COMMUNICABLE DISEASE o Diseases common during the rainy season of the

year
» Leading causes of morbidity - communicable • Wild diseases:
diseases a. Water-borne diseases (such as dysentery,
cholera or typhoid fever)
» Communicable diseases – this refers to diseases that
b. Influenza
is brought about by an infectious agent or its toxic
c. Leptospirosis
products that is transmitted directly or indirectly to a
d. Dengue
person, animal or intermediate vector under
conducive environment à reflects the ECOLOGIC
CONTAGIOUS VS. INFECTIOUS [2 Major
TRIAD of DISEASE CAUSATION
Classifications of Communicable Diseases]
» Infectious Agent or its toxic products – AGENT
Contagious
» Diseases that are easily spread directly transmitted
o Pathogenic organism (bacteria, virus, fungi,
from person to person (direct contact) through an
protozoa, or the toxin being produced by the
intermediary host.
pathogenic agent).
Infectious
o Agent – causes/ serves as a stimulus to the
» Diseases that caused by a pathogen not transmitted
development of diseases
by ordinary contact but require a direct inoculation
through a break in the skin or mucous membrane.
» Directly or Indirectly – MODE OF
TRANSMISSION
• Transmitted via indirect contact (through an
inanimate object)
o Person, Animal or Intermediate Vector – HOST
• Skin – open wound à portal of entry of
o Most common: human beings/ person pathogenic organism à may cause infection
• The first line of defense of the body against
o Not limited to humans à these pathogenic infectious microorganism is through an
organisms may stay in other biological beings, intact skin à when handling pts. with
such as animals à (diseases acquired through communicable diseases, one way to protect
animals source/host of pathogenic organism) – oneself is through the use of gloves (serve as
though not all diseases can be acquired through initial barrier against pathogenic organism)
animal-to-human/person transmission. Note: all communicable diseases are infectious but most and not
all are contagious
o Most often, these are acquired through other human
beings in different modes (can be direct or
indirect contact to human beings) CHAIN OF INFECTION

AGENT
» Environment – ENVIRONMENT
Bacteria, Virus, Fungi,
o Milieu which provides opportunity for this Protozoa, Toxins
pathogenic organism to transfer to human being Susceptible Host Reservoir
to produce and cause a disease condition.
Age, Nutritional Status, Level of Stress, Respiratory Tract, GI Tract, Urinary
Underlying Disease, Medical Treatment Tract, Reproductive Tract, Blood
o Example, certain diseases common during the hot/
summer season of the year
• Chicken pox Portal of Entry Portal of exit
• Measles
Nose/Mouth, Urethral Meatus, Nose/Mouth, Urethral Meatus,
• Conjunctivitis Vagina, Open wound Vagina, Open wound

Mortal of transmission

Direct Contact, Indirect Contact, Airborne, Droplet, Vector

J. Marquez | COMMUNICABLE DISEASE NURSING

 CHAIN OF INFECTION
MOD
1. AGENT
» Direct contact – person to person
» Pathogenic agent – serves as a stimulus in the transmission
development of communicable diseases. CONTACT
» Indirect contact – through an
» Bacteria, virus, fungi, protozoa or the toxins inanimate object
» The size of the microorganism is
being produced by the pathogenic agent. AIRBORNE <5 microns. It’s so minute that it
can travel beyond 3 feet distance.
» Among these pathogenic agents, the most » The size of the microorganism is
common causes are the bacteria and viruses >5 microns. The organism can be
(highly pathogenic by nature) DROPLET acquired if you have exposure to
that individual within 3 feet
distance.
o Bacteria – specific Tx – part of the » Common vehicles of transmission
management involves administration are food or water. Vehicles (food/
of antibiotics water) are contaminated with the
pathogenic organism.
o Virus – no specific treatment à can VEHICLE
» Water-borne diseases – can be
administer antiviral agents that inhibits acquired via ingestion of
the replication of the viruses. But the contaminated food or water with
management would focus on the feces of infected individuals
fecal-oral mode of transmission
symptomatic management (based on » Common vectors of transmission
the signs and symptoms manifested by of these pathogenic organisms are
the infected individual) insects (e.g., dengue hemorrhagic
fever – can be acquired via a bite
o Toxin – administration of antitoxin of an infected mosquito with a
dengue virus)
which provides immediate protection
to the infected individual à short-term » Animals, generally, are vectors of
immunity (artificial passive immunity) VECTOR diseases

» In the chain of infection, the Mode

2. RESERVIOR
of Transmission is the weakest
» Pertains to the body organs or systems affected element.
by the pathogenic organism.
» To prevent infection,
» They are interrelated with the portal of exit. interrupt/avoid the MOT of these
pathogenic organisms.

3. PORTAL OF EXIT
» Nose/mouth, Urethral meatus, Vagina, Open They can stay in the air environment
à these microorganisms may enter
Wound through respiratory route causing
infection.
» Respiratory tract à portal of exit: nose/ mouth
à diagnose through sputum microscopy/
5. PORTAL OF ENRTRY
culture of secretions
» Nose/ Mouth, Urethral meatus, Vagina, Open
wound.
» GI tract à anus à Fecalysis
6. SUSCEPTIBLE HOST
4. MODE OF TRANSMISSION
» Susceptibility of the host
» Refers to how this pathogenic organism can
enter through a susceptible host. There are
a) Age
several ways:
o Those who are severely young
(underdeveloped immune system) or severely
old (degenerative changes in older adults /
Senior citizens).

J. Marquez | COMMUNICABLE DISEASE NURSING

 o If the body is able to fight the disease, proceed
b)Nutritional Status to convalescent stage of the disease wherein the
o Undernourished symptoms will start to disappear.

o One of the indications for immunization is o Able to fight the disease à convalescent
malnutrition – highly at risk for acquiring
diseases. o Not able to fight the disease à complications
& death
c) Level of stress
INFECTIOUS AGENT
d) Underlying disease
FACTORS THAT AFFECT THE AGENT TO
o Presence of comorbidity or an underlying DEVELOP A DISEASE
disease condition
1) Pathogenicity
e) Medical Treatment » The ability of the microorganism to cause an
o E.g., if they are undergoing Tx/ receiving infection.
chemotherapy – chemotherapeutic agents
attack not only the abnormal cells but as well o Bacteria and viruses are highly pathogenic by
as the normal cells nature – high chance of causing a disease.

STAGES OF INFECTION 2) Infective dose

» The number of microorganisms to cause an
1) Incubation infection.
» Agent enters until onset of first symptoms
o General rule: the greater the number of
o Refers to the time wherein the pathogenic agent microorganisms, the higher the chances to
enters the body and develop the first/ initial develop the infection.
signs and symptoms.
3) Virulence
o Each disease condition has different incubation » The ability of the microorganism to enter or move
period. to the body tissues and organs.

2) Prodromal o Bacteria and viruses are highly virulent à they

» Nonspecific to Specific symptoms appear (Most have the capacity to move or travel in body
Infectious) tissues and organs.

o Dysentery à bloody mucoid stool; cholera à 4) Specificity

rice watery stool
» The ability of the microorganism to resist
o Most infectious stage of infection antibodies/ antibiotics.

3) Illness/ Acme o E.g., Mycobacterium tuberculosis – high in

» Local & Systemic Symptoms evident specificity because the cell membrane of the
mycobacterium tuberculosis is made of fatty
o Time wherein the body starts to fight against acids – acid fast bacilli organism à the cell
the presence of infection local and systemic wall is made of fatty acid which renders them
symptoms. impermeable to antibiotics/ antibodies.

4) Convalescent
» Symptoms abate and return to normal

J. Marquez | COMMUNICABLE DISEASE NURSING

 MODE OF TRANSMISSION » PPE

1) CONTACT 3) Environmental Sanitation

a) Direct Contact (Person to person)
b) Indirect Contact (Inanimate object) Objectives of CCD

2) DROPLET » The objectives represent the different levels of

» < 5 microns / beyond 3 feet distance prevention: primary, secondary, & tertiary
prevention.

3) AIRBORNE o Restoration of health, reduce deaths and

» > 5 microns / within 3 feet distance disability [restore health]

» Tuberculosis, Measles, Chicken Pox, Small Pox, o Interpretation of control measures to IFC for
SARS practice to prevent spread of CD.

4) VECTOR o Promotion of health and prevention of spread

» Contaminated food/water of CD.

5) VEHICLE CONTROL OF COMMUNICABLE DISEASES [7

» Insect bites (mosquitos)/ urine of animals (Rats) strategies]
New Diseases
DEFINITION OF PREVENTION a) Notification without vaccine
(Secondary
» Aim when handling patients with CD is to prevent the b) Epidemiological Investigation Prevention
transmission of these diseases or pathogenic c) Isolation and Quarantine
organisms. • Suspected and infected
d) Medical Asepsis
» Focus à prevention • Handwashing
• Personal Protective Equipment
» A Dictionary of Epidemiology, Fourth Edition by e) Disinfection and Sterilization
John M. Last f) Immunization
g) Early Diagnosis and Treatment
o “Actions aimed at eradicating, eliminating, or
minimizing the impact of disease and I. NOTIFICATION
disability. The concept of prevention is best
defined in the context of levels, traditionally » In the hospital/ clinical setting, report to the Infectious
called primary, secondary, and tertiary Control Committee (ICC)
prevention”
» In the community setting, as a Public Health Nurse à
a) Primary – focuses on health promotion responsible for reporting communicable diseases by
and disease prevention Health Teaching virtue of Republic Act 3573 “Mandatory Reporting”

b) Secondary – early diagnosis and » CDs require immediate reporting to the District
treatment Health Offices | Health Center District Health

c) Tertiary – rehabilitation o Diseases that require weekly monitoring:

REVENTION OF COMMUNICABLE DISEASE 1. Acute flaccid paralysis (AFP) polio

» Vehicle ingestion of contaminated food and
1) Health Education water.
» Health education is an important means of preventing » 24 hours monitoring
the spread of communicable diseases. 2. Measles
» Airborne
2) Specific Protection

J. Marquez | COMMUNICABLE DISEASE NURSING

 3. Severe acute diarrhea (SAD) 3. Outbreak
4. Neonatal tetanus » There is an increase in the usual number of
5. AIDS expected cases.
» Un-notifiable Diseases.
4. Epidemic
o Diseases that require reporting w/in 24 hrs. » There is a clear excess of the disease across a
1. Acute flaccid paralysis (AFP) polio large region.
2. Measles • E.g., Number of cases exceed from the
expected number and the cases are
o Diseases targeted for eradication distributed in all regions of the
Philippines
1. Acute flaccid paralysis polio
» Through polio immunization OPV vaccine 5. Pandemic
and IPV vaccine » There is an emergence of a new disease that
spreads across multiple countries & large
2. Neonatal tetanus regions of the world.
» As part of the maternal health program of the
Philippines, administer tetanus toxoid TYPE OF EPIDEMIC ACCORDING TO SOURCE
(diphtheria vaccine) to pregnant mothers.
1. Point Source
» Tetanus for children – administration of the » Source of the disease
pentavalent vaccine Diphtheria, Pertussis,
Tetanus, Hib, & Hepatitis B vaccine » E.g., food poisoningà those persons who ingested
the food in an event or party develops an infection
3. Measles (E.g., Typhoid/ food poisoning)
» Through the administration of the AMV
given at the age of 9 months, and MMR at the 2. Propagated
age of 12 months. a) Human
o e.g., Sexually Transmitted Infection –
4. Rabies human propagated epidemic
» In rabies, the vaccine is administered towards
the animals particularly dogs and cats, and b) Vector borne
not o Vector borne propagated epidemic –
animals, particularly insects, e.g., dengue
II. EPIDEMIOLOGICAL INVESTIGATION hemorrhagic fever – the mosquito
» Patterns of Disease According to Frequency spreads the infection
[Community Burden of Disease Terms]
PATTERNS OF DISEASE ACCORDING TO TIME
1. Sporadic
» The disease occurs occasionally in small pockets. 1. Cyclical Variation
o In small number of cases » Cycle – it increases or decreases.

2. Endemic » Dengue hemorrhagic fever – dengue is high

» The disease is present within the community or during the rainy season of the year then low
region. during summer

• The disease is present in a particular region 2. Short Time Fluctuation

or location or in the community. » There is a change in the patterns of disease
• E.g., malaria over a short period of time.
• Endemic – it is persistently present in a
community or region (not necessarily high » E.g., short time interval of one year as disease
cases) occurs.

J. Marquez | COMMUNICABLE DISEASE NURSING

 3. Secular Variation 4. Health Service Data
» There is a change in the pattern of disease o Ration of HCP
over a long period of time. o Ration of Hospitals

»
E.g., smallpox – eradicated, 1978, but if Public Hospital
1 – 10,000 à Nurse à 90% Ward
there’s a sudden occurrence after a long period à 10 % Private
1 – 20,000 à Doctor
of time à secular variation - change in the
1 – 5,000 à midwife
frequency of the disease over a long period of Private Hospital
time. à 10 % Ward
à 90 % Private
TYPES OF EPIDEMIOLOGY
III. ISOLATION AND QUARANTINE
1. Descriptive Epidemiology
» Study/ Describe the patterns of diseases 1. Isolation
» Separate the “infected” individual.
2. Analytic Epidemiology o How long?
» Study the factors which causes the development à depend on communicability period of the
or distribution of the disease. disease
à depend on the prodromal stage of the
3. Therapeutic/ Clinical disease
» Study the effectiveness of a treatment/ intervention
» Confirmed disease – isolation
» The use of tawa-tawa grass (Euphorbia hirta) in
the treatment of dengue fever, particularly in rural » Basis of the isolation period convalescent stage
areas when the patient is no longer manifesting the signs
and symptoms
» Study the effectiveness of the different vaccines
against COVID-19 infection 2. Quarantine “FIRST STEP”
» Limit the movement of “suspected” individual.
4. Evaluation Epidemiology o In order to observe for developing signs and
» Evaluate or study the effectiveness of a particular symptoms
health program. o How long?
à depend on the incubation period the days
» E.g., the DOTS (Directly Observed Treatment of quarantine.
Short-Course Chemotherapy) program of the » Suspect
government to fight against TB | effectiveness of
the COVID-19 control program » Basis of the quarantine period is the incubation
period of the disease.
Conducting Epidemiology o Expose to the person who are infected.
Evaluation:
(What, When, Where, Who) 3. FACTORS AFFETING ISOLATION (Source:
Fundamentals of Nursing, Erb and Kozier)
1. Establish fact of presence of epidemic
2. Establish time and space relationship
1) Mode of Transmission
3. Relations to characteristics
4. Correlation of all data obtained. 2) Source
3) Status of the Client’s Defense Mechanism [The
status of the immune system]
TYEPS OF EPIDEMIOLOGIC DATA 4) Ability of Client to Implement Precautions
1. Demographic
2. Vital Statistics
3. Environmental Data
o Source of water
o Source of Food
o Types of households

J. Marquez | COMMUNICABLE DISEASE NURSING

 » Personal Protective Equipment:

a) Gloves – direct contact patients, change every

after patient

o Surgical gloves à when handling body

orifices
o Sterile gloves à Procedure e.g., IV or
catheter

b) Mask – all staff, all patients with respiratory

problems

o Droplet transmission – surgical mask

o Airborne transmission – N95 mask

c) Gown – procedures generate splashes or sprays

of blood or body fluids, secretions
IV. ASEPSIS
d) Eye Protection/Goggles – for aerosols,
» Asepsis – absence of disease producing splashes generating procedures
microorganisms

1. Medical Asepsis/Clean
» Technique
o REDUCE the number and transfer of
pathogens

2. Surgical Asepsis/Sterile
» Technique
o FREE of microorganisms

» Handwashing – is one of the most important

procedures for preventing infection

*All diseases are infectious but not all are contagious

(they may enter through the body if you have an
open mucus membrane)

» Prevention of Needlestick Injuries

1. Dispose used needles in puncture proof needle

containers

2. Don’t recap needles (unless using the one-handed

technique)

3. Use gloves when handling needles (won’t prevent

injuries but may lessen chance of transmitting
diseases)

J. Marquez | COMMUNICABLE DISEASE NURSING

 a. Ethylene Oxide Gas – for heat & moisture
labile instruments
V. DISINFECTION AND STERILIZATION b. Chemical Solution – Chlorine, Iodine,
Alcohols, Formaldehyde, Phenolic
a) Disinfection – pathogens but not spores are destroyed compounds, Glutaraldehyde – soak in 10 hours

1. Concurrent disinfection – ongoing practices Classification:

(while pt. is still communicable in one stage of • Low level Disinfectant- alcohol
the disease) • Intermediate level Disinfectant- ethylene oxide
gas, chlorine
2. Terminal disinfection – after his illness is no • High level Disinfectant
longer communicable (pt. is communicable all
throughout the disease process)
VI. IMMUNIZATION
o Disinfectant – use on inanimate objects
» Immunization – introduction of specific protective
o Antiseptic – use on persons that INHIBITS antibodies in a susceptible person or the production of
the growth of pathogens but does not cellular immunity.
necessarily destroy them
*Immunization is one way of helping prevent the
• e.g., alcohol- both disinfectant and spread of communicable diseases.
antiseptic
» Immunity-condition being secure against any
• Zonrox & muriatic- disinfectant particular disease or resistance against infection

a. Active immunity – there is antigen and

o Bactericide/Germicide – substance that destroy antibody formation; A+A; provides long term
bacteria but not necessarily spores immunity (Produces own antibodies to fight
against the antigen)
b) Sterilization – micro including spores are destroyed
b. Passive immunity – antibodies; provides short
1. Physical term immunity
a. Heat
• Dry Heat (Oxidation) – iron, oven
• Moist Heat (coagulation of CHON cell)
àSteam under pressure (Autoclave) - 121-’ C
at 5-17 psi for 15 minutes – black (from gray to
black sterile strip- already undergone
sterilization process)

àBoiling
§ Form of heat sterilization at the
community setting

§ Kills microorganism including spores

of the pathogenic organism

b. Radiation – UV rays particularly in the OR

2. Chemical – immerse in high level disinfectant in

long duration to achieve the sterilization process
(the longer the duration, the higher the chance to
achieve sterilization)

J. Marquez | COMMUNICABLE DISEASE NURSING

 SCHEDULE OF IMMUNIZATION
IMMUNIZATION ANTIGEN ROUTE SITE
• Vaccine
(killed ex. BCG (Bacillus
ID Right deltoid area
HBV, PCV, Calmette – Guerin)
Hib)
» Exposure • Attenuated ex. Hepa B IM Anterolateral Thigh
ACTIVE » Carrier BCG, OPV,
» Sick of the diseases measles DPT – Hep B-Hib IM Anterolateral Thigh
• Toxoid
(weakened Oral Polio Vaccine
Oral Mouth
toxins) – (OPV)
Pertussis. Inactive Polio
IM Anterolateral Thigh
• Gamma Vaccine (IPV)
globulin Pneumococcal
(protection of Conjugate Vaccine IM Anterolateral Thigh
• Placental Transfer 9PVC)
6 mos – 1
PASSIVE (IgG) Attenuated Measles
year)
• Breastfeeding (IgA) Vaccine (AMV)/ Outer part of the
• Antitoxin / SQ
antiserum / Measles -Rubella upper arm
serum (MR)

ANTIGEN AGE DOSE

BCG (Bacillus
At birth 0.05 ml
Calmette – Guerin)

Hepa B At birth 0.05 ml

DPT – Hep B-Hib 6, 10, 14 weeks 0.05 ml

Oral Polio Vaccine

6,10, 14 weeks 2 drops
(OPV)
Inactive Polio
14 weeks 0.05 ml
Vaccine (IPV)
Pneumococcal
Conjugate Vaccine 6, 10, 14 weeks 0. 05ml
9PVC)
9 months
Attenuated Measles
(Early 6 months 0.05ml
Vaccine (AMV)/
(epidemic)
Measles -Rubella
12-15 months 0.05ml
(MR)

» No fever (surface antigen)

» Local tenderness on sight Contraindications
of injection » Conditions that require hospitalization
» Avoid massage » The following conditions are NOT contraindications:
» Applied cold compress » Rushes Upper (2
weeks) after 1. Fever up to 8.5’C
» Fever (3 days)
» Fever (normal) 2. Simple or mild acute respiratory infection
antipyretic (simple coughs and colds)
» Local tenderness 3. Diarrhea without dehydration
» Cold compress
4. Malnutrition (it is indication for immunization)

J. Marquez | COMMUNICABLE DISEASE NURSING

 ENSURING POTENCY OF BIOLOGICALS

1. Maintenance of the cold chain

TYPES OF VACCINE

OPV (live
Most Sensitive to attenuated)
- 15 OC to – 25 OC
Heat AMV (Freeze
dried) MMR
DT (weakened
toxin)
P (Toxin)
Hepa B
Least Sensitive to 2OC to – 8 OC
heat REFIGERATOR
BCG

Hib, PVC Rotavirus

Note: All live microorganism (Freezer)

DISCARDING UNUSED BIOLOGICALS

» Unopened, exposed – may be put back in the
ref/freezer

» Discard
• BCG- 4-6 hours
• AMV 6-8 hours
• Others by the end of the day

DISCARDING UNUSED BIOLOGICALS VII. EARLY DIAGNOSIS AND TREATMENT

» VACCINE VIAL MONITOR (VVM)
o Not just for polio

o By the end of this year, VVMs will be on all

UNICEF – produced (PI Vaccines)

o That’s right, VVMs will be on BCG, DT,

DTP, Measles, OPV, Td, Tetanus, and
Yellow Fever.

o This means that VMV introduction activities

are in full swing to ensure that the benefits of
VVMs are realized in all countries.

J. Marquez | COMMUNICABLE DISEASE NURSING

 COMMUNICABLE DISEASES
5. Bronchodilators – e.g., aminophylline or salbutamol
I. RESPIRATORY – MOST COMMON » Common in the community

A. PNEUMONIA (Acute Respiratory Infection) NURSING MANAGEMENT:

(Rust Sputum – Pathognomonic Signs) 1. Maintain patent airway
» Expectorate secretion à foul ears à position
CA: à increase fluid intake.
o Infectious
§ bacteria (Streptococcus pneumonia) 2. Teach Deep Breathing Exercises (DBE)
(Klebsiela pneumonia) 3. Proper disposal of secretions
4. Monitor for signs or respiratory distress.
o Non-infectious 5. Complete bed rest (to decrease oxygen demand)
» Monitor respiratory distress
» MOT: Droplet
» IP: 1-3 days 6. Nutrition – High calorie, high fluid
o Portal of Entry: Nose à Respiratory
o Signs of respiratory distress à Nasal Flaring PREVENTION:
» Pneumococcal vaccine

SIGNS AND SYMPTOMS: » PENTAVALENT VACCINE – 3 doses

1. Fever with chills (rapidly rising) o 6, 10, 14 weeks - 0.5 ml, IM in Vastus lateralis (VL)
2. Cough characterized by rusty sputum (prune
juice) o Nurse Instruction:
3. Chest pain – stabbing aggravated by respiration § For children:
& coughing àFever → antipyretic -4 hrs
» Inclusion of air passages à Local tenderness → cold compress

4. Symptoms of respiratory distress (fast breathing, § For adult: (once every 5 years.)
chest indrawing/retractions, stridor or noisy à PCV- 3 doses IM
inspiration) à 0.5 ml

DIAGNOSTIC EXAMINATIONS: o Do NOT dilute

1. Sputum examination = (+) organism
2. Chest X-ray = presence of consolidation in the
lungs B. TUBERCULOSIS (AIRBORNE) highly
communicable).
» MEDICAL MANAGEMENT: (Hemoptysis – Pathognomonic Signs)
» Destroy the cells of respiratory tract.
1. Antibiotics »
o Penicillin G Na for 7-10 days (drug of choice) CA: gram (+) acid fast bacilli
• First choice
• Amoxicillin 3x a day à after meal to o Mycobacterium tuberculosis (humans)
prevent GI o Mycobacterium africanum (humans)
o Cotrimoxazole (Streptococcus) o Mycobacterium bovis (cattle)
• Second line thru IV
MOT: Airborne/Droplet/contact: coughing/sneezing
2. Oxygenation – low flow (via nasal cannula 2-3 L per IP: 4-6 weeks, 2-10 weeks (Latent)
min) POC: virulence & exposure
» Not communicable after 2 weeks of treatment
3. Suction secretions with (-) sputum smear
» If cannot expectorate the secretion

4. Expectorants/Mucolytics * History of TB, Primary Complex (2-10 days incubation period)

* Extra Pulmonary TB à TB of the Bones (infiltrates the wall of alveoli

and any body organs)
J. Marquez | COMMUNICABLE DISEASE NURSING
 SIGNS AND SYMPTOMS:
Gene Xpert = Antimicrobial resistance
1. Fever: low grade, late afternoon (Highly Active) Xpert MTB/ RIF results and Interpretation
2. Loss of appetite MTB detected; Rifampicin resistance not
3. Easy fatigability T
detected.
4. Night sweats RR
MTB detected; Rifampicin resistance
5. Respiratory: dry cough, later productive with detected
hemoptysis TI MTB detected; Rifampicin indeterminate
6. Chest pain: occasional (only during coughing N MTB not detected
because attack à blood in the sputum). I Invalid/ no result. Error

DIAGNOSTIC EXAMINATIONS: 2. (+) Tuberculin Test

1. Sputum Microscopy = (+) acid fast smear, 3 a) Mantoux – PPD, ID, After 48-72 hours
specimen o 5mm = Immunocompromised = (+)
à isolate of sputum
microorganism o 10mm = (+) less than 2 years
(Confirmatory Test) o 15mm = (+) low risk

1st specimen Consultation o 0.1 ml of tuberculin PPD via ID, after 48 – 72

nd
2 specimen Following day hrs.
3rd specimen Upon return o 5 mm = Immunosuppressed, PLHIV, recent
contact with infectious TB, people with CXR
1 specimen (+) = doubtful, repeat
suggestive of TB, organ transplants
2 specimens (+) = Treated o 10mm = drug abuser, Myco lab workers,
work in high-risk congregate areas,
DSSM Results and Interpretation comorbidity, malnourished (<90% ideal
Fluorescence Microscopy BW), under five y/o, children exposed to
Convention 200x
400x
adults in high risk.
IUATLD/ magnificatio o 15mm = people with no known risk of TB
al Light magnificatio
WHO scale n:
Microscopy
1 length = 30
n: 1 Length = factors.
40 fields
fields
No AFB b) Patch Test/Von Pirquet Test/Tine –
seen in 300 No AFB No AFB allergens, 24-28 hours (+) erythema
0 oil Observed / 1 Observed / 1
immersion length length
field (OIF)
c) Heaf Multiple Puncture Test – for large
Confirmatio Confirmation 1 – 2 AFB / 1 group, puncture, dried tuberculin, 48-72 hours
n required* required* Length (+) erythema = chest x-ray
1-9 AFB
5 – 49 AFB / 3 – 24 AFB /
+n seen in 100 Quantitative Classification of Tuberculosis Based on
1 length 1 length
OIF
10 – 99
Radiologic Results
3 -23 AFB / 1 – 6 AFB / 1
1+ AFB seen in
1 field field
100 OIF a) PTB 1 à Minimal – slight lesion to small part of one
1 -10 AFB / or both lungs
OIF in at 25 -250 / 1 7 – 60 / 1
2+ b) PTB 2 à Moderately Advanced - one or both lungs
least 50 field field
fields are involved but not extending one lobe and cavity not
> 10 exceed 4cm
3+
AFB/OIF in > 250 / 1
> 60 / 1 field c) PTB 3 àFar Advanced – lesions more extensive than
at least 20 field moderate
fields

J. Marquez | COMMUNICABLE DISEASE NURSING

 DRUGS:
1. ISONIAZID INH
§ Effective and inexpensive
§ SE: Peripheral Neuritis
§ Vitamin B6 (5-10mg/day)/Pyridoxine is given
because INH interferes with natural vitamin
synthesis

2. ETHAMBUTOL
§ SE: Optic Neuritis
o Not given to children as it causes blurring of
vision

3. Rifampicin
§ SE: Orange to red output
o Advise the patient to increase fluid intake

4. Streptomycin
MAINTENANCE OF TB PATIENT § SE: 8th CN damage – Tinnitus
o Route: Parenteral, via IM
DRUG FDC – A FDC – B
COMPOSITION 4 – Drug (RHZE) 2 – Drug (RH) 5. Pyrazinamide
RIFAMPICIN ® 150mg 150mg § SE: Joint pains and occasional attacks of gout
INH (H) 75 mg 75mg
Note:
PZA (Z) 400 mg * ALL these ANTI- TB DRUGS ARE HEPATOTOXIC
ETHAMBUTOL * Prior to administration of anti-tb drugs, they should
275mg
(E) undergo liver function test.
= 1Tablet = 1 Tablet

DISEASE CONTOL PROGRAM

» Directly – Observed Treatment Short Course (DOTS)

» Strategy, 1996

SHIFT: Single – Dose Formulation

à (SDF) to Fixed Dose
à Combination (FDC) Drugs

Two types of FDCs

1) FDC -A (4 – drug combination)
2) FDC – B (2 – drug combination)

TYPES OF FDCs (Fixed Dose Combination)

Note: Total
Regimen Type of Pt. Intensive Maintenance
» FDA A- are taken by the patient during the (months)
INTENSIVE PHASE Pyrazinamide, Kanamycin,
Standard Rifampicin
Levofloxacin,
» FDC B- are taken by the patient during Drug Resistant of
Prothionamide, Cyloserine 18 at least
Resistance Multi Drug
MAINTENANCE PHASE (SRDR) Resistant
(Based on Drug Sensitivity
Test Result)
» Taken in MORNING BEFORE MEALS- to ensure
absorption.
» The greater the weight the greater of tablet

J. Marquez | COMMUNICABLE DISEASE NURSING

 Extensively
PTB MGT FOR CHILDREN – 6 mos.
Extensively
Drug Based in Drug Sensitivity Test Result and
Drug
Resistant History of previous treatment
Resistant DRUGS DURATION
(XDR-TB)
INTENSIVE

à Isoniazid
2 months
à rifampicin
à Pyrazinamide

MAINTENANCE

à isoniazid 4 moths
à Rifampicin

PTB MGT FOR CHILDREN – 12 mos.

DRUGS DURATION
INTENSIVE
*** Encourage to comply with the Treatment
Regimen*** à Isoniazid
à rifampicin 2 months
à Pyrazinamide
à Strptomycin
Dx of Children with TB
MAINTENANCE

» Case Finding: à isoniazid 4 moths

o 2 instances à Rifampicin

1) Consultation 1) Tuberculin Testing

= Sx of TB = 0-9 y/o sx.
Prevention Strategies:
2) Exposure to Adult 2) Sputum Microcopy
TB patient = if productive cough 1. BCG Vaccination of newborn infants
» BCG

o Given after birth

TST – Tuberculin Skin Test
Child – Undeveloped Immune System.
o 0.01, ID – Upper arm (R)
Mgt. of Children with TB
o Expected: inflammatory reaction on the site
of injection (will last up to 2 weeks);
TB suspect – TB symptomatic – Any 3:
wheal/bleb – [disappear] 30 min to 1 hour –
1) Cough / Wheezing of 2 wks. or more
then become edematous at becomes wound.
2) Unexplained fever for 2 wks. Or more
3) Loss of appetite/ weight/ failure to gain wt.
o NI: Warm compress [on the site of injection];
4) Failure to respond to 2 wks. of antibiotic tx for lower
after 12 weeks, formation of scar (normal)
respiratory tract infection
5) Failure to regain previous state of health 2 wks. after
o Abnormal SE: subcutaneous abscess (cause:
viral infection or measles
wrong technique of the administration)
TB Confirmation – Any 3:
§ Management:
1) (+) hx of exposure to adult / adolescent
• Incision and Drainage
2) Signs & symptoms of TB
3) (+) Tuberculin test • Administer antibiotics
4) Abnormal chest X-Ray
5) Laboratory (+) sputum o IF NO REACTION WITHIN 2 WEEKS –
NEED TO repeat the administration of
vaccine.

J. Marquez | COMMUNICABLE DISEASE NURSING

 o IF (+) REACTION – NO NEED to repeat the
administration

o Presence of Subcutaneous abscess - don’t

need to repeat the administration of BCG
vaccine

2. Health Education

3. Improve social conditions- can transmit via air/

airborne

4. Make available facilities for examination

5. Provide public health nursing and outreach services

for home supervision of patients

NURSING CARE:

1. Avoid direct contact with sputum – good

handwashing, cover mouth and nose when coughing,
sneezing
o Morning – the collection of sputum

2. Proper disposal of secretions

3. Provide good circulation of fresh air

J. Marquez | COMMUNICABLE DISEASE NURSING