Communicable Disease Nursing Study Bullets

Communicable Disease Nursing

DRUG OF CHOICE

Tetanus: PEN G Na; DIAZEPAM (Valium)Meningitis: MANNITOL (osmotic diuretic); DEXAMETHASONE (anti-inflammatory); DILANTIN/PHENYTOIN (anti-convulsive); PYRETINOL/ENCEPHABO L (CNS stimulant)Rabies Vaccines: LYSSAVAC, VERORABImmunoglobulins: ERIG or HRIg

DIAGNOSTIC TESTS

Tetanus: WOUND CULTUREMeningitis: LUMBAR PUNCTUREEncephalitis: EEGPolio: EMG; Muscle testingRabies: Brain biopsy (Negri bodies) Fluorescent rabies antibody testDengue: TOURNIQUET test (Rumpel lead)Malaria: Malarial smear; QBC (Quantitative Buffy Coat)Scarlet: DICK'S TEST; SCHULTZ-CHARLTON TESTDiphtheria: SCHICK'S TEST; Moloney's TestPertussis: Nasal swab; agar plateTuberculosis: MANTOUX testLeprosy: SLIT SKIN SMEARPinworm: SCOTCH TAPE SWABTyphoid: WIDAL'S testHIV/AIDS: ELISA; WESTERN BLOT; PCT: Polymerase Chain Reaction Test

CAUSATIVE AGENTS

Tetanus: CLOSTRIDIUM TETANIMeningococcemia: NEISSERIA MENINGITIDISRabies: RHABDOVIRUSPoliomyelitis: LEGIO DEBILITANS (Type I Brunhilde); (Type II Lansing); (Type III Leon)Dengue Fever: ARBOVIRUSES (Chikunggunya); (Onyong-nyong); (West Nile); (Flaviviruses) (Common in the Phil.)Malaria: PLASMODIUM (protozoa) P. Falciparum (most fatal); P. Vivax P. Malariae; P. OvaleFilariasis: WUCHERERIA BANCROFTI; BRUGIA MALAYILeprosy: MYCOBACTERIUM LEPRAEMeasles: PARAMYXO VIRUSGerman measles: TOGA VIRUSChicken pox: VARICELLA ZOSTER VIRUSHerpes zoster: HERPES ZOSTER VIRUSScarlet fever: Group A HEMOLYTIC STREPTOCOCCUSScabies: SARCOPTES SCABIEI (itch mite)Bubonic plague: YERSINIA PESTISDiphtheria: KLEBS LOEFFLERPertussis: BORDETELLA PERTUSSISTuberculosis: MYCOBACTERIUM TUBERCULOSISTyphoid: SALMONELLA TYPHICholera: VIBRIO CHOLERA

Amoebiasis: ENTAMOEBA HYSTOLITICALeptospirosis: LEPTOSPIRA SpirocheteSchistosomiasis: Schistosoma japonicumGonorrhea: N. GONORRHEAESyphilis: TREPONEMA PALLIDUMChlamydia: C. trachomatis, T. vaginalisGenital herpes: HERPES SIMPLEX 2

CD PHARMACOLOGY

Malaria: CHLOROQUINESchistosomiasis: PRAZIQUANTEL Scabies: EURAX/ CROTAMITONChicken pox: ACYCLOVIR/ZOVIRAXTuberculosis: R.I.P.E.S.Pneumonia: COTRIMOXAZOLE; Procaine PenicillinHelminths: MEBENDAZOLE; PYRANTEL PAMOATE

Infectious Agent or its toxic products - AGENT Directly or Indirectly - MODE OF TRANSMISSIONPerson, Animal or Intermediate Vector – HOSTEnvironment - ENVIRONMENT

ECOLOGIC TRIAD OF DISEASEAgent – element, substance, animate or inanimate that may serve as stimulus to initiate a disease processHost – organism that provides nourishment for another organismEnvironment – physical (climate), biological (plants & animals)

CONTAGIOUS VS. INFECTIOUSContagiousDiseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary hostInfectiousDiseases that caused by a pathogen not transmitted by ordinary contact but require a direct inoculation through a break in the skin or mucous membrane.NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS CONTAGIOUS

What is Infection?INFECTION - "the state or condition in which the body or part of the body is invaded by a pathogenic agent ( bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces effects which are injurious…"

Infectious Agent

A. RESIDENT ORGANISMSdeeply seated in the epidermis, not easily removed by simple handwashing,Ex: Staphylococci

B. TRANSIENT ORGANISMrepresent recent contamination,survive for a limited period of time, acquired during contact with the infected colonized patient or environment,easily removed by good handwashingEx: ( Klebsiella & Pseudomonas)

Infectious AgentBacteria – heama organism, systemicVirus – nuero organism, systemicFungi – skin organism, localProtozoa – GI organism, localInfectious Agent

FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASEPathogenicity – ability to cause a diseaseInfective dose – no of organism to initiate infectionVirulence – ability to enter or move through tissuesSpecificity – ability of the organism to develop antigens

STAGES OF INFECTIOUS PROCESSMeans of Transmission1. CONTACT - most common means of transmitting microorganisms from one person to another.A. Direct Contact (person to person) occurs when one person touches anotherbest vehicle is the Hands especially those of the Health Care workers

Indirect Contact (inanimate object)- occurs when a person touches an inanimate object contaminated by an infected patient

2. AIRBORNE- droplet, dust, organisms in env.3. VECTOR - insects or animals4. VEHICLE- food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated infusion)

PREVENTION OF COMMUNICABLE DISEASEPrevention is worth a pound than curePREVENTION OFCOMMUNICABLE DISEASEHealth Education – primary role of the nurseSpecific Protection- handwashing, use of protective devicesEnvironmental Sanitation – clean and conducive for healthDefinition of Prevention“Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention”

A Dictionary of Epidemiology, Fourth Editionby John M. Last

Prevention of Needlestick InjuriesDispose Used Needles in Puncture Proof Needle ContainersDon’t Recap Needles (Unless using the One-handed Technique)Use Gloves When Handling Needles (Won’t Prevent Injuries but May Lessen Chance of Transmitting Diseases)

CONTROL OF C0MMUNICABLE DIESEASE1. Notification2. Epidemiological Investigation3. Case finding; early dx and prompt treatment4. Isolation and Quarantine5. Disinfection; disinfestation6. Medical Asepsisa. Handwashingb. Concurrent disinfectionc. Personal protective equipments (PPEs)d. Barrier Cards/PlacardingObjectives of CCDRestoration of health, reduce deaths and disabilityInterpretation of control measures to IFC for practice to prevent spread of CD.Promotion of health and prevention of spread of CD

Diseases that require weekly monitoring:

1. Acute flaccid paralysis (AFP) polio2. Measles3. Severe acute diarrhea (SAD)4. Neonatal tetanus5. AIDS

Diseases that require reporting w/in 24 hrs1. Acute flaccid paralysis (AFP) polio2. Measles

Diseases targeted for eradication1. Acute flaccid paralysis polio2. Neonatal tetanus3. Measles4. RabiesEpidemiologyStudy of the occurrence and distribution of diseases in the population

Patterns of occurrence of disease –frequency of disease occurrenceSporadicOn and off occurrence of the diseaseMost of the time it is not found in the communityOne or two cases that occur are not relatedEndemicPersistently present in the community all year roundEx: malaria in PalawanEpidemicAn unexpected increase in the number of cases of diseasePandemicEpidemic of a worldwide proportionsTime Related Patterns of Occurrencecyclical variationa periodic increase in the number of cases of a diseasea seasonal disease, an increase is expected or there is usual increase- dengue fever during rainy seasons are increased but it is not considered an epidemic because it is expected to rise at this particular timehot spot-a rising increase that may lead to an epidemic

Time Related Patterns of OccurrenceShort time fluctuationA change in the frequency of occurrence of a disease over a short period of timeMaybe (+) or (-)Secular variation

A change in the frequency of occurrence of a diseae taking place over a long period of timeEx: a.) the change in the pattern of occurrence of polio after being eradicated in 2000, then sudden repport of cases in 2001 due to mutant restraints.b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of todayTypes of EpidemiologyDescriptive Epidemiology - concerned with disease frequency & distributionAnalytic EpidemiologyIs a study of the factors affecting occurrence and distribution of the disease.Ex. Epidemiologic investigationTherapeutic/ClinicalStudy of the efficacy of a treatment of a particular diseaseEx. Clinical trial of a newly proposed therapeutic regimenEvaluation EpidemiologyStudy of the over-all effectiveness of a total/ comprehensive public health program.Ex. Evaluation of the under five clinic

Note: We make use of the epidemiology in CHN in order to come up a community diagnosis and also to determine the effectiveness of a particular treatmentTypes of Epidemiologic DataDemographic dataDemography is the study of population groupsEx. Population size and distributionVital StatisticsEnvironmental dataHealth services dataEx. Ratio between nurse and the population being servedEx. Degree of utilization of health facility/ serviceEpidemiologic Investigation

1st step- Statement of the problem2nd step- Appraisal of facts – describing the epidemic in terms of time, place, person.3rd step- formulation of hypothesis4th step-Testing the hypothesis5th step- Conclusion and recommendation

TERMSDisinfection – pathogens but not spores are destroyed

Disinfectant – substance use on inanimate objects

Concurrent disinfection – ongoing practices in the care of the patient to limit or control the spread of microorganisms.

Terminal disinfection – practices to remove pathogens from the patient’s environment after his illness is no longer communicable

FACTORS AFFECTING ISOLATIONMode of TransmissionSourceStatus of the client’s defense mechanismAbility of client to implement precautionsISOLATIONEPILaunched by DOH in cooperation with WHO and UNICEF last July 1976Objective – reduce morbidity and mortality among infants and children caused by the six childhood immunizable diseasesPD No. 996 (Sept. 16, 1076) – “ Providing for compulsary basic immunization for infants and children below 8 y/oPP No. 6 (April 3, 1996) – “ Implementing a United Nations goal on Universal Child Immunization by 1990”RA 7846 (Dec. 30, 1994) – immunization hepa BPD No. 4 (July 29, 1998) – “Declaring the period of September 16 to October 14, 1998 as Ligtas Tigdas Month and launching the Phil Measles Elimination Campaign”

Legislation, Laws affecting EPI

Proclamation No. 46 – “polio eradication project”Proclamation No. 1064 – AFP surveillanceProclamation No. 1066 – National Neonatal Tetanus Elimination Campaign

EPIBCG - TBDPT – Diptheria, Pertussis, TetanuOPV - PoliomyletisHepatitis BMeaslesImmunizationContraindications-conditions that require hospitalizationFor DPT 2 and 3 – history of seizures/ convulsions within 3 days after the first immunization with DPTNursing responsibility: ask how the child reacts to the first doseFor infant BCG – clinical AIDS

The following conditions are NOT contraindications:Fever up to 38.5 ºCSimple or mild acute respiratory infectionSimple diarrhea without dehydrationMalnutrition (it is indication for immunization)

Schedule of immunizationInfant BCG0 to 11 months or 0 to 1 yearat birth0.05 ml (dose) – ID, right armSchool entrance BCGWhen the child enters Grade 1 with or without scar on the right arm then still go on with the vaccination except if he is repeating Grade 1

Schedule of immunizationDPT3 doses, 4 weeks or 1 month intervalTarget age: 1 ½ to 11 months but child is eligible up to 6 yearsIf 7 years old and above DT only not P0.5 ml, IM, vastus lateralis

Schedule of immunizationOPV3 doses, 4 weeks/1 monthTarget population: same as above, eligibility until Grade 62-3 drops, oral route*Feb 8-March 8: Oplan Polio Revival DriveNo side effect, but advise the mother to avoid feeding the child for 30 minutes after the vaccine, if vomits within the 30 minute period, repeat the vaccination

Schedule of immunizationHepa B3 doses, 4 weeksCan be given at birthTarget age 1 ½ to 11 months0.5 ml, IM, vastus lateralisPatient may experience local tenderness

Schedule of immunizationMeasles9 to 11 monthsMost babies have protection because of maternal antibodies thus this vaccine is given at 9 months because the time where the maternal antibodies wear off, other virus if it still active it will kill the vaccine0.5 ml, subcutaneous, any armMeaslesFever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles)

ImmunizationFully Immunized Childwhen he received all the antigens that should be given in the first year of life (1 dose BCG, MV; 3 doses DPT, OPV, HB)Completely Immunized ChildAll vaccines given but went beyond 0ne year of age

1. The clinic nurse notes that the physician has documented a diagnosis of herpes zoster (shingles) in the client’s chart. Based on an understanding of the cause of this disorder, the nurse would determine that this definitive diagnosis was made following which diagnostic test?

A. Skin biopsyB. Wood’s light examinationC. Culture of the lesion

D. Patch test

ANSWER: CViral culture is the confirmatory test for Herpes.  Patch test is an allergy test.

2.  Nurse Jezel is preparing to care for a child with rubella (German measles) and anticipates contact with infectious material during care.  She enters the supply closet where the masks, gloves, gowns, and goggles are kept. Which item(s) does the nurse obtain to care for this child?

A.    mask, gogglesB.    mask, gown and glovesC. mask, gloves, goggles, gownD. gown, gloves, goggles

ANSWER: BNo need of goggles because causative agent cannot cause infection when it enters the mucous membrane of the eyes.

3.  Eunice, six year old,  is scheduled to receive a measles, mumps, rubella (MMR) vaccine. The nurse preparing to administer the vaccine reviews the child’s record and questions the order if which of the following is documented in the child’s record?

A.    a local reaction at the site of injection of a previous MMR vaccineB.    a history of an anaphylactic reaction to neomycinC.    a history of frequent respiratory infectionsD.    recent recovery from a cold.

ANSWER: BMMR vaccine contains aminoglycosides antibiotic.  Allergic reaction to neomycin aminoglycosides warrant further check by the doctor.

4. Ms. Flores clinic nurse prepares to administer a measles, mumps, rubella (MMR) vaccine to a 5-year-old child. The nurse administers this vaccine:

A.    Intramuscularly in the anterolateral aspect of the thighB.    Intramuscularly in the deltoid muscleC.    Subcutaneously in the outer aspect of the upper armD.    Subcutaneously in the gluteal muscle.

ANSWER: CMMR vaccine is given via this route.  Before administration always check for allergy to eggs.

5.  Mrs. Analesa Plaga mother brings her six years old child to the clinic because the child has developed a rash on the trunk and on the scalp. Mrs. Analesa reports that the child has had a low grade fever, has not felt like eating and generally has been tired. The child is diagnosed with chickenpox. Mrs. Plaga  inquires about the communicable period associated with chickenpox. A nurse plans to base the response on which of the following?

A.    The communicable period is unknown.B.    The communicable period s one to two days before the onset of rash to 6 days after the first crop of vesicles, when crusts have formed.C.     The communicable period is 10 days before the onset of symptoms to 15 days after the rash appears.D.    The communicable period ranges from 2 weeks or less to several months.

ANSWER: BThis is the POC of chicken pox.  Remember chicken pox is not contagious when crust or scabs appear.

6. A nurse provides instructions to the mother of a child with mumps regarding respiratory precautions. The mother asks the nurse about the length of time required for the respiratory precautions. The nurse most appropriately responds:

A.    Respiratory precautions  are not necessary once the swelling appears.B.    Respiratory precautions are not necessary before the swelling begins.C.    Respiratory precautions are indicated during the period of communicability.D.    Respiratory precautions are indicated for 18 days following the onset of parotid swelling.

ANSWER: CThe patient is placed on isolation during the period of communicability.

7. Decontamination of surgical instrument by soaking in 0.5% chlorine bleach for 10 minutes results to which of the following?

A.    Makes the micororganisms less contaminated.B.    Completely kills all microorganisms.C.    Enables the health worker to reuse the insturment immediately.D.    Rapidly kills viruses causing AIDS and Hepatitis B.

ANSWER: DChlorine is used in disinfecting objects because it rapidly kills viruses causing AIDS and Hepatitis B.  It does not kill all microorganisms but is effective in killing most microorganisms.  The presence of pathogenic microbes would mean contamination.

8. In Communicable Diseases cases, which of the following should be done to the CHN bag?

A.    Thoroughly cleanse and disinfected.B.    Well Kept and convenient to the nurse.C.    Basic Medication and articles competence.D.    Contents thoroughly completed.

ANSWER: AIn communicable diseases cases in the community in relation to CHN bag; the main goal is to prevent the spread of infection.  Therefore the bag should be thoroughly cleanse and disinfected.  Option B would be appropriate if the question is asking for neatness and organization of the nurse.  Option C and D are not related to the topic in communicable disease.

9. Which of the following should be done first?A.    Putting Apron.B.    Put out things needed for the case.C.    Take out hand towels.D.    Handwashing.

ANSWER: CDuring home visit, the nurse performs handwashing first after placing the bag in a convinient

place, As a preparation for handwashing activity, the nurse first takes the towel out, soap dish as well as the apron.  The nurse then performs handwashing.

10. After completion of the nursing care or treatment, the nurse must protect himself and prevent the spread of infection.  What is used to clean item used?

A.    AlcoholB.    IsopropylC.    ZephiranD.    Wet ones

ANSWER: AAfter completing nursing care or treatment, clean and alcoholize the things used.