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C. Major Non- Communicable Diseases TABLE 1 CARDIOVASCULAR DISEASES Risk Factors Prevention and Control a) Hypertension Heredity Advancing Age Race High salt intake Obesity Excess alcohol intake Stress Contraceptive drugs b) Coronary Artery Disease Hyperlipidemia Hypertension Smoking Diabetes mellitus Obesity Sedentary lifestyle Stress Proper nutrition Maintenance of ideal body weight Smoking cessation Early detection and modification of risk factors Regular exercise Proper nutrition Maintenance of ideal body weight Smoking cessation Early diagnosis and prompt treatment Control of DM and HPN c) Cerebrovascular Disease CANCER DIABETES MELLITUS Type I (IDDM) Type II (NIDDM) CHRONIC OBSTRUCTIVE PULMONARY DISEASE BRONCHIAL ASTHMA Advancing age Heredity Race Gender Hypertension Smoking Diabetes mellitus Heredity Carcinogens Chemicals Environmental agents Heart disease High RBC count Season and climate Socioeconomic factors Excessive alcohol intake Drug abuse Treatment and control of HPN Smoking cessation Prevention of thrombus formation Limited alcohol consumption Avoidance of drug abuse and cocaine Prevention of atherosclerosis Benzopyrene Nitrosamines Radiation Viruses Heredity Overweight and obesity Sedentary lifestyle Hypertension Hyperlipidemia Smoking Chronic bronchitis Emphysema History of gestational DM Delivery of baby weighing 9lbs Previously identifies to have IGT Smoking cessation Proper nutrition Limited alcohol intake Maintenance of ideal body weight Early diagnosis and prompt treatment Maintenance of ideal body weight Proper nutrition Regular exercise Smoking cessation Genetic predisposition Atopy/ allergy Smoking cessation Smoking Air pollution Recognition of triggers that exacerbate asthma Airway hyperresponsiveness Gender Race Allergens Respiratory infections Parasitic infections Socioeconomic factors Family size Diet and drugs Obesity Asthma triggers Avoidance of triggers Promotion of exclusive breastfeeding (Continuation of table 1) COMMUNICABLE DISEASE PREVENTION AND CONTROL A. Infection- implantation and successful replication of an organism in the tissue of the host resulting to signs and symptoms as well as immunologic response. B. Chain of infection Agent Portal of exit Reservoir Portal of entry Mode of transmission susceptible host C. Stages of infection Incubation period Illness stage Prodromal stage Convalescence D. General care of patients with Communicable Diseases Health education Immunization Environmental sanitation Infection control Table 2. Bacterial Infections AGENT TUBERCULOSIS Mycobacterium tuberculosis M. Africanum M. Bovis INCUBATION PERIOD 2-10 weeks PERIOD OF COMM. All throughout his lifetime if untreated MOT Airborne/ droplet CLINICAL MANIFESTATIONS Fever in the afternoon Night sweats Body malaise Weight loss Dry productive cough Dyspnea NURSING INTERVENTIONS Immunize newborn, infants, and grade school entrants with BCG vaccine. Provide medical, laboratory and x-ray facilities for examination of patients, contacts and suspects as well as for Hoarseness of voice Hemoptysis Occasional chest pains Sputum positive for AFB early treatment of cases. Perform diagnostic evaluation such as sputum and smear culture, chest xray, and tuberculin skin test Give prescribed anti-TB drugs Treatment: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, Streptomycin DOH Program: National Tuberculosis Control Program LEPROSY Mycobacterium Leprae or Hansen’s Bacillus 5 ½ months to 8 years Respiratory droplet Inoculation through skin break and mucous membrane Early stage: Change in skin color (reddish or white), loss of sensation on the skin lesion, decrease/loss of sweating and hair growth on the lesion, thickened and/or painful nerves, muscle weakness/ paralysis of extremities, pain and redness of the eyes, nasal obstruction/ bleeding, unhealed ulcers Late stage: Madarosis, lagophthalmos, clawing of the fingers/ toes, contractures, sinking of the nose bridge, gynecomastia, chronic ulcers Administer BCG vaccination, particularly to infants and children. Promote community health through participation in: - Seminars, workshops or consultative meetings of other GOs and NGOs on leprosy control - Tri-media dissemination of leprosy facts and NLCP-MDT Program - Use pads, wooden handles of utensils (hand protection), special shoes with paddled soles (feet protection) - Urgent prevention of injuries to hand, feet, and eyes to prevent deformities Recommend the patient, if necessary, to other health and allied workers such as the physician, dentist, social worker, physiotherapist, mental hygienist, occupational therapist Provide and arrange for home rehabilitation. Treatment: Rifampicin, Dapsone, Ofloxacin,Clofazimine, Minocycline DOH Program: National Leprosy Control Program DIPTHERIA Corynebacterium diptheriae (KlebsLoeffler bacillus) 2-5 days 2-4 weeks in untreated patients 1-2 days in treated patients Contact with patient/ carrier or with articles soiled with discharges of infected persons Nasopharyngeal and tonsillar diphtheria: Malaise, low grade fever, anorexia, whitish-gray membranous patch on tonsils, lymph node swelling, fever, rapid pulse Nasal diphtheria: Coryza with increasing viscosity, Immunize with three doses of Diphtheria, Pertussis, and Tetanus (DPT) toxoid at 4-6 weeks intervals and then booster doses the following year after the last dose of primary series and another dose on the 4th or 5th year of age to all infants (6 weeks) and children. existaxis, low-grade fever, whitish-gray membrane may appear on nasal septum Laryngeal diphtheria: fever, harsh voice, barking cough, respiratory difficulty with inspiratory retraction ANTHRAX Bacillus anthracis 9 hours- 2 weeks CHOLERA Vibrio cholerae Few hours to 5 days; usually 1-3 days Stool positive stage Carrier may have organism for several months Direct contact Indirect contact Airborne Fecal- oral Cutaneous form: Characterized by itching, presence of papules which become vesicles that evolve to depressed black eschars. These become painful lesions, which if untreated, cause death. Inhalational Form: Characterized by mild symptoms like that of common upper respiratory tract infection; after 3-5 days, symptoms become acute, with fever and shock resulting to death. Gastrointestinal form: Characterized by violent gastroenteritis, vomiting, bloody stools leading to death Sudden onset of acute and profuse colorless diarrhea, vomiting, severe dehydration, muscular cramps, cyanosis, collapse (severe cases) Instruct clients on milk pasteurization. Treatment: Diphtheria antitoxin, antibiotics (penicillin or erythromycin), tracheotomy, if airway obstruction occurs. Immunize high risk with cell free vaccine Conduct health education on handling potentially contaminated articles of anthrax transmission, care of skin abrasions, and personal cleanliness. Prompt and continuous immunization of animals at risk Treatment: High dose penicillin Conduct stool examination of all the contacts and treatment as well if found positive Hospitalize patient for proper isolation as well as for prompt and competent medical care Explain treatment such as rehydration or replacement of lost fluids and electrolytes (NaCl, K, and bicarbonate) Treatment: Isotonic saline solution, isotonic sodium bicarbonate or sodium lactate or oral glucose electrolyte solution, Docycycline (severe cases) DOH Program: Integrated Management of Childhood Illnesses; Oresol Therapy PERTUSSIS Hemophylus pertussis or Bordet gengou or Bordetella pertussis, or pertussis bacillus 7-14 days 7 days after exposure to 3 weeks after typical paroxysms Direct Indirect through solid linens Droplet Stage I (Catarrhal stage): Coryza, sneezing tearing, tickling/ dry cough, fever, loss of appetite Stage II (Paroxysmal stage): Severe, violent coughing in clusters leading to vomiting, cyanosis, exhaustion Stage III (Convalescent stage): Decrease coughing attacks but return with each respiratory infection Routine immunization of DPT to all infants given starting at 1 ½ months, once month for three months consecutively, booster at two years and four to five years of age Segregation of the patient until after three weeks from the appearance of paroxysmal cough Conduct health education Follow the general care for nose and throat discharges Train parents on handling an infant or a child during paroxysmal cough, e.g. giving abdominal support Modify diet if patient vomits after cough paroxysms Treatment: DPT vaccine, antibiotics (erythromycin and ampicillin), corticosteroids DOH Programs: Expanded Program for Immunization PNEUMONIA Streptococcus pneumonia Staphyloccocus aureus Haemophilus influenzae Klebisiella pneumoniae 1-3 days Droplet Indirect through contaminated objects Rhinitis/ common cold, chest indrawing, rusty sputum, productive cough, fast respiration, high fever, vomiting at times, convulsions, flushed face, dilated pupils, severe chills (young children), pain on Advise bed rest Provide a diet with adequate salt, fluid, calories, and vitamins. Perfom tepid sponge bath (for fever). Advise the client to turn from side to side, frequently. Treatment: Cotrimoxazole, amoxicillin, procaine penicillin affected lung, highly colored urine with reduced chlorides, increased urates BACILLARY DYSENTERY 27 zero-types of germs Shigella (dysentery bacillus) Four main groups: S. Flexneri, S. Boydii, S. Sonnei, S. Dysenterae TYPHOID FEVER Salmonella typhosa, typhoid bacillus MENINGITIS Neisseria miningitidis 7 hours to 7 days; average of 3-5 days 5-40 days; average of 10-20 days 1-10 days During acute infection until feces are negative of the organism Some remain carriers for 2 years As long as patient excretes organism DOH Program: Integrated Program for Childhood Illnesses Ingestion of contaminated food/ water Flies Fecal- oral Fever and headache Cramping and abdominal pain Persistent diarrhea (passage of varying amounts of blood, mucus and pus) Profound prostration Encourage medical care for any case of diarrhea Obtain stool specimens from a person with undiagnosed diarrhea and request examinations for pathogens. Encourage the patient to eat the therapeutic diet (low fiber, liberal fluids). Treatment: Ampicillin, tetracycline, cotrimoxazole (severe cases) DOH Program: Integrated Management of Childhood Illnesses Fecal-oral Ingestion of contaminated food, water, milk Continued fever, malaria, anorexia, slowed pulse, involvement of lymphoid tissues particularly ulceration of Peyer’s patches, enlargement of spleen, rose spots on trunks, diarrhea Ask the family to report any bleeding in the rectum, blood in stools, sudden acute abdominal pain, restlessness, falling of temperature to the physician. Take TPR (Temperature, Pulse and Respiration) and train the family on taking and recording the same. Demonstrate the procedure of bedside care like tepid sponge bath, feeding, changing of linen, use of bedpan, and mouth care. Hospitalize the patient, if necessary. Respiratory droplet Direct invasion through otitis Assess neuro vital signs Monitor fluid balance Position carefully to prevent joint stiffness and neck pain Fever Brudzinki’s sign Kernig’s sign Opisthotonus Nuchal rigidity Exaggerated symmetrical deep tendon reflexes media LEPTOSPIROSIS Leptospira interrogans 6-15 days 10-20 days after onset Ingestion or contact with nonintact skin and mucous membrane by infected urine or carcasses of wild and domestic animals Adequate nutrition and elimination Aseptic technique Isolation if nasal culture is positive Treatment: IV antibiotics (ampicillin, cephalosporin, aminoglycosides) Leptospiremic Phase: Presence of leptospires in the blood and cerebrospinal fluid, with abrupt onset of fever, headache, myalgia, nausea, vomiting, cough, chest pain Immune Phase: Appearance of circulating IgM Conduct health educationon topics such as rat eradication, keeping the surrounding’s clean Investigate contacts and source of infection Treatment: Penicillin, other related B-lactam antibiotics, tetracycline (doxycycline), erythromycin (in patients allergic to penicillin) Viral Infections AGENT DENGUE FEVER Dengue virus Types 1,2,3,4 and chikungunya virus INCUBATION PERIOD PERIOD OF COMM MOT CLINICAL MANIFESTATIONS NURSING INTERVENTIONS 3-14 days; commonly 7-10 days Infective to mosquito from a day before the febrile period to the end of it Mosquito becomes infective from day 8-12 after the blood meal and all throughout life Bite of an infected mosquito (Aedes aegypti, Aedes albopictus, Aedes polynensis, Aedes scutellaris simplex) First 4 days (Febrile or invasive stage): high fever, abdominal pain and headache, later flushing which may be accompanied by vomiting, conjunctival infections and epistaxis 4th-7th day (toxic or hemorrhagic stage): lowering of temperature, severe abdominal pain, vomiting and frequent bleeding in the GI tract Isolate the patient. Conduct epidemiological investigation. Immediately refer all cases, slight or severe, that exhibit symptoms of hemorrhage from any part of the body to the nearest hospital. Organize health education programs on environmental sanitation particularly on eliminating mosquitoes. Investigate the cause of the disease. Keep the patient at rest. Maintain an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through an ice bag over the forehead (nose bleeding) in the form of hematemesis and melena, unstable BP, narrow pulse pressure and shock; death may occur 7th-10th day (convalescent or recovery stage): generalized flushing, regained appetite, stable blood pressure) MEASLES Filtrable virus of measles INFLUENZA Influenza virus A, B, C 10-12 days (longest is 20 shortest is 8 days) 24-48 hours 4 days before and 5 days after the appearance of rashes Until 5th day of illness and up to 7 days in children Place an ice bag on the abdomen (melena) Advise to avoid unnecessary movement Observe signs of deterioration (shock) like low pulse, cold clammy skin, and prostration. Prevent shock by preparing the patient mentally and physically and providing warmth through lightweight covers Encourage the patient to follow a therapeutic diet i.e. low fat, low fiber, nonirritating, and non- carbonated Droplet Indirect through articles/ fomites freshly contaminated with secretions of infected persons Fever, rashes, coryza, presenc of Koplik’s spots on the cheeks and morbiliform rash affecting the face, body and extremities ending in branny desquamation (3rd or 4th day) Emphasize the significance of immediate isolation when early catarrhal symptoms appear. Explain the importance of taking the immune globulin (gamma globulin). Refer to a physician or clinic providing this service. Protect eyes of patients from bright lights. Put the patient in a wee-ventilated room free from drafts and chilling to avoid complications of pneumonia. Monitor correct technique of giving sponge for comfort of patient Prepare treatment and medication made by the physician. Airborne Direct contact with droplet Sudden onset of fever (39ºC- 40ºC), malaise, sore throat, cough, rhinorrhea, headache, myalgia Gastrointestinal symptoms: Nausea, vomiting, abdominal pain, diarrhea Quarantine the patient during the acute stage. Immediately report the cases to local health officer. Instruct the client on proper sneezing and coughing techniques as well as proper disposal of contaminated objects Keep the patient warm and without drafts in bed. Use lukewarm sponge for fever. Advise patients to stay in bed during epidemics. Treatment: Aspirin or acetaminophen in children (uncomplicated cases), amantadine, oseltamivir phosphate, zanamivir (antiviral agents) SEVERE ACUTE RESPIRATORY SYNDROME SARS CoV, new virus from Coronavirus family HEPATITIS A Hepatitis virus A 2-10 days after exposure to a SARS case 15-60 days; average 30 days Person-to-person through respiratory droplets Direct contact with body fluids of an infected person Fomites or orofecal spread, aerosol transmission (uncommon) 1 week before and 1 week after the appearance of symptoms Fecal-oral, poor sanitation, personto-person, waterborne, foodborne (shellfish), blood transfusion Prodromal period: Sudden onset of fever: (>38ºC), cough, myalgia, chills, headache and body malaise Lower Respiratory Phase: Severe, dry, non-productive cough, shortness of breath and/or difficulty in breathing, progressing to hypoxemia Laboratory Findings: CXR may be normal (febrile prodrome), may show early infiltrates progressing to more generalized patchy, interstitial infiltrates; respiratory distress syndrome (severe cases); low white cell and platelet count and abnormal liver function (some) Other symptoms: muscular stiffness, confusion, dizziness, rash, night sweat, nausea, diarrhea Body malaise, headache, anorexia, abdominal pain, nausea and vomiting, fever, lymphadenopathy, Precautions, written below must be taken when entering all ICU, MICU, CCU, SICU, and respiratory therapy units, regardless of whether the hospital or unit is known to have SARS cases. Leave all personal belongings, not relevant to the visit in the unit. Before entering the unit, wear N95 or FFP-1 grade mask, eye protector (goggles), hair cover or cap, long sleeves solid front disposable laboratory gown, rubber gloves (in handling equipment), and shoe cover. Spread paper towel on the working surface. Sterilize equipment according to hospital procedures by a member of the ICU staff before returning it to the office. Give immune globulin intramuscularly or subcutaneously within a few days of exposure. Use hand gloves in handling bedpans and fecalcontaminated linens Advise the patient to rest during acute or symptomatic stage (rare) RABIES Rhabdovirus 1 week- 7 days and half months in dogs 10 days-15 years in human 3-5 days before the onset of symptoms until the entire course of illness Bite of infected animals jaundice, clay-colored stools Incubation Period: Signs of inflammation and wound healing Prodrome (2-10 days non-specific): Malaise, anorexia, fatigue, fever, headache, apprehension, anxiety, agitation, irritability, depression, insomnia Acute Neurologic/ Excitation Stage (2-7 days): Observe signs of CNS involvement like hydrophobia, hyperactivity, aphasia, disorientation, hallucinations, seizures, bizarre behavior, nuchal rigidity, increased deep tendon reflexes Paralysis Stage: Coma and/or sudden death VARICELLA Herpes virus varicellae 10-21 days direct contact with vescicles of infected patients indirect through linens and fomites airborne-droplet Pre-eruptive stage: mild fever and malaise Eruptive stage: Rash starting from the trunk spreading to the other parts of the body Red papules where contents become milky and pus-like in 4 days Vescicular lesions which are pruritic Treatment: Gamma globulin vaccine Know the history of exposure and development of characteristic symptoms. Note for the presence of rabies antibodies in the patient’s blood and Negri bodies in samples of brain tissue of infected animal. Immediately wash the wound and the surrounding area with soap and water. Bring the patient to Emergency Department for further cleansing and flushing of wound. Administer tetanus prophylaxis and antibacterial therapy, as required. Recommend the use of active and passive immunization. Treatment: Antiseptics (povidone iodine, alcohol), tetanus-diphtheria vaccine, rabies immune globulin (Rig), human diploid cell vaccine DOH Program: National Rabies Prevention and Control Program Respiratory isolation Proper hygiene Disinfect linens under the sunlight or through boiling Cut fingernails short Pruritus control Treatment: Zoverax, Acyclovir, Antipyretic Parasitic Infections AGENT SCHISTOSOMIASIS Schistosoma japonicum S. mansoni S. haematobium PARALYTIC SHELLFISH POISONING Pyromidium bahamamense var. compressum INCUBATION PERIOD 2 mos GIT MOT ingestion of contaminated water direct contact with open skin through an intermediate host (oncomelania quadrasi) diarrhea, bloody stools, enlargement of abdomen, splenomegaly, weakness, anemia, inflamed liver Eating of raw or insufficiently cooked Numbness of the face, particularly around the mouth, vomiting, seafood ( shellfish, mollusks) during red tide season PARAGONIMIASIS Paragonimus westermani HELMINTHIASES a. Hookworm infestation Ancylostoma duodenale b. Roundworm infestation Ascaris lumbricoides CLINICAL MANIFESTATIONS GIT Eating raw/ half- done crab’s meat Skin (bare feet) GIT Direct contact through skin of foot Fecal-oral NURSING INTERVENTIONS Examine contacts for infection from a common source Convince the people to have a stool examination annually Treatment : Praziquantel, Oxam niquine (S. mansoni), Metrifonate (S. haematobium) dizziness, headache, tingling sensation, paresthesia, eventual paralysis of hands and feet, floating sensation, weakness, rapid pulse, ataxia, dysphagia (severe cases) total muscle paralysis with respiratory arrest resulting to death Induce vomiting Remind the people on the following: a. b. Bivalve mollusks (talaba, halaan, kabiya, abaniko) should be avoided during red tide season. Vinegar hastens Pyromidium (toxin) production; cooking does not completely destroy the toxin Cough (long duration), coughing Treat infected person. out of blood/ blood streaked Dispose human feces properly. sputum Treatment: Praziquantel and Bithionol a. Hookworm infestation Irritation, pruritus, and edema at the site of entry with pustule formation, pneumonitis, hemorrhage with fever, sore throat, crackles and cough, fatigue, nausea, weight loss, dizziness, melena, uncontrolled Treat infected individual Conduct health education on personal hygiene, proper feces disposal, and proper handling, processing, and serving of pork and its products. Encourage the use of shoes and slippers in walking on the soil. Discourage use of night soil and sewage effluents as fertilizer. FILARIASIS Wuchereria bancrofti Brugia malayi Brugia timori SCABIES Sarcoptes scabiei Skin Skin Mosquito (Aedes poecillus) bite Direct contact with infected individuals, their clothes and bedding Crowding and lack of personal hygiene (predisposing factors) diarrhea, and anemia, which may lead to cardiomegaly, heart failure and massive edema b. Roundworm infestation Vague stomach discomfort (mild), stomach pain (severe), vomiting, restlessness, disturbed sleep, intestinal obstruction (extreme cases), pneumonitis (due to migration of larvae to the lungs) Provide foods rich in iron to treat muscle wasting and anemia of the patient (hookworm disease). Follow-up stool examination 1-2 weeks after the treatment (ascariasis). a. Asymptomatic Stage Presence of microfilariae in the blood No clinical signs and symptoms for years or for life Others progress to chronic and acute stages Increase in microfilariae b. Acute Stage Lymphadenitis Lymphangitis Funiculitis Epidydimitis Orchitis c. Chronic Stage Hydrocele Lymphedema Elephantiasis Advocate control of vector through implementation of environmental sanitation and use of insecticides Primary Symptom: severe itching, specifically at night Frequent scratching leads to secondary skin infection (feels hot and burning , a minor discomfort) Wide skin area is infected Treatment: Mebendazole Treatment: Diethylcarbamazine Citrate (DEC) Examine the whole family for infection. Follow the general guideline for control of infectious diseases. Monitor the lesions in infected areas and systemic manifestation of infection. Advise the client to consume a diet rich in Vitamins A and C. with severe secondary infection: fever, headache, malaise, secondary dermatitis Destroy the parasite to relieve itching as well as to lessen skin irritation. a. Wash with soap and water; soak, scrub skin to remove scaling and crusting debris. b. Apply a scabicide like Lindane 1% (Kwell), Crotamiton, 6-10% precipitate of sulfur in petrolatum, benzyl benzoate emulsion for a more rapid effect. c. Instruct client or parents to launder all clothing and bedding with enough heat to kill mites. d. Use topical antipruritic to control itching two to three weeks after destruction. Sexually Transmitted Diseases AGENT AIDS/HIV Retrovirus (Human T-cell lymphotropic virus 3 or HTLV-3) MOT CLINICAL MANIFESTATIONS NURSING INTERVENTIONS Skin contact Blood transfusion Contaminated syringes, needles, nipper, razor blades Direct contact with open Wounds or mucous membrane with contaminated blood, body fluids, semen, vaginal discharges Prodrome: Fatigue, malaise, fever, weight loss, lymphadenopathy, persistent diarrhea, recurrent oral thrush, extensive herpes of mucus membranes, folliculitis, blue or brown spot on skin (may indicate Kaposi’s sarcoma) Appearance of Disease: Pulmonary syndrome (dyspnea, hypoxemia, chest pain, pulmonary infiltration), CNS syndrome (dementia, confusion, headache, neurologic symptoms), GI syndrome (diarrhea, weight loss, colitis), fever of unknown origin, malignancies (Kaposi’s sarcoma) Participate in prevention, case-finding and supportive care during management of AIDS cases. Protect oneself form being infected through Careful handling of sharp instruments contaminated with potrentially infectious material from AIDS patients Preventing contact of open skin lesions with material from AIDS patients. Wearing gloves and gowns as protection from contamination Thorough washing of hands immediately after contact with patients Label contaminated blood and specimens. Clean blood spills with a disinfectant solution like sodium hypochlorine (household bleach). Place contaminated articles in impenetrable bag and label properly. Place needles in a puncture resistant container. Disposable needles are preferred. Treatment: Reverse Transcriptase inhibitors, Protease inhibitors. DOH Programs: 4C’s in the Management of AIDS Compliance Counseling Contact tracing Condoms GONORRHEA Neisseria gonorrheae SYPHILIS Treponema pallidum Sexual activity, orogenital and/or anogenital contacts Incubation period: 3-21 days; average of 3-5 days Period of comm.: as long as the microorganism is present Women: vaginal discharge/ abnormal uterine bleeding, urinary frequency and pain, pelvic infection, nausea and vomiting, fever, abdominal pain/ tenderness, disseminated gonococcal infection Men: Acute anterior urethritis, purulent discharge followed by painful urination, spread of infection to posterior urethra, prostate, seminal vescicles and epidydimis, prostatitis, pelvic pain, fever, epidydimitis, post gonococcal urethritis and urethral stricture Anorectal Manifestations: Anal and rectal burning, itching, bleeding, mucopurulent discharge or painful defecation (may be asymptomatic) Pharyngeal Manifestations: Sore throat but may be asymptomatic Adult Gonococcal Conjunctivitis: (Gonococci usually reach the eyes through the fingers Sexual contact Blood transfusion Transplacental route Incubation period: 10-90 days. Average of 3 weeks. Period of comm.: variable and indefinite Primary Syphilis: Appearance of a painless, firm and smooth chancre at the inoculation site, regional lymphadenopathy, early invasions of the blood Secondary Syphilis: Healed chancre, widespread skin (palms and soles) and mucous membrane rash, presence of treponema in lesions, lymphadenopathy, fever, involvement of various organs such as liver, eyes, bones, and CNS Latent Syphilis: Absence of clinical symptoms, (+) serological test for the organism Tertiary Syphilis (5-30 years after the primary syphilis): Paralysis, delusions, blindness, deafness, tabes dorsalis gait, cardiovascular abnormalities, presence of gummata Congenital Syphilis: Miscarriage, stillbirth, bone malformation, widespread skin rash, meningitis, Follow the nursing interventions in the Nursing Process for Control and Management of Infectious Diseases. Advocate regular check-ups for persons at risk. Treatment: Ceftriaxone, Doxycycline, Penicillin Universal precautions In secondary syphilis, keep lesions dry IN Cardiovascular syphilis, Check CV status In neurosyphilis, Check LOC, and neurovital signs Encourage patient to have a post treatment followup. VDRL testing Treatment: Penicillin G hepatosplenomegaly CHLAMYDIA Chlamydia trachomatis Sexual and congenital contact ( children born from infected mother may acquire associated conjunctivitis, otitis media, and pneumonia during vaginal delivery). Women: slight vaginal discharge (sometimes), itching and burning of vagina, painful intercourse, abdominal pain, fever (late stages) Men: Discharge from penis, burning and itching of urethral opening, burning sensation during urination Control the discomfort and improve the fluid and nutritional status. Give analgesics for abdominal discomfort. Apply heat to the abdomen externally and warm douches vaginally as prescribed to improve circulation. Control the infection. Follow the guidelines for asepsis. Give appropriate antibiotics and chemotherapeutic agents as prescribed. Place the patient in a Semi-fowler’s position to facilitate drainage. Discourage use of tampons. Monitor and document the progress of the patient (vital signs, responses to therapy, nature and amount of vaginal discharge. Disinfect utensils, bedpans, toilet seats, and linens. Encourage use of contraceptives after the completion of treatment. Prevent complications from untreated or recurrent infection. Treatment: Doxycycline, Azithromycin TRICHOMONIASIS Trichomoniasis vaginalis HEPATITIS B Hepatitis B virus Sexual contact Contact with wet objects Contact with infected blood through broken skin and mucous membrane of mouth, rectum, genitals Sexual contact Using contaminated personal items (razor, Women: white or greenish-yellow odorous discharge, vaginal itching soreness, painful urination Loss of appetite, easy fatigability, malaise, joint and muscle pain, low grade fever, nausea, vomiting, right sided abdominal pain, jaundice, dark-colored urine Incubation Period: 50-189 days or 2-5 mos; average of 90 days Period of comm.: During the latter part of the incubation period and during the acute phase Same as in other STDs. Give oral medications, as prescribed by the physician. Perform the applicable guidelines in the control of infectious diseases. Immunize against Hepatitis B, particularly infants and at- risk groups, with negative HB- Ag test Practice asepsis in handling body fluids and dealing with clients nail clipper, toothbrush) that may cause skin break. Use of contaminated instruments for injection, ear piercing, acupuncture, tattooing. Use of contaminated hospital and laboratory equipment (e.g. dialysis apparatus) Prenatal transmission