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DiPhThErIaDiPhThErIa
Cruz, Monica Angela E.
BSN 4-A; Group 5
Mr. Romeo B. Villanueva
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y DEFINITION:
Is an acute bacterial disease that can infect the
body in two areas; the throat (respiratorydiphtheria) and the skin (skin or cutaneous
diphtheria).
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y ETIOLOGICAL AGENT:
Corynebacterium diphtheriae (Klebs Leoffler bacillus)x Is a toxic-producing organism that manufactures an exotoxin
which is responsible for major pathologic changes.
x Is a gram positive (+), non-sporulating, and generally aerobic.
x It is unstable and easily destroyed by light, heat, and aging.
x It is capable of damaging muscles, especially the kidneys, liver,cardiac nerve, and other tissues.
x It has three strains of organisms:
x Gravis (Severe)
x The strain that produces the most severe and greatest number of fatal cases in Europe.
x Mitis (Mild)x The strain that produces lesions extending to the larynx and lungs
but are rarely the cause of death.
x Intermedius (Intermediate)
x Related to gravis but has the tendency to bleed.
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y INCUBATION PERIOD:
It usually takes 2-5 days for the symptoms to
develop.y PERIOD OF COMMUNICABILITY:
It is usually 2-4 weeks in untreated patients or1-2 days in treated patients.
y SOURCE OF INFECTION:
From discharges of the nose, pharynx, eyes, orlesions on other parts of the body.
y
MODE OF TRANSMISSION: Diphtheria is transmitted through contact
with a patient or a carrier, or with articlessoiled with discharges of infected persons.
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y PREDISPOSING FACTORS:
An operation in an area of the nose and
throat.
Economic status.
Lack of proper nutrition.
Overcrowding.
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y TYPES OF DIPHTHERIA:
Nasalx With foul-smelling serosagniunous secretions from the nose.
Tonsilarx Has low fatality rate.
x Lesions are confined to the tonsils only but tend to spread over thepillars, into the soft palate and uvula.
Nasopharyngealx More severe type.
xCervical lymph nodes are swollen
x Neck tissues are edematous that result in the appearance of ´bull·s neck.µ
x It has marked degree of toxemia.
x Breath usually is fetid.
Laryngealx Most commonly found in pediatric patients ranging from2-5 years old.
x Considered as the most the severe and more fatal type due toanatomical reason.
Wound or Cutaneous Diphtheriax Affects the mucous membrane and any break on the skin.
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y COMMON SYMPTOMS:
Breathing difficulty
Husky voice Increased heart rate
Stridor
Nasal drainage/secretions
Low-grade fever
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y COMPLICATIONS:
Myocarditis caused by action of diphtheria
toxin on the heart muscles
Polyneuritis that includes paralysis of the soft
palate, paralysis of the ciliary muscles of the
eye, pharynx, larynx, or extremities. Airway obstruction may lead to death through
asphyxiation.
Cervical adenitis
Otitis media
Bronchopneumonia
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y DIAGNOSTIC TESTS:
Swab from nose and throat or other
suspected lesions
Virulence test
Schick test
Molony test
Loefler slant
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y TREATMENT MODALITIES:
Drugs:
x Penicillins
x Antitoxins
x Erythromycin
Supportive therapy:x Maintenance of adequate nutrition
x Maintenance of adequate fluid and electrolyte
balance
x
Bed restx Oxygen inhalation
x In presence of laryngeal obstruction, tracheostomy
is usually done
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y NURSING MANAGEMENT:
Patient must be advised to take absolute bed
rest for at least 2 weeks.
For patient·s diet, soft food is recommended.
Small frequent feeding is advised.
Patient must be encouraged to drink fruit juice rich in vitamin C to maintain the
alkalinity of the blood and to increase the
resistance of the patient.
Ice collar must be applied to the neck (Bull·sneck).
Nose and throat must be taken care of.
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y COMMON NURSING DIAGNOSIS:
Ineffective airway clearance
Risk for activity intolerance
Activity intolerance
Poor tissue perfusion
Fear
Anxiety
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y PREVENTION:
Cases of diphtheria must be mandatorilyreported.
Patients should be isolated for a minimum of fourteen days from the onset of the disease untilthree cultures from the nose and throat arereported negative.
DPT immunization.
Children <5yrs old should be given booster doseof diphtheria tetanus vaccine.
Patients should avoid contact with children.
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EnCePhAlItIsEnCePhAlItIs
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y DEFINITION:
Encephalitis is an inflammatory disease
involving part or all of the nervous system
resulting in abnormal function of the brainand the spinal cord.
Inflammation of the brain.
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y ETIOLOGICAL AGENT:
Viral encephalitisx Viral encephalitis can occur either as a direct effect of an
acute infection, or as one of the sequelae of a latentinfection.
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y INCUBATION PERIOD:
It usually takes 5-15 days, with a range from 4-
21 days.
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y MODE OF TRANSMISSION:
Encephalitis is transmitted to humans by the
bite of an infected mosquito. The mosquito
becomes infected by biting an infected bird.Then the virus is incubated in the body of the
mosquito for 5-7 days, the mosquito carries
the virus to healthy birds, horses, pigs, and
humans. The man is the end of cycle, since theinfection is not transmitted from man to man.
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y CLASSIFICATION OF ENCEPHALITIS:
Primary encephalitisx Is an infection caused by direct invasion of the CNS by the
virus resulting in an inflammatory reaction.
x
St. Louis encephalitisx The organism is believed to gain entrance through olfactory tract.
x It is caused by the bite of an infected mosquito.
x Eastern equine encephalitis (EEE)
x Also known as ´sleeping sicknessµ.
x Considered as a serious epidemic disease of the horses.
xWestern equine encephalitis (WEE)x Is milder and usually affects adults.
x Japanese encephalitis
x Is a potentially severe viral disease that is spread by the bite of aninfected mosquito, Culex triteaniorhynchus, that live in rural rice-growing and pig-farming regions.
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y Secondary encephalitisx Post infection encephalitis
x Is usually a complication or a sequelae to some viral
disease like measles, chickenpox, and mumps.
x Post vaccinal
x Is most common in anti-rabies vaccine.
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y CLINICAL MANIFESTATION:
Fever, headache, dizziness, vomiting, and apathy.
May experience chills, sore throat, conjunctivitis,arthralgia, myalgia, and abdominal pain.
Feel disturbance inswallowing, mastication, phonation,respiration, and movement of the eyes or face.
y DIAGNOSTIC TESTS:
CSF analysis
Serologic test ² 90% confimatory, done on thr 7th dayof illness
ELISA (IgM)
PolyMerase chain reaction
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y TREATMENT MODALITIES:
Treatment must be symptomatic and
supportive.
Convulsion must be controlled.
Nose and throat secretions should be
sanitarily disposed of.
TSB or alcohol sponges may be given if temperature is excessively high.
Oral fluid should be encouraged, unless
patient is comatose.
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y NURSING MANAGEMENT: Provide comfortx Keep patient in a quiet, well ventilated room
x Stretch lines
x Encourage or do oral hygienex Do bed bath if not contraindicated
Prevention from complicationx Turn patient to side at least 3-4 hours
x Encourage increase oral fluid intake
x Encourage high caloric intakex Moisten lips with mineral oil
x Render TSB if febrile
Monitor intake and output
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y PREVENTION:
Preventive measures are directed toward the
identification of mosquito vectors.
Public education programs.
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FiLaRiAsIsFiLaRiAsIs
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y DEFINITION:
Filariasis is a parasitic disease caused by an
African eye worm, a microscopic threat-like
worm. An adult worm can ONLY live in human
lymphatic system.
It is rarely fatal; however, it causes extensive
disability, gross disfigurement, and untold
suffering of millions of men, women, and
children.
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y ETIOLOGICAL AGENT:
Wuchereria bancroftix Is the causative agent of filariasis.
x 4-5cm long threat-like worm thataffects the body·s lymph
nodes and lymph vessels of the legs, arms, vuvla, and breasts. Brugaria malayi
x Shows manifestations resembling that of the bancroftian butswelling of the extremities is confined more to areas belowthe knees and below the elbows.
Brugaria trimorix Rarely affects the genitals.
Loa loax Another filarial parasite in humans transmitted by deer fly.
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y MODE OF TRANSMISSION: The disease is transferred from person to person by
mosquito bite.
y CLINICAL MANIFESTATION:
The most spectacular symptom of lymphatic filariasisis elephantiasis³edema with thickening of the skinand underlying tissues³which was the first diseasediscovered to be transmitted by mosquito bites.Elephantiasis results when the parasites lodge in thelymphatic system.
W uchereria bancrofti can affect the legs, arms, vulva,breasts, and scrotum (causing hydrocele formation)
Brugaria timori rarely affects the genitals
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y DIAGNOSTIC TESTS:
Circulating Filarial Antigen (CFA) test isperformed on a finger-pricked blood droplettaken anytime of the day and gives results in a few
minutes.
W. bancrofti, whose vector is a mosquito; nighttime is the preferred time for blood collection.
M. streptocerca and O. volvulus produce
microfilarae that do not use the blood; theyreside in the skin only. For these worms, diagnosisrelies upon skin snip, and can be carried out atany time.
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y TREATMENT MODALITIES:
Inermectin, abendazole, or diethylcarbamazine
(DEC) are used to treat
Surgery may be used to remove surplustissues and provide a way to drain the fluid
around the damaged lymphatic vessels.
Elevating the legs and providing support with
elastic bandages.
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y NURSING MANAGEMENT:
Health education
Environmental sanitation
Psychological and emotional support to clientand the family are necessary
Personal hygiene must be encourage
y PREVENTION:
Use of mosquito nets
Use of mosquito repellants in hours betweendusk and dawn
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PeRtUsSiSPeRtUsSiS
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y DEFINITION:
Pertussis is an infectious disease characterized
by repeated attacks of spasmodic coughing
which consists of a series of explosiveexpirations, typically ending in a long-drawn
forced inspiration which produces a crowning
sound, the ́ whoopµ and usually followed by
vomiting.
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y ETIOLOGICAL AGENT:
Bordetella pertussis.
x is a Gram-negative, aerobic coccobacillus of the
genus Bordetella, and the causative agent of pertussisor whooping cough.
x Humans are its only host.
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y INCUBATION PERIOD:
typically seven to ten days in infants or young
children.
y MODE OF TRANSMISSION: The bacterium is spread by airborne droplets.
y CLINICAL MANIFESTATION:
Paroxysmal cough, inspiratory whoop, andvomiting after coughing.
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y DIAGNOSTIC TESTS:
Culturing of nasopharyngeal swabs on
Bordet-Gengou medium, polymerase chain
reaction (PCR), direct immunofluorescence(DFA), and serological methods.
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y TREATMENT MODALITIES:
Fluid and electrolyte replacement
Adequate nutrition
Oxygen therapy
Antibiotics (erythromycin and ampicillin)
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y NURSING MANAGEMENT:
Isolation and medical asepsis should be carriedout.
Sunshine and fresh air are impotant, but thepatients should be protected from draft.
Provide warm baths.
I & O should be monitored.
y PREVENTION:
It should be reported once!
Patients should be isolated 4-6 weeks from onsetof illness.
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