Communicable Diseases

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Epidemiological triad:

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Environment: warm, moist, dark aerobic or anerobic
Host: Poor immune, autoimmune newborn, strong indiv.
Agent: pathogen

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Incubation period:

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Interval in time b/t exposure to infectious agent and time 1st sx appear

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Prodromal period:

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Time from initial onset of sx to appearance of rash or fever

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Period of communicability:

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Time person is contagious

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Virulence:

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Strength of pathogen

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Tetanus definition:

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Tetanus is a life threatening disease caused by a bacterium that produces a powerful toxin which attacks the CNS. Enters through break in skin.

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S/s of tetanus:

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Drooling, sweating, fever, irritability, difficult swallowing, difficult urinating and defecating

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Tetanus diagnostic:

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Chest x ray, CBC, BMP, wound cx, blood cx, gram stain

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Communicable assessment:

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Id pathogen, assess recent exposure, assess prodromal sx, take immunization hx, assess hx of having disease

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Nasal diptheria:

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Most common in infants, nasal d/c, white membrane, irritation from nasal discharge

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Pharyngeal or tonsillar diptheria:

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Insidious beginning, more severe form, white or grey membrane forms, lymphadenopathy, neck edema, in severe cases, death may occur 7-10 days.

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Prodromal period of pharyngeal diptheria:

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Malaise, low grade fever, sore throat

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Lymphadenopathy in diptheria:

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Severe obstruction

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Therapeutic management of diptheria:

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Antitoxin, be aware of allergy to horse serum, abx (tx on day 1 <1% mortality),( tx on day 4 ~20% mortality)

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Complications of diptheria:

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Causes of morbidity, airway obstruction, myocarditis, CNS related (paralysis of soft palate, limb paralysis, ocular paralysis)

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Poliomyelitis:

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An acute viral disease that causes inflammation of the gray matter of the spinal cord.

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Polio symptoms:

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Severe cold and GI sx, muscle weakness/paralysis

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Polio complications:

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Death from paralysis of respiratory muscles, post polio sequelae (PPS) Recovers from polio but suffers a new set of symptoms 10-40 years later

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Pertussis:Whooping cough:

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Bacterium, Bordatella pertussis. Incubation period: 10-14 days. Highly contagious, especially serious in infants.

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Pertussis transmission:

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Direct contact, nasal secretions, droplets. Communicable period: 4-6 weeks.

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Pertussis clinical manifestations:

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3 stages
1. Catarrhal - URI sx with mild cough, low grade fever
2. Paroxysmal- Episodes of severe repetitive coughing, following by a single sudden massive inspiration, often lasts 4-6 weeks.
3. Convalescent - decrease in severity and frequency of spells

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Pertussis complications:

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1. Respiratory: Pneumonia, pneumothorax, otitis media
2. CNS: Encephalopathy, inflammation of the brain, blindness, deafness, paraplegia, aphasia
3. Effects of secondary pressure: Epistaxis, hernia, retinal prolapse, subdural hematoma

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Scarlet fever - Scarletina:

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Group A betahemolytic strep. Incubation period: 2-4 days.

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Scarlet fever transmission: Nasopharyngeal:

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Direct contact with infected persons, droplets, sneezing or coughing, indirect (milk, foods); less common

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Clinical manifestations scarlet fever Prodromal:

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Abrupt high fever, rapid pulse, n/v, headache, chills, malaise. Then: Enanthema (mouth) Beefy red pharynx, big red tonsils with exudate, sore throat, white strawberry tongue.
Exanthema (skin) Fine red maculopapular rash on trunks, infolds of joints, not on face, followed by sloughing

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Scarlet fever complications:

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Rheumatic fever, AGN, Sinusitis, otitis media

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Rubeola - measles:

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Viral. Incubation period 10-20 days.

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Rubeola transmission:

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Direct contact, blood urine and respiratory secretions. Communicable period: 4 days before til 5 days after rash

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Rubeola clinical manifestations prodromal: 3-5 days:

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Fever (104-105), malaise, coryza, cough, conjunctivitis, koplik spots (white spots circumscribed in red, buccal mucose and roof of mouth)

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Acute Rubeola:

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Maculopapular rash begins on face. Discrete, then becomes confluent, red to brownish in color. Lymphadenopathy

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Therapeutic management of acute rubeola:

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Supportive and symptomatic: Antipyretic, abx to prevent/treat secondary infections, Vitamin A supplementation (photophobia)

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Complications of acute rubeola:

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CNS: Encephalitis, seizures, convulsions, cerebral edema, neurological deficits.
Respiratory: Pneumonia (primary cause of death)

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Rubella (german measles):

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Viral 3 day measles.

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Rubella transmission:

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Nasopharyngeal. Need nasal and throat swab, blood test for IgM antibodies to diagnose

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Communicable period of rubella:

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7 days before, 5 days after rash.

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Clinical manifestations of rubella: Prodromal:

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1. Absent/asymptomatic in children
2. low grade fever
3. cough/coryza
4. Conjunctivitis
5. Lymphadenopathy

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Therapeutic management of rubella:

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Analgesics, antipyretics, benadryl

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Acute rubella has:

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Red discrete maculopapular rash

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Mumps - Parotitis:

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Paramyxovirus: Inflammation of parotid salivary glands.

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Mumps transmission:

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Direct: through saliva of infected person. Incubation period: 2-3 weeks. Communicable period: 1 week before until swelling disappears. Use saliva swabs, u/s and ct scan to diagnose

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Mumps prodromal clinical manifestations:

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Low grade fever, earache, malaise, anorexia, abdominal pain

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Mumps acute symptoms:

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Inflammation of glands, sweling, orchitis, meningitis, pancreatis

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Complications for mumps:

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Deafness, arthritis, myocarditis, hepatitis

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Varicella (chicken pox) :

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Source - respiratory tract. Incubation: 2-3 weeks. Communicable - 1 day before eruption of rash til all vesicles have crusted over.

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Varicella transmission:

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Direct contact and droplet

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Varicella diagnostics:

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Viral cx, cbc, smear

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Clinical manifestations prodromal of varicella:

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Low grade fever, malaise, anorexia, headache.

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Acute varicella symptoms:

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very pruritic rash, begins as macule, then papule, then vesicular, then crusts over. All stages present at one time, profuse on trunk and in oral mucosa, sparse on limbs, fever (102)

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Acute varicella therapeutic management:

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Supportive: Tylenol for fever, not aspirin, due to link with Reyes, antipruritic medications, Benedryl, Hydroxyine
Specific: Varicella zoster immunie globulin (VZIG), Zovirax. Note immunosuppressed or immunocompromised children aer at risk for fatal chickenpox

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Mononucleosis:

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Etiology - Epstein barr virus. Incubation: 10 days to 6 weeks.

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Mono manifestations:

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Malaise, fatigue, sore throat, fever, lymphoadenopathy, splenomegaly, abdominal pain

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Mono diagnosis:

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Monospot, CBC, heteroantibody test: Agglutinizes sheep RBCs 1:16- rate.

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Mono management:

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Analgesia, limited activity with splenomegaly, throat gargles/lozenges

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Nursing considerations for communicable diseases:

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1. Nursing considerations: Communicable
2. Isolation precautions
3. Rest/quiet diversion (dim light for measles)
4. Respiratory support- suction equipment, O2 with humidity
5. Sore throat comfort measures
6. Skin care - tepid baths, soft lightweight clothing
7. Have readily avaiable - epinephrine and emergency trach equipment
8. Decrease irritants - Decrease irritants.
9. Observe for s/s of airway obstruction and pneumonia.
10. Compliance with abx: Seizure precautions if prone to febrile seizures