View
453
Download
2
Category
Preview:
Citation preview
Communicable DiseasesPocholo Santos
COMMUNICABLE DISEASE
It is an illness caused by an infectious agent or its toxic products that are transmitted directly or indirectly to a well person through an agent, vector or inanimate object.
TWO TYPES:
Infectious Disease - Not easily transmitted by ordinary contact but require a direct inoculation through a break in the previously intact skin or mucous membrane
Contagious Disease - easily transmitted from one person to another through direct or indirect means.
Terminologies
Disinfection –destruction of pathogenic microorganism outside the body by directly applying physical or chemical means.
Concurrent – method of disinfection done immediately after the infected individual discharges infectious material/secretions. This method of disinfection is when the patient is still the source of infectionTerminal – applied when the patient is no longer the source of infection.
Disinfectant -chemical used on non living objectsAntiseptic – chemical used on living things.Bactericidal – kills microorganismSterilization – complete destruction of all microorganism
General Principles
Pathogens move through spaces or air current Pathogens are transferred from one surface to
another whenever objects touch Hand washing removes microorganism Pathogens are released into the air on droplet
nuclei when person speaks, breaths, sneezes Pathogens are transferred by virtue of gravity Pathogens move slowly on dry surface but
very quickly through moisture
INFECTION
invasion and multiplication of microorganisms on the tissues of the host resulting to signs and symptoms as well as immunologic response
injures the patient either by:o competing with the host’s metabolism o cellular damage produced by the microbes
intracellular multiplication.
CLASSIFICATION ACCORDING TO INCIDENCE
Sporadic - disease that occur occasionally and irregularly with no specific pattern
Endemic – those that are present in a population or community at times.
Epidemic – diseases that occur in a greater number than what is expected in a specific area over a specific time.
Pandemic – is an epidemic that affects several countries or continents
CAUSES OF INFECTION
Some bacteria develop resistance to antibiotics Some microbes have so many strains that a single
vaccine can’t protect against all of them ex. Influenza
Most viruses resist antiviral drugs Opportunistic organisms can cause infection in
immunocompromised patients Most people have not received vaccinations . Increased air travel can cause the spread of virulent
microorganism to heavily populated area in hours Use of immunosupressive drugs and invasive
procedures increase the risk of infection Problems with the body’s lines of defense
THREE LINES OF DEFENSE
First line of defenseo Mechanical Barrierso Chemical Barrierso Body’s own pop of microorganisms -
“microbial antagonism principle” Second – inflammatory response
o Phagocytic cells and WBC to destroy invading microorganism manifesting the cardinal signs
Third – immune response o Natural/Acquiredo Active/passive
RISK FACTORS
Age, sex, and genes Nutritional status, fitness, environmental factors General condition, emotional and mental state Immune system Underlying disease ( diabetes mellitus, leukemia,
transplant) Treatment with certain antimicrobials ( prone to
fungal infection), steroids, immunoisuppresive drugs etc.
CHAIN OF INFECTION
MODE OF TRANSMISSION
Contact transmission o Direct contact - person to persono Indirect - thru contaminated objecto Droplet spread - contact with respiratory
secretions thru cough, sneezing, talking. Microbes can travel up to 3 feet.
Airborne Transmission Vector Borne Transmission Vehicle Borne Transmission
EMERGING INFECTIOUS DISEASES
Developing resistance to antibiotics eg: anti tb drugs, MRSA, VRE
Increasing numbers of immunosuppressed patients. Use of indwelling lines and implanted foreign bodies
has increased.
INFECTION CONTROL MEASURES
Universal Control Measures – All blood, blood products and secretions from patients are considered as infected
Communicable DiseasesPocholo Santos
Work Practice Control
Used needles and sharps shall not be bent, broken, recapped. Used needles must not be removed from disposable syringes.
Eating, drinking, smoking, applying cosmetics or handling contact lenses are prohibited in work areas.
Foods and drinks shall not be stored in refrigerators, freezers where blood or other infectious materials are stored.
All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, or spraying.
Masking – Wear mask if needed. Patient with infectious respiratory diseases should wear mask.
Handwashing – Practice it with soap and water. Gloving – Wear gloves for all direct contact with
patients. Change gloves and wash hands every after each patient.
Gowning - Wear gown during procedures which are likely to generate splashes of blood or sprays of blood and body fluids, secretions or excretions.
Eye protection (goggles) – wear it to prevent splashes.
Environmental disinfection – Clean surfaces with disnfectant (70% alcohol,diluted bleach)
ISOLATION PRECAUTIONS
separation of patients with communicable diseases from others so as to reduce or prevent transmission of infectious agents.
7 Categories Recommended in isolation
Strict isolation – prevent spread of infection from patient to patient/staff.- handwashing, infectous materials must be discarded, use of single room, use of mask, gloves and gowns and (-) pressure if possible
Contact isolation – prevent spread by close or direct contactRespiratory isolation – prevent transmission thru air.
TB isolation – for (+)TB or CXR suggesting active PTB.
Enteric Isolation – direct contact with feces Drainage/secretion precaution- prevent infection
thru contact with materials or drainage from infected person.
Universal Precaution – for handling blood and body fluids.( bloods, pleural fluid, peritoneal fluid etc.)
PREVENTION
Immunization – introduction of specific antibody to produce immunity to certain disease.
Natural – passive (from placenta), active (thru immunization & recovery from diseases)
Artificial – passive (antitoxins), active (vaccine, toxoid)
Maintain vaccine potency by preventing:
Heat and sunlight Freezing Antiseptic/ disinfectants/ detergents lessen the
potency of vaccine. Use water only when cleaning fridge/ref.
COLD CHAIN SYSTEM – maintenance of correct temperature of vaccines, starting from the manufacturer, to regional store, to district hospital, to the health center to the immunizing staff and to the client.
DISEASES ACQUIRED THRU RESPIRATORY
TUBERCULOSIS
Chronic respiratory disease affecting the lungs characterized by formation of tubercles in the tissues---> caseation –--> necrosis ---> calcification.
AKA: Phthisis, Consumption, Koch’s, Immigrant’s dse
Etiologic agent: – Mycobacterium tuberculosis Incubation period: 2 – 10 wks. Period of communicability: all throughout the life
if not treated MOT: Droplet Sources of infection – sputum, blood, nasal
discharge, saliva Classification
1. Inactive – asymptomatic, sputum is (-), no cavity on chest X ray
2. Active – (+) CXR, S/S are present, sputum (+) smear
Classification 0-51. Minimal – slight lesion confined to small part of
the lung2. Moderately advanced – one or both lungs are
involved, volume affected should not extend to one lobe, cavity not more than 4 cm.
3. Far advance – more extensive than B
Manifestations
Primary Complex (TB in children): non contagious o children swallow phlegmo fevero cough o anorexiao weight losso easy fatigability
Adult TBo afternoon rise in temperatureo night sweatso weight losso cough dry to productiveo Hemoptysiso sputum AFB (+)
Milliary TB - very ill, with exogenous TB like Pott’s disease
Primary Infectiono Asymptomatico No manifestations even at CXR, Sputum
AFB Primary Complex
o Minimal manifestationo Lymphadenopathy
Diagnosis
Tuberculin testing Chest X-Ray Sputum AFB
Prevention
BCG Avoid overcrowding Improve nutritional status
Treatment
DOTS 6 months of RIPE Respiratory isolation,
Inhalation
Tubercle
lesions (Ghon’s Tubercl
e)
Granuloma
Caseation
Necrosis
Fibrosis
Scarring
Communicable DiseasesPocholo Santos
Take medicines religiously – prevent resistance Stop smoking Plenty of rest Nutritious and balance meals, increase CHON, Vit.
A, C
MENINGITIS
Acute meningococcemia - with or without meningitis
o Waterhouse Friederichsen Syndrome Inflammation of the meninges usually some
combination of headache, fever, stiff neck, and delirium
Meningococcemia: cerebrospinal fever Etiologic agent: Neisseria meningitides Incubation: 2-10 days MOT: droplet
Diagnostics
Lumbar tap, CSF - high WBC and CHON, low glucose
Manifestations
Sudden onset of fever x 24h Petechiae, Purpuric rashes Meningeal irritation
o Stiff necko Opisthotonus o Kernig’s signo Brudzinski sign
ALOC S/S of Increase ICP
Nursing Management
Administer prophylactic antibiotics: Rifampicin - drug of choice
Aquaeous Pen Mannitol Dexamethasone Priority: AIRWAY, SAFETY Maintain seizure precaution Respiratory precaution Handwashing Suction secretions
DIPTHERIA
Acute contagious disease characterized by generalized toxemia coming from localized inflammatory process
Etiologic agent: Corynebacterium Diptheria (Klebs loffer bacillus)
Incubation period: 2-5 days Period of communicability: variable, ave:2-4
weeks MOT – Droplet, direct or intimate contact, fomites,
discharge from nose, skin, eyes
Manifestations
Pseudomembrane - grayish white, smooth, leathery and spider web like structure that bleeds when detached
Types of Respiratory Diptheriao Nasal
serous to serosanginous purulent discharge
Pseudomebrane on septum
Dryness/ excoriation on the upper lip and nares
o Pharyngeal pharyngeal pseudomembrane bull neck ( cervical adenitis) Difficulty swallowing
o Laryngeal Sorethroat, pseudomemb Barking, dry mettallic cough
Complications
Due to Toxemiao Toxic endocarditiso Neuritiso Toxic nephritis
Due to Intercurrent Infectiono Bronchopneumoniao Respiratory failure
Diagnostics
Nose and throat swabs - culture of specimen form beneath membrane
Virulence test Shick’s test : test for susceptibility to diptheria Moloney’s test: for hypersensitivity to diphtheria
Management
Penicillin, Erythromycin Diptheria Antitoxin – after – skin test if (+),
fractional dose Supportive
o O2, if laryngeal obstruction – tracheostomyo CBR for 2 weekso Increase fluids, adequate nutrition- soft
food, rich in Vit Co Ice collar
Isolation till 3 negative cultures
Prevention
DPT
PERTUSIS (WOOPHING COUGH)
Repeated attacks of spasmodic coughing with series of explosive expirations ending in long drawn force inspiration
Etiologic agent: Bordetella pertusis or Haemiphilus pertussis
Incubation period: 7-14 days Period of communicability: 7 days post exposure
to 3 wks post disease onset MOT – DropleT
Manifestation
rapid cough 5-10x in one inspiration ending a high pitched whoop.
Catarrhal – slight fever in PM, colds, watery nasal discharge, teary eyes, nocturnal coughing, 1-2 weeks
Paroxysmal – Spasmodic stage; 5-10 successive forceful coughing ending with inspiratory whoop, involuntary micturition and defecation, choking spells, cyanosis
Convalescent – 4th- 6th week; diminish in severity, frequency
Complications
Communicable DiseasesPocholo Santos
Otitis media Acute bronchopneumonia Atelectasis or emphysema Rectal prolapse, umbilical hernia Convulsions (brain damage - asphyxia, hemorrhage)
Diagnostics
Elevated WBC Nasopharyngeal swab
Nursing Management
Prevention:o DPT
Parenteral fluids Erythromycin - drug of choice Prone position during attack Abdominal binder Adequate ventilation, avoid dust, smoke Isolation Gentle aspiration of secretions
MEASLES
Sources of infection – secretions from eyes, nose and throat
Pathognomonic sign:o Koplik’s spots
Manifestations
Pre eruptive stage / Prodromal (10-11 days)o Coryza, Cough, Conjunctivitiso Koplik’s Spots, whitish spot at the inner
cheeko Fever, photophobia
Eruptive stageo Maculopapular rasheso Rash is fully developed by 2nd dayo High grade fever –on and offo Anorexia, throat is sore
Convalescence (7-10 days)o Desquamation of the skin
Diagnostics
Nose and throat swab
Treatment
Antiviral drugs- Isoprenosine Antibiotics – if with complications Supportive – O2, IVF
Complications
Bronchopneumonia otitis media encephalitis
Nursing Management
Preventive – measles vaccine at 9 months, MMR 15 months and then 11-12; defer if with fever, illness
Isolation - contact/respiratory TSB , Skin care – daily cleansing wash
Oral and nasal care Plenty of fluids Avoid direct glare of the sun- due to photophobia
GERMAN MEASLES
Mild viral illness caused by rubella virus. AKA: Rubella; 3-Day Measles Incubation period– from exposure to rash 14 -21d Period of communicability – one week before and
and 4 days after onset of rashes. Worst when rash is at it’s peak.
MOT: Droplet, nasal ceretions, transplacental in congenital
Manifestations
Prodromal – low grade fever, headache , malaise, colds, lymph node involvement on 3rd to 5th day
Eruptive – Forscheimer’s spots: pinkish rash on soft palate, rash on face, spreading to the neck, arms and trunk
o lasts1-5 days with no pigmentation or desquamation
o muscle pain
Treatment
symptomatic treatment
Complications
Encephalitis, neuritis Rubella syndrome – microcephaly, mental
retardation, deaf mutism, congenital heart disease RISK for congenital malformation
o 100% when maternal infection happens on first trimester of pregnancy.
o 4% - second/third trimester
Nursing Management
Isolation. Bed rest Room darkened – photophobia Encourage fluid like measles tx
Prevention
MMR, Pregnant women should avoid exposure to rubella patients
Administration of Immune serum globulin one week after exposure to rubella.
CHICKENPOX
Acute and highly contagious viral disease characterized by vesicular eruptions on the skin
Infectious agent – Herpes zoster virus or Varicella zoster
Incubation period – 10 -21 days Period of communicability: 1 day before eruption
up to 5 days after the appearance of the last crop MOT: airborne, direct, indirect
o Direct contact thru shedding vesicles,o Indirect thru linens or fomites
Manifestations
Pre eruptive: Mild fever and malaise Eruptive: rash starts from trunk Lesions - red papules then becomes milky and pus
like within 4 days, Pruritis Stages of skin affectations
o Macule – flat o Papule – elevated above the skin diameter
about 3 cmo Vesicleo Pustuleo Crust – scab , drying on the skin
Communicable DiseasesPocholo Santos
Complications
pneumonia sepsis
Treatment
Zovirax 500mg tablet 1 tab BID X 7 days Acyclovir Oral antihistamine Calamine lotion Antipyretics
Nursing Management
Strict isolation until all vesicles scabs disappear Hygiene of patient Cut finger nails short Baking soda - pruritus
Prevention
Live attenuated varicella vaccine VZIG - effective if given 96h post exposure
HERPES ZOOSTER
Acute inflammatory disease known to be caused by herpes virus varicellae or VZ virus
Infection of the sensory nerve charac by extremely painful infection along the sensory nerve pathway
Occurs as reinfection of VZ virus MOT
o Directo Indirect – airborne
Incubation: 1-2 weeks
Diagnostic procedure
Hx of chickenpox Pain and burning sensation over lesions of vesicles
along nerve pathway Smear of vesicle fluid- giant cells Viral cultures of vesicle fluid Electron microscopy Giemsa-stained scraping – multinucleate giant
epithelial cells
Signs and Symptoms
Burning, itching, pain then erythematous patches followed by crops of vesicles
Eruptions are unilateral Lesions may last 1-2 weeks Fever, regional lymphadenopathy Paralysis of cranial nerve, vesicles at external
auditory canal Paralytic ileus, bladder paralysis, encephalitis
Complications
Opthalmia herpes – blindness because of damage of gasserian ganglion
Geniculate herpes – deafness because of infection of 7th CN (AKA: Ramsay Hunt Syndrome)
Nursing Intervention
Compress of NSS or alluminum acetate over lesions Analgesics, sedatives – weeks to mos Steroids Keep blister covered with sterile powder esp after
break Prevent bacterial invasion Encourage proper disposal of secretions and usage
of gown and mask
MUMPS
Acute viral disease manifested by swelling of one or both of the parotid glands, with occasional involvement of other glandular structures,particularly testes in male.
Etiologic agent – filterable virus of paramyxovirus group usually found in saliva of infected person.
AKA: Epidemic/ infectious parotitis Incubation period: 14 -25 days. Period of communicability – 6d before and 9d
post onset of parotid gland swelling 48 hrs immediately preceding the onset of swelling
is the highest communicability. MOT: direct, indirect - droplet, airborne
Clinical Manifestations
sudden headache, earache , loss of appetite swelling of the parotid gland pain is related to extent of the swelling of the gland
which reaches it’s peak in 2 days and continues for 7-10 days.
fever may reach 40 C during acute stage, one gland may be affected first and 2 days later the
other side is involved
Complications
Orchitis – testes are swollen and tender to palpation. Oophoritis- pain and tendeness of the abdomen Mastitis Deafness may happen Meningo-encephalitis –possible
Diagnostics
Viral Culture WBC count
Prevention
MMR Vaccine
Treatment Modalities
Antiviral drugs NSAIDS – Acetaminophen
Nursing Interventions
Symptomatic Application of warm/ cold compress Oral care, warm salt water gargle Diet – semi solid, soft food easy to chew
o Acid foods/fluids – fruit juices may increase discomfort
Communicable DiseasesPocholo Santos
DISEASES ACQUIRED THRU GIT
Diseases caused by Bacteriao Typhoid Fever o Cholera o Dysentery
Diseases caused by Viruso Poliomyelitiso Infectious Hepatitis A
Diseases caused by Parasiteso Amoebiasiso Ascariasis
THYPHOID FEVER
infection of the GIT affecting the lymphoid tissues(ulceration of Peyer’s patches) of the small intestine
Etiologic Agent: Salmonella typhosa and typhi, Typhoid bacillus
Incubation period: 1-2 weeks Period of communicability: as long as the patient
is excreting the microorganism, MOT: fecal-oral route, contaminated water, milk or
other food Sources of Infection
o A person who recovered from the disease can be potential carrier.
o Ingestion of shellfish taken from waters contaminated by sewage disposal
o Stool and vomitus of infected person are sources of infection.
Clinical Manifestations
Ladderlike fever Nausea, vomiting and diarrhea RR is fast, skin is dry and hot, abdomen is distended Head-ache, aching all over the body Worsening of symptoms on the 4th and 5th day Rose spots
Complications
Hemorrhage, Peritonitis, Pneumonia, Heart failure, Sepsis
Diagnostics
WBC – elevated Blood Culture – (+) S. typhosa Stool Culture (+) Widal test – blood serum agglutination test
o antigen – active typhoido H antigen- previously infected or
vaccinatedo Vi antigen – carrier
Treatment
Chloramphenicol – drug of choice Paracetamol
Nursing Management
Restore FE balance
Bedrest Enteric precautions Prevent falls/safety precautions WOF intestinal bleeding
o Bloody stoolso Sweatingo Pallor
NPO, BT
CHOLERA
an acute bacterial disease of the GIT characterized by profuse diarrhea, vomiting, loss of fluid.
Etiologic agent: Vibrio cholerae, V. comma Pathognomonic sign: rice watery stool Incubation period: 2-3 days Period of Communicability: entire illness, 7-14d MOT: fecal oral route
Clinical manifestations
Acute, profuse, watery diarrhea. Initial stool is brown and contains fecal material
becomes “rice water” Nausea/ Vomiting S/s of Dehydration poor tissue trugor, eyes are sunken Pulse is low or difficult to obtain, BP is low and later
unobtainable. RR – rapid and deep Cyanosis – later Voice becomes hoarse– speaks in whisper Oliguria or anuria Conscious, later drowsy Deep shock Death may occur as short as four hours after onset. Usually first or 2nd day if not treated Principal deficits
o Severe dehydration - circulatory collapseo Metabolic acidosis – loss of large volume
of bicarbonate rich stool. RR rapid and deep
o Hypokalemia – massive loss of K. abdominal distention – paralytic ileus
Diagnostics
Fecal microscopyo Rectal swab o Stool exam
Treatment
IVF- rapid replacement Oral rehydration Strict I and O Antibiotics – Tetracycline, Cotrimoxazole.
Nursing Management
Medical Asepsis Enteric precaution VS monitoring I and O Good personal hygiene
Communicable DiseasesPocholo Santos
Proper excreta disposal Concurrent disinfection. Environmental sanitation
Prevention
protection of food and water supply from fecal contamination.
Water should be boiled/ chlorinated. Milk should be pasteurized. Sanitary disposal of human excreta Environmental sanitation.
DYSENTERY
Acute bacterial infection of the intestine characterized by diarrhea and fever
Etiologic Agent: Shigella group Shigella flesneri - commmon in the Philippines Shigella boydii, S. connei, S. dysenteria – most infectious, habitat exclusively
in man, they develop resistance to antibiotics Incubation period – 7 hrs. to 7 days
Period of communicability – during acute infection until the feces are (-)
MOT – fecal-oral route, contaminated water/ milk/ food.
Clinical Manifestations
Fever esp. in children Nausea, vomiting and headache Anorexia, body weakness Cramping abdominal pain (colicky) Diarrhea – bloody and mucoid Tenesmus Weight loss
Diagnostics
Fecalysis Rectal Swab/culture Bloods – WBC elevated Blood culture
Treatment
Antibiotics- Ampicillin, Cotrimoxazole, Tetracycline IVF Anti diarrheal are Contraindicated
Nursing Management
Maintain fluid and electrolyte balance Restrict food until nausea and vomiting subsides. Enteric precaution Excreta must be disposed properly. Prevention- food preparation, safe washing facilities,
fly control
POLIOMYELITIS
An acute infectious disease caused by any of the 3 types of poliomyelitis virus which affects mainly the anterior born cells of the spinal cord and the medulla, cerebellum and the midbrain
AKA: Acute anterior poliomyelitis, heinmedin disease, infantile paralysis
Etiologic Agent: Poliovirus (Legio Debilitans) 3 Types of Poliovirus
o Type I - most paralytogenic, most frequento Type II - next most frequento Type III - least frequent associated with
paralytic disease 3 Strains
o Brunhildeo Laasingo Leon
MOT: Fecal-Oral Incubation period: 7-14 days ave (3-21 days) Period of communicability: 7-16 days before and
few days after onset of s/s
Sign and Symptoms
Febrile episodes with varying degrees of muscle weakness
Occasionally progressive Flaccid Paralysis
3 Types of Paralysiso Spinal Paralytic
Flaccid paralysis Autonomic involvement Respiratory difficulty
o Bulbar Form Rapid & serious Vagus and glossopharyngeal
nerves affected Cardiac and respiratory reflexes
altered Pulmo edema Hypertension, impaired temp
regulation Encephalitic s/s
o Bulbospinal Combination
Minor Polioo Inapparent / subclinicalo Abortive: recover within 72 hours; flulike;
backache; vomiting Major Polio
o Paralytic: asymmetrical weakness, paresthesia, urinary retention, constipation
o Non paralytic: slight involvement of the CNS; stiffness and rigidity of the spine, spasms of hamstring muscles, with paresis
o Tripod position: extend his arms behind him for support when upright
o Hoyne’s sign: head falls back when he is in supine position with the shoulder elevated
o Meningeal irritation: (+) Brudzinski, Kernig’s sign
Diagnostics
Throat swab, stool exam, LP
Nursing Interventions
Supportive, Preventive – Salk and Sabin Vaccine
Communicable DiseasesPocholo Santos
NO morphine Moist heat application for spasms Airway: tracheotomy Footboard to prevent foot drop Fluids, NTN, Bedrest Enteric and strict precautions
HEPATITIS A
Inflammation of the liver caused by hepatitis A virus AKA: infectious hepatitis Incubation period: 2-6weeks MOT: oral-fecal/ enteric transmission Diagnostic test: liver function (SGOT/SGPT)
Clinical Manifestations
Prodromal/ pre icterico S/S of URTIo Weight losso Anorexiao RUQ paino Malaise
Icteric o Jaundiceo Acholic stoolo Bile-colored urine
Diagnostic tests
HaV Ag, Ab, SGOT, SGPT
Nursing Interventions
Provide rest periods Increase CHO, mod Fat, low CHON Intake of vits/minerals Proper food preparation/handling Handwashing to prevent transmission
AMOEBIASIS
involves the colon in general but may involve the liver or lungs as well
Etiologic agent: Entamoeba histolytica Incubation: 3-4 weeks Period of communicability: duration of illness MOT: fecal oral route
o Indirect - Ingestion of food contaminated with E.Histolytica cysts, polluted water supply, exposure to flies, unhygienic food handlers.
o Direct contact – sexual, oral, or anal, proctogenital
Clinical Manifestations
Intermittent fever Nausea, vomiting, weakness Later : anorexia, weight loss, jaundice Diarrhea – watery and foul smelling stool often
containing blood streaked mucus Colic and abdominal distention Intestinal perforation –bleeding
Diagnostics
Stool Exam ( cyst, amoeba+++) WBC – elevated
Treatment
Amoebacides – Metronidazole(Flagyl) 800mg TID X 7days
Bismuth gylcoarsenilate combined with Chloroquine Antibiotic – Ampicillin, Tetracycline,
Chloramphenicol Fluid replacement – IVF, oral
Nursing Management
Enteric precaution Health education- boil drinking water (20-30
mins), Use mineral water. Cover leftover food. Avoid washing food from open drum/pail. Wash hands after defecating and before eating. Observe good food preparations. Fly control
ASCARIASIS
Helminthic infection of the small intestine caused by Ascaris Lumbrecoides
MOT: fecal-oral Incubation period: 4-8 weeks Communicability: as long as mature fertilized
female worms live in intestine
Diagnostics
Microscopic identification of eggs in stool CBC Hx of passing out of worms (oral or anal), Xray,
Signs and Symptoms
Stomachache Vomiting Passing out of worms
Complications
Energy / Protein malnutrition Anemia Intestinal obstruction
Treatment:
Pyrantel Pamoate Piperazine Citrate Mebendazole, Tetramizole
Communicable DiseasesPocholo Santos
Dicyclomine Hcl, NSAIDS for abdominal pain For intestinal obstruction
o Decompressiono Fluid and electrolyte therapyo If persistent, laparotomy
FF up stool exam 1-2 weeks after treatment
Nursing Intervention
Isolation- not needed Enteric precaution Handwashing Proper nutrition Maintenance of hydration / fluid balance / boil of
water Improve personal hygiene Proper food prep/handling Administer meds (NSAIDS, MEBENDAZOLE)
DISEASES ACQUIRED THRU THE SKIN
Diseases caused by Trauma and Inoculationo Tetanuso Rabieso Malariao DHFo Leptospirosiso Schistosomiasis
Disease acquired thru ContactO Leprosy
TETANUS
an acute, often fatal, disease characterized by generalized rigidity and convulsive spasms of skeletal muscles caused by the endotoxin released by C. Tetani
AKA: Lockjaw Etiologic Agent: Clostridium Tetani
o Anerobico Spore forming, gram positive rod
Sources:o Animal and human feceso Soil and dustO Plaster, unsterile sutures, rusty scissors,
nails and pins MOT:
o Direct or indirect contact to woundso Traumatic wounds and burnso Umbilical stump of the newborno Dirty and rusty hair pins o GIT- port of entry – rareo Circumcision/ ear pearcing
Incubation period: 3d-3week (ave:10d)
Signs and Symptoms
persistent contraction of muscles in the same anatomic area as the injury
Local tetanus Cephalic tetanus - rare form otitis media (ear infections) Generalized tetanus
o trismus or lockjaw
o stiffness of the necko difficulty in swallowingo rigidity of abdominal muscleso elevated temperatureo sweatingo elevated blood pressure episodic rapid
heart rate Neonatal tetanus - a form of generalized tetanus
that occurs in newborn infants
Diagnostics
entirely clinical CSF – normal WBC- normal or slight elevated
Treatment
Wounds should be cleaned Necrotic tissue and foreign material should be
removed Tetanic spasms - supportive therapy and
maintenance of an adequate airway Tetanus immune globulin (TIG)
o help remove unbound tetanus toxino cannot affect toxin bound to nerve endingso single intramuscular dose of 3,000 to 5,000
unitso contains tetanus antitoxin.
Oxygen NGT feeding Tracheostomy Adequate fluid, electrolyte, caloric intake During convalescence Determine vertebral injury Attend to residual pulmonary disability Physiotherapy TT
Nursing Interventions
Preventiono DPT
Adverse ReactionsLocal reactions (erythema, induration)Fever and systemic symptoms not commonExagerated local reactions
Prevention of CV and respiratory complicationso Adequate airwayo ICU – ET- MV
Provide cardiac monitoring KVO Wound care (TIG, Debridement, TT) Administer antibiotics as ordered
o Penicillin Care during tetanic spasm/ convulsion
o Administer Diazepam – muscle rigidity/spasm
o Administer neuromuscular blocking agents (metocurin iodide) – relax spasms and prevent seizure
Keep on seizure precaution Parenteral nutrition Avoid complications of immobility (contractures,
pressure sores) WOF urinary retention, fractures
RABIES
a viral zoonotic neuroinvasive disease that causes acute encephalitis
Etiologic agent: Rhabdovirus AKA: Hydrophobia, Lyssa Negri bodies in the infected neurons –
pathognomonic Incubation period: 4-8 weeks; 10d-1yr Period of communicability: 3-5 days before the onset
of s/s until the entire course of disease MOT: contamination of a bite of infected animals
Diagnostics
History of exposure PE/ assessment of s/s Microscopic examination of Negri bodies using
Seller’s May-Grunwald and Mann Strains
Communicable DiseasesPocholo Santos
Fluorescent Rabies Antibody technique / Direct Immunofluorescent test
Clinical Manifestations
Prodromal Phase / Stage of Invasiono Fever, anorexia, malaise, sorethroat,
copious salivation, lacrimation, perspiration, irritability, hyperexcitability, restlessness, drowsiness, mental depression, marked insomia
o Sensitive to light, sound, and changes in temp
o Myalgia, numbness, tingling, burning or cold sensation along nerve pathway; dilation of pupils
Stage of Excitemento Marked excitation, apprehensiono Delirium, nuchal stiffness, involuntary
twitchingo Painful spasms of muscles of mouth,
pharynx, and larynx on attempting to swallow food or water or the mere sight of them – hydrophobia
o Aerophobiao Precipitated by mild stimuli – touch or noiseo Death – spasm from or from cardiac /
respiratory failure Terminal Phase or Paralytic Stage
o Quiet and unconsciouso Loss of bowel and bladder controlo Tachycardia, labored irregular respiration,
steady rising tempo Spasm, progressively increasing paralysiso Death due to respiratory paralysis
Treatment
No cure No specific – symptomatic/ supportive – directed
toward alleviation of spasm Employ continuing cardiac and pulmonary
monitoring Assess the extent and location of the bite – biting
incident/ status of the animalo Severe exposureo Mild exposure
Wound treatment (local care)o Cleanse thoroughly with soap and water (or
ammonium compounds, betadine, or benzalkonium cl)
o Anti rabies serum o Tetanus prophylaxiso Antibioticso Suturing should be avoided
Antirabies serao Heterologous serum obtained by
hyperimmunization of different animal species i.e. horses
o HRIG – Homologous reabies immunoglobulin – human origin
Rabies Vaccine Active immunization
o Administered 3 years durationo Used for lower extremity biteso Lyssavac (purified protein embryo), Imovax,
Anti-rabies vaccine Passive immunization
o 3 months
o Rabuman, Hyper Rab, Imogam
Nursing Interventions
Isolation of patiento Provide comfort for the patient by:o Place padding of bedside or use restraintso Clean and dress wound with the use of
gloveso Do not bathe the patient, wipe saliva or
provide sputum jar Provide restful environment
o Quiet, dark environmento Close windows, no faucets or running water
should be heardo IVF should be coveredo No sight of water or electric fans
MALARIA
Acute and chronic disease transmitted by mosquito bite confined mainly to tropical areas.
Etiologic agent – Protozoa of genus Plasmodiao Plasmodium Falciparum (malignant tertian)
most serious, high parasitic densities in RBC with tendency to agglutinate and form into microemboli. Most common in the Philippines
o P. Vivax - non life threatening except for the very young and old. Manifests chills every 48 hrs on the 3rd day onward if not treated
o P. malarie (Quartan) – less frequent, non life threatening, fever and chills occur every 72 hrs on the 4th day of onset
o P. ovale - rare Incubation period:
o 12days P. falciparum, 14 days P vivax and ovale, 30 days P. malariae
Period of communicabilityo If not treated /inadequate – more than 3
yrs. P malariae, 1-2 yrs. P. vivax, 1 yr- P. falciparum
Mode of transmissiono Mosquito bite: Vector – female Anopheles
mosquitoo Also by blood transfusion
Diagnostics
Malarial smear – film of blood is placed on a slide, stained and examined
Rapid diagnostic test (RDT) – done in field. 10 -15 mins result blood test
Clinical Manifestions
Rapidly rising fever with severe headache Shaking chills Diaphoresis, muscular pain Splenomegaly, hepatomegaly Hypotension
o May lasts for 12 hours daily or every 2 days.
Complicated Malariao GIT
Communicable DiseasesPocholo Santos
Bleeding from GUT, N/V, Diarrhea, abdominal pain, gastric, tyhoid, choleric, dysenteric
o CNS or Cerebral Malaria Changes in sensorium Severe headache N/V
o Hemolytic Blackwater fever - Reddish to
mahogany colored urine due to hemoglobinuria
Anuria – deatho Malarial lung disease
Management
Antimalarial drugs – Chloroquine (all but P. Malarie), quinine, Sulfadoxine (resistant P falciparum) Primaquine (relapse P vivax/ovale)
RBC replacement/ erythrocyte exchange transfusion
Nursing Management
Isolation of patient Use mosquito nets Eradicate mosquitos Care of exposed persons – case finding I and O BUN & creatinine – dialysis could be life saving ABG TSB, ice cap on head Hot drinks during chilling, lots of fluid Monitoring of serum bilirubin Keep clothes dry, watch for signs of bleeding
Prevention
Mosquito breeding places should be destroyed Insecticides, insect repellant Blood donor screening
DENGUE FEVER
Is an acute febrile disease cause by infection with one of the serotypes of dengue virus which is transmitted by mosquito (Aedes aegypti).
Dengue hemorrhagic fever – fatal characterized by bleeding and hypovolemic shock
Etiologic agent – Arbovirus group B – AKA: Chikungunya, O’ nyong nyong, west nile fever Mode of Transmission: Bite of infected mosquito –
Aedes Aegypti Incubation period – 3-14 days Period of communicability – mosquito all
throughout life Sources of infection
o Infected person- virus is present in the blood and will be the reservoir when sucked by mosquitoes
o Stagnant water = any
Diagnostics
Torniquet test Platelet Count
Hematocrit
Manifestations
Prodromal symptomso malaise and anorexia up to 12 hrs.o Fever and chills, head-ache, muscle paino N &V
Febrile Phase o Fever persists (39-40 C)o Rash - more prominent on the extremities
and trunko (+) torniquet test- petechia more than 10.o Skin appears purple with blanched areas
with varied sizes ( Herman’s sign)o Generalized or abdominal paino Hemorrhagic manifestations – epistaxis,
gum bleedingo
Circulatory Phaseo Fall of temp on 3rd to 5th dayo Restless, cool clammy skino Profound thrombocytopeniao Bleeding and shocko Pulse - rapid and weako Untreated shock --- coma – deatho Treated – recovery in 2 days
Classification
Grade 1 Grade 2 Grade 3 Grade 4
Treatment
No specific antiviral therapy for dengue Analgesic – not aspirin for relief of pain IV fluid BT as necessary O2 therapy
Nursing Management
Kept in mosquito free environment Keep pt. at rest VS monitoring Ice bag on the bridge of nose and forehead. Observe for signs of shock – VS (BP low), cold
clammy skin
Prevention
Mosquito net Eradication of breeding places of mosquito
o house sprayingo change water of vaseso scrubbing vases once a weeko cleaning the surroundingso keep water containers coveredo avoid too many hanging clothes inside the
house
LEPTOSPIROSIS
Infectious bacterial disease carried by animals whose urine contaminates water or food which is ingested or inoculated thru the skin.
Etiologic agent: spirochete Leptospira interrogans found in river, sewerage, floods AKA: Weil’s disease, mud fever, Swineherd’s
disease Incubation Period: 6 -15 days Period of Communicability – found in urine
between 10-20 days MOT – contact with skin of infected urine or feces of
wild/domestic animals; ingestion, inoculation
Diagnostics
Clinical manifestations Culture
Communicable DiseasesPocholo Santos
Source of Infection Rats, dogs, mice
Manifestations Septic Stage
o Early - Fever (40 ‘C), tachycardia, skin flushed, warm, petechiae
o Severe – (Multiorgan)Conjunctival affectation, jaundice, purpura, ARF, Hemoptysis, head-ache, abdominal pain, jaundice
Toxic stage – with or w/o jaundice, meningeal irritation, oliguria– shock, coma , CHF
Convalescence – recovery
Management
IV antibiotic o Pen G Nao Tetracyclineo Doxycycline
Dialysis – peritoneal IVF Supportive Symptomatic
Nursing Interventions
Isolation of patient – urine must properly disposed Care of exposed persons – keep under close
surveillance Control measures
o Cleaning of the environment/ stagnant water
o Eradicate ratso Avoid bathing or wading in contaminated
pool of watero vaccination of animals
(cattles,dogs,cats,pigs)
SCHISTOSOMIASIS
Parasitic disease caused by Schistosoma japonicum, S. mansoni, S. Hematobium
AKA: Bilharziasis, Snail fever Incubation period: 2-6 weeks MOT: bathing, swimming, wading in water
o Vector: Oncomelania quadrasio Cercariae: most infective stage
Diagnostics Fecalysis
o Identification of eggs Liver and rectal biosy Immunodiagnostic tests / circumoval precipitin test
and cercarial envelope reactions
Signs and Symptoms
Swimmers itcho Itchinesso Redness and pustule formation at site of
entry of cercariaeo Diarrheao Abdominal paino Hepatosplenomegaly
Clinical Manifestations
Abdominal pain Cough Diarrhea Eosinophilia - extremely high eosinophil granulocyte
count. Fever Fatigue Hepatosplenomegaly - the enlargement of both the
liver and the spleen. Colonic polyposis with bloody diarrhea (Schistosoma
mansoni mostly) Portal hypertension with hematemesis and
splenomegaly (S. mansoni, S. japonicum); Cystitis and ureteritis with hematuria bladder
cancer; Pulmonary hypertension (S. mansoni, S. japonicum,
more rarely S. haematobium); Glomerulonephritis; and central nervous system
lesions.
Complications
Pulmonary hypertension Cor pulmonale Myocardial damage Portal cirrhosis
Treatment
Trivalent antimonyo Tartar emetic – administered thru veino Stibophen (Fuadin) – given per IM
Praziquantel – per orem Niridazole
Nursing Interventions
Administer prescribed drugs as ordered Prevent contact with cercaria-laden waters in
endemic areas like streams Proper sanitation or disposal of feces Creation of a program on snail control – chemical or
changing snail environment
LEPROSY
Communicable DiseasesPocholo Santos
Chronic systemic infection characterized by progressive cutaneous lesions
Etiologic agent: Mycobacterium leprae Acid fast bacilli that attack cutaneous tissues,
peripheral nerves producing skin lesions, anesthesia, infection and deformities.
Incubation period – 5 1/2 mo - eight years. MOT – respiratory droplet, inoculation thru break in
skin and mucous membrane.
Diagnosis
Identification of signs and symptoms Tissue biopsy Tissue smear Bloods – inc. ESR Lepromin skin test Mitsuda reaction
Manifestations
Corneal ulceration, photophobia –blindness Lesions are multiple, symmetrical and
erythematous– macules and papules Later lesions enlarge and form plaques on nodules
on earlobes, nose eyebrows and forehead Foot drop Raised large erythemathous plaques appear on skin
with clearly defined borders. – rough hairless and hypopigmented – leaves an anesthetic scar.
Loss of eyebrows/eyelashes Loss of function of sweat and sebaceous glands Epistaxis
Prevention
multiple drug therapy sulfone rehab occupational Health isolation moral support
Prevention
Report cases and suspects of leprosy BCG vaccine may be protective if given during the
first 6 months.
Nursing Interventions
Isolation of patient – until causative agent is still present
Care of exposed persons Household contact – Diaminodiphenylsulfone for 2
years Observe carefully for symptoms of the disease
DISEASES ACQUIRED THRU SEXUAL CONTACT
HIV/AIDS
Chronic disease that depresses immune function Charecterized by opportunistic infections when
T4/CD4 count drops <200 MOT – sexual contact with infected – unprotected,
injection of blood/products, placental transmission
History
1959 - African man 1981- 5 homosexual men 1982-Designated as disease by CDC 1983- HIV 1 discovered 1987- 1.5 million HIV-infected in USA 1994- WHO reports 8-10 mil. Worldwide & protease
inhibitors introduced 1999-First clinical trials for HIV vaccine
The Immune System
Macrophages Humoral response Cell-mediated response RNA virus Retrovirus Reverse transcriptase Protease
Diagnostics
ELISA Western Blot CD4 count Viral load testing Home test kits
HIV/AIDS Spectrum
Manifestations
Communicable DiseasesPocholo Santos
Minor signs – cough for one month, general pruritus, recurrent herpes zoster, oral candidiasis, generalized lymphadenopathy
Major signs – loss of weight 10% BW, chronic diarrhea 1month up, prolonged fever one month up.
Persistent lymphadenopathy Cytopenias (low) PCP Kaposis sarcoma Localized candida Bacterial infections TB STD Neurologic symptoms
Criteria for Diagnosis of AIDS
CD4 counts of 200 or less Evidence of HIV infection and any of
o Thrusho Bacillary angiomatosiso Oral hairy leukoplakiao Peripheral neuropathyo Vulvovaginal candidiasiso Shingleso Idiopathic thrombocytopeniao Fatigue, night sweats, weight losso Cervical dysplasia, carcinoma in situ
Evidence of HIV infection and any one of the following:
o Bronchial candidiasis o Esophageal candidiasis o CMV diseaseo CMV retinitiso HIV encephalopathyo Histoplasmosis o Kaposi’s Sarcomao Herpes simplex ulcers, bronchitis,
pneumonia
Treatment
Started in CD4 counts of <200 Viral load >10,000 copies All symptomatic regardless of counts Note: CD4 reflects immune system destruction.
Viral load- degree of viral activity Nucleoside Reverse Transcriptase Inhibitors
o Blocks reverse transcriptaseo Acts by binding directly to the reverse
transcriptase enzymeo Not used aloneo Rapid development of resistance
Generic Trade Dose Notes
Zidovudine AZT, ZDV, Retrovir
300 mg. Bid
Taken with food
Didanosine ddI, Videx 200 mg bid
Peripheral neuropathy
Zalcitibine ddC,Hivid .75 mg TID
No antacids
Stavudine d4T, Zerit 400 mg bid
Peripheral neuropathy
Lamivudine 3TC, Epivir
150 mg bid
Used as resistance develops
Lamiduvine/Zidovudine
Combivir 150/300mg
Bone marrow toxicity
Protease Inhibitorso Introduced in 1995o Acts by blocking protease enzymeo Indinavir (Crixivan)o CDC Guidelines
Combination of 2 NRTI + PI
Nursing Management
Administer Antiviral meds as ordered Universal precaution Reverse isolation gloves, needle stick injury prevention Assist in early diagnosis and management of
complications 4 C’s
o Compliance – info, + drugso Counselling – educationo Contact tracing – tracing out and tx for
partnerso Condoms – safe sex
GONORRHEA
a curable infection caused by the bacteria Neisseria gonorrhoea
AKA: Clap, Drip, G. vulvovaginitis MOT: transmitted during vaginal, anal, and oral sex Incubation period: 3-10 days initial manifestations Period of communicability: considered infectious
from the time of exposure until treatment is successful
Manifestations
Urethritis – both male and female S/S: dysuria and purulent discharge Cervicitis Upper Genital Tract – females (PID), Endometritis,
Salpingitis, Pelvic Abscess
Complications PID Infertility Upper Genital Tract – male Epididymitis, Prostatitis, Seminal Vesiculitis Disseminated Gonococcal Infection (DGI) Tenosynovitis or Polyarthritis, skin lesions and fever Anorectal Infection Pharyngeal Infection Gonococcal Conjuctivitis Opthalmia Neonatorum Meningitis, Endocarditis
Diagnosis
Culture & Sensitivity Blood tests for N. gonorrhoeae antibodies
Treatment
Antibioticso Penicillino Single dose Ceftriaxone IM + doxycycline
PO BID for 1 weeko Prophylaxis: Silver nitrate, Tetracycline,
Erythromycin
Nursing Interventions
Case finding Health teaching on importance of monogamous
sexual relationship Treatment should be both partners to prevent
reinfection Instruct possible complications like infertility Educate about s/s and importance of taking
antibiotic for the entire therapy
SYPHILIS
a curable, bacterial infection, that left untreated will progress through four stages with increasingly serious symptoms
Etiologic agent: Treponema pallidum AKA: Lues, The pox, Bad blood Type of Infection: Bacterial
Modes of transmission :o Through sexual contact/ intercourse,
kissingo abrasions
Communicable DiseasesPocholo Santos
o Can be passed from infected mother to unborn child (transplacental)
Symptoms
Primary syphilis (10 – 90 days after infection)o Chancre – a firm, painless skin ulceration
localized at the point of initial exposure to the bacterium appear on the genitals
o can also appear on the lips, tongue, and other body parts
Secondary syphilis (last 2 – 6 weeks)o syphilis rash - an infectious brown skin
rash that typically occurs on the bottom of the feet and the palms of the hand
o condylomata lata - flat broad whitish lesions
o Fever, sore throat, swollen glands, and hair loss can also be experienced
Third stage o Will manifest 1 – 10 years after the
infectiono characterised by gummas - soft, tumor-like
growths o seen in the skin and mucous membranes –
occurs in boneso joint and bone damage o increasing blindness o numbness in the extremities, or difficulty in
coordinating movements.
neurosyphilis o generalized paresis of the insane which
results in personality changes, changes in emotional affect, hyperactive reflexes
cardiovascular syphilis o aortitis, aortic aneurysm, Aneurysm of
sinus of valsalva and aortic regurgitation, - death
Consequences in Infantso congenital syphilis o extremely dangerouso Deformitieso Seizureso Blindnesso Damage to the brain, bones, teeth, and
ears.
Test and diagnosis
Venereal Disease Research Laboratory (VDRL) test Flourescent treponemal antibody absorption (FTA –
Abs) Micro hemagglutination test (MHA - TP) CSF examination
Treatment
Syphilis is easily treatable when early detected Penicillin & other antibiotics Prevention Abstinence Mutual monogamy Latex condoms for vaginal and anal sex
Nursing interventions
Case finding Health teaching and guidance along preventive
measures Utilization of community health facilities Assist in interpretation and diagnosis Reinforce ff up treatment VD control program participation Medical examination of patient’s contacts
HEPATITIS B
serious disease caused by a virus that attacks the liver
Etiologic agent: hepatitis B virus (HBV) Source of infections: Blood and body secretions
Risk factors
multiple sex partners or diagnosis of a sexually transmitted disease
Sex contacts of infected persons Injection-drug users Household contacts of chronically infected persons Infants born to infected mothers Infants/children of immigrants from areas with high
rates of HBV infection Health-care and public safety workerr Hemodialysis patients
Complications
Lifelong infection Liver cirrhosis Liver cancer Liver failure Death
Signs ans Symptoms
Jaundice Pruritus Fatigue RUQ - Abdominal pain Loss of appetite Nausea, vomiting Joint pain
Prevention
Hepatitis B vaccine has been available since 1982. Routine vaccination of 0-18 year olds Vaccination of risk groups of all ages Immune globulin if exposed
Medical Management
Interferon alfa-2b Lamivudine Telbivudine Entecavir Adefovir dipivoxil
Nursing Interventions
Blood and body secretions precautions Prevention- Hepa B vaccine Proper rest periods Prevent stress – physio/psychological Proper NTN, increase in CHO, high in CHON, low
fats, Vit. K rich foods and minerals Assistance to prevent injury, promote safety AAT WOF s/s bleeding, edema Health education on safe sex
SEVERE OF ACUTE RESPIRATORY SYNDROME
An acute and highly contagious respiratory disease in humans
Etiologic agent: SARS coronavirus November 2002 and July 2003, with 8,096 known
infected cases and 774 deaths Incubation period: 2-3days MOT: Airborne
Signs and Symptoms
Communicable DiseasesPocholo Santos
flu like: fever, myalgia, lethargy, gastrointestinal symptoms, cough, sore throat
fever above 38 °C (100.4 °F) Shortness of breath Symptoms usually appear 2–10 days following
exposure
require mechanical ventilation
Diagnostics
Chest X-ray (CXR)- abnormal with patchy infiltrates WBC and PLT CT. - LOW ELISA test detects antibodies to SARS
o but only 21 days after the onset of symptoms
Immunofluorescence assay can detect antibodies 10 days after the onset of the disease
o labour and time intensive test Polymerase chain reaction (PCR) test that can
detect genetic material of the SARS virus in specimens ranging from blood, sputum, tissue samples and stools
CXR - increased opacity in both lungs, indicative of pneumonia
SARS may be suspected
o fever of 38 °C (100.4 °F) or more AND
o Either a history of:
Contact (sexual or casual) with someone with a diagnosis of SARS within the last 10 days OR
Travel to any of the regions identified by the WHO as areas with recent local transmission of SARS (affected regions as of 10 May 2003 were parts of China, Hong Kong, Singapore and the province of Ontario, Canada).
probable case of SARS
o above findings plus positive chest x-ray findings of atypical pneumonia or respiratory distress syndrome
Treatment
supportive with antipyretics, supplemental oxygen and ventilatory support as needed.
Suspected cases of SARS must be isolated, preferably in negative pressure rooms, with full barrier nursing precautions taken for any necessary contact with these patients
steroids antiviral drug SARS vaccine
Recommended