FEU DEPARTMENT OF NURSING | IN-HOUSE REVIEW

COMMUNICABLE DISEASE | TRANSCRIBED NOTES | BATCH 2023 | LECTURER: SIR PARIAL

INFECTION CONTROL •
large particles, all other respiratory
EPIDEMIOLOGIC TRIAD infections.
• Agent – viruses, bacteria, fungi, protozoa • Medical/surgical mask, goggles (HCP)
o Bacteria need medication • 3 to 6 feet distance
o Viruses heal on their own, long immunity C. Contact
but has a certain period; self-limiting. • Bloody fluids
• Environment • GI, skin diseases, STD
o COVID – 3 C’s: close contact, crowded, • Clean gloves, gown
closed space. LEVELS OF PREVENTION
• Host – patient, carrier, suspect, contact. Level Target Activities
CHAIN OF INFECTION Primary Well person • Prevention
(risk
• Mode of transmission – weakest
reduction)
• Infectious agent (blood) – use bleach (1:10) • promotion
• For dengue, remove stagnant waters around Secondary Early sick • early
your home. diagnosis
• prompt
treatment
Tertiary Late sick • rehabilitation
DISEASE CONTROL
• Isolation – sick patient; separation of the
infected person from the well people; strict
protective
• Quarantine – well person limitation of the
freedom of movement.
Basis: longest incubation period
COVID-19
• SARS-CoV-2 – severe acute respiratory
syndrome coronavirus 2.
DISEASE PRECAUTIONS
• MOT:
• Standard Precaution (minimum)
o Droplet – large respiratory droplets,
o Practice to all patients
within 6 feet.
o Barriers – gloves, PPE
o Contact – direct/indirect
o Handling of sharps – do not recap
o Aerosol – small respiratory particles
(fishing method); puncture proof.
from intubation, bronchoscopy.
o Hand washing – BEST way to combat
o Environment – 3 C’s (Crowded places,
infection; not soiled (20 to 30), soiled (40
Closed contact, Closed space)
to 60)
o Potential pre-symptomatic &
- Before touching px
asymptomatic transmission.
- Before procedure
• Most px will experience mild to moderate
- After touching px respiratory illness.
- After fluid exposure AT RISK POPULATIONS:
- After touching px surrounding. • Aged 60 years and over
TRANSMISSION-BASED PRECAUTION • HTN, CVD
A. Airborne
• COPD, Asthma
• Small particles
• DM
• Can travel in some instance
• Obesity
• MTVS – measles, tuberculosis, varicella,
• Cancer
SARS.
• High risk pregnancies
• High filter mask (KN95), HEPA (high
• Immunodeficiency
efficiency particulate air filter).
B. Droplet • Unvaccinated
CARE PATHWAY
• Pneumonia, diphtheria
A. CONFIRM – diagnosis
• Short distance

ALVAERA, M.E., BROSOTO, A.J., CAJIGAL, A.V., EDILLON, A.M. 1

FEU DEPARTMENT OF NURSING | IN-HOUSE REVIEW
COMMUNICABLE DISEASE | TRANSCRIBED NOTES | BATCH 2023 | LECTURER: SIR PARIAL

• RT-PCR (reverse transcriptase D. EVALUATE

polymerase chain reaction), NAAT
(nucleic acid amplification
tests)/molecular testing.
• Rapid antigen test – case finding, contact
tracing, outbreak investigations;
diagnostic and confirmatory for close
contacts and suspects.
B. ASSESS – symptoms, risk factors, severity.
• Most common symptom: fever, loss of
taste or smell, dry cough, tiredness.
• Less common: body aches and pains,
sore throat, diarrhea, conjunctivitis,
headache, rash on skin, or discoloration
of fingers or toes.
• Serious: DOB, chest pain or pressure,
loss of speech or movement.
• Incubation period: 5 to 6 days (average);
14 days (longest).
• X ray – ground glass opacities (scattered
over the lungs of px)
• Viral load: high levels (increased
diseases severity and transmissibility)
• Viral shedding: expulsion and release of
viral materials following successful
reproduction in the host; Severe COVID
(longer viral shedding period). Nursing Care:
• Non severe – mild to moderate • Symptomatic and supportive
• Severe • Fluid intake
• Critical – organ damage • DBCT
C. RESPOND – appropriate care and treatment. • Management of fever
• Non severe without risk factors (mild & • Positioning – improve gas exchange, semi
moderate): Symptom management & fowlers; ARDS (reposition in different
supportive care; Monitoring. positions), prone is considered; Rationale:
• Non severe with risk factors: redistributes blood & airflow more evenly
Nimatrelvir / ritonavir; Molnupiravir (not Prevention:
for pregnant, children, breastfeeding); • Hand hygiene – alcohol based / soap
Remdesivir. • Face mask
• Severe: symptomatic & supportive care, • Physical distancing (1 m or 3 ft)
O2 therapy, Dexamethasone • Avoid 3 C’s
(corticosteroids – anti-inflammatory and • Avoid touching surfaces in public setting
immunosuppressant), VTE prophylaxis
• Regular cleaning/disinfection – bleach
(Enoxaparin – prevent blood clotting),
solution (1:10 dilution).
Immunomodulators: Interleukin-6
Health Education:
receptor blocker (Tocilizumab,
• NOT RECOMMENDED: outdoor disinfection,
Sarilumab), Janus Kinase Inhibitor
spraying individuals with disinfectants
(Baricitinib)
(tunnel, cabinet, chamber), disinfecting food
packages.
• Masks – DO NOT wear when performing
vigorous PA; prolonged use DOES NOT
cause CO2 intoxication nor O2 deficiency
Masking:
• Non-medical fabric (for general public)

ALVAERA, M.E., BROSOTO, A.J., CAJIGAL, A.V., EDILLON, A.M. 2

FEU DEPARTMENT OF NURSING | IN-HOUSE REVIEW
COMMUNICABLE DISEASE | TRANSCRIBED NOTES | BATCH 2023 | LECTURER: SIR PARIAL

o Rinse with hot H2O and soap NOTE: tetanus toxoid vaccine during pregnancy
o Wash with room temp H2O, followed is more on protection of the baby and the mother
by boiling is only the vessel.
• Medical or surgical (for high-risk groups) • Active – slow to come, slow to go/own body
• Respirators (for frontliners) • Passive – quick to come, quick to go/from
Pregnancy/Breastfeeding: others
• High risk for severe illness/complications Eligibility to Vaccination
• No evidence for abortion, impaired fetal • Not eligible: allergy to any vaccine, severe
development, intrauterine infection from allergic reaction to first dose, less than 18
vertical transmission years old (except Pfizer/Moderna).
• Maintain skin-to-skin contact after delivery. • Need for special clearance:
Continue breastfeeding! o Autoimmune disease
o Hand hygiene and face mask o HIV
o Express breastmilk o Cancer
o Ref – 24 hours, freezer – 30 days o Transplant
o Wet nursing or donor human milk o Steroidal therapy
PPE Guidance of HCW: o Bedridden, vegetative state, life
• Respirator mask (FFP2=N95, FFP3=N99. expectancy of <6 months.
• Perform user seal check • For rescheduling
o Positive Pressure: exhale à pressure o Diagnosed with COVID
o Negative Pressure: – inhale à collapse o History of exposure to confirmed or
suspected case in the past 14 days.
• Face mask
o Received convalescent plasma or
• Gown
monoclonal antibodies for COVID-19 in
• Face shield or goggles the past 90 days.
• Gloves o First 3 months of pregnancy
• Doffing (removal) o Any other vaccine in the past 14 days.
o Glove in glove method (insert pic) o Had attacks, been admitted/changed
o Bird beak method (insert pic) medications for comorbidities for the past
o Gloves à gown from behind (or for some 3 months.
instance, side)à hand hygiene à face o Hypertensive emergency, BP >180/120
shield/goggles from behind à mask from with symptoms of possible organ
strap/ties only à hand hygiene. damage.
VACCINATION Priority Groups for Vaccination:
• Immunity duration: around 6 to 8 months • Frontline health workers
• No vaccine provides 100% protection from • Senior citizens
getting COVID-19. • Persons with chronic diseases
Immunity DISEASES OF RESPIRATORY
• Natural
• Acquired PNEUMONIA
o Active – body produce antibodies. • Inflammation of the lungs is caused by
o Natural – disease exposure; chickenpox, infection & injury.
measles. • Lung consolidation (hardens)
o Artificial – vaccines (weakened • Restrictive lung disease à restrict lungs from
microorganisms). expanding the lungs.
o Passive – simply receive antibodies. • COPD, Emphysema, Asthma à obstructive
- Natural- placental transfer (IgG), lung disease.
breastfeeding (IgA). • MOT: Droplet
- Passive Artificial- immunoglobulin, • Anti-cholinergic à anti PNS à
gamma globulin, anti-toxin, anti- bronchoconstriction
serum (rabies, tetanus). Causes
• Viral: CMV, RSV (respiratory syncytial virus),
coronavirus

ALVAERA, M.E., BROSOTO, A.J., CAJIGAL, A.V., EDILLON, A.M. 3

FEU DEPARTMENT OF NURSING | IN-HOUSE REVIEW
COMMUNICABLE DISEASE | TRANSCRIBED NOTES | BATCH 2023 | LECTURER: SIR PARIAL

• Bacterial: CAP (streptococcus pneumoniae), • DOTS

HCAP (staphylococcus aureus). o Directly observed treatment, short
• Fungal: pneumocystis carinii course.
(immunocompromised: HIV). o Political support – funding
• Aspiration – Omeprazole (decrease acid o Regular drug supply
reaction among ventilated px) à avoid peptic o Sputum microscopy
ulcer. o Recording system
Manifestations o Intake supervision – home visit if needed
• Infectious respiratory s/sx • Pharmacotherapy (RIPES); oral meds
• Sputum: rusty, yellowish, greenish. o Rifampicin – red orange discoloration of
• Chest pain – pleuritic pain; due to secretions
inflammation (sides only); crackles/rales, o Isoniazid – peripheral neuritis
wheezes (pedia). (paresthesia) à Vitamin B6 (promote
• Dull sounds – because of secretions nerve impulse transmission)
Diagnostic o Pyrazinamide – hyperuricemia (elevated
• CXR (cloudiness, haziness); sputum exam uric acid (hyperuricemia) à gout à
Management prone to kidney stones à increase OFS.
• Antibiotics (Penicillin, Cephalosporins). o Ethambutol – optic neuritis (burring of
• Bronchodilators (Salbutamol (beta II: dilates vision)
bronchi; beta I: for the heart), Ipratropium o Streptomycin – IM, ototoxic (vertigo,
(anticholinergic) ). tinnitus) & nephrotoxic (CREA).
• PNS— Rest (bronchoconstrict) ; SNS— o Before breakfast (best time to take Anti-
Stress (bronchodilate) TB drugs for better absorption)
• Mucolytics – acetylcysteine, carbocisteine o Remember the side-effects of Anti-
(Solmux, Lagundi). TB drugs.
• Independent Nursing Care: deep breathing, NOTE: Rifampicin and Isoniazid à hepatotoxic
coughing exercise (check for liver enzymes).
NURSING CARE
TUBERCULOSIS
• Mycobacterium tuberculosis
• Compliance
• MOT: Airborne • Nutrition: increase carbs & proteins,
moderate fats
• Cavity formation in the lungs
• Chronic because it slowly develops in the • Counseling
cavity. • Prevention of spread; after 2 weeks of
• Restrictive Lung Disease continuous treatment, no longer contagious.
Manifestations NOTE: Primary complex (TB in children) à
• Cough for 2 weeks or more not gaining weight; not contagious, intact in
• Low grade fever the lungs.
• Chest/back pain • BCG immunization (upon birth) à
• Weight loss/anorexia intradermal (R upper arm), deltoid muscle;
• Hemoptysis: blood in the sputum because of against extrapulmonary TB.
lung destruction. DISEASES OF CIRCULATORY
Diagnostic
• Screening – exposure MALARIA
o TST, PPD; Mantoux Test à after 48-72 • Common in provinces
Causes
hours à measure size of induration (+)
>10mm, HIV (5mm is considered • Protozoan: Plasmodium species (falciparum,
positive). vivax, ovale, malariae).
• Confirmatory – GeneXpert MTB/RIF assay. • Vector
o Rapid diagnosis and drug resistance. o Female Anopheles mosquito
• Others: DSSM (direct sputum smear o Night biting (9PM to 3AM); clear, slow-
microscopy), CXR flowing, shaded bodies of water.
Management Mode of Transmission

ALVAERA, M.E., BROSOTO, A.J., CAJIGAL, A.V., EDILLON, A.M. 4

FEU DEPARTMENT OF NURSING | IN-HOUSE REVIEW
COMMUNICABLE DISEASE | TRANSCRIBED NOTES | BATCH 2023 | LECTURER: SIR PARIAL

• Mosquito bite DENV à continuous capillary injury (plasma

• Pregnancy; Vertical transmission (mother to leakage) à platelet activation (consumption) à
baby) bleeding à SHOCK.
• Blood transfusion; needle stick Diagnostic
• Dengue NS1, Dengue blot test; platelet count
(before)
• Platelet count decreased (Normal: 150k to
450k/ mm3), increased Hct (F: 35 to 47, M:
42 to 52)
• Rumple Leede Test (Torniquet Test):
Petechiae (>20) à capillary fragility.
Manifestations
Manifestations • Fever 3 days or more
• Cold stage • Bleeding (nose, UGI, skin, gum, small BV)
o Chilling sensation • Grade 1: dengue fever symptoms (no
o Chattering of lips hemorrhage)
o Shaking of body • Grade 2: grade 1 symptoms + bleeding
• Hot stage (peak) (epistaxis, hematemesis, melena).
o High grade fever • Grade 3: Grade 2 symptoms + circulatory
o Abdominal pain failure (weak thready pulse grade 1 pulse,
o Vomiting narrow pulse pressure).
o HA • Grade 4: Grade 3 symptoms + Shock; DSS
• Wet stage (Dengue Shock Syndrome)
o Profuse sweating with body NOTE:
weakness; dehydration • 1 – weak, thready
• Others: jaundice, anemia • 2 – normal
Complications • 3 – increased
• Cerebral hypoxia – the brain can manage • 4 – bounding pulses
without oxygen for 4 to 6 minutes. Pulse Pressure: between SBP & DBP, 30 to 40;
• Liver failure – microorganism in the liver up to 60 is acceptable.
• Kidney failure – impaired oxygenation, tea- Narrow pulse pressure: <30 (sign of respiratory
colored urine (bilirubin). failure); 90/70 bpm
Diagnostic Management
• History (travel within 4 weeks) • Supportive
• Peripheral blood smear • Management of bleeding – epistaxis (flex (for
Management 5 mins), ice compress; (if extend, aspiration);
• Anti-malarials: Artemeter-Lumefantrine, melena (ice compress in upper abdomen).
Chloroquine, Primaquine. • Tranexamic Acid (coagulant)
Prevention (CLEANZ) • Diet modification
• Chemically treated mosquito nets (kulambo • Antipyretic – Paracetamol (drug of choice);
na binabad sa pesticide). NSAIDs (GI irritants à GI bleeding); Aspirin
• Larvae eating fishes (stream seeding) (Acetylsalicylic Acid) not recommended,
• Environmental sanitation (stream clearing). antiplatelet
• Anti-mosquito soaps (Eucalyptus) • Vitamin C – promote integrity of blood vessel;
• Neem trees (aromatic trees); eucalyptus Scurvy (Vitamin C deficiency)
• Zooprophylaxis • IVF à OFS, hydration
DENGUE • Blood transfusion – platelet concentrate
• Etiology: DENV (Dengue Virus) NOTE: Upper GI (avoid gastric irritants) – NPO,
lavage; NO coffee, carbonated drinks, hot &
• Vector: aedes aegypti (day and night biting,
spicy, dark colored food (to prevent discoloration
stagnant water)
on stool).
• MOT: Mosquito bite (by tiger mosquito)
• Upper GI – from mouth to duodenum
• Affects the platelets

ALVAERA, M.E., BROSOTO, A.J., CAJIGAL, A.V., EDILLON, A.M. 5

FEU DEPARTMENT OF NURSING | IN-HOUSE REVIEW
COMMUNICABLE DISEASE | TRANSCRIBED NOTES | BATCH 2023 | LECTURER: SIR PARIAL

• Insert NGT to mouth when px vomits blood

• Mefenamic acid – no to pregnant women à CHOLERA
malformation & abortion. • Vibrio cholerae
Prevention (4 S, 3 A) • Causes severe diarrhea and dehydration
(violent peristalsis)
• Rice watery stool
• “Washer woman’s hands”
• Dehydration: Sunken eyes; poor skin turgor;
absence of tears (pedia); dry mucus
membranes
Complications
• Acid-base and electrolyte imbalance
• Metabolic acidosis
• Sodium and Potassium loss but potassium is
more prominent because it is easily loss à
neurological stimulants (Na); cardiac
stimulants (K)
Diagnostic
• Fecalysis
• 4S: Search & Destroy, Seek Consultation, Management
Secure self-protection, Support fogging • Tetracycline (drug of choice)
• AAA: Alcohol, Asin, Aceite de Mansanilla • F&E replacement: (to compensate to fluid
ETIOLOGY VECTOR AFFECTATION loss)
Malaria Protozoa Female RBC o Commercial available ORS
(Plasmodi Anopheles (electrolyte) – Hydrite, Pedialyte,
um) mosquito
- Night biting
Glucolyte.
- Clear, o Home-made ORS – 8 teaspoon of
flowing, sugar, 1 liter of H2O, 1 teaspoon of
shaded bodies salt.
of water
DHF Virus Aedes aegypti Platelets
• All fruits are rich in potassium (raisins), buko
mosquito juice (not acidic), rice water.
- Day & Night NOTE: Antibiotics (empty stomach to maximize
biting absorption); only take with full stomach if it is GI
- Stagnant
water irritant drug.

DIAGNOSIS MANIFESTATIONS TREATMENT ORS – Oral Rehydration Solution

Malaria Peripheral Fever Anti-malarials
Blood Smear - Cold, hold and
wet

Anemia
DHF Screening: TT Signs & symptoms Symptomatic
Confirmatory: of bleeding and
Dengue NS1, supportive
Plt count

DISEASES OF GASTROINTESTINAL
DIARRHEAL DISEASE
• MOT: Fecal-oral route
• 5 F’s
o Food
o Fingers
o Feces
o Fomites – utensils
o Flies

ALVAERA, M.E., BROSOTO, A.J., CAJIGAL, A.V., EDILLON, A.M. 6