Monica Cruz RLE

8/3/2019 Monica Cruz RLE

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DiPhThErIaDiPhThErIa

Cruz, Monica Angela E.

BSN 4-A; Group 5

Mr. Romeo B. Villanueva



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).



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.



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.



y PREDISPOSING FACTORS:

An operation in an area of the nose and

throat.

Economic status.

Lack of proper nutrition.

Overcrowding.



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.



y COMMON SYMPTOMS:

Breathing difficulty

Husky voice Increased heart rate

Stridor

Nasal drainage/secretions

Low-grade fever



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



y DIAGNOSTIC TESTS:

Swab from nose and throat or other

suspected lesions

Virulence test

Schick test

Molony test

Loefler slant



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



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.



y COMMON NURSING DIAGNOSIS:

Ineffective airway clearance

Risk for activity intolerance

Activity intolerance

Poor tissue perfusion

Fear

Anxiety



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.



EnCePhAlItIsEnCePhAlItIs



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.




Viral encephalitisx Viral encephalitis can occur either as a direct effect of an

acute infection, or as one of the sequelae of a latentinfection.




It usually takes 5-15 days, with a range from 4-

21 days.



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.



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.



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.



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




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.



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



y PREVENTION:

Preventive measures are directed toward the

identification of mosquito vectors.

Public education programs.



FiLaRiAsIsFiLaRiAsIs



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.




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.



y MODE OF TRANSMISSION: The disease is transferred from person to person by

mosquito bite.


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



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.




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.




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



PeRtUsSiSPeRtUsSiS



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.




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.




typically seven to ten days in infants or young

children.

y MODE OF TRANSMISSION: The bacterium is spread by airborne droplets.


Paroxysmal cough, inspiratory whoop, andvomiting after coughing.



y DIAGNOSTIC TESTS:

Culturing of nasopharyngeal swabs on

Bordet-Gengou medium, polymerase chain

reaction (PCR), direct immunofluorescence(DFA), and serological methods.




Fluid and electrolyte replacement

Adequate nutrition

Oxygen therapy

Antibiotics (erythromycin and ampicillin)




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.

Monica Cruz RLE

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