Prior to the invention of vaccination, mumps used to cause epidemics every three years. Upon the introduction of the MMR vacine, a rapid fall in the incidence was noted and by mid-1990s there were less than 2,000 cases notified per year.

Mode of Transmission of Mumps

Man is the only reservoir. Mumps is transmitted through direct contact by droplet transmission.

Incubation Period of Mumps

Incubation period averages from 2-3 weeks with an average of 18 days. Majority of cases are infectious for at least a week before swelling until 9 days after swelling.

Signs and Symptoms of Mumps

• Earache
• Fever
• Pain upon mastication (chewing)
• Tenderness and swelling of parotid glands

Diagnostic Exam for Mumps

Diagnosis is formulated by clinical observation. Saliva, CSF or urine may be collected for viral culture.

Medical Management for Mumps

Treatment is asymptomatic.

Nursing Care for Clients with Mumps

• Provide bed rest until swelling subsides
• Provide male client with fitted supporter to prevent pulling of gravity on testes and blood vessels. Pulling of the testes will lead to atrophy then will lead to sterility.
• Provide adequate nutrition. Soft bland diet, may give apple juice only.
• Apply ice cap over the parotid gland to deaden the nerve endings.
• Instruct client that he is communicable until the swelling subsides.

Prevention of Mumps

Proper disposal of nasopharyngeal secretions should be observed and the client should cover his nose and mouth when sneezing and coughing.

Administration of MMR vaccine is recommended.

Mode of Transmission of Cholera

The mode of transmission of Cholera is by the fecal-oral route.

Signs and Symptoms of Cholera

• Abdominal cramps
• Vomiting
• Initially, yellowish watery stool
• Rice watery stool
• Rapid dehydration
• Washer-woman’s hand
• Fever with cold skin
• Fishy odor stools

Diagnostic Exam for Cholera

The diagnostic tests for Cholera are Stool exam and the rectal swab.

Medical Management for Cholera

• Administer antibiotics as prescribed. (Drug of Choice: Tetracycline, by intravenous route)
• Replace fluids and electrolytes.

Nursing Care for Clients with Cholera

• Maintain fluid and lectrolyte balance. Note that the no. 1 indicator of dehydration before 48 hours is weight loss.
• Provided adequate nutrition.
• Monitor Input and Output regularly.
• Maintenance of nutrition.
• Intravenous fluid regulation.
• Provide for the comfort of the client

Prevention of Cholera

• Cholera, Dysentery, Typhoid (CDT) Immunization.
• Frequent hand washing.
• Better food handling, preparation, and storage.
• Eradication of flies.

Mode of Transmission of Dengue Fever

Thru the bites of the mosquito Aedes Aegypti, which usually bites from dawn until dusk. Bites usually are found in the lower extremities. The Aedes Aegypti usually are bred in stagnant water found in most urban areas. Characteristics of the mosquito are the white stripes on its legs and that it bites parallel to the skin.

Pathophysiology of Dengue Fever

The virus is introduced into the blood stream. It will then produce multiple lesions that increases capillary fragility and capillary permeability.

Signs and Symptoms of Dengue Fever

Grade 1

• High grade fever for 3-5 days
• Headache, pain behind the eyes, joint pain, bone pain, and abdominal pain.
• Nausea and vomiting
• Signs of pathological vascular changes. Petechiae or Herman sign (General flushing or redness of the skin)

Grade 2

• Signs of Grade 1 plus bleeding
• Bleeding from the nose (epistaxis), gums, stomach (hematemesis), melena (black tarry stools), hematochezia

Grade 3

• Grade 2 plus Circulatory failure
• Cold, clammy skin
• Cold extremities
• Altered vital signs

Grade 4

• Grade 3 plus Shock (Hypovolemic). Excessive blood loss due to uncontrolled bleeding.

Diagnostic Exam for Dengue Fever

Torniquet Test or Rumpel Leede Test

Is a presumptive diagnostic exam that tests for the capillary fragility, To get for the amount of the Inflation of the Cuff, take the blood pressure then add the systolic and diastolic pressure then divide by two (Inflation=[Sys+Dia]/2). Keep the cuff inflated for 10 minutes in adults and 5 minutes in children. After which deflate the cuff and check for petechial formation, count for petechial formation. The test falls positive if there are more than 20 petechiae in 1 square inch.

Before administering the test patient: should be 6 months or older, positive for fever in 3 days, and has no other signs of Dengue Hemorrhagic Fever.

Platelet Count

There is a decreased number in the platelets.

Hematocrit Determination

The patient has hemoconcentration which presents as an increase in the hematocrit level.

Medical Management for Dengue Fever

Treatment is symptomatic.

Fever

Administer analgesics or anti-pyretic. Do not administer aspirin.

Bleeding

Administer a vitamin k preparation to aid in coagulation. Administer vitamin c to increase capillary resistance. Provide for blood transfusion to replace lost blood. Hook client to an intravenous fluid to restore intravascular volume.

Nursing Care for Clients with Dengue

to prevent and control of bleeding.

• Increase body resistance, no dark colored foods.
• Supportive

Prevention of Dengue Fever

Eradicate the mosquito.

Mode of Transmission of Rabies

Contact with the saliva of a rabid animal. The Rhabdo virus affects the peripheral nerves, throughout the Central Nervous System, most especially the negri bodies. The virus also affects the efferent nerves which stimulates the salivary glands.

Signs and Symptoms of Rabies in Animals

1. Dumb Stage – there is a change in the disposition of the animal, it can be withdrawn or depressive, overly affectionate, and hyperactive.
2. Furious Stage – the animal is easily angered, fierce, and drooling can be observed.

Signs and Symptoms of Rabies in Humans

Symptoms can present in the period of 10 days up to until years after the infection. The average manifestation is 1 to 3 months.

Invasive Stage

• Numbness, itchiness, or pain at the site of bite
• Flu like symptoms
• Marked insomnia
• Restless, irritable, and apprehensive
• Slight photo sensitivity

Excitement Stage

Presence of Aero, Hydro, and Photo Phobia. Swallowing becomes difficult due to pharyngeal spasm when water or air passes thru. This results to strangling of the patient. The patient also manifests a maniacal behavior, similar to a rabid animal.

Paralytic Stage

There are no spasms present but patient experiences rapid and progressive paralysis. Expect the patient to die in 24-72 hours.

Diagnostic Exam for Rabies

Animal Brain Biopsy

Direct Fluorescent Antibody Test

Observation of Animal

Check for the Proximity and Extent of the Bite.

History Taking. Obtain reasons for the bite (what the patient was doing to provoke the bite).

Medical Management for Rabies (Post Exposure Prophylaxis)

Active Immunization

Made from the microorganism. Purified Vero Cell Vaccine (PVRV): Verorab (0.5 cc / vial), Purified Duck Embryo Vaccine (PDEV): Lyssavach (1 cc / vial), Purified Chick Embryo Vaccine (PCEV): Rabipur (1 cc / vial). This can be administered in two ways:

• Day 0 – 2 vials
• Day 7 – 1 vial
• Day 21 – 1 vial

Intradermal (skin test is not needed prior to administration)

• Day 0 – 0.1 cc (both arms)
• Day 3 – 0.1 cc (both arms)
• Day 7 – 0.1 cc (both arms)
• Day 28-30 – 0.1 cc (one site)
• Day 90 – 0.1 cc (one site)

• Day 0 – 0.2 cc (both arms)
• Day 3 – 0.2 cc (both arms)
• Day 7 – 0.2 cc (both arms)
• Day 28-30 – 0.2 cc (one site)
• Day 90 – 0.2 cc (one site)

Passive Immunization

Given on a single dose within 7 days only. Dosage will depend on the patient’s weight.

Equine Rabies Immunoglobulin (ERIg): ARS (Anti-Rabies Serum), Hyper RAB, Favirab – Given 0.2 cc / kilogram body weight.

Human Rabies Immunoglobulin (HRIg): Imogam, Rabuman – given 0.133 cc / kilogram body weight.

Nursing Care for Clients with Rabies

• Provide a dim and quiet environment.
• Room should be away from sub-utility room.
• Restrain before maniacal behavior.
• Provide comfort measures.
• When dealing with patient, wear personal protective equipment.

Prevention of Rabies

Be a responsible pet owner.

• Have the animals immunized.
• Keep animal cage or chained
• Always clean the surrounding environment of the animal.

Mode of Transmission of Tuberculosis

Airborne

Signs and Symptoms of Tuberculosis

• Low grade fever
• Night sweats
• Anorexia
• Weight loss
• Fatigability
• Body malaise
• Chest and back pain
• Productive cough
• Hemoptysis (the erosion of lung capillaries)
• Dyspnea

Diagnostic Exam for Tuberculosis

Tuberculin Testing or Mantoux Tuberculin Skin Test

A screening test that when the result is positive, the patient is positive for EXPOSURE to tuberculosis. If the result is consistently positive, there is sensitivity to the microorganism. Tuberculins are purified protein derivative and is administered intradermally. It is left for 48-72 hours after which the client is asked to return and see the doctor. A positive result yields an induration more than 10mm.

Sputum Exam (Acid Fast Bacilli)

The sputum exam is the confirmatory exam for the presence of tuberculosis in a client.

Chest X-ray

A chest X-ray is used to evaluate the extent of the infection.

Medical Management for Tuberculosis

Administration of Anti-Tubercular Agents

• Rifampicin – an antibiotic, administered regularly daily and is used in combination with other medications to prevent Rifampicin resistance.
• Isoniazid – an anti-tuberculosis medication, it is bacteriocidal to rapidly multiplying mycobacteria and bacteriostatic to slow multiplying mycobacteria. It is used in combination with other medications to prevent Isoniazid resistance.
• Pyrazinamide – largely bacteriostatic but is bacteriocidal to rapidly multiplying mycobacteria.
• Ethambutol – is a bacteriostatic antimycobacterial drug. It is used in combination to other drugs to prevent drug resistance.
• Streptomycin – is an antibiotic used in combination to other anti-tubercular drugs.

Nursing Care for Clients with Tuberculosis

• Provide adequate rest
• Provide adequate nutrition (Small frequent, High Caloric diet)
• Encourage drug compliance – Direct Observable Treatment Short Course (DOTS)

Prevention of Tuberculosis

Immunization

Bacillus-Calmet Guerin (BCG), is given at at birth, 0.05cc, intradermally at the right deltoid. School entrants are also given the vaccine at 0.1cc, intradermally at the left deltoid. Always remember not the massage the injection site to prevent spillage.

Observe the site of injection. An abscess heals with a scar within 2-3 months. If an indolent abscess occurs (Koch’s phenomenon), incision and drainage is done as prophylaxis.

Proper disposal of nasopharyngeal secretions and covering of the nose and mouth when sneezing and coughing.

Signs and Symptoms of Herpes Zoster

• Presence or absence of low grade fever
• Headache, body malaise, muscle pain 24 to 48 hours before eruption
• Vesiculo-Pustular Rashes
  • Painful and the pain persists for up to 2 months
  • Unilateral distribution which follows the nerve pathway
  • Appears in clusters
• Crusts

Diagnostic Exam for Herpes Zoster

Clinical observation only because only a few disease produces a rash in a dermatomal pattern.

Nursing Care for Herpes Zoster

Nursing care or interventions are focused on symptoms or are supportive care. Nurses should focus on skin care. Pain management is also advised.

Prevention of Herpes Zoster

A newly developed vaccine named Zostavax was found to have prevented half of the cases of herpes zoster in the United States

Cardinal Signs and Symptoms of Pneumonia

• Fever
• Shaking chills
• Productive cough
• Sputum production
  • Rusty colored – Streptococcus pneumoniae
  • Creamy Yellow – Staphylococcus pneumoniae
  • Currant Jelly – Klebsiella
  • Greenish – Pseudomonas
  • Clear – No infection
• Pleuritic chest pain due to the friction between the pleural layer.

Infants and Children with Pneumonia have:

With the findings above plus chest in drawing or stridor is observed, the client has Severe Pneumonia.

Diagnostic Exam for Pneumonia

• Chest X-Ray. Most confirmatory diagnostic exam for pneumonia. Lung consolidation or patchy infiltrates are observed.
• Sputum exam. This is taken in the morning, upon rising, because of copious amounts of sputum in the morning. Teach the client deep breathing and coughing.
• Bronchoalveolar lavage.

Management for Pneumonia

Antibiotic therapy like Co-trimoxazole is administered, Oxygen administration as needed, and Pulmonary toilet (suctioning, chest physiotherapy, blow bottles, and nasotracheal suctioning).

Nursing Care Management for Pneumonia

• Splint the chest or apply chest binder
• Turn the patient towards affected side
• Maintain patent airway
• Provide adequate rest
• Provide comfort measures. Keep patient warm and dry

Prevention of Pneumonia

• Pneumococcal and influenza vaccines
• Proper disposal of nasopharyngeal secretions
• Covering of the nose and mouth when sneezing and coughing
• Never kiss the patient

Signs and Symptoms of Chicken Pox

• The presence or absence of low grade fever
• Headache, body malaise, muscle pain 24-48 hours before eruption of the rashes.
• Vesiculo-Pustular Rashes. It starts as a macular rash that then develops into a papule after a few hours, then turns into a vesicle after a few hours, the becomes a Vesiculo-pustular rash after a few hours.
  • The skin becomes very itchy. It can lead to scarring or pox marks. The client is advised to bathe daily.
  • Generalized distribution. It appears first at a covered part of the body, usually the trunk or the scalp.
  • Unifocular appearance or has one focus.
• Crusts fall off. The client is on the road to recovery.

Diagnostic Exam for Chicken Pox

Clinical Observation.

Medical Management for Chicken Pox

Management is symptomatic. Acyclovir, an anti-viral medication, can be administered. Anti-pruritic agents are also recommended.

Nursing Care for Chicken Pox

Nursing care is symptomatic. Client should be provided with daily skin care. The client should also have adequate rest and nutrition.

Prevention of Chicken Pox

Chicken pox gives a permanent immunity. It is communicable until all rashes have dried.

Immunization, Varivax can be given for clients 12-18 months old in 0.5 cc, Subcutaneously, in the deltoid. For clients 13 years old and above, 2 doses with 1 month interval.

Signs and Symptoms of Pertussis

Catarrhal Stage

Insidious onset, with irritating cough that gradually becomes paroxysmal (violent) and is followed by crowing or a high pitched whoop. The disease is highly contagious in this stage. Patient also manifests colds, fever, nocturnal coughing, tiredness, and listlessness.

Paroxysmal Stage

The client experiences violent, successive coughing. The client has 5-10 successive, forceful coughing which ends in a prolonged inspiratory phase or whoop. This could cause respiratory arrest in the client. The client’s eyes turn red and may seem to be bleeding.

Convalescent Stage

The signs and symptoms subsides and the client is on the road to recovery.

Diagnostic Exam for Pertussis

Nasal swab

A specimen is obtained by swabbing the Nares.

Nasopharyngeal culture

Is the confirmatory test for Pertussis.

Management of Pertussis

Antibiotic therapy

The client is given Erythromycin or Cotrimoxazole for 7-10days.

Pertussis immuneglobulin

These are globulins obtained from the plasma of people who have been immunized against pertussis and have already formed antibodies.

Fluid and electrolyte replacement

This loosens the secretions and allows it to be easily expelled.

Administration of Codeine

Codeine acts as an anti-tussive and gives a mild sedation.

Nursing Care for Clients with Pertussis

• Provide adequate rest and conserve the energy of the patient. This decreases the oxygen demand and consumption of the client.
• Maintain fluid and electrolyte balance
• Maintain adequate nutrition with aspiration precaution
• If the client experiences spasmodic cough place the client on Nothing per Orem (NPO) diet.
• For Bottle-fed clients, the nipple should have small holes or use dropper.
• Apply abdominal binder

Prevention of Pertussis

• Provision of DPT vaccine in 3 doses, IM. Should be completed before the age of 6 months.
• The first attack does not give permanent immunity but 2nd attacks are rare.
• Proper disposal of nasopharyngeal secretions.
• Covering of the nose and mouth when sneezing and coughing.
• Never kiss the patient.
]]> http://www.nursingcare101.com/pertussis/feed 0 http://www.nursingcare101.com/hepatitis http://www.nursingcare101.com/hepatitis#comments Sat, 19 Sep 2009 01:00:05 +0000 eajrn http://www.nursingcare101.com/?p=987 Hepatitis is the inflammation of the liver. This conditions can be self-limiting or could progress to the development of scar in the liver. The causes of hepatitis can be alcoholism, drug intoxication, chemical intoxication, or the invasion of a microorganism.
]]> Hepatitis is the inflammation of the liver. This conditions can be self-limiting or could progress to the development of scar in the liver. The causes of hepatitis can be alcoholism, drug intoxication, chemical intoxication, or the invasion of a microorganism.

Types of Hepatitis

• Hepatitis A. Is an infectious hepatitis and is characteristic of catarrhal jaundice. It is also called as the epidemic hepatitis. The causative agent is the Hepatitis A virus (RNA) and mode of transmission and incubation period is 2 to 6 weeks.
• Hepatitis B. Is called Serum hepatitis. It is a homologous hepatitis and is considered to be the most fatal. The causative agent is the Hepatitis B virus (DNA) and the mode of transmission is parenteral via blood transfusion or contaminated sharps, oral, sexual contact, or vertical transmission (mother to child). Incubation period is 6 weeks to 6 months.
• Hepatitis C. Is also called the post transfusion hepatitis. The causative agent is the Hepatitis C virus and the mode of transmission is parenteral. Incubation period is 5 to 12 weeks.
• Hepatitis D. Is a dormant type of Hepatitis B. Vausative agent is the Hepatitis D virus or the delta virus and the mode of transmission is the same as Hepatitis B. Incubation period is 3 to 13 weeks.
• Hepatitis E. Is an enteric hepatitis. The causative agent is the Hepatitis E virus and the mode of transmission is fecal-oral route. The incubation period is 3 to 6 weeks.
• Hepatitis G. The causative agent is the Hepatitis G virus and the mode of trnasmission is the same as hepatitis C. The incubation period is unknown.

Signs and Symptoms of Hepatitis

Pre-Icteric

• Fever, right upper quadrant pain due to the inflammation of the liver.
• Fatigability, weight loss, and body malaise due to the inability to convert glucose to glycogen and the liver cannot deaminase the protein.
• Anorexia, nausea, and vomiting.
• Anemia due to the decrease in the lifespan of the Red Blood Cells.

Icteric

• Jaundice and pruritus because the bilirubin is sweat out by bile salts.
• Unconjugated bilirubin.
• Tea colored or brown colored urine.
• Acholic stool. (Clay colored stool)

Post-Icteric

• Jaundice disappears and signs and symptoms subsides.
• Energy level increases.

It takes the liver 3 to 4 months to regenerate.

Diagnostic Exam for Hepatitis

Liver enzyme test

• Alanine aminotransferase (ALT). No. 1 test if with liver problems.
• Aspartate aminotransferase (AST). Is included upon onset of jaundice.
• Alkaline phosphatase (ALP). Confirmatory of obstructive jaundice or hepatitis.
• Gamma glutamyl transferase (GGT). Confirmatory for toxic hepatitis.
• Lactic dehydrogenase (LDH). Confirmatory for liver organ damage.

Serum Antigen-Antibody Test. To determine what specific virus causes the infection.




Medical Management for Hepatitis

Management is symptomatic. For Chronic Hepatitis B, Lamivudine is given once a day.

Nursing Care Management for Hepatitis

Give provide adequate nutrition, low in fat and high in carbohydrates. If the client is infected moderate protein is required, if the client is recovering then high protein diet is required, and if there is a complication of the hepatitis then low protein is required.

Prevention of Hepatitis

• Immunization. A Hepatitis B vaccine is given at 9 months after birth.
• Avoid mode of transmission.
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