NCM 113 MIDTERM NOTES COMMUNIY HEALTH NURSING 2

INTEGUMENTARY DISEASES E. Impetigo_______________________________________

 Description
D. Scabies________________________________________ o A highly contagious superficial infection of
 Description the skin characterized by the formation of
o It is a highly transmissible skin infection that is bullae (large, fluid-filled blisters) from original
characterized by burrows, pruritus, and vesicles. The bullae rupture, leaving raw, red
excoriations with secondary bacterial areas. The exposed areas of the body, face,
infection. hands, neck and extremities are most
 Etiologic Agent: Sarcoptes scabiei var hominis frequently involved.
 Source of Infection: Human skin  Etiologic Agent: Staphylococci, streptococci,
 Mode of Transmission or multiple bacteria
o Skin to skin contact  Mode of transmission
o Direct contact with fomites o Direct contact
 Incubation Period o Contact with contaminated towels and
o The itch mite may burrow under the skin and other fomites
lay ova within 24 hours of an original contact  Medical Management
 Period of Communicability o Systemic antibiotic
o This disease is communicable for the entire  For nonbullous impetigo
period that the host is infected  Benzathrine penicillin
 Clinical Manifestations  Oral penicillin
o Intense itching that becomes more severe at  Cloxacillin (Cloxapen)
night  Dicloxacillin (Dycill)
o Burrows (lesions) seen in the webs of the  For penicillin allergic clients
fingers, wrists, and elbows  Erythromycin
o Burrows in immunocompromised, infants, o Topical Antibiotic
young children and elderly appears in face,  Mupirocin (Bactroban)
neck, scalp and ears o Antiseptic
 Complications  Povidone-iodine (Betadine)
o Persistent pruritus  Nursing Management
o Intense scratching can lead to excoriation, o Soak lesion in soap solution to remove the
tissue trauma and secondary bacterial central site of bacterial growth and give the
infection topical antibiotic an opportunity to reach the
 Diagnostic Procedures infected site
o Superficial scraping and examination under o Wear gloves when providing patient care
low-power microscope of material from a o Bathe at least once daily with bactericidal
burrow soap
 Treatment Modalities o Promote cleanliness and good hygiene
o Aqueous Malathion lotion practices
o Permethrin dermal cream left on the skin for 8 o Have a separate towel and wash cloth
to 12 hours o Advice infected people to Avoid contact
o Benzyl Benzoate with other people until the lesions heal
o Sulfur in petrolatum
o Ivermectin – antihelminthic drug is effective F. Herpes Zoster: Shingles _________________________
in resistant cases  Description
o Antipruritic emollient or topical steroid for o It is an acute unilateral and segmental
itching inflammation of the dorsal root ganglia
 Nursing Interventions caused by infection with the herpes
o Patient’s fingernails should be cut short to varicella-zoster, which also causes
minimize skin breaks during scratching chickenpox
o Proper education on the application of o Usually occurs in adults
medicines  Causative agent: Varicella virus
o Contaminated clothing or beddings should  Incubation Period: unknown, but it is believed to
be dry-cleaned or boiled be 13-17 days
o Advise patient to report any skin irritation  Period of Communicability
o Advise family member and other people o Communicable a day before the
who had close contact with the patient be appearance of the first rash until 5-6 days
checked for possible symptoms and be after the last crust
treated accordingly  Mode of Transmission
o Practice contact precaution o Airborne
o Terminal disinfection should be carried out o Droplet
 Prevention and Control o Direct contact
o Good personal hygiene  Clinical Manifestations
o Avoid contact with infected person o Begins with fever and malaise
o All members of the household, including
close contact should be treated

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o Severe deep pain, pruritus, and paresthesia o Tickling sensation of something moving in the
or hyperesthesia usually on the trunk and hair may be noticed
occasionally on the arms and legs o Head lice and their nits are most common
o Small, red, nodular skin lesions (Unilateral) found behind the ears and on the hairs of
erupt on the painful areas up to 2 weeks the neck and occiput
after first symptoms o Body lice are found on clothing seams
o Vesicles filled with fluid or pus o Pubic lice will be found attached to the base
o Cranial nerve involvement of the pubic hair and the infestation
 Complications generally results in severe itching
o Generalized central nervous system infection  Diagnostic Tests
o Acute transverse and ascending myelitis o Wood’s light examination (Fluorescence of
o Intractable neurologic pain the adult lice)
 Diagnostic Procedures o Microscopic examination (presence of nits
o Differentiation of herpes zoster from herpes on the hair shaft)
simplex virus though fluorescent light  Treatment Modalities
o Tissue culture technique o Permethrin (Elimite) / Pyrethrin (Rid Mousse)
o Smear of vesicle fluid  Initial treatment of choice
o Microscopy  Topical insecticide
 Medical Management  For pediculosis capitis & pediculosis
o Antiviral therapy- Acyclovir pubis
o Analgesics to control pain o Fine-tooth comb dipped in vinegar
o Anti-inflammatory o Washing hair with ordinary shampoo
 Nursing Interventions o Oral antihelminthics (ivermectin, Levamisole,
o Airborne and contact precautions albendazole) are effective against head lice
o It vesicles rupture, apply a cold compress as infestation
ordered o Prevention of head reinfestation
o To minimize neuralgic pain, administer  Clothes and bed linens must be washed
analgesics as ordered and evaluate their in hot water, ironed or dry cleaned
effects  Storing clothes or linens for more than 30
o Instruct the patient to avoid scratching the days or placing them in dry heat of 60
lesions degrees Celsius kills lice
o Keep the patient comfortable and maintain  Complications
meticulous hygiene o Excoriation
o Encourage sufficient bed rest and give o Secondary bacterial infections
supportive care o If left untreated, pediculosis may result in dry,
 Prevention hyperpigmented, thickly encrusted, scaly skin
o Vaccination against Varicella with residual scarring
o Avoid exposure to patient with varicella  Nursing Considerations
infection o Contact precautions should be maintained
until treatment is complete to prevent
G. Pediculosis____________________________________ spreading the infection
 Description o Have the patient’s fingernails cut short to
o Any human infestation of lice prevent skin breaks and secondary bacterial
o May occur anywhere on the body infections caused by scratching
 Types o Be alert for possible adverse reactions to
o Pediculosis capitis treatment with an antiparasitic, including
 Lice feed on the scalp and rarely on the sensitivity reactions and, in some cases,
skin under the eyebrows, eyelashes and central nervous system toxicity
beard o To prevent self infestation, avoid direct
o Pediculosis corporis contact with the patient’s hair, clothing and
 Lice live next to the skin in clothing bed sheets
seams o Use gloves, a gown, and a protective head
o Pediculosis pubis covering when administering delousing
 Lice are found primarily in pubic hairs treatment
but may extend to the eyebrows, o After each treatment, inspect the patient for
eyelashes and axillary or body hair remaining lice and eggs
 Mode of Transmission o Teach the patient and family how to inspect
o Head-to-head contact and identify lice, eggs and related lesions
o Fomites o Instruct the patient and family about the use
o Sexual activity of the creams, lotions, powders and
 Incubation Period: 3 to 7 days shampoos that eliminates lice
 Clinical Manifestations o Instruct the patient in the proper application
o Pruritus (most common symptom of of lindane, which can be absorbed by the
infestation) skin and cause CNS complications

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H. German Measles: Rubella/ Three-day Measles___ o Convalescent serum that shows a fourfold
 Description rise in antibody titers supports the diagnosis
o It is a mild viral illness caused by rubella virus  Treatment Modalities
o It causes mild feverish illness associated with o Acetaminophen for fever and joint pain
rashes and aches in joints o Isolation
o It has a teratogenic effect on the fetus  Complications
 Etiologic Agent: Rubella Virus o Encephalitis
 Mode of Transmission o Neuritis
o Direct person to person contact by o Arthritis
respiratory droplets o Arthralgia
o Transplacental transmission in congenital o Rubella syndrome manifested by:
rubella  Microcephaly
 Incubation Period: 2-3 weeks  Mental retardation
 Clinical Manifestations  Cataract
o Prodromal  Deaf-mutism
 Low grade fever  Heart disease
 Headache  Nursing Considerations
 Malaise o Provide comfort
 Mild coryza o Make sure female patients understand how
 Conjunctivitis important it is to avoid exposure to this
 Post-auricular , sub-occipital and posterior disease when pregnant
cervical lymphadenopathy which occur o Report confirmed cases of rubella to local
on the 3rd to 5th day after onset public health officials
o Eruptive Period o Warn the patient about possible mild fever,
 Forcheimer’s spot (pinkish rash on the soft slight rash, transient arthralgia and arthritis
palate) o If lymphadenopathy persists after the initial
 Eruption appears after the onset of 24 hours, suggest a cold compress to
adenopathy promote vasoconstriction and prevent
 Children usually present less or no antigenic cyst formation
constitutional symptoms o Patient’s room must be darkened to avoid
 The rash may last for one to five days and photophobia
leaves no pigmentation nor o Patient’s eyes should be irrigated with warm
desquamation saline to relieve irritation
 Testicular pain in young adults o Good ventilation is necessary
 Transient polyarthralgia and polyarthritis  Prevention
may occur in adults and occasionally in o Administration of live attenuated vaccine
children (MMR)
o Congenital Rubella o Pregnant women should avoid exposure to
 Classic Congenital Rubella Syndrome patients infected with rubella virus
 Intrauterine growth retardation o Administration of immune Serum Globulin
 Infant has low birth weight one week after exposure to rubellaLesions
 Thrombocytopenic purpura known as are more on covered than on exposed parts
blueberry muffin skin of the body and may appear on scalp and
 Intrauterine Infection mucous membrane of upper respiratory
 May result in spontaneous abortion tract.
 Birth of a live child who may have  Etiologic Agent : Human (alpha) herpesvirus 3
one or multiple birth anomalies such (varicella- zoster virus), a member of the
as: Herpesvirus group
• Cleft palate, talipes and eruption  Source of Infection
of teeth o Secretion of respiratory tract of infected
• Cardiac defects (patent persons.
ductusarteriosus, atrial septal o Lesions of the skin are of little consequences
defect) o Scabs themselves are not infective
• Eye defects (glaucoma,  Mode of Transmission
retinopathy, micropthalmia) o Direct contact or droplet spread
• Ear defects o Indirect through articles freshly soiled by
• Neurologic (Microcephaly, mental discharges of infected persons
retardation, psychomotor o Airborne
retardation, vasomotor instability)  Incubation Period
 Diagnostic Tests o 2-3 weeks, commonly 13 to 17 days
o Clinical observation  Period of Communicability
o Cell cultures of the throat, blood, urine and o Not more than one day before and more
cerebrospinal fluid to confirm the presence than 6 days after the appearance of the first
of the virus crop of vesicles.

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 Diagnostic Test o It is a free swimming larval forms (cercariae)

o Isolation of the virus from the vesicular fluid of the parasite that penetrate the skin
within the first 3 to 4 days of the rash o Ingestion of contaminated water
o Serum antibodies is present in 7 days after  Incubation Period
onset o At least 2 months
 Congenital varicella results in:  Clinical Manifestations
o Hypoplastic deformities and scarring of limbs o 1st Stage
o Retarded growth  Pruritic rash known as ‘swimming itch’
o CNS and ophthalmic manifestations occurs24 hours after penetration of
cercariae in the skin
 Nursing considerations o 2nd Stage
o Strict isolation  Bloody mucoid stools (on and off for 2
o Tell the patient not to scratch the lesions weeks)
o Teach the client and the family how to apply  Katayama fever- clinical constellation of
topical antipruritic medications correctly the following
 Susceptibility, Resistance and Occurrence  Fever, headache
o Universal among those not previously  Cough, chills and sweating
attacked. Severe in adults. An attack confers  Lymphadenopathy and
long immunity hepatosplenomegaly
o Second attacks are rare. Probably 70% have o 3rd Stage (Chronic Stage)
the disease by the time they are 15 years of  Granulomatous reactions to egg
age. deposition in the intestine, liver, bladder
o Not common in early infancy  Inflammation of the liver
 Methods of Prevention and Control o Icteric and jaundice
o Case over 15 years of age should be  Bulging of the abdomen
investigated to eliminate possibility of  Enlargement of the spleen
smallpox.  Sometimes the brain is affected that
o Report to local authority. caused epilepsy
o Isolation  Eggs are deposited in the bladder wall
o Concurrent disinfection of throat and nose leading to hematuria, bladder
discharges. obstruction
o Exclusion from school for 1 week after  Hydronephrosis and recu7rretn urinary
eruption first appears and avoid contact with tract infections
susceptible  Pale and marked muscle wasting
o Vaccine- Varicella- zoster immune globulin  Complications
(VZIG). It should be given within 10 days of o Liver cirrhosis and portal hypertension
exposure o Bleeding esophageal varices
o Bladder cancer
o Pulmonary hypertension
GASTROINTESTINAL DISEASES o Heart failure
o Ascitis
A. Schistosomiasis Bilharziasis (or snail fever)________ o Renal failure
 Description o Cerebral schistosomiasis
o Tropical disease  Diagnostic Procedure
o Caused by blood fluke, Schistosoma o Fecalysis
Japonicum that is transmitted by a tiny snail o Liver and rectal biopsy
oncomelania quadrasi (intermediary host) o ELISA
o High prevalence of schistosomiasis in Region o Circumoval precipitation test (COPT)-
5 (Bicol), Region 8 (Samar and Leyte), Region confirmatory test
11 (Davao)  Nursing Interventions
 Causative Agent o TSB
o Schistosoma Japonicum- endemic in the o Skin Care
Philippines and China o Provide comfort
o Schistosoma Mansoni- South America, the o Proper nutrition
Middle East and Caribbean  Methods of Control
o Schistosoma Haematobium- Africa and a. Preventive Measures
Middle East o Educate the public in endemic areas
 Sources of Infection regarding the mode of transmission and
o Stool and urine of the infected persons or methods of protection
animals o Dispose of feces and urine so that viable
 Mode of Transmission eggs will not reach bodies of fresh water
o Infection occurs when skin comes in contact containing intermediate snail host
with contaminated fresh water in which o improve irrigation and agriculture practices:
certain types of snails that carry schistosomes reduce snail habitats by removing
are living vegetation or by draining and filling
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o Treat snail-breeding sites with molluscicides. o Deep rapid breathing

o Provide water for drinking, bathing and o Oliguria
washing clothes from sources free of  Diagnostic Tests
cercariae or treatment to kill them. Water o Rectal swab
treatment using chlorine and iodine. o Darkfield orphase microscopy
o Treat patients in endemic areas to prevent o Stool exam
disease progression and to reduce o Blood test
transmission by reducing egg passage.  Elevated BUN and creatinine level
o Travelers visiting endemic areas should be  Increase in serum lactate, protein and
advised of the risks and informed about phosphate levels
preventing measures.  Treatment Modalities
b. Control of patient, contacts and the o IV Treatment
immediate environment. o Oral Therapy Rehydration
o Isolation: none o Coconut water
o Report to local health authority in selected o Give ORESOL
endemic areas o Antibiotics
o Concurrent disinfection: sanitary disposal of  Tetracycline
feces and urine  Furazolidone
o Quarantine: none  Chloramphenicol
o Immunization of contacts: None  Cotrimoxazole
c. Investigation of contacts and source of  Nursing Management
infection o Hand washing
o Specific treatment: Praziquantrel (Biltricide) o Enteric isolation
is the drug of choice against all species. o Vital signs
Alternative drugs are Oxamniquine for S. o I and O monitoring
mansoni and Metrifonate for o Personal hygiene
haematobium. o Proper excreta disposal
o Epidemic measures: examine for o Environmental sanitation
schistosomiasis and treat all who are  Susceptibility, Resistance and Occurrence
infected, but especially those with o Susceptibility and resistance general
moderate to heavy intensities of egg although variable. Frank clinical attack
passage; pay particular attention to confers a temporary immunity which may
children afford some protection, for several years.
o Motivate people in these areas to have o Immunity artificially induced by vaccines of
annual stool exam. variable and uncertain duration.
o PHN in endemic areas participates actively o Appears occasionally in epidemic form in
in the above preventive and control the Philippines
measures.  Methods of Prevention and Control
o Food and water supply must be protected
B. Cholera (El Tor)_________________________________ from fecal contamination
 Description o Wat5er should be boiled and chlorinated
o It is an acute bacterial enteric disease o Milk should be pasteurized
characterized by profuse diarrhea, o Sanitary disposal of human excreta is a
vomiting, massive loss of fluid and must
electrolytes that can result to hypovolemic o Report case at once to Health Officer
shock, acidosis and death o Bring patient to hospital for proper isolation
 Etiologic Agent and prompt and competent medical care.
o Vibrio El Tor o All contacts of the cases should submit
 Sources of Infection themselves for stool examination and be
o Vomitus and feces of infected persons and treated accordingly if found or discovered
feces of convalescent or healthy carriers positive.
o Contacts may be temporary carriers
 Mode of Transmission  PHN Responsibilities
o Food and water contaminated with o Assist family and patient to make
vomitus and stools of patients and carriers arrangement for immediate hospitalization
 Incubation Period o Give necessary measures to control spread
o From few hours to 5 days; usually 3 days of disease
 Period of Communicability o Share with patient and family the nature of
o 7-14 days after onset, occasionally 2-3 the treatment Rehydration/ replacement of
months lost fluids and electrolytes (Sodium chloride,
 Clinical Manifestations bicarbonate and potassium)
o Rice-watery stools
o Washer-woman’s hands
o Vomiting
o Diarrhea
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C. Typhoid Fever _________________________________ o Ceftriaxone (recommended for

 Description complicated cases)
o A systemic infection characterized by  Nursing Management
continued fever, malaise, anorexia, slow o Isolation
pulse, involvement of lymphoid tissues, o Monitor V/S
especially ulceration of Peyer’s patches, o Give nourishing fluids in small quantities at
enlargement of spleen, rose spots on trunk frequent intervals
and diarrhea. o Maintain standard precautions or in diapers
o Many mild typical infections are often or if an outbreak develops in an institution
unrecognized. o Prevent further injury
o A usual fatality of 10% is reduced to 2 or 3% o Provide good skin and mouth care
by antibiotic therapy  Prevention and Control
 Etiologic Agent o Sanitary and proper disposal of excreta
o Salmonella Typhosa o Proper supervision of food sanitation
o Typhoid bacillus o Enteric precaution
 Sources of Infection o Provision of safe water supply
o Feces and urine of infected persons o Detection and supervision of typhoid
o Family contacts may be transient carrier carriers
o Carrier state is common among persons  Susceptibility, Resistance and Occurrence
over 40 years of age especially females o Susceptibility is general although many
 Mode of Transmission adults appear to acquire immunity through
o Direct or indirect contact with patient or unrecognized infections
carrier o Attack rates decline with age after second
o Principal vehicles are food and water or third decades.
o Contamination is usually by hands of carrier o A high degree of resistance usually follows
o Flies are vectors recovery.
 Incubation Period
o Variable; average 2 weeks, usual range 1 D. Bacillary Dysentery (Shigellosis, Bloody Flux)_____
to 3 weeks  Description
 Period of Communicability o An acute bacterial infection of the intestine
o As long as typhoid bacilli appear in characterized by diarrhea, fever, tenesmus
excreta; usually from appearance of and in severe cases bloody and mucoid
prodromal symptoms from first week stools.
throughout convalescence o Patients with mild undiagnosed infections
 Clinical Manifestations have only transient diarrhea or no intestinal
o Onset symptoms.
 Headache o Severe infections are frequent in infants and
 Ladder-like fever in elderly debilitated persons
 Rose spots on the abdomen  Etiologic Agent
o Typhoid state o Shigellasonnei (most common specie in
 Coma vigil western Europe
 Subsultus tendinum o Shigellaflexneri
 Carphologia o Shigellaboydii
 Delirium o Sh-dysenteriae
 Complications  Incubation Period
o Hemorrhage/ perforation (most dreaded o 1 day, usually less than 4 days
complication)  Sources of Infection
o Peritonitis o Feces of infected persons, many in
o Bronchitis and pneumonia apparent mild and unrecognized infections
o Typhoid spine  Mode of Transmission
o Septicemia o Ingestion of contaminated food
o Reiter’s syndrome- joint pains and eye o Drinking contaminated water and milk
irritation o Fecal-oral transmission
 Diagnostic tests  Period of Communicability
o Typhidot- confirmatory o During acute infection and until
o ELISA microorganism is absent from feces usually
o Widal within a few weeks even without specified
o Rectalswab therapy. A few individuals become carriers
o Bone marrow aspiration (identifies S. Typhi) for a year or two and rarely longer
 Treatment Modalities  Clinical Manifestations
o Chloramphenicol- drug of choice o Fever
o Ampicillin o Tenesmus
o Co-trimoxazole o Headache
o Ciprofloxacin
o Cefixime/ Azithromycin
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 NCM 113 MIDTERM NOTES COMMUNIY HEALTH NURSING 2

o Colicky or cramping abdominal pain o Contaminated water supplies

associated with anorexia and body o Unsanitary method of preparing and
weakness serving food
o Bloody-mucoid stool o Malnutrition
o Rapid dehydration o Disaster and war time conditions
 Diagnostic Tests  Incubation Period
o Microscopic examination of fresh stool o 15 to 50 days, depending on dose
specimen may reveal mucus, red blood  Signs and Symptoms
cells, and polymorphonuclear leukocytes o Influenza-like such as headache
o Direct immunoflourescence with specific o Malaise and easy fatigability
antisera will demonstrate shigella o Anorexia and abdominal discomfort/ pain
o Sigmoidoscopy or prostoscopy maqy reveal o Nausea and vomiting
typical superficial ulcerations o Fever
o Stool cultures must rule out other causes of o Lymphadenopathy
diarrhea o Jaundice accompanied by pruritus and
 Treatment Modalities urticaria
o Antibiotics o Bilirubinemia with clay-colored stools
 Ampicillin  Management/ Treatment
 Ceftriaxone o Prophylaxis –”IM” injection of gamma
 Trimethoprim-sulfamethoxazole globulin
 Ciprofloxacin o Complete bed rest
o IV therapy o Low fat diet but high in sugar
o Low residue diet  Prevention and Control
o Contraindicated: antidiarrheal drugs (they o Ensure safe water for drinking
may delay fecal excretion that can lead to o Sanitary method in preparing, handling and
prolong fever) serving food
 Nursing Management o Proper disposal of feces and urine
o Maintain fluid and electrolyte balance o Washing hands very well before eating and
o Keep the patient warm and comfortable after using the toilet
o Restrict food until nausea and vomiting o Separate and proper cleaning of articles
subsides used by patient
o Isolation precaution
o Low fiber, plenty of fluids; easily digestible F. Epidemic parotitis (Mumps, infectious parotitis)___
foods  Description
o Use a disposable warming pad to relieve o It is an acute viral disease manifested by
abdominal discomfort, and schedule care swelling of one or both parotid glands, with
to conserve patient strength occasional involvement of other glandular
 Susceptibility, Resistance and Occurrence structures, particularly the testes in male.
o Disease is more common and more severe  Etiologic Agent
in children than in adults. o Mumps virus, a member of the family
o A relative and transitory strain-specific Paramyxomviridae, genus paramyxovirus, is
immunity follows recovery antigenically related to the parainfluenza
 Methods of Prevention and Control viruses
o Sanitary disposal of human feces  Source of Infection
o Sanitary supervision of processing, o Secretion of the mouth and nose
preparation and serving of food particularly  Mode of Transmission
those eaten raw o Direct contact
o Adequate provision of safe washing o Indirect contact with the articles freshly
facilities soiled with secretion from the nasopharynx
o Fly control and screening to protect foods  Incubation Period
against fly contamination o 12- 26 days, usually 18 days
o Protection of purified water supplies and  Period of Communicability
construction of safe privy o Cases are infectious for up to a week
o Control of infected individual contacts and (normally 2 days) before parotid swelling
environment until 9 days after
o Reporting to local health officer o 48 hour period immediately preceding
o Isolation of patient during acute illness onset of swelling is considered the time of
o Rigid personal precautions by attendants highest communicability
 Clinical manifestations
E. Hepatitis A (Infectious hepatitis, epidemic o Painful swelling in front of the ear, angle of
hepatitis, catarrhal jaundice)______________________ jaws and down the neck
 Etiology o Fever
o Hepatitis A virus o Malaise
 Predisposing Factors o Loss of appetite
o Poor sanitation
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 NCM 113 MIDTERM NOTES COMMUNIY HEALTH NURSING 2

o Swelling of one or both testicles (orchitis) in  Causative Organism

some boys o Single celled organism called
 Complications dinoflagellates
o Orchitis o It is commonly referred to as plankton
o Oophoritis o Pyromidium bahamense var. compressum
o Mastitis (Manila Bay, Samar, Bataan and Zambales)
o Nuchal rigidity  Mode of Transmission
o Deafness o Ingestion of raw or inadequately cooked
o Meningoencephalitis seafood usually bi-valve shellfish or mollusks
o Pancreatitis during red tide season
o Myocarditis  Incubation Period
o Nephritis o Varies from about 30 minutes to several
 Diagnostic Tests hours after ingestion of poisonous shellfish
o Serum Amylase Determination (most useful  Signs and Symptoms
test) in making earlypresumptive diagnosis o Numbness of the face especially around
for mumps): elevated amylase level the mouth
o Complement Fixation test o Vomiting and dizziness
o Hemo-agglutination Inhibition Test o Headache
 Used to determine the immune status o Tingling sensation, paresthesia and
o Neutralization Test eventual paralysis of hands and feet
 Determines immunity to mumps o Floating sensation and weakness
o Viral culture o Rapid pulse
 Treatment Modalities o Difficulty of speech (aphasia) and difficulty
o Analgesics for pain of swallowing (Dysphagia)
o Antipyretics for fever o Total muscle paralysis with respiratory arrest
o IV fluid replacement and death occur in several cases
o Hot and cold application o Poison victims who survive the first 12 hours
 Nursing Management after ingestion of the toxic shellfish have a
o Medical aseptic protective care greater chance of survival
 Single-occupancy room  Management and Control Measures
 Oral care and personal hygiene (warm o No definite medication indicated
salt-water gargles) o Induce vomiting
o General management of the disease o Drinking pure coconut milk weakens the
 Bed rest toxic effect of red tide. Sodium
 Diversional activities bicarbonate (25 grams in ½ glass of water
 Eye care may be taken)
 Provide extra fluids o Drinking of coconut milk and sodium bicar
o Diet sol. Is advised during the early stage of
 No restriction of food poisoning only. If given during the late
 Soft bland and semi-solid is easily stage, they may make the condition of the
managed patient worse.
 Acid foods (fruit juices) increases o Shellfish affected by red tide must NOT be
discomfort cooked with vinegar as the toxin of
 Prevention and Control Pyromidium increases when mixed with
o Active immunization (MMR) acid
o Reporting cases to health authorities
o Isolation of patient
 Disinfection H. Botulism________________________________________
o All materials contaminated by nose and  Description
mouth secretions should be properly boiled. o Rare but severe form of poisoning caused
o Paper handkerchiefs should be burned by gram-positive, anaerobic bacteria.
 Terminal Disinfection o It is an illness of descending paralysis and
o The usual method of cleaning a room or autonomic dysfunction due to neurotoxin
unit should be used.  Causative Agent: Clostridium botulinum
o The room should be aired for 6 to 8 hours o Foodborne botulism
o Wound botulism
o Infant botulism
 Sources of Infection
G. Paralytic Shellfish Poisoning (PSP I Red Tide o Untreated water
Poisoning) _______________________________________ o Undercooked and improperly preserved
 Introduction canned foods, especially those with a low
o A syndrome of characteristic symptoms acid content
predominantly neurologic which occur o Home-canned vegetables
within minutes or several hours after o Cured pork and ham
ingestion of poisonous shellfish o Smoked and raw fish
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 NCM 113 MIDTERM NOTES COMMUNIY HEALTH NURSING 2

o Honey and corn syrup o Teach patient and families to see their
 Mode of Transmission doctors promptly for infected wounds and
o Ingestion (or injection)of preformed toxin to avoid injectable street drugs
o Spores may resist 100 degrees Celsius for  Suggested on-call action
many hours o Ensure that the case is admitted in the
o Inhalation of toxin may also cause disease hospital
o Ingestion of spores o Obtain food history as a matter of urgency
o Introduction of spores into the wound o Obtain suspect food
 Incubation Period o Identify others at risk
o 12 to 72 hours but extremes of 2 hours to 10 o Inform appropriate local and national
days are reported authorities
 Clinical Manifestations
o Double or blurred vision I. Amoebiasis_____________________________________
o Droopy eyelids  Description
o Dry mouth o Protozoal infection that initially involves the
o Difficulty swallowing or talking colon but may spread into the liver and
o Difficulty breathing lungs by lymphatic dissemination
o Flaccid paralysis (Descending)  Etiologic Agent
o Deep tendon reflexes are decrease or o Entamoeba Histolytica
absent  2 stages
o Initial vomiting or diarrhea followed by  Cyst- considered to be the infective
constipation stage and the resistance to
 Diagnostic Tests environmental conditions and can
o A toxicology screen may identify C. survive for few days outside of the
Botulinum body
o Stool culture may identify C. Botulinum  Trophozoites/ vegetative form-
o The suspected food may also be cultured facultative parasites that invade the
to isolate C. botulinum tissue
o Electromyography will show little response  Sources of Infection
to nerve stimulation in the presence of o Contaminated food and water
botulism o Flies
o Diagnostic tests should be conducted as  Mode of Transmission
needed to rule out diseases that maybe o Fecal-oral
confused with botulism, such as myasthenia o Oral-anal
gravis and Guillain-Barre syndrome  Incubation Period
o A mouse- inoculation test will be positive o Severe infection-3 days
and is the most direct way to confirm a o Average 2-4 weeks
diagnosis of botulism  Period of Communicability
 Complications o Communicable for the entire duration of
o Aspiration the illness or until cysts are present in the
o Weakness and nervous system problems stool
can be permanent  Clinical Manifestations
o Death o Acute amoebic dysentery
 Treatment Modalities  Slight attack of diarrhea altered with
o Botulinus antitoxin- IV,IM constipation
o Infants- indusing vomiting or giving enema  Watery foul smelling stools containing
o IV fluid can be administered blood-streaked mucus
o Nasogastric tube  Gaseous distention of the lower
o Endotracheal intubation- respiratory distress abdomen
 Nursing Considerations  Nausea, flatulence
o Obtain a careful history of foods eaten in  Tenderness in the right iliac region
the past few days o Chronic amoebic dysentery
o Monitor respiratory and cardiac function  Diarrhea for several days, succeeded by
carefully constipation
o Perform frequent neurologic checks  Anorexia, weight loss, weakness and
o Purge the GI tract as ordered fatigue
o If giving the botulinus antitoxin, check the  Watery, bloody, mucoid stool
patient’s allergies, perform a skin test first  Flatulence and irregular bowel
o Educate the patient and family about the movement
importance of proper hand hygiene  Abdomen loses its elasticity
o Teach the patient and family to cook food  Severe cases- scattered ulceration is
thoroughly before ingesting seen through sigmoidoscopy
o Instruct the patient who eats home canned
food to boil the food for 10 minutes before
eating to ensure that it is safe to consume
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 NCM 113 MIDTERM NOTES COMMUNIY HEALTH NURSING 2

 Diagnostic Procedures  Prevention and control

o Stool exam- cyst (plenty of amoeba on the o Treatment of infected person
stool) o Anti-mollusk campaigns
o Blood exams- leukocytosis o Education of the population
o Sigmoidoscopy o Avoid eating infected foods
 Management
o Metronidazole (Flagyl) 800 mg. TID for 5
days
o Tetracycline, ampicillin, streptomycin,
chloramphenicol
 Nursing Interventions
o Observe isolation and enteric precautions
o Proper collection of stool specimen
 No oil prep for 48 hours
 Large portion of stool containing blood
mucus
 Label specimen properly
 Send specimen immediately to the
laboratory
o Provide skin care and hygiene
o Provide optimum comfort- dysenteric
patient should never be allowed to feel
cold
o Diet-fluids should be forced
 Cereal and strained meat broths without
fats
 Bland diet without cellulose of bulk
producing foods
 Chicken and fish maybe added when
convalescence is established
 Prevention
o Health education and fly control
o Sanitary disposal of feces
o Safe drinking water
o Proper food preparation and food handling
o Detection and treatment of carriers

J. Paragonimiasis_________________________________
 Etiologic Agents
o Lung Fluke
o Paragonimus westermani
o Paragonimus siamenses
 Mode of Transmission
o Ingestion of raw/ uncooked crabs
o Contamination of food
o Using meat/ juice of infected
animals
 Reservoir of Hosts
o Cats
o Dogs
o Rats
o Pigs
 Clinical Manifestations
o Cough of long duration
o Recurrent blood-streaked sputum
o Chest-back pain
o PTB-like signs and symptoms not
responding to anti-TB medications
 Diagnostic test
o Sputum examination
o Immunology
o Cerebral paragonimiasis
 Treatment
o Praziquantel (Biltrizide)

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Notes by: Nojas, Frendchet Dranel D. PLEASE DO NOT DISSEMINATE