2. OUTBREAK
Main Characters:
General Plot:
Synopsis:
Trace the Pathogenesis of the disease which served as the main theme of the
movie.
What strategies were employed to control the epidemic.
Suggest ways and means on how a highly contagious disease be prevented
from being contacted by people in your family or community.
3. MEASLES, RUBEOLA, 7 DAY FEVER,
HARD RED MEASLES
• Paramyxo virus
• MOT = droplets and airborne
• PC 4 days before and 5 days after rash
• HIGHLY CONTAGIOUS
• IP 7-14 days
• IMMUNITY
• Active = measles vaccine, MMR
• Passive = measles Ig
• Natural = lifetime
8. DIAGNOSTIC TEST
• Nose and throat swabbing
• u/a
• Blood chemistry
• Confirmatory test is complement fixation on or
hemagglutination inhibition tests
9. PHARMACOLOGY
• Sulfadiazine – bacteriostatic
• Guaifenesin – sympromatic management of cough
• Cephalexin – treatment of skin and skin infection, pneumonia and otitis
media
• Paracetamol – anti pyretic
10. GERMAN MEASLES, RUBELLA,
ROTHELIN DISEASE, 3 DAY MEASLES
• RNA rubella virus
• MOT = droplets and airborne
• PC 5 days before and 5 days after rash
• HIGHLY CONTAGIOUS
• IP = 10-21 days
• IMMUNITY
• Active = MMR
• Passive = rubella Ig
• Natural = lifetime
15. CHICKEN POX, VARICELLA
• Herpes Zoster Virus
• Varicella Zoster Virus
• MOT = droplets and airborne
• PC one day before rash and 6 days after first crop of vesicles
• HIGHLY CONTAGIOUS
• IP 14-21 days
• IMMUNITY
• Active = varicella vaccine
• Passive = xxx
• Natural = lifetime
16. • Rashes: Maculopapulovesicular (covered areas),
Centrifugal, starts on face and trunk and spreads to
entire body
• Leaves a pitted scar (pockmark)
• PS Maculo Papular rashes
17. • Dx = Tzanck smear (scraping of ulcer for staining)
• Rashes:
• Maculopapulovesicular (covered areas)
• Centrifugal
• Leaves a pitted scar (pockmark)
• CX furunculosis, erysipelas, meningoencephalitis
• Dormant: remain at the dorsal root ganglion and may recur as
shingles
18. • Corynebacterium diphtheriae
• Klebsloeffler’s bacillus (bacteria)
• MOT = droplets and airborne
• HIGHLY CONTAGIOUS
• IP 2-5 days
• IMMUNITY
• Active = DPT
• Passive = DAT
• Natural = xxx
DIPHTHERIA
20. Nursing Considerations:
OBSERVE CNS, CARDIAC AND KIDNEY COMPLICATIONS
PSEUDOMEMBRANOUS MAY LEAD TO RESP. OBSTRUCTION
ISOLATION UNTIL 2 NEGATIVE CULTURE AT 24 HOUR INTERVAL
F&E RESUSCITATION
PARENTS OR SIBLINGS WHO HAVE NEVER IMMUNIZED SHOULD RECEIVE A DOSE OF
DIPH. ANTI-TOXIN
• ATTENTION TO NASOPHARYNGEAL DISCHARGE
• ANTIBIOTICS-PENICILLIN, ERYTHROMYCIN IF ALLERGIC TO PENICILLIN
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21. DIPHTHERIA KEY POINTS!
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Highly contagious
Pseudomembrane and bullneck
Immunization best intervention PREVENTION
Obstruction and myocarditis
Isolation technique
24. ACUTE PYOGENIC BACTERIAL
MENINGITIS
• Most important
• Can be fatal if untreated
• Organisms:
E.coli ---------- neonates
Streptococci B ---------- neonantes
H. influenzae-------------adolescents
Neisseria meningitidis------------- young adults
Streptococcus pneumonia--------- elderly
25. CLINICAL SIGNS
• Signs of infection (fever,malaise,rigor….)
• Signs of meningeal irritation:
1.headache
2.neck stiffness
3.photophobia
4.irritability
C.S.F by lumbar puncture shows :
a.cloudy purulent csf
b.abundant neutrophils > 90,000/mm3
c.high protein level and
d.reduced glucose level.
26. COMPLICATIONS
• Antibiotic treatment------ full recovery
• Delayed or untreated cases--- can be fatal
• Healing by fibrosis cause obliteration of subarachenoid space--HYDROCEPHALUS
• Brain abscess
• Septic shock and skin rashes, why ?
27. SKIN RASHES
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•
•
•
Is due to small skin bleed
All parts of the body are affeced
The rashes do not fade under pressure
Pathogenesis:
a. Septicemia
b. wide spread endothelial damage
c. activation of coagulation
d. thrombosis and platelets aggregation
e. reduction of platelets (cosumption )
f. BLEEDING 1.skin rashes
2.adrenal hemorrhage
Arenal hemorrhage is called Waterhouse-Friderichsen Syndrome.It cause acute adrenal
insufficiency and is uaually fatal
28.
29.
30. ACUTE ASEPTIC (VIRAL )
MENINGITIS
• Can follow any viral infection
• Less danger
• CSF shows :
1.lymphocytes
2. mild increase in protein
3. normal glucose level
Viral meningitis is usually self-limiting and treated
symptomatically.
31. BRAIN ABSCESS
• Causes :
1. complication of bacterial meningitis
2. bacterial endocarditis
3. pulmonary sepsis : peumonia……etc
4. other sepsis
Brain abscess cause a space occupying lesion in the brain
38. IINTRODUCTION:
Philippine Hemorrhagic Fever was first reported in 1953. In
1958, hemorrhagic became a notifiable disease in the
country and was later reclassified as Dengue Hemorrhagic
Fever.
What is Dengue
Hemorrhagic Fever?
• A severe mosquito transmitted viral illness endemic
in the tropics.
• It is characterized by increased vascular
permeability, hypovolemia and abnormal blood
clotting mechanisms.
39. Occurrence:
Dengue occurrence is sporadic throughout the year.
Epidemic usually occurs during the rainy seasons June
– November.
Peak months are September and October.
DHF are observed most exclusively among children of
the indigenous population under 15 years of age.
Occurrence is greatest in the areas of high Aedis
Aegypti prevalence.
40. • The DOH reported 70,204 dengue cases for week ending September 10, 2011.
This was over 24,000 cases less or 25.87% lower than for the same period last
year. In addition, the number of cases in July and August (the peak months
for dengue) was 52% lower than last year. A total of 396 deaths were reported
for this year, which is lower than last year’s number of 620.
41. Reservoir / Source of Infection:
• Some source is a vector mosquito, the Aedes
Aegypti or the common household mosquito
• The infected person
42. Mode of Transmission:
Mosquito bite (Aedis Aegypti)
Incubation Period:
Probably 6 days to one week
Period of
Communicability:
Presumed to be on the 1st week
of illness – when virus is still
present in the blood
Susceptibility and
resistance:
All persons are susceptible. Both
sexes are equally affected. The age
groups predominantly affected are
the preschool age and school age.
Adults and infants are not
exempted. Peak age affected 5-9
years. Susceptibility is universal.
Acquired immunity may be
temporary but usually permanent.
43. Diagnostic Test:
1.) Tourniquet Test (Rumpel Leads Tests)
• Inflate the blood pressure cuff on the upper arm to
a point midway between the systolic and diastolic
pressure for 5 minutes
• Release cuff and make an imaginary 2.5 cm
square or 1 inch just below the cuff, at the
antecubital fossa
• Count the number of petechiae inside the box
• A test is (+) when 2 or more petechiae per 2.5 cm
square or 1 inch square are observed
2.) A con firmed diagnosis is established by
culture of the virus, polymerase-chain-reaction
(PCR) tests, or serologic assays.
44. Clinical Manifestations (Public Health Nursing in
the Philippines, 2007):
An acute febrile infection of sudden onset with 3 stages:
• 1st-4th day (febrile or invasive stage)
-high fever, abdominal pain and headache; later flushing which
may be accompanied by vomiting, conjunctiva infection and
epistaxis.
• 4th-7th day (toxic or hemorrhagic stage)
-lowering of temperature, severe abdominal pain, vomiting and
frequent bleeding from gastrointestinal tract in the form of
hematemesis or melena. Unstable blood pressure, narrow pulse
pressure and shock. Death may occur. Tourniquet test which may be
positive may become negative due to low or vasomotor collapse.
45. • 7th-10th day (convalescent or recovery
stage)
-generalized flushing with intervening areas of
blanching, appetite regained and blood
pressure already stable.
• Dengue shock syndrome is defined as dengue
hemorrhagic fever plus:
*Weak rapid pulse,
*Narrow pulse pressure (less than 20 mm Hg) or,
*Cold, clammy skin and restlessness
46. Grading of Dengue Fever:
The severity of DHF is categorized into four grades:
• grade I, without overt bleeding but positive for tourniquet test
• grade II, with clinical bleeding diathesis such as petechiae, epistaxis and
hematemesis
• grade III, circulatory failure manifested by a rapid and weak pulse with
narrowing pulse pressure (20 mmHg) or hypotension, with the presence of
cold clammy skin and restlessness; and
• Grade IV, profound shock in which pulse and blood pressure are not
detectable. It is note-worthy that patients who are in threatened shock or
shock stage, also known as dengue shock syndrome, usually remain
conscious.
* Grade III and IV are considered to be Dengue Shock Syndrome
47. MALARIA
• Malaria, King of Tropical Disease
• Protozoan plasmodium
• plasmodium ovale - dormant (liver)
• plasmodium vivax - benign
• plasmodium malariae - mild but
resistant
• plasmodium falciparum - malignant
(cerebral malaria)
• P. VIVAX AND OVALE MAY HAVE
RECCURENCE OF SYMPTOMS
• tertian-febrile paroxysm q24H-48H
• quartan-febrile paroxysm q48H-72H
48. • MOT
• Bite from infected anopheles mosquito or minimus flavire (night biting)
• Blood Transfusion
• Sexual cycle
• sporogony (mosquito)
• gametes is the infective stage
• Asexual cycle
• schizogony (human)
• IP (Incubation Period) 5-6 days
49. • Nursing Considerations
• Dx:
• blood extraction (extract blood at the height of fever)
• Fever, chills, profuse sweating-convulsion
• Anemia and fluid and electrolytes imbalance, hepatomegaly, splenomegaly,
rigor, headache and diarrhea.
• Chloroquine and Primaquine drug of choice
• Chloroquine for pregnant women
• For resistant plasmodium-use chemo drug
• RBC is being attack
50. •
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Nursing Considerations
IV FLUIDS AND ELECTROLYTES
Blackwater Fever – hemolysis and hemoglobinuria
Sickle Cell Trait – provides natural resistance
DECREASE FLUIDS IN CEREBRAL EDEMA
ASSISTED VENTILATION IN PULMONARY EDEMA
DIALYSIS IN RENAL FAILURE
BT IN ANEMIA
51. • TRAVELERS TO MALARIA ENDEMIC area SHOULD FOLLOW PREVENTIVE MEASURES(CHEMOPROPHYLAXIS CHLOROQUINE MAY BE TAKEN 1 WEEK BEFORE ENTERING
ENDEMIC AREA)
• SOAKING OF MOSQUITO NET IN AN INSECTICIDE SOLUTION
• BIO PONDS FOR FISH
• ON STREAM CLEARING (TO EXPOSE THE BREEDING STREAM TO SUNLIGHT)
• VECTORS PEAK BITING AT NIGHT 9PM-3AM
• PLANTING OF NEEM TREE (REPELLENT EFFECT)
• ZOOPROPHYLAXIS (DEVIATE MOSQUITO BITES FROM MAN TO ANIMALS)
• INFECTED MOTHER CAN STILL CONTINUE BREAST FEEDING
52. FILARIASIS, ELEPHANTIASIS, HUMAN
LYMPHATIC FILARIASIS
• CAUSATIVE AGENT-NEMATODE PARASITE
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MICROFILARIAE OR FILARIAL WORMS
WUCHERERIA BRONCOFTI
BRUGIA MALAYI
BRUGIA TIMORI
• MOT
• Bite from aedes poecilius (night biting)
• Invade the lymph vessel, obstructing the lymphatic channel-leads to edema and
may infiltrate the reproductive organs.
• IP 8-16 months
54. • INCIDENCE-REGION 5,8,11 AND CARAGA, MARINDUQUE, SARANGGANI
• Drug: Diethyl Carbamazine Citrate or Hetrazan 6mg/KgBW one dose every year
• Dx:
• NBE nocturnal blood exam (night)
• ICT immunochromatographic test (day)
55. NURSING CONSIDERATIONS
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MASS TREATMENT-DOSE IS 6mg/KBW, SINGLE DOSE PER YEAR.
ENVIRONMENTAL SANITATION
PERSONAL HYGIENE
MOSQUITO NETS
LONG SLEEVES, LONG PANTS AND SOCKS
INSECT REPELLENT
SCREENING OF HOUSES
HEALTH EDUCATION
56. SCHISTOSOMIAS, SNAIL FEVER,
TAKAYAMA
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Blood fluke
Schistosoma japonicum
S. hematobium
S. mansoni
MOT skin entry (cercaria) travel in to the blood stream where they will infiltrate
the liver, from liver to intestines
57. • Cycle: Egg-larvae (miracidium)-intermediary host (oncomelania quadrasi-tiny
snail)-cercaria
• Itchiness at the site
• RUQ pain (hepatomegaly)
• Intestine infiltration-abd’l cramps, diarrhea with blood
• Praziquantel
• Dx COPT (stool exam)
