DiphtheriaEtiologic Agent: Corynebacterium diphtheria (Klebs-Loeffler bacillus)

Source of Infection:Discharges and Secretions from mucus surface of the nose and nasopharynx and from the skin and other lesions

Description:Acute febrile infection of the tonsil, throat, nose larynx, or a wound marked by a patch or patches of grayish membrane from which the diphtheria bacillus is readily cultured.Nasal Diphtheria is commonly marked by one sided nasal discharge and excoriated nostril. Non-respiratory or cutaneous diphtheria appears as localized punched out ulcers.

Mode of Transmission:Contact with a carrier/ Aeg./ with articles soiled with discharges of infected persons.Milk serve as vehicle.

Incubation Period:2-5 Days, occasionally longer

Period of Communicability:Variable until V.bacilli has disappeared from secretions and lesions: usually 2 wks. & seldom more than 4wks. Risk FactorsAn operation in an area of the nose and throatEconomic StatusLack of proper NutritionOvercrowding

SymptomsFeeling of fatigueMalaiseSlight sore throatLow Grade FeverIn severe cases: entire neck becomes swollen (bulls neck) with Edema extending to the chestBreathing DifficultyHusky voiceIncrease Heart RateStridor (shrill breathing sound heard in aspiration)Nasal Drainage/Secretions (Serosanguinous w/ foul smell)Swelling of palate

Complications:Myocarditis cause by the action of Diphtheria toxin on the heart musclesPolyneuritis that includes paralysis of the soft palate, the ciliary muscles of the eyes, pharynx, larynx, or extremities. Airway obstruction may lead to death through asphyxiationCervical adenitisOtitis MediaBronchopneumoniaDiagnostic Tests:Swab from nose and throat or other suspected lesionsVirulence test- measures the degree of pathogenicitySchick Test- Determines the immunity status. 1 ml. of Diphtheria toxin is injected intradermally and results is read after 72hrs. Presence of immunity is indicated by absence of any erythema and inflammation at point of injection.

Susceptibility, Resistance, and Occurrence:Infants born of mother who had diphtheria infection are relatively immune but the immunity disappears before the 6th mon.Recovery from attack of Diphtheria is usually but not necessarily followed by persistent immunityImmunity is often acquired through unrecognized infectionTwo-thirds or more of the urban cases are in children under 10yrs. of age. Treatment:Penicillin- effective in treating Respiratory diphtheria before it releases toxins in the blood.Antitoxins combination with Penicillin (Skin test before admin.)ErythromycinSupportive Therapya. Maintain adequate nutrition, fluid and electrolyte balanceb. Bed restc. Oxygen Inhalationd. Tracheostomy (+ laryngeal obstruction)

Methods of Prevention and Control:Active immunization of all infants (6wks.) and children with 3 doses of Diphtheria, Pertussis, and Tetanus (DPT) toxoid administered at 4-6 wks. Intervals and then booster doses following year after the last dose of primary series and another dose on the 4th or 5th yr. of agePasteurization of MilkEducation of parentsReporting of the case to the Health Officer for proper medical Care.Nursing Diagnosis:Ineffective Airway ClearanceRisk for activity intolerancePoor tissue PerfusionFearAnxiety

Nursing Care Management:Follow prescribed dosage and Correct technique in administering antitoxin infections.Comfort of the Aeg. Should always be in mind.Aeg. Advised to take full bed rest (atleast 2wks.). Not permitted to bathe by himself and avoid exertion during defecation to conserve energy & decrease cardiac workload.DIET: Soft Diet / Small Frequent FeedingEncourage drinking fruit juice rich in Vit. C to maintain alkalinity of the blood and increase body resistance.Ice collar must be applied to the neckNose and throat care is prioritized.

Pertussis (Whooping Cough)Description:Acute infection of the respiratory tract. Begins with ordinary cold, becomes increasingly severe, and after the 2nd wk. Is attended by paroxysms of cough ending in a characteristic whoop as the breath is drawn in.Vomiting may follow spasmCough may last for several weeks and occasionally 2-3 mons.

Etiologic Agent:Hemophilus Pertussis/ Bordet Gengou Bacillus/ Bordetella pertussis/ pertussis bacillus

Mode of Transmission:Direct spread through respiratory and salivary contacts (Droplets). Crowding and close association with patients facilitate spread.

Highly contagiousFirst Stage (Prodromal/catarrhal stage)-involves mild, cold like symptomsSecond stage: (paroxysmal Stage)-produces severe, uncontrollable coughing fits. Coughing often ends in a prolonged , high-pitched, deeply indrawn breath . Coughing fits produce a clear, tenacious mucus and vomiting. They may be so severe as to cause lung rupture, bleeding in the eyes and brain, broken ribs, rectal prolapse, or herniaThird Stage (Recovery or Convalescent Stage)- Usually begins w/in 4wks. of onset.

Incubation Period:7-14 days

Period of Communicability:In early catarrhal stage, paroxysmal cough confirms provisional clinical diagnosis 7 days after exposure to 3 wks. After onset of typical paroxysms. SymptomsThe disease starts like the common cold, with runny nose or congestion, sneezing, and maybe mild cough or fever. But after 12 weeks, severe coughing can begin.series of coughing fits that continues for weeks, can cause violent and rapid coughing

ComplicationTissues around the bronchioles become inflamed and interstitial pneumonia occurs. Air passage become obstructed by mucus plugs. This results in atelectasis.Convulsion due to lack of oxygen on the tissuesUmbilical HerniaOtitis MediaBronchopnemuniaSevere malnutrition and starvation, due to persistent vomiting, sleep and rest

Diagnostic Procedures Nasopharyngeal swabSputum CultureCBC (leukocytes)TreatmentSupportive Therapya. Fluid and Electrolytes Replacementb. Adequate Nutritionc. Oxygen Therapy2. Antibiotics (erythromycin and ampicillin) helpful in eliminating infection and to shorten the period of communicability3. Hyperimmune convalescent serum/ gammaglobulinNursing Management Isolation and medical asepsis should be carried outDuration of paroxysm, the patient should not be left alone. Suctioning equipment should be ready at all times for emergency use to avoid obstruction of the airways.Sunshine and fresh air important, but the patient should be protected from drafts.The child should be kept still and quiet as possible since activity and excitement precipitate paroxysm.Provide warm baths and keep the bed dry and free from soiled linensIntake and output should be closely monitored. Nursing DiagnosesIneffective Airway ClearanceAltered Nutrition: Less than body requirementRisk for Infection/ ComplicationSleep Pattern DisturbanceAlteration in Comfort

Susceptibility, Resistance, and Occurrence:Susceptibility is general, predominantly a childhood disease. Highest under 7 yrs. of age & Mortality highest in infants under 6 mons.One attack confers definite and prolonged immunity. Second attack occasionally occurs.Prevalent and common in children.

Method of prevention and control:Routine DPT immunization, started at 1 mons. Given at monthly intervals in 3 consecutive mons. Booster given at 2 yrs. of age and again in 4-5 yrs.Patient should be isolated 4-6 weeks from the onset of illness.Public education for active immunization and early diagnosis, together with reporting of all cases, should be encouraged.

Tetanus (Lockjaw)Description:Acute disease induced by toxin of tetanus bacillus growing anaerobically in wounds & at site of umbilicus among infants. Characterized by painful muscular contractions, primarily of the masseter (Muscle that closes the jaw) and the neck muscles, spasm, and rigid paralysis.Respiratory failure and death may occurEtiologic Agent:Tetanus Bacillus (Clostridium Tetani)

Source of Infection:Immediate source of infection is soil, street dust, animal and human feces.

Mode of Transmission:1. Rugged, traumatic wounds and burns2. Umbilical stump of a new born, especially if delivered at home and thus have faulty cord dressings3. Babies delivered to mothers without T. Toxoid immunization4. Unrecognized wounds5. Dental extraction, circumcision, and ear piercing

Incubation Period:Varies from 3 days-1mon./ more, falling between 7 & 14 days in high proportion of cases.SymptomsNeonate1. Feeding and Sucking difficulties2. May cry excessively; most of the time, however the cry is short, mild and voiceless3. Attempt to suck results to spasms and cyanosis4. Fever; due to infection and dehydration5. Jaw becomes so stiff that the baby cant swallow/suck6. Tonic/rigid muscular contractions, spasms or convulsions are provoked by stimuli.7. Cyanosis and pallor develop8. Severe cases may lead to flaccidity, exhaustion and DEATH.

Older children and Adult1. If tetanus remains localized, signs of onset are Spasm and increased muscle tone near the wound.2. If it becomes systemic or generalized, signs includes:a. Neck and Muscle rigidity (trismus)b. Grinning expression (risus sardonicus)

c. Board-like abdomen/ abdominal rigidityd. Opisthotonos A form of tetanic spasm where the body bends backwardse. Intermittent tonic convulsion lasting for several mins., may result in cyanosis and sudden death due to asphyxiationf. Severe cases; laryngospasm is followed by accumulation of secretions in the lower airways, resulting to respiratory distressg. Fracture of the vertebrae during spasm, leading to coma and DeathComplicationsResults of laryngospasm and involvement of the respiratory muscles:a. Hypostatic pneumoniab. Hypoxia due to laryngospasm and decreased oxygenc. Atelectasis and pneumothoraxd. Traumatic glossitis and microglossia ComplicationChanges related to symphathetic nervous system:Transitory hallucinosisHypersalivation, diaphoresis, and unusual tachycardia, especially with the use of aerosolized bronchodilatorsCardiac Standstill and Bradycardia

Due to traumaLaceration of the tongue and buccal mucosaIntramuscular HematomaFracture of the spine and ribs

Septicemia

TreatmentSpecificTetanus toxoid, .5cc IM, given on standard schedulePen G Na, to control infectionMuscle relaxantNon-specificOxygen inhalationNGT FeedingTracheostomyAdequate fluid and electrolyte, and caloric intake

Nursing DiagnosisAltered nutrition: Less than body requirementImpaired physical mobilityActivity intoleranceSensory perceptual AlterationHigh risk for Infection/complicationKnowledge deficitMethod of Prevention and Control:Pregnant women should be actively immunized.Proper methods, equipment and techniques in sepsis in childbirthDPT for babies and childrenHealth education of mothers, relatives and attendants in the practice of strict aseptic methods of umbilical care in the newborn.Nursing Care:Employ measures which decrease frequency & severity of convulsions.Keep Aeg. away from noise, bright lights or anything that might irritate him/herAdmin. Prescribed medication by physician & observe & report untoward effects to physician.Health teaching about the infectious processControl accompanying discomfort

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