COMMUNICABLE DISEASE retrovirus – HIV, plasmodium falciparum

 Disease that are transmittable from one - malaria

person or another 2. Reservoir – “environment”
2 Types of Communicable Disease  Humans, animals, non-living things
1. Contagious 3. Portal of Exit
 Easily transmitted  Skin, GIT, GUT, placenta
 Ex. COVID-19 4. Mode of Transmission
2. Infectious  Way to transmit
 Direct contact 2 Types
 Ex. HIV a. Direct Contact
o Ex. Scabies, HIV/AIDS
Infection
Subtype
 Invasion of microorganism in the body
Droplet Contact
Types
o Respiratory secretion
1. Community-Acquired Infection
o Within 3 feet
 “Within the community” before
o Large particle settles on surface
admission in the hospital
o Ex. COVID-19
 Ex. Tuberculosis, pneumonia
 DR P!MP – Diptheria, Rubella, Pertussis,
2. Nosocomial Infection
Meningitis, Pneumonia
 Hospital-acquired infection
 After admission in the hospital
b. Indirect
 Ex. Sepsis, pneumonia, U.T.I.
Airborne
3. Opportunistic Infection
o Fine Particle
 Immunocompromised,
o 3ft transmissible suspended on
immunosuppresed
air
 Most opportunistic infection in HIV/AID
o MTV – Measles, Tuberculosis,
is PCP – Pneumocystis carinii
pneumonia (fungi) Varicella
4. Iatrogenic Infection Vector-borne
 From treatment regiment or healthcare o Living things
provider o Dengue – Aedes aegypti
o Malaria – Anopheles
Chain of Infection o Hepa A & E – Fecal-Oral route
1. Causative Agent o Cholera – Typhoid fever
 Microorganism, causing the infection o Dysentry
 Could be bacteria, parasite, fungi, virus o Leptospirosis – rat
 Biological hazard, most acquired in the Vehicle
hospital o Non-living thing w/ nutrients;
 Ex. Typhoid fever – Salmonella, Shigella food – Hepa AE, blood – Hepa
– dysentery, clostridium – tetanus, BCD, HIV
Staph au – infection, Rhabdovirus – o
rabies, syphilis – treponema pallidum, 5. Portal of Entry
 Pathogen invade another host 2. Vaccination – contains antigen, makes body
6. Susceptible Host to produce antibodies
 Immunocompromised or immunosuppresed 3. Environmental sanitation
 Ex. Leptospirosis, cholera, typhoid fever
*If you want to break the chain of infection, cut 4. Health Teaching
the mode of transmission. Easiest link to break.  Nurses conducts health teaching
* Need to wear PPE
Control
Six (6) Stages of Infection 1. Quarantine & Isolation
1. Exposure a. Quarantine
 Contact with microbes  The limitation of movement of individual
2. Incubation Period* exposed to communicable disease during
 Entry of microorganism until first signs and the maximum incubation period
symptoms appears b. Isolation
 Number of days  Separation of individual suffering from
 Usually last from 2-10 days communicable disease during the maximum
 Ex. Hepa A – 15-45 days, COVID-19 – 2-14 period of communicability
days  Chicken pox highly communicable during
3. Prodromal Period* vesicle stage
 Pathognomonic signs
 Highly contagious stage 2. Disinfection & Sterilization
 Ex. Hemoptysis – TB, hydrophobia – rabies,  Destruction of microorganism
risus sardonicus – tetanus, vesiculopapular a. Disinfection
rash – varicella, rice watery stool – cholera,  Excluding the spores
dysentery – bloody stool, rose spots in the  Ex. Use of Bleach
abdomen – typhoid fever, Herman’s sign - o Concurrent Disinfection – used for
dengue immunocompromised
4. Acute/Illness Period o Terminal Disinfection – paglabas ng
 All signs and symptoms appear patient
 Full blown b. Sterilization
5. Convalescent Period*  Including the spores
 Gradual decrease in signs and symptoms  Ex. Use of autoclave
6. Resolution/Recovery Stage
 Completely cured or healed 3. CDC: Center for Disease Control
 Full recovery Implemented
a. 1st Tier – Universal or Standard Precaution
Prevention and Control of Disease  To prevent nosocomial infection
R.A. 3573 – Law of Reporting Notifiable  Precaution applied to body fluids (blood,
Communicable Disease saliva, semen) or mucous membrane & non-
intact skin
Prevention  Designed and applicable to all patient
1. Handwashing Elements of Universal or Standard Precaution
1. Handwashing – water, soap, friction (most 2. Droplet precaution
important factor)  Mask is sufficient
2. Gloves  COVID-19 required N95 mask
 operation or surgery (invasive  Handwashing
procedure), IVT, urinary catheterization  Cohorting
– used sterile gloves 3. Airborne precaution
 all GIT procedure use clean gloves  N95 mask
3. Mask & Goggles  Handwashing
4. Gowns & aprons  Negative air pressure room – room
5. PRC – Puncture Resistant Container is fully closed all the time
 High efficient particulate air (HEPA)
Donning of PPE respiratory
1. Handwashing
2. Gown COMMUNICABLE DISEASEs
3. Mask 1. Dengue Hemorrhagic Fever (DHF) - also
4. Googles known as H. Fever, Break bone fever, Dandy
5. Gloves Fever
 Causative Agent: Arbovrius, Flavivirus,
Doffing of PPE Dengue virus type 1, 2, 3, & 4
1. Gloves  Incubation Period: 3-7 days
2. Goggles  Mode of Transmission: Vector-borne
3. Gown Aedes aegypti (female) – they need blood to get
4. Mask albumin to lay eggs, males are vegetarians
5. Handwashing  Description: white stripes, gray wings
 Day biting – 2hrs after sunrise (8am) & 2 hrs
b. 2nd Tier – Transmission-based Precaution before sunset (4pm), peak time of biting
 Epidemic cases/outbreak 4:00pm-4:30pm
 Depends on the mode of transmission  Low-lying
Three (3) precautions  Stagnant-clean water
1. Contact precaution – direct contact  Urban – City-proper
 Ex. Scabies, leprosy
 gloves & gown
 handwashing
 Private room, if available Signs and Symptoms
 cohorting – putting all patients with Classification According Severity
same communicable disease in the Grade 1
same room  Fever
 If suctioning is required, mask should  Headache
be worn  Flu-like symptoms
 If anticipating splashes of secretion or  Chills
bloods, mask and googles should be  Body pain
additionally worn  Abdominal pain
 Skin petechiae – red pinpoint-like o Restless, irritable
 (+) Tourniquet test – Rumpel-Leede test,
Capillary-Fragility Test Grade 4
o Presumptive test, not confirmatory  All s/sx in Grade 3
o (SBP + DBP) / 2 = answer  Shock
o Answer = inflate BP cuff to answer
o After 5 minutes, deflate the BP cuff Diagnostic Test
o (+) test = 20 or more petechiae Presumptive Test
 Pathognomonic sign – Herman’s sign  (+) Tourniquet test, Rumpel-Leede test,
(generalized flushing of skin) Capillary-Fragility Test
 Thrombocytopnea Confirmatory Test
 Platelet normal value – 150,000-400,000  Platelet count
cells/mm3  CBC
 Hemoconcentration  NS1 Platelatest
 Hematocrit norma value – male – 42-52%,  Dengue Duo Test Kit – pregnancy test-like
female – 35-47% but w/ blood, commonly used in the
community
Grade 2
 All s/sx in Grade 1 Treatment & Management - Symptomatic &
 Bleeding supportive treatment
o Gum Bleeding Symptomatic Supportive
o Epistaxis  Fever. Paracetamol  IVF – Child:D5LR
 BT as ordered – (Pink), Adult: PNSS
o Skin petechiae
Fresh Frozen (Green), LR (Blue)
o Melena – Upper GI Bleeding, Black Plasma, Plasma  O2 inhalers
Tarry Stool Expander
o Hematochezia – Lower GI Bleeding,  *Avoid dark-
Fresh blood in the stool colored food
o Hematemesis – blood in the  *Tawa-tawa –
herbal treatment,
vomitus
increase platelet,
 Purpura – ecchymosis Euphorbia hirta

 First Aid Position for shock -Trendelenburg

Grade 3 position, to increase blood volume in the
 All s/sx in Grade 2 head part
 Epistaxis: leaning forward, to avoid
 Circulatory collapse
aspiration, cold compress – ice pack on the
o Tachycardia
bridge of the nose
o Tachypnea
 GI Bleeding: apply ice pack on abdomen
o Hypotension
o Cold clammy skin
Prevention
o Pulse pressure (SBP – DBP)
 4s DOH Campaign for Dengue
o Prolonged capillary refill
 Seek early consultation
  Secure Search and Destroy 3. Diaphoretic Stage
 self protection  Profuse sweating
 Say yes to fogging  Lasts 2-4 hours
o 2 hrs after sunrise, 2 hrs before
sunset Diagnostic Procedure
Confirmatory Test
 Light-colored clothes, mosquito dark-  Blood Smear – Hot Stage, firing of malarial
attracted parasite in the RBC

2. Malaria Treatment
 Aka: Marsh Fever, Periodic Fever, Agve Fever  Oral – antimalarial drug
 *Causative Agent: Plasmodium falciparum,  1st line: Artemether & Lumefantrine
Plasmodium vivax, Plasmodium ovale,  *2nd line:
Plasmodium malariae o Chloroquine: Prophylactic, take
 Incubation Period: 12-30 days once or two times a week, *take 1-
o 12 days P. fal, 14 days – P. ovale & 1-2 weeks before travelling, *can be
vivax, 30 days – P. malariae being to a pregnant client
 Mode of Transmission: Vector-Borne, Blood o Pyrimethamine
Transfusion, contaminated needles & o Primaquine
syringes o Sulfadoxine
Anopheles mosquito
 Characteristics – opposite of aedis a. Management
 Night biting – 9pm – 3am 1. Cold stage – c
 High-flying  Cover with blanket
 Running/free-flowing water  Offer warm liquids
 Rural area 2. Hot stage
 Female anopheles mosquito  Tepid sponge bath
 Brown-colored  Proper ventilation of room
 Loose clothing
Signs & Symptoms  Paracetamol as ordered
Progressive Stage – Cycle (Chill-Fever- 3. Diaphoretic stage
Sweating)*  Provide warm sponge bath
1. Cold stage  Offer iron rich food
 Lasts 15-30 mins o Iron supplement
 Chills o Dark & red meat
 Goosebumps
2. Hot/Pyretic stage Prevention – CLEAN
 Increase of body temp. >40°C, may damage  Chemically treated mosquito net
brain -permethrine
 Lasts 2-6 hours  *Larvae-eating fish/stream seeding – St.
 Convulsion Peter fish – “tilapia”
 Tumitirik mata
 Environmental sanitation – through stream  Epididymitis – inflammation of
clearing epididymis
 Anti-mosquito soap 3. Chronic – HEL mnemonic
 Natural anti-mosquito plant  Hydrocele – Fluid in testicle/scrotum
o Neem tree  Elephantiasis – thickening or
o Oregano enlargement of skin tissue
o Eucalyptus  *Lymphedema – swelling of upper &
o *Natural menthol odor – drives lower extremities
mosquito away
 Zooprophylaxis – use of animal/s to deviate Diagnostic Test
mosquito bite from human  ICT – Immunochromatograpic Test, done at
day time
3. Filariasis – aka Elephantiasis  NBE – Nocturnal Blood Exam, after 8pm
 Vector-borne disease
 Sarangani – most common in the Philippines Treatment – SAD mnemonic
 *Causative Agent: Wuchereria bancrofi –  Steroids
most common, Brugia malayi, Brugia fimori  Albendazole
 Incubation Period: 8-16 mos.  DEC – Diethylcarbamazine citrate
 Mode of Transmission: Vector-borne
Aedes poecilus Management
 Characteristic – brown with white stripes  Secure consent for possible lymphatic
 Dirty water* drainage
 Night biting – 10pm-3am  Moral support
 Rural area  Protect from injury
 Advice patient to wash the affected area, at
least two times a day – to prevent
secondary infection
Signs & Symptoms
1. Asymptomatic Prevention
 Blood – micro-filariae  Wear long sleeves & pajama at night
2. *Acute stage  Mosquito repellent
Male & Female  Screen
 Lymphadenitis – inflammation of lymph  Neem tree, oregano, eucalyptus
nodes, “kulani”  Zooprophylaxis
 Lymphangitis – inflammation of  Environmental sanitation
lympathic vessel
FOE - male 4. Tuberculosis - aka. Consumption disease,
 Funniculitis – inflammation of spermatic Poor man’s disease, Kuch’s disease, Puff’s
cord disease, Phthisis
 Orchitis – inflammation of testis  Causative Agent: Mycobacterium
tuberculosis/tuberculae, Mycobacterium
bovis
 Incubation Period: 2-10 weeks  Isoniazid (INH)
 Mode of Transmission: Airborne – droplet o Adverse effect: Peripheral neuritis
 N95 mask is more preferable to wear o Diet: increase foods in vitamin B6
(pyridoxine): chicken, beef, pork,
Signs & Symptoms – CHODAS mnemonic peanuts, fruits
 Cough - > 2 wks: dry to productive o *Prophylactic drug
 Hemoptysis – blood-tinged sputum o *Hepatotoxic – need to check
 Occasional chest pain SGPT/SGOT
 Dyspnea/DOB  Pyrazinamide
 Afternoon low grade fever, Anorexia o Adverse effect: Feet: gouty arthritis
 Sudden weight loss, Sweating at night o Diet: No to purine rich food
 Ethambutol
Diagnostic Procedure o Adverse effect: Eye: optic neuritis
Presumptive test o Contraindicated to < 6 years old
 P.P.D. or Purified Protein Derivative –  Streptomycin
Mantoux test o Ototoxic – Cranial Nerve 8
o Determines exposure
o Watch out for vertigo and tinnitus
o Immunocompromised: (+) 5 or
more than mm induration Management
o Not immunocompromised (+) 10 >  Ensure patent airway
mm induration  *Partnership with one of the family
o Less than 5 – (-) negative test member – to ensure drug compliance, finish
o *Must be interpreted after 48-72 drug regimen
hrs or 2-3 days  Proper nutrition
 Dispose secretion properly
 Semi-Fowler’s position

Confirmatory test
 Sputum culture (Gold Standard Test)
o Acid Fast Bacili test, if sputum
culture not available Prevention
 Chest X-ray  BCG (Bacilli Calmette-Guerin) – given at
o Determines extent of lesion in the birth, right deltoid
lungs  N95 mask

Treatment – DOTS (Direct Observed Treatment 5. HIV/AIDS – Human Immunodeficiency Virus

Shortcourse), RIPES – Autoimmune Deficiency Syndrome
 Rifampicin  Africa – origin
o *Adverse effect: red orange urine,  USA – 1981, first registered case 1984, first
sweat & feces registered case
o Nephrotoxic
 HIV AIDS Confirmatory Test
Causative Agent: Causative Agent:  Western Blot
Retrovirus HTLV3 – Human T-cell  CD4 T-cell Count
Lymphotropic Virus 3  Normal value: 600 – 1,200
Incubation Period: Incubation Period: 6
 Check CD4 T-cell Count before and after
within 3 wks – 6 mos mos – 15 yrs
Mode of Transmission giving medication
 Sexual contact – most common  <200 HIV infection, increases after
 Higher risk in anal sex – lining of anus is thin treatment regimen (effective)
that virus could easily penetrate
 Transplacental *R.A. 8504 – Law about HIV/AIDS
 Blood transfusion  Protected to work
 Breastfeeding
 Contaminated needles & syrines
 Oral sex Treatment
 (+) Mother: PMTCT – Prevention of Mother
Horizontal Transmission – sexual contact to Child Transmission
Vertical Transmission – transplacental  Combination of Zidovudine +
Nevirapine
Signs & Symptoms  PREP: Pre-exposure Prophylaxis
HIV AIDS  Truvada
 Asymptomatic  Opportunistic  Descovy
 Prolonged infection  PEP: Post-exposure Prophylaxis
undiagnosed  PCP: Pneumocystis  Healthy adults and adolescents: tenofovir
infection carinii pneumonia disoproxil fumarate + emtricitabine plus
 Flu-like symtpoms  Shingles
raltegravir or dolutegravir
 Candidiasis –
white cheesy
discharge
 Cryptosporidiosis
– Chronic Diarrhea Management – 4C’s
 Cancer –  Contact tracing
 Kaposis sarcoma -  Case finding
skin cancer,
 Counselling
purplish lesion in
the skin or mouth  Condom
 Non-Hodgkin’s
Lymphoma – Prevention
cancerous tumor  Abstinence
in the lymphoma  In a monogamous relationship
 Diagnostic exam
Diagnostic Procedure  Safe sex practice
Presumptive Test
 ELISA test – Enzyme Link Immunosorbent * First Aid management – Handwashing
Assay * No need to wear gloves if taking vital signs
o Determines HIV antigen
6. Gonorrhea  Mode of Transmission
 Aka: Morning drip clap, “Gleets”  Sexual contact
 Causative Agent: Neisseria Gonorrhea  Transplacental
 Incubation Period: 2-10 days  Crucial during first trimester
 Mode of Transmission
 Sexual Contact Signs & Symptoms – Stages
 Baby > eye to vagina (direct contact) 1. Primary Syphilis
 Painless chancre – raised edges-like
Signs & Symptoms pimple, can be found in lips, anus,
Male Female breast, genitals
 Asymptomatic 2. Secondary Syphilis
 Dysuria (painful urination)  Flu-like symptoms
 Gleets: yellowish & greenish discharge  Condylomata – whitish-pinkish lesion
 Pelvic pain  Abnormal
found on moist area of the body
 Prostatitis menstrual
bleeding  Alopecia – hair loss
 Lymphadenitis
Diagnostic Procedure 3. Latent Syphilis
 Urethral swab/culture  No signs and symptoms
 Blood: Reactive (+)
Treatment 4. Tertiary/Late Syphilis
 Intramascular – Ceftriaxone  Gumma – painless solitary nodules,
 Oral – Azithromycin (new), Doxycycline (old) usually found in the long bone or
internal organs

Management – 4C’s
 Contact tracing Diagnostic Procedure
 Case finding  Venereal Disease Research Laboratory
 Counselling
 Condom Treatment
 Penicillin
Prevention
 Abstinence Management – 4C’s
 In a monogamous relationship  Contact tracing
 Diagnostic exam  Case finding
 Safe sex practice  Counselling
 Condom
7. Syphilis
 Aka: Bad blood, Venereal disease Prevention
 Causative Agent: Treponema pallidum  Abstinence
 Incubation Period: 10-90 days or 3 mos  In a monogamous relationship
 Diagnostic exam
 Safe sex practice  Lamprene/Clofazimine
R.A. 4073 – Domiciliary treatment of Leprosy
8. Leprosy – “ketong”
 Aka. Hansen’s disease, Hansenosis Management
 Causative Agent: Mycobacterium leprae  Ensure drug compliance
 Incubation Period: 8 mos – 8 years  Protect from injury
 Mode of Transmission:  Moral support
 Direct-contact  Proper nutrition – protein rich food w/
 Droplet vitamin C

Signs & Symptoms Prevention

Early S/Sx - LLLEPROSY mnemonic  Contact and droplet precaution
 Loss of skin sensation  Vaccination – BCG
 Loss of sweating
 Loss of hair growth 9. Leptospirosis
 Extremities paralysis  Aka. Weil’s disease, Canicola fever, Mud
 Painful/thickened nerve fever
 Redness of eyes  Causative Agent: Leptospira interrogans-
 Obstruction of nose rats, can also be acquired in pigs, cats, &
 Skin color change rabbits
 Your ulcer does not heal  *Incubation Period: 7-19 days
 Mode of Transmission
o Direct contact
o Abraded skin (open skin)
Late S/Sx – LATES mnemonic
 Large breast in male – gynecomastia Signs & Symptoms
 Chronic ulcer *1st Stage: Septic Stage
 Toes and finger clawing  Non-specific
 Eyebrow loss – madarosis  Fever
 Eyelids can’t lose – lagophthalmos  Abdominal pain
 Sinking of nose bridge  Chills

 Lion’s face *2nd Stage: Toxic/Immune Stage

 Jaundice
Diagnostic Procedure – SSS  Yellow sclera
 Slit skin  Meningitis
 Smear Signs of meningeal irritation
 Skin biopsy  Nuchal rigidity – stiff neck
 Brudzinski sign – flex neck there is also
Treatment flexion of lower extremities
 Rifampicin
 Dapsone
  Kernig’s sign – pain or resistance when  Complication: pneumonia
you extend the knee
 Increase of BUN & creatinine Diagnostic Procedure
Confirmatory Test
*3rd Stage: Convalescent stage – gradual  RT-PCR – Reverse Transcript – Polymerase
decrease in signs & symptoms Chain Reaction – it detects present infection
 Home antigen test kit
Diagnostic Test  RAT: Rapid antibody test – determine past
 Leptospira Antibody Antigen test infection

Treatment Treatment
 (+) Penicillin  Remdesivir – FDA approved
 Evusheld – Pre-exposure Prophylaxis – given
Management to those who have been vaccinated and
 Provide non-stimulating environment experienced severe reaction
 Safety  PAXLOVID (Pfizer) – not FDA approved, EU
drug
Prevention o (+) RT-PCR
 Prophylatic drug: Doxycycline o Mild to severe COVID-19
 Environmental sanitation o Immunocompromised
 Contact precaution

Management
 Ensure patent airway
10. COVID-19  Increase oral fluid intake
 Originate: Wuhan, China – seafood  Tea w/ lemon (warm)
 Coronavirus Disease 2019  Ginger (luya) juice
 Causative Agent: Corana Virus – SARS COV2  Paracetamol
 Incubation Period: 2-14 days  Rest
 Mode of Transmission: Droplet  Supportive treatment – IVF

Signs & Symptoms Prevention

 Asymptomatic  Vaccination
 Fever  Droplet precaution
 Chills  Handwashing
 Headache
 Body pain
 Sore throat
 Cough
 Diarrhea
 Loss of sense of smell & taste