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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.