Diptheria
Tuesday, 18 March 2014
Diphtheria is an infectious disease caused by the bacterium Corynebacterium diphtheriae. This disease primarily affects the mucous membranes of the respiratory tract (respiratory diphtheria), although it may also affect the skin (cutaneous diphtheria) and lining tissues in the ear, eye, and the genital areas.
You can also get infected by coming in
contact with an object, such as a toy, that has bacteria on it.Diphtheria usually affects the nose and
throat.
What causes diphtheria?
Diphtheria is caused by toxin-producing strains of the gram-positive bacillusCorynebacterium diphtheriae. There are four biotypes of the bacterium
- gravis
- mitis
- intermedius
- belfanti
- and each differs in the severity of disease it produces. Nontoxigenic strains are usually responsible for less severe diphtheria involving the skin (cutaneous diphtheria).
How is diphtheria transmitted?
Diphtheria is transmitted to close contacts via airborne respiratory droplets or by direct contact with nasopharyngeal secretions or skin lesions. Rarely, it can be spread by objects contaminated by an infected person. Overcrowding and poor living conditions can further contribute to the spread of diphtheria.
Pathophysiology of diphtheria
The organism usually infects the epithelium of the skin and the mucosa of the upper respiratory tract, leading to inflammation of those tissues.Diphtheria classically involves the tonsils and pharynx, although the nose and larynx are also common foci of infection.The pathogenicity of C diphtheriae is related to secretion of an exotoxin that interferes with cellular protein synthesis, resulting in tissue necrosis. The exotoxin is composed of two chains: chain B is responsible for entry into host cells, and chain A inhibits protein synthesis and causes cell death.The local inflammation in the upper respiratory tract leads to an accumulation of inflammatory cells, necrotic epithelial cells, and organism debris, which form the characteristic adherent grey pseudomembrane. Attempts to remove the pseudomembrane result in bleeding and expose an inflamed erythematous mucosa. Due to local neurological effects of the exotoxin, paralysis of the palate and hypopharynx can also occur. This paralysis, in combination with inflammation and oedema of the upper respiratory tract, can lead to airway obstruction. In addition, systemic spread of the toxin can cause injury to the kidneys, heart, and neural tissue.
Sign and symptoms of diptheria
The symptoms of diphtheria usually begin two to seven days after you become infected.
The time it takes for symptoms to develop is called the incubation period.
Symptoms of diphtheria can include:
- a high temperature (fever) of 38ºC (100.4ºF) or above
- chills
- fatigue (extreme tiredness)
- sore throat
- hoarse voice
- cough
- headache
- difficulty swallowing or pain when swallowing
- difficulty breathing
- foul-smelling, bloodstained nasal discharge
- swollen glands (nodes) in the neck
- pale, blue skin
If you have diphtheria, a grey-white membrane can develop inside your throat. It covers the back of your throat and tonsils and can obstruct your breathing. The membrane will bleed if you try to remove it.
Prevention
The vaccine for diphtheria is safe and is effective at preventing the disease.
All children with few exceptions should receive the DTaP vaccine series.
This protects against diphtheria, tetanus, and pertussis.
Another vaccine called Tdap is routinely given to children aged 11-12 years after they have completed the DTaP series of shots.
After that, adults should receive a booster dose of the tetanus and diphtheria vaccine (Td) every 10 years or after exposure to tetanus in some cases.
The diphtheria vaccine is usually combined with vaccines for tetanus and whooping cough (pertussis). The three-in-one vaccine is known as the diphtheria, tetanus and pertussis vaccine. The latest version of this vaccine is known as the DTaP vaccine for children and the Tdap vaccine for adolescents and adults.
The diphtheria, tetanus and pertussis vaccine is one of the childhood immunizations that doctors in the United States recommend during infancy. Vaccination consists of a series of five shots, typically administered in the arm or thigh, given to children at these ages:
· 2 months
· 4 months
· 6 months
· 12 to 18 months
Nursing diagnosis 1 :
Body temperature imbalance: Hyperthermia related to the release of an exotoxin.
Expected Outcomes:
The patient shows the body temperature within normal limits (36.5 °C to 37.2 °C) and sweats out naturally.
Nursing Interventions and Rationales:
1. Assess and monitor patient body temperature hourly.
Rationale: To obtain the baseline data of the body temperature readings for further nursing interventions.
2. Maintain room temperature.
Rationale: To establish an exchange by convection temperature.
3. Provide thin clothes that easily absorb sweat for patient.
Rationale: To enhance the process of evaporation.
4. Encourage patient to drink plenty of fluids at least 1.5 to 2.0 litres a day.
Rationale: To excrete the toxins from the body and enhance in reducing body temperature.
5. Encourage patient to have enough rest by sleeping at least 8 hours at night.
Rationale: To restore energy.
6. Administer antipyretic drugs such as Paracetamol as ordered by the doctor.
Rationale: To reduce the heat in the centre of the hypothylamus.
7. Administer antitoxin Diphtheria in the route of I/M or I/V as ordered by the doctor.
Rationale: To neutralize circulating toxin that can prevent damage to myocardium and myelinsheath.
8. Administer antibiotics such as Penicillin, Cephalosporin or Erythromycin as ordered by the doctor.
Rationale: To fight against diptheria bacilli.
Nursing Diagnosis 2 :
Imbalanced nutrition: Less than body requirements related to dysphagia.
Expected Outcomes:
The patient will maintain an adequate nutritional status as evidenced by weight within or returning toward normal range.
Nursing Interventions and Rationales:
1. Assess for any signs and symptoms of malnutrition:
· weight significantly below patient's usual weight or below normal for patient's age, height, and body frame
· weakness and fatigue
· sore, inflammed oral mucous membrane
Rationale: To detect the degree of malnutrition.
2. Assist patient to select foods that are easily chewed and swallowed such as eggs, custard, macaroni and cheese, baby foods and avoid serving foods that are sticky such as peanut butter, and soft bread.
Rationale: To promote easier digestion of patient.
3. Encourage patient to have a rest period before meals.
Rationale: To minimize fatigue.
4. Ensure the environment is clean, free from odour, relaxed, and with pleasant atmosphere.
Rationale: To increase the appetite of the patient.
5. Provide oral hygiene before meals.
Rationale: To moisten the mouth, which may make it easier to chew and swallow; it also removes unpleasant tastes, which often improves the taste of foods or fluids.
6. Advice patient to take food in small meals and frequently rather than large ones.
Rationale: To establish easier digestion of food.
7. Encourage significant others to bring in patient's favourite foods or foods that patient more desired.
Rationale: To increase the the appetite hence food intake of the patient.
Nursing Diagnosis 3 :
Impaired gas exchange related to pseudomembranous.
Expected Outcomes:
Patient is able to maintain the effectiveness of breathing as there is clear, noiseless breath sounds, no excessive secretion from the respiratory tract.
Nursing Inteventions and Rationales:
1. Auscultation of breath sounds, note the presence of an additional breath sounds.
Rationale: To detect earlier presence of airway obstruction in the respiratory tract.
2. Position the patient in a comfortable and appropriate position, such as Semi fowler’s position.
Rationale: To improve chest expansion by lower the diaphragm.
3. Encourage patient to drink plenty of fluids at least 1.5 to 2 litres a day.
Rationale: To reduce the viscosity of the secretions, therefore facilitating in remove out the secretions.
4. Perform chest physiotherapy for patient as tolerated.
Rationale: Percussion is an important and useful action to remove the secretions hence improve ventilation and breathing pattern.
5. Perform suctioning for patient as needed.
Rationale: To clear the airway and improve breathing of the patient.
6. Administer oxygen theapy as indicated.
Rationale: To maximize the transportation of oxygen between tissues in the lung.
22:54
Whooping cough
what is whooping cough?
Also called: Pertussis
Whooping cough is an infectious bacterial disease that causes
uncontrollable coughing.
Whooping cough is a disease that causes
very severe coughing that may last for months. You can cough so hard that you
hurt a rib.
The name comes from the noise you make
when you take a breath after you cough. You may have choking spells or may
cough so hard that you vomit.
Whooping cough is contagious. This means
it spreads easily from one person to another.
Whooping cough can lead to other
problems, such as pneumonia.
These problems can be very serious in adults ages 60 and older and in young
children, especially babies who are born early or have not had shots to prevent whooping cough.
What causes whooping cough?
Whooping cough is caused by an infection with a bacterium known as Bordetella pertussis. The bacteria attach to the lining of the airways in the upper respiratory system and release toxins that lead to inflammation and swelling.
Most people acquire the bacteria by breathing in the bacteria that are present in droplets released when an infected person coughs or sneezes. The infection is very contagious is often is spread to infants by family members or caregivers, who may be in the early stages of infection and not realize that they are suffering from whooping cough.
How is whooping cough transmitted?
Whooping cough is highly contagious and is spread among people by direct contact with fluids from the nose or mouth of infected people. People contaminate their hands with respiratory secretions from an infected person and then touch their own mouth or nose. In addition, small bacteria-containing droplets of mucus from the nose or lungs enter the air during coughing or sneezing. People can become infected by breathing in these drops.
What are risk factors for whooping cough?
Whooping cough can infect anyone. Unimmunized or incompletely immunized young infants are particularly vulnerable to the infection and its complications, which can include pneumonia and seizures.
Pathophysiology
The pathophysiology of whooping cough has given us important information about the disease. We know know that humans are the only reservoir for B pertussis and B parapertussis. B pertussis is a gram negative pleomorphic bacillus, and is the main cause of the disease whooping cough, otherwise known as pertussis. B parapertussis is much less common, and produces a similar illness with milder symptoms. B pertussis is spread via aerosolized droplets that are produced by the coughing of infected individuals. These droplets attach themselves to the ciliated respiratory epithelium and damage it, causing the whooping cough disease .After about 1 to 2 weeks, the dry, irritating cough evolves into coughing spells. During a coughing spell, which can last for more than a minute, the child may turn red or purple. At the end of a spell, the child may make a characteristic whooping sound when breathing in or may vomit. Between spells, the child usually feels well.
Sign and symptoms
Once you become infected with whooping cough, it can take one to three weeks for signs and symptoms to appear. They're usually mild at first and resemble those of a common cold:
· Runny nose
· Nasal congestion
· Sneezing
· Red, watery eyes
· A mild fever
· Dry cough
After a week or two, signs and symptoms worsen. Thick mucus accumulates inside your airways, causing uncontrollable coughing. Severe and prolonged coughing attacks may:
· Provoke vomiting
· Result in a red or blue face
· Cause extreme fatigue
· End with a high-pitched "whoop" sound during the next breath of air
What is the treatment?
The infection is most severe in young children, half of whom require hospital treatment. Antibiotic therapy is most commonly used. Children under 5 or those who have not been inoculated who are in contact with whooping cough may be given antibiotics to prevent infection.
The best way to prevent whooping cough is with the pertussis vaccine, which doctors often give in combination with vaccines against two other serious diseases — diphtheria and tetanus. Doctors recommend beginning vaccination during infancy.
The vaccine consists of a series of five injections, typically given to children at these ages:
· 2 months
· 4 months
· 6 months
· 15 to 18 months
· 4 to 6 years
Vaccine side effects
Side effects of the vaccine may include fever, crankiness or soreness at the site of the injection. In rare cases, severe side effects may occur, including:
· Persistent crying, lasting more than three hours
· High fever
· Seizures, shock or coma
Booster shots
· Adolescents. Because immunity from the pertussis vaccine tends to wane by age 11, doctors recommend a booster shot at that age to protect against whooping cough (pertussis), diphtheria and tetanus.
· Adults. Some varieties of the every-10-year tetanus and diphtheria vaccine also include protection against whooping cough (pertussis). In addition to protecting you against whooping cough, this vaccine will also reduce the risk of your transmitting whooping cough to infants.
Nursing Diagnosis :
Ineffective breathing pattern associated with airway edema and a thick mucus.
Goal:
Children will maintain free airway breathing disorder characterized by reduced.
Nursing Interventions and Rationales:
1. Assess the respiratory status of children continuously including increased respiratory rate, stridor, retraction, dilation of nostrils, cyanosis, confusion, anxiety, noise reduction breath, tachycardia, and a barking cough.
Rationale : To detect earlier signs and symptoms of increased difficulty breathing and respiratory obstruction.
2. Give the cool air humidity by using a tent, humidification tools, or facial maskers.
Rationale : Moist air to dilute the mucus.
3. Give oxygen, if necessary.
Rationale : Oxygen may be advisable to reduce hypoxia and anxiety.
4. Give steam racemic epinephrin, if necessary, watch for signs re obstruction.
5. If a child can receive, place on high-Fowler's position.
Rationale : This position will increase lung capacity because of reduced pressure diaphragm to the lung.
22:31
Mumps
What is mumps?
Mumps is a contagious viral
infection that can cause painful swelling of the salivary
glands, especially the parotid glands.
Some people with mumps won't
have gland swelling. They may feel like they have a bad cold or the flu instead.
Mumps usually goes away on
its own in about 10 days.
But in some cases it can
cause complications that affect the brain (meningitis), the testicles (orchitis),
the ovaries (oophoritis), or the pancreas (pancreatitis).
What Causes Mumps?
A person suffers mumps when infected with the mumps virus. It can be transmitted via respiratory secretions (e.g. saliva) from a person already affected with the condition. When contracting mumps, the virus travels from the respiratory tract to the salivary glands and reproduces, causing the glands to swell. Examples of how it can be spread are:
- sneezing or coughing
- using the same plates with someone infected
- sharing food and drink with someone infected
- kissing
- someone infected touching their nose or mouth and then passing it onto a surface someone else may touch
Someone infected with the mumps virus is contagious for approximately 15 days (six days before the symptoms start to show, up to nine days after they start). The mumps virus is part of the paramyxovirus family, which is a widespread cause of infection, especially in children.
What are risk factors for contracting mumps?
1. Failure to be immunized completely (two separate doses) with exposure to those with mumps
2. Age: The highest risk of contracting mumps is to children between 2-12 years of age
3. Season: epidemics of mumps were most likely during the winter/spring seasons
4. Travel to high-risk regions of the world: Africa, general Indian subcontinent region, and Southeast Asia. These areas have a very low rate of vaccination.
5. Weakening immune system: either due to diseases (for example, HIV/AIDS, cancer) or medication (oral steroid use for more than two weeks, chemotherapy)
Pathophysiology
Mumps is transmitted by droplet spread or by direct contact. The primary site of viral replication of the epithelium of the upper respiratory or the GI tract or eye. The virus quickly spreads to the local lymphoid tissue and a primary viraemia ensues, whereby the virus spreads to distant sites in the body. The parotid gland is usually involved but so may the CNS, testis or epididymis, pancreas and ovary. A few days after the onset of illness, virus can again be isolated from the blood, indicating that virus multiplication in target organs leads to a secondary viraemia Parotitis is the most frequent presentation, occurring in 95% of those with clinical symptoms. Occasionally, meningitis may precede parotitis by a week. Virus is excreted in the urine in infectious form during the 2 weeks following the onset of clinical illness. It is not known whether virus actually multiplies in renal tissues or whether the virus is of haematogenous origin. Life-long immunity is the rule after natural infection, but reinfections can occur and 1 - 2% of all cases are thought to be reinfection .
Sign and symptoms
Up to half of people who get mumps have very mild or no symptoms, and therefore do not know they were infected with mumps.
The most common symptoms include:
· Fever
· Headache
· Muscle aches
· Tiredness
· Loss of appetite
· Swollen and tender salivary glands under the ears on one or both sides (parotitis)
· Neck swelling
· Dry mouth
Symptoms typically appear 16-18 days after infection, but this period can range from 12-25 days after infection.
What is the treatment for mumps in adults and in children?
Taking analgesics (acetaminophen, ibuprofen) and applying warm or cold packs to the swollen and inflamed salivary gland region may be helpful.
Prevention
Children are usually vaccinated against mumps between 12 and 15 months of age and then again between the ages of 4 and 6.
Mumps is considered a rare disease, with only a few hundred cases each year in the United States. Still, outbreaks occur in the United States on a regular basis, especially in places where there is close human contact, such as schools and dormitories. Therefore, it is important that your child be vaccinated to reduce his or her risk of contracting the disease.
Imbalanced nutrition less than body requirements related to inability to ingest adequate nutrients due to infectious conditions.
Body weight of patient returned to normal ranges.
Nursing interventions and Rationales:
1. Assess the nutrition status through body weight, oral intake, mucous membrane condition, and appetite.
Rationale: To determine the degree of malnutrition.
2. Advice patient to take food in small meals and frequently throughout the day.
Rationale: To establish easier digestion of food.
3. Provide soft foods diet such as porridge, mashed potatoes, puddings, jelly, or ice cream.
Rationale: To establish easier digestion of food.
4. Provide ice cubes, mints, or tart candies for patient.
Rationale: To prevent dehydration and dryness of the mucous membrane.
5. Advice patient to avoid spicy, fried, or acidic food.
Rationale: To prevent the sense of discomfort that may triggers the pain of the salivary glands.
6. Advice patient to drink plenty of fluids as tolerated.
Rationale: To moisten the mucous membrane of the mouth.
7. Provide oral care before and after meal gentlly by using soft toothbrush.
Rationale: To prevent bad mouth odour and improve patient appetite.
Altered oral mucous membrane: Dryness related to fluid volume deficit associated with restricted oral intake and fluid loss.
The patient will maintain a moist, intact oral mucous membrane.
Nursing interventions and Rationales:
1. Assess patient for dryness of oral mucous membrane.
Rationale: To detect earlier signs and symptoms of dehydration.
2. Instruct and assist patient to perform oral hygiene as often as needed.
Rationale: To maintain the hygiene of the oral, therefore protect the oral mucous membrane.
3. Advice patient to avoid use of products that contain lemon and glycerin and mouth washes containing alcohol.
Rationale: These products have a drying and irritating effects on the oral mucous membrane.
3. Encourage patient to rinse or gargle mouth frequently with salt water.
Rationale: To reduce the inflammation.
4. Lubricate patient's lips frequently by using vaseline.
Rationale: To act as a mosturizer to the lips.
5. Encourage patient to breath through nose rather than mouth.
Rationale: To promote better breathing pattern.
6. Encourage patient not to smoke.
Rationale: Smoking can dry the mucosa of the mouth.
7. Maintain intravenous fluid therapy as ordered by the doctor.
Rationale: To improve hydration of the patient.
8. Encourage patient to suck on hard candy unless contraindicated.
Rationale: To stimulate salivation.
9. Increase oral fluid intake as soon as allowed and tolerated.
Rationale: To improve hydration and stimulate salivation.
Pain related to swelling of the salivary glands.
The patient verbalizes adequate relief of pain or ability to cope with incompletely relieved pain.
Nursing Interventions and Rationales:
1. Assess patient pain characteristics:
· Quality (e.g., sharp, burning, shooting)
· Severity (scale of 1-10, with 10 being the most severe)
· Other methods such as a visual analog scale or descriptive scales can be used to identify extent of pain
· Location (anatomical description)
· Onset (gradual or sudden)
· Duration (how long; intermittent or continuous)
· Precipitating or relieving factors
Rationale: To identify the level of pain of the patient.
2. Observe or monitor signs and symptoms associated with pain, such as blood pressure, heart rate, temperature, colour and moisture of skin, restlessness, and ability to focus.
Rationale: To detect earlier signs and symptoms of pain that may help the nurse in evaluating pain.
3. Apply ice or heat packs to the swelling area on the neck of the patient.
Rationale: Ice packs can reduce swelling of the affected area by constrict the blood vessels and promote some numbing, therefore promoting comfort while heat packs can improve the healing of the affected area by dilate the blood vessels and promote good blood circulation to the affected area.
4. Provide rest periods for patient by prepare a quiet, shooting light, and good ventilation environment.
Rationale:To facilitate comfort, sleep, and relaxation of patient that may prevent exaggerated pain and exhaustion.
5. Encourage patient to do deep breathing exercise as tolerated.
Rationale: To relieve the pain of the patient and promoting comfort to the patient.
6. Provide patient divertional therapy such as listening to music, and watching television.
Rationale: To divert the patient from pain.
7. Administer analgesic such as Acetaminophen / Tylenol as ordered by the doctor, evaluating effectiveness and observing for any signs and symptoms of untoward effects.
Rationale: To reduce the pain of the patient.
22:09
