b. Rectal infection is common in homosexuals.
c. Inflammation of the urethra can cause stricture
that can prevent passage of urine.
d. Prostatitis
e. Pelvic pain and fever
 Diagnostic Exam
1. In female – culture of specimen taken from
the cervix and anal canal (use of Thayer-
Martin medium)
2. In male – gram stain
 Treatment Modalities
• Ceftriaxone – for uncomplicated gonorrhea in
adults
• Ceftriaxone & Erythromycin – for pregnant
women
• Aqueous procaine Penicillin
• Direct fluorescent antibody test
 Nursing Management
1. All information concerning the patient is
considered confidential.
2. The patient should be isolated until he/she
recovers from the disease.
3. Infants born to mothers positive of
gonorrhea should be instilled with
ophthalmic prophylaxis into both eyes at the
time of birth.
 HERPES SIMPLEX TYPE 2
CA: Herpes simplex virus type 2
MOT:
• SEXUAL contact oral/genital sex
• During delivery through an infected maternal
genital tract
DX TEST: Viral culture
S/SX:
• Rashes in genital areas
• Recurrent clusters of blisters
• DOC: Acyclovir/Zovirax
INFECTIOUS MONONUCLEOSIS/KISSING’S DISEASE
CA: Epstein Barr virus
MOT: saliva, intimate physical
disease
Dx test: Heterophil antibody
agglutination
TREATMENT:
S/SX: symptomatic and
• severe sore throat supportive
• Fever
• swollen lymph nodes (glands)
in the neck area.
 SYPHILIS
Other names: the pox;
bad blood; Morbu
Gallicus
CA: Treponema pallidum
MOT:
• Close sexual contact
• An infected mother can
pass on the infection to
the child during birth
• Blood infection from
infected person PRIMARY SYPHILIS
S/SX
1. Primary stage: painless chancre
at 2-6 mm
2. Secondary stage: DX TEST:
• Condylomata lata- hypertrophic, •Reaginic tests- screening
flattened, dull pink or gray •Treponemal tests-
papules at mucocutaneous confirmatory
junctions and in moist areas of •Darkfield microscopy- the
the skin most sensitive and specific
• Alopecia araeta-baldness test for early primary syphilis
3. Latency (Resting stage)
• Early- most syphilis infections TREATMENT:
are spread to other people
•Sustained-release
• Late- not infectious
penicillin
•Treatment of sex partners
4. Late syphilis:
• meningeal syphilis
• Stroke syndrome
Condylomata lata Alopecia araeta
Primary
(Genital Primary (Anal
Chancre) Chancre) Primary (Mouth
Chancre)
 Acquired Immune Deficiency
Syndrome (AIDS)
Human Immunodeficiency Virus (HIV) – causes
AIDS.
- retrovirus
- belongs to lentevirus, also called “slow
virus”.
 Pathophysiology of AIDS:

HIV

Antibodies

Lymphocytes, macrophages,
Langerhans & neurons

CD4 ---------T4 cells T4 cell dies

Signs & symptoms will manifest

 Signs and Symptoms:
• AIDS-related Complex (ARC)
 Memory loss
 Altered gait
 Depression
 Sleep disorders
 Chronic diarrhea
Minor Sign Major Signs
Persistent cough for one month • Loss of weight – 10% of
Generalized pruritic dermatitis
Recurrent herpes zoster
body weight
Oropharyngeal candidiasis
Chronic disseminated herpes
• Chronic diarrhea for
simplex more than one month
Generalized lymphadenopathy
• Prolonged fever for one
s:
month
 Common Opportunistic Infections
• Pneumocystis carinii peumonia
• Oral candidiasis
• Toxoplasmosis of the CNS
• Chronic diarrhea/wasting syndrome
• Pulmonary/extra-pulmonary tuberculosis
• Cancers (Kaposi’s sarcoma, cervical dysplasia
& cancer, Non-Hodgkin’s lymphoma)
 Mode of Transmission
• Sexual intercourse
• Blood transfusion and sharing of infected
syringes and needles among intravenous drug
users
• Vertical or perinatal transmission (from a
pregnant woman to the fetus during
pregnancy, child delivery, or breastfeeding)
 Diagnostic Examinations
• EIA or ELISA – Enzyme link immunosorbent
assay
• Particle Agglutination (PA) test
• Western Blot analysis – confirmatory
diagnostic test
• Immunofluorescent test
• Radio immuno-precipitation assay (RIPA)
 Treatment Modalities
“AIDS Drugs” – medicines used to treat but not
to cure HIV infection.
- referred to as “anteroviral drugs”.
- inhibits the reproduction of the virus.
 Nursing Management
1. Health Education
- know the patient
- avoid fear tactics
- avoid judgmental and moralistic messages
- be consistent and concise
- use positive statement
- give practical advice
2. Practice universal/standard precaution
a. Thorough medical hand washing after every
contact with patient and after removing the
gown and gloves, and before leaving the
room of an AIDS suspect or known AIDS
patient.
b. Use of Universal barrier or Personal
Protective Equipment (PPE).
3. Prevention
a. Avoid accidental pricks from sharp
instruments contaminated with potentially
infectious materials from AIDS patient.
b. Wear gloves when handling blood
specimens and other body secretions
c. Label blood and other specimens with
special warning “AIDS Precaution”.
4. Blood spills should be cleaned immediately using
common household disinfectants, like “chlorox”.
5. Needles should not be bent after use, but should be
disposed into a puncture-resistant container.
6. Personal articles should not be shared with other
members of the family.
7. Patients with active AIDS should be isolated.