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Name: Carlo M. Yao

Bachelor of Science in Nursing



y Philippine Hemorrhagic fever was first reported in 1953. In1958, hemorrhagic fever became a notifiable disease in thecountry and was later reclassified as Dengue HemorrhagicFever.

y P

artially data from National Epidemic SentinelSurveillance System shows a total of 7,894 dengue fevercases from all regions from January 1 to November 19, 1999.Most (38%) of cases are the national capital region (NCR),Nueva Ecija, Pampanga, Cebu and Tarlac. There was noclustering of cases in any barangay. Majority (53%) of the

cases were male. Most (49%) cases belong to the 1-9 yearsage group. The next most affected age group is the 10-19 years. The were 113 deaths and the Case Fatality Ration(CFR) is 1.4 CFR was highest (3.4%) among cases forty years and above.



yDengue Virus Type 1, 2, 3, & 4and Chikungunya virus



y Immediate source is a vector mosquito,the Aedes Aegypti or the common

household mosquito.

yThe infected person.



An acute febrile infection of sudden onset withclinical manifestation of 3 stages:

y First 4 days Febrile or invasive stage starts abruptly as high fever, abdominal pain and headache; laterflushing which may be accompanied by vomiting,

conjunctival function and epistaxis.



y 4th-7th days Toxic or hemorrhagic stage lowering of

temperature, severe abdominal pain, vomiting and frequent bleeding from gastrointestinal tract in the form of hematemesis or melena. Unstable B.P., narrow pulse pressure and shock . Death may occur .

Tourniquet test which may be positive on 3

rd

day may become negative due to low or vasomotor collapse.

y 7th-10th days Convalescent recovery stage

generalized flushing with intervention areas of blanching appetite regained and blood pressure alreadystable.



y Sever, frank type with flushing, sudden high fever,sever hemorrhagic, followed by sudden drop of temperature, shock and terminating in recovery or

death.y Moderate with high fever, but less hemorrhage, no

shock

y Mild with slight fever, with or without petichial

hemorrhage but epidemiological related to typical casesusually discovered in the course of investigation of typical cases.



yMosquito bite (Aedes Aegypti)



y Uncertain. Probably 6 days to one week.



yUnknown.

yPresume to be on the 1st week of illness

when virus is still present in the blood.



y All person are susceptible. Both sexes are equally affected. Age group predominantly affected are thepreschool age and school age. Adults and infants arenot exempted. Peak age affected 5-9 years.

y Sporadic throughout the year. Epidemic usually occurduring the rainy seasons June November. Peakmonths are September and October.

y Occurs wherever vector mosquito exists. Susceptibility is universal. Acquired immunity may be temporary butusually permanent.



y TourniquetTests (R umpel LeadsTest)

y Inflate the blood pressure cuff on the upper arm to a

point midway between the systolic and diastolicpressure for 5 minutes.

y Release cuff and make an imaginary 2.5 cm. square or1inch square just below the cuff, at the antecubital fossa.

y Count the number of petechiae inside the box.

A test is (+) when 20 or more petechiae per 2.5cm squareor 1 inch square are observed.



ySupportive

ySymptomatic

y e.g. for fever, give paracetamol for muscle pains.For headache, give analgesic. Dont give ASPIRIN.



y Rapid replacement of body fluids is themost important treatment.

y Includes intensive monitoring/follow-up

y Give ORESOL to replace fluid as in moderate

dehydration at 75ml/kg in 4-6 hours or up to 2-3L inadults.

y Continue ORS intake until patients condition improves.



y The inf ected indi v idual, contacts anden v ironment:

y Recognition of the diseasey Isolation of patient (screening or sleeping under

the mosquito net)

y Epidemiological investigation

y Case finding and reportingy Health education



y Eliminate vector by:y Changing water and scrubbing sides of lower vases once

a week.

y

Destroy breeding places of mosquito by cleaningsurroundings proper disposal of rubber tires, empty bottles and cans.

y Keep water containers covered.

y Avoid too many hanging clothes inside the house.

y Residual spraying with insecticide.



y Reporting immediately to the Municipal Health Officeany know case outbreak.

y

Refer immediately to the nearest hospital, cases thatexhibit symptoms of hemorrhage from any part of thebody no matter how slight.

y Conduct a strong health education program directedtowards, environmental sanitation particularly destruction of all known breeding places of mosquito.



y Assist in the diagnosis of suspect based on the signsand symptoms. For those without signs of hemorrhage, the nurse may do the tourniquet test.

(Apply tourniquet as is preparing for an I.V.. Let itstay for 5minutes. Release. Presence of petichialhemorrhage on skin indicates circulatory disturbance).

y

Conduct epidemiologic investigations as a means of contracting families, case finding and individual as wall as community health education.



Any disease or condition associated with hemorrhageis enough cause for alarm. Immediate control of hemorrhage and close observation of the patient for vitalsigns leading to shock are the nurses primary concern.

y ForHemorrhage keep the patient at rest duringbleeding episodes. For nose bleeding, maintain an elevatedposition of trunk and promote vasocontriction in nasal

mucosa membrane through an ice bag over the forehead.For melena, ice bag over the abdomen. Avoid unnecessary movement. If transfusion is given, support the patientduring the therapy. Observe signs of deterioration (shock)such as low pulse, cold clammy perspiration, prostration.



y For Shock Prevention is the best treatment.Dorsal recumbent position facilitates circulation.

Adequate preparation of the patient, mentally and

physically prevents occurrence of shock. Provision of warmth through lightweight covers

(overheating causes vasodilation which aggravatesbleeding).

y Diet low fat, low fiber, non-irritating, non-carbonated. Noodle soup may be given.



Measles



yFilterable virus of measles



ySecretion of nose and throat of infected persons



y An acute highly communicable infection characterizedby fever, rashes and symptoms referable to upperrespiratory tract. The eruption is preceded by about2days of coryza, during which stage grayish, pecks

(Koplik spots) may be found in the inner surface of thecheeks. A morbilliform rash appears on the 3rd or 4th

day affecting face, body and extremities ending inbranny desquamation.

y

Death is due to complication, e. g, secondary pneumonia, usually in children under 2yrs. Old.Measles is sever among malnourished children withfatality 95-100%.



y By droplet spread or direct contact with

infected persons, or indirect through articlesfreshly soiled with secretions of nose andthroat, in some instances, probably

airborne.



y 10 days from exposure to appearance of fever, about 14 days until rash appears.



y During the period of coryza or catarrhalsymptoms 9 days, (from 4th day before and5 days after rash appears).



y All persons are susceptible. Babies born of

mothers who had the disease before thebaby is born are immune for the firstmonths of life.



y Avoid exposing children to any person with fever or with acutecatarrhal symptoms.

y Isolation of cases from diagnosis until about 5-7 days after onsetof rash.

y Disinfection of all articles soiled with secretion of nose and

throat.

y Encouragement by health department and by private physicianof administration of measles immune globulin to susceptibleinfants and children under 3yrs. of age in families or institutions

where measles occurs.

y Live attenuated and inactivated measles virus vaccines have beentested and are available to use in children with no history of measles at 9 months of age or soon thereafter.



y Emphasize the need for immediate isolation when early catarrhalsymptoms appear.

y If immune serum of globulin is available (gamma Globulin), explainthis to the family and refer to physician or clinic giving this service.

y Observe closely the patient for complications during after the acutestage.

y Teach, demonstrate, guide and supervise adequate nursing careindicated.

y Explain proceeding in proper disposal of nose and throat discharge.

y Teach concurrent and terminal disinfection.



y Protect eyes of patients from glare of strong light asthey are apt to be inflamed.

y Keep the patient in an adequately ventilated room butfree from drafts and chilling to avoid complications of pneumonia.

y Teach, guide and supervise correct technique of givingsponge bath for comfort of patient.

y Check for corrections of medication and treatmentprescribed by physician.



GERMAN MEASLES

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