Download Diphtheria - Philadelphia University Jordan

Out line
•
OBJECTIVE
•introductio
n
•History
•Diphtheria in jordan
•DEFINITION
•CAUSES
•SIGNS &
SYMPTOMS
•POSSIBLE COMPLICATIONS
•How is diphtheria transmitted
•Prognosis of the disese and Prevention
•Diagnosi
s
•Exams and
Tests
•Treatmen
t
•When was the last death from
diphtheria
•Case
study
•Nursing process
Summary
REFERANCES
OBJECTIVE
• At the end of this seminar we will be able to:
• Identify the disease, signs,symptoms, CAUSES• Know how the disease is
transmitted,treatment,complications and the
prevention methods.
• Know the diagnostic studies(testand exams).
• Know the diagnosis and prognosis of the disease
• Know the nursing role.
introduction
Diphtheria: (greek_pair of leather scroll)
From the common diseaes between
children Ancient disease
In the past its name(general
disease,killer disease )because no
treatment in the past and it was lead
high mortility between chlidren
History
• The beging of the disease :In1920 there were an
estimated 100.00to200.000cases of diphtheria per year in
U.S.A(130.00TO150.00)DEATH
• Then it go to alaska 1925
•
its enter British royal family during the late of 19th
century including(Queen victoria,prinnccess alice of Hesse
and her family all died in diphteria
• We present 2 case reports in the United States(2008)
fatal case occurred in a 75-year-old male.
• A second, nonfatal case occurred in a 66-year-old female
who received erythromycin and diphtheria antitoxin .
History
• . For 1993, WHO received reports of
15,211 diphtheria cases in Russia and 2,987
cases in Ukraine. The main reasons for the
return of diphtheria in these countries
were: 1-decreasing immunization coverage
among infants and children
2- movements of the population during the
last few years,
3- and an irregular supply of vaccines
Diphtheria in jordan
• Twenty-seven cases of diphtheria (15 male, 12
female) admitted over a 2-year period, 19771978, at the Jordan University Hospital were
reviewed. The majority were admitted during
autumn and were in the 2-9-year age group.
Eleven patients were not vaccinated and six were
questionably vaccinated
. One patient died with upper airway obstruction, four
died with myocarditis, and three patients died with
the respiratory complications of polyneuritis
DEFINITION
• An acute, highly contagious bacterial
throat infection.
• BODY PARTS INVOLVED--Throat; skin;
heart; central nervous system
• SEX OR AGE MOST AFFECTED--Older
children (5 years and up), adolescents and
adults .
CAUSES-• A bacteria, Corynebacterium
diphtheriae, infects the throat and
sometimes the skin. The bacteria
produces poisons that spread to the
heart, central nervous system and
other organs .
Corynebacterium
Corynebacterium
SIGNS & SYMPTOMS
• Sore throat, which may range from mild to severe
with painful swallowing, hoarseness. Drooling suggests
that airway obstruction is about to occur .
• Fever and chills .
• Bloody, watery drainage from nose .
• Croup-like (barking) cough .
• Stridor, difficulty breathing or rapid breathing.
Absent breathing (apnea) may occur. Bluish coloration
of the skin may be caused by lack of oxygen .
Pt with diphteria
Pt with diphteria
POSSIBLE
COMPLICATIONS:-
•
• Heart inflammation and heart failure
• Suffocation
• Nerve inflammation Severe nerve
damage can cause paralysis
• Kidney damage or nephritis may also
occur.
If the skin is affected there may be
an
ulcer
that does not heal.
Diphtheria skin lesion on
the neck
A diphtheria skin lesion
on the leg.
How is diphtheria
transmitted
• Diphtheria is found only in humans and is
usually transmitted by respiratory droplets
from infected persons or asymptomatic
carriers, but can be transmitted by
contaminated objects or foods (such as
contaminated milk). Diphtheria is contagious
and can be passed from person to person
through the tiny droplets in sneezes and
coughs. It can be spread by close, prolonged
contact (for example in the home) or by close
face-to-face contact with an infected person.
The incubation period is 2 to 5 days
(Prognosis)
• Diphtheria may be mild or severe. Some
people may not have symptoms. In others,
the disease can slowly get worse.
• The death rate is 10%. Recovery from the
illness is slow
(Prevention):• Routine childhood immunizations and adult
boosters prevent the disease
Exams and Tests
The health care provider will perform a physical
exam and look inside your mouth. This may reveal
a gray-to-black covering (pseudomembrane) in the
throat, enlarged lymph glands, and swelling of the
neck or larynx.
Tests used may include:
Gram stain or throat culture to identify
Corynebacterium diphtheriae
Electrocardiogram (ECG)
Diagnosis
• The diagnosis is based on the symptoms that you have
been experiencing and the physical signs, for example,
the grey throat membrane and swollen neck.
• If your doctor thinks you may have diphtheria, swabs will
be taken from your nose, throat and any skin wounds,
cuts or ulcers so that the infection or bacteria can be
examined under the microscope in a laboratory. If the C.
diphtheria bacteria is found so the doctor can establish
how the illness may progress and if there are any risks
to anyone the infected person has been in contact with.
• Antitoxin treatment is given within the first 48 hours of
symptoms developing and a blood sample is also needed
to measure your antibodies to the diphtheria toxin
(poison).. A second blood sample will be taken a couple of
weeks later to measure the antibodies again
Treatment
•
Diphtheria anti-toxin is given as a shot into a muscle or through
an IV The infection is then treated with antibiotics, such as
penicillin or erythromycin.
• People with diphtheria may need to stay in the hospital while the
anti-toxin is being received. Other treatment may include:
1- Fluids by IV
2- Oxygen
3- Bed rest
5- Insertion of a breathing tube
blockages
•
.
4- Heart monitoring
6- Correction of airway
Anyone who has come into contact with the infected person
should receive an immunization or booster shots against
diphtheria. Protective immunity lasts only 10 years from the time
of vaccination, so it is important for adults to get a booster of
tetanus-diphtheria (Td) vaccine every 10 years.
Diphtheria Antitoxin
When was the last death from diphtheria in
someone who acquired the infection
indigenously or elsewhere?
The last death from indigenous diphtheria caused by –
C diphtheriae was in 1982, in a three-year-old child
who had not been immunised.
In 1994 a 14-year-old boy died after contracting –
the disease in Pakistan. His vaccination status was
unknown, but it is unlikely that he had been
immunised.
There have been two recent deaths, one in 2000 and –
one in 2006, caused by the C ulcerans bacteria. Both
were elderly unvaccinated women.
Case study
A 64-year old male reports to your practice
with fever, malaise and a cough.. His
condition worsens over several days, with
his temperature increasing to 40.4C and
development of dyspnea (difficulty of
breathing.) where laboratory analysis
reveals abnormal liver and kidney
function. His lungs show signs of mild
inflammation with watery secretion
Nursing process
1. Diagnosis:
Ineffective air way clearance related
to secretion as evidenced by
ineffective cough and dyspnea.
Goal: at the end of this shift the pt. will
be able to demonstrate effective
coughing and increase air exchange
Intervention
• Position to alleviate dyspnea (eg. Head of
bed elevated 30-40degrees )To allow
maximum lung expansion and More forceful
cough.
• Remove secretions by encouraging
coughing or by suctioning to clear air way
2.Diagnosis:.
• Ineffective breathing pattern
related to the mild inflammation of
the lungs as evidenced by dyspnea.
• Goal: at the end of this shift the pt.
will be able to demonstrates an
effective resp. rate .(18 breath\min)
Intervention
• Monitor resp. rate and oxygenation status
to determine change in status.
• Initiate supplemental oxygen to improve
respiratory status.
• Administer medications (bronchodilators)
that promote airway patency and gas
exchange.
3- Diagnosis
• hyperthermia related to inflammation as
evidenced by vital sign(temp.40.4C)
GOAL: at the end of this shift the pt.temp
will be decreased 1C with my assistance.
Intervention
• Monitor vital sign every 2 hrs.
• Apply warm compression
• give medication as doctor order
(antipyrtic).
Summary
• Diphtheria An acute, highly contagious bacterial throat
infection.
A bacteria, Corynebacterium diphtheria, infects the throat and sometimes the skin
SIGNS & SYMPTOMS:- .Sore throat, hoarseness. Drooling
Fever and chills
Heart inflammation and heart failurNerve
COMPLICATIONS:
Severe nerve damage can cause inflammation
paralysis
.Kidney damage or nephritis may also occur
How is diphtheria transmitted:- is usually transmitted by respiratory
droplets from infected persons or
asymptomatic carriers, but can be
transmitted by contaminated objects
or foods
Summary
(Prognosis):- Diphtheria may be mild or severe. Some people may
not have symptoms
(Prevention):- •Routine childhood immunizations and adult boosters
prevent the disease
Exams and Tests:- Tests used may include:
Gram stain or throat culture to identify
Corynebacterium diphtheriae
Electrocardiogram (ECG)
Treatment:•Diphtheria anti-toxin is given as a shot into a
muscle or through an IV The infection is then
treated with antibiotics, such as penicillin or
erythromycin.
REFERANCES
1.
www.cdc.gov/epo/dphsi/casedef/diphtheria current .htm
2.^ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology,
4th ed., McGraw Hill, 299–302. ISBN 0838585299.
3.^ Office of Laboratory Security, Public Health Agency of Canada
Corynebacterium diphtheriae Material Safety Data Sheet. January
2000.
4.^ a b c d Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds.
(2007). Diphtheria. in: Epidemiology and Prevention of VaccinePreventable Diseases (The Pink Book), 10, Washington DC: Public
Health Foundation, 59-70.