Rotsen J.

Jambongana, RN, MN, CICN (PHICNA)

Former Nurse Supervisor, Infection Control & HACT, RMCI
Board of Director, Phil. Hospital Infection Control Society
DOH & St. Luke’s Medical Center - Certified IPC Professional
WHO and DOH - Certified Re-Emerging Diseases ICN, RITM
Associate Faculty Lecturer, John B. Lacson Colleges Fdn.
Trainer & Lecturer, Province of Neg. Occ. EEDD-HOD

Prev. Emplyr. Trained Trained Member Apointee Member Trained Reviewer

2
• CD means an illness caused by
an infectious agent or its toxins
that occurs through the direct
or indirect transmission of
the infectious agent from an
infected source to a susceptible
host.
It occurs in the community, in
the hospital, or in the
workplace.
The importance of re-learning
Communicable Diseases?
Guarantee #1 out of 3
Next topic:
Process of Infection in the Human Body
 WHEN ARE WE AT RISK OF ACQUIRING
COMMUNICABLE DISEASES?

Number of Patient’s defences/

infecting bacili DISEASE
Immune system
1. Very + + + + + + + + 1. Very 1. Very
+
large probable poor

2. Large + + + + + + 2. Probable +++ 2. Poor

3. Small +++ 3. Unlikely ++++++ 3. Good

4. Very 4. Very
+
unlikely + + + + + + + + 4. Very
small good
 THE BASICS OF
INFECTION
CARDINAL SIGNS OF INFECTION
– Fever
– Pain
– Redness
– Swelling
– Interference of normal function

Infectious
Agent

Mode of
Transmission
 Primary Disease Transmission
(Modes of Transmission)

• Airborne (PTB, Measles, Mumps, Varicella, Herpes zoster)

• Droplet (Pneumonia, Meningitis, Flu, Pertussis, diptheria, etc)
• Contact
– Direct Contact (Sexual Contact, BT, blood-borne,
Multiple Drug-Resistant Organisms on wounds/
discharges)
– Indirect Contact (Fecal-Oral route, or thru
animate/inanimate vectors and fomites)
(Tetanus, Typhoid Fever, Conjunctivitis, Hepatitis A,
Lice/ Pediculosis, etc.)
•Conveyors (Filthy hands, food, water, fomites)
– Vectors (mechanical & biological—animals, insects)
9
– Fomites (objects)
Personal Protective Equipment
(Proper Use of PPE)

MRSA/MDRO, Polio,
wounds with drainage, etc.

Pneumonia, Meningitis, Strep

Pharyngitis, Diphtheria,
Meningococcemia, etc.

Pulmonary TB, Measles,

Mumps, Varicella,
Herpes Zoster, etc.
 When do we use
Standard Precaution?
• Standard precautions are a set of
infection control practices used to
prevent transmission of diseases that
can be acquired by contact with
blood, body fluids, non-intact skin
(including rashes), and mucous
membranes.
• Used on an unknown case with a
differential Dx or unconfirmed Dx.
• Which hospital is Standard Precautions
mostly observed & best applicable?
– ER/Emergency Section, OPD
 ESSENTIAL COMPONENTS
OF STANDARD PRECAUTION

12
 Microbiology Basics

• Bactericidal antibiotics kills bacteria

• Bacteriostatic antibiotics inhibits
bacterial growth and multiplication
• Broad spectrum antibiotics kills wide
range Gm+ & Gm- e.g. Penicillin
• Narrow spectrum antibiotics kills
only specific group e.g. Isoniazid
• Commonly, antibiotics weaken
bacterial cell wall causing cell to lyse
& stops CHON synthesis
13
 Antibiogram 101
• How antibiotics work?

14
 Infection can happen
anywhere, when a host is
vulnerable and has weak
immune defenses, infection
may easily set in.
 FACTS: The Infection
• Invasion, colonization and
multiplication of bacteria inside the host
• Colonization (no interaction w/ host; no S/Sx)
• Injurious contamination of the body or
part of the body by pathogenic agents,
such as fungi bacteria, protozoa or
viruses, or by the toxins that these
agents may produce.
• Extent: May be local or generalized
• Once the infectious agent enters the
host and begins to proliferate, the
defense mechanisms of the body react
to the infection.
Infection can happen within the hospital.
Before, its Nosocomial; Now its HAI
• Some Common/ Frequently
occurring HAI:

HAP (Hospital Associated Pneumonia)

VAP (Ventilator Associated Pneumonia)
CAUTI (Catheter Associated UTI)
SSI (Surgical Site Infection)
BSI (Bloodstream Infection-Sepsis)
CLABSI (Central Line Associated BSI)
MDRO, MRSA
Prevention: BUNDLES OF CARE 17
(Proven; Evidence-based Practices)
 BUNDLES OF CARE (CDC)
• REMINDER (High Risk devices
for HAIs)
– FC-DB, IV, Central Lines, MV, etc.

Patient Patient
needs these? needs these?
YES NO

18
FREQUENCY OF CHANGING SUPPLIES AND
Changing OF IV SITE
 RECOMMENDATIONS (CDC) AND
EVIDENCE BASED PRACTICES
• Prevention of Catheter Associated UTI (CAUTI)

• Insert aseptically; Hand Hygiene

• Remove when not needed
• Silicon material (long term use of FC)
• Use of port for sterile urine collection
• Keep Urine bag always lower than
bladder
• No unnecessary kinks
• Fix FC properly on the thigh
INSERT FC ONLY WHEN INDICATED (CDC)
Retention/Obstruction, Accurate MIO, assist in healing of open
sacral wounds, Perioperative use, required for prolong
immobilization, end of life comfort
• IN FOCUS: Prevention of
HAP/ and VAP
• Strict hand hygiene
• Head of bed elevated 30-450 angle
• Prevent further/unnecessary
aspirations
• Sedation Protocols (Sedation
vacations- MV)
• Oral Care at least 2x/day
• Prevent hyperacidity (aspiration)
• Use suction tips once; dispose after use
21
• DVT prevention (antiembolic stockings)
• IN FOCUS: Prevention of
CAUTI
• Insert only when clinically indicated
• Minimize duration for high risk Px
• Avoid using for mgmt. of incontinence only
especially at Nursing Homes
• Intermittent catheterization is preferable to
indwelling urethral catheters in patients
with bladder emptying dysfunction
• In the acute care hospital setting, insert FC
using aseptic technique and sterile
equipment.
22
• Maintain closed drainage system and secure
FC properly.
CDC Recommendations – CAUTI Prevention

23
 ROLE OF NURSES:
Clinical Eye / Assessment is the key!
• History of current infection
• History of fever (onset and pattern)
• Systematic and sign/symptom based
• Any presence of swelling/rashes/ discharges
• Vaccination history and Medications taken
• Exposure to diseases/ infected person
• Insect or animal bites
• Last chronic antibiotic use
• Previous diseases and hospitalization
• Sexual history and social history (work)
• Travel history and/or prophylaxis taken
 Infection can happen
anywhere, when a host is
vulnerable and has weak
immune defenses, infection
may easily set in.
Review: Epidemiology and
Communicable Diseases of
Public Health Importance
• The study of distribution
of disease or physiologic condition
among human populations and
the factors affecting such
distribution.
• The study of the occurrence and
distribution of health conditions
such as disease, death,
deformities or disabilities on
human populations
 Patterns of disease
occurrence
• Endemic: The habitual presence
of a disease within a given
geographic area; may also refer to
the usual prevalence of a given
disease within such an area.
• Epidemic: The occurrence in a
community or region of a group of
illnesses of similar nature, clearly
in excess of normal expectancy.
 Patterns of disease occurrence

• Epidemic potential: an rea

becomes vulnerable to diseases
due to casual factors like
climate changes, ecologic and
socio-economic changes
• Pandemic: A worldwide
epidemic.
• Sporadic: disease occurs every
now and then affecting only a
small number of people
(intermittent occurrence)
31
Next topic:
DOH mandated - Notifiable Diseases
INFECTIONS: VISUAL
ASSESSMENT
AO 0036-2007- Phil. Integrated Disease Surveillance &
Response
CATEGORY I Reportable Dse. CATEGORY II Reportable Dse.
Acute Flaccid Paralysis Acute Bloody Diarrhea
Adverse Event Following Immunization Acute Encephalitis Syndrome

Anthrax Acute Hemorrhagic Fever Syndrome

Human Avian Influenza Acute Viral Hepatitis

Measles Bacterial Meningitis
Meningococcal Disease Cholera
Neonatal Tetanus Dengue
Paralytic Shellfish Poisoning Diphtheria
Rabies Influenza-like Illness
Severe Acute Respiratory Syndrome Leptospirosis

Outbreaks Malaria
Clusters of Diseases Non-neonatal Tetanus
Unusual Diseases or threats (e.g. Zika) Pertussis
Typhoid & paratyphoid fever
35
 EXPANDED PROGRAM OF
IMMUNIZATION
Introduction to New Vaccines
• Six vaccine-preventable diseases
were initially included in the EPI:
tuberculosis, poliomyelitis,
diphtheria, tetanus, pertussis and
measles.
• In 2012, Rotavirus and
Pneumococcal vaccines was be
introduced.
• Other new vaccines: Japanese
Encephalitis and Pneumococcal
Conjugate Vaccines
 EPI 2019 Update from
DOH-PMA and PISMD
• The schedule contains total 13
vaccinations children need from age
0 to 18 yrs. Including new inclusions
• It also covers new and recently
added vaccines that can protect
children from h. influenzae type B,
pneumococcal infections,
rotavirus infections, influenza,
Japanese encephalitis, and
human papillomavirus (HPV).
37
Routine EPI for Infants

38
Tetanus Toxoid for
Pregnant Women

39
Catch-up Immunization Schedules
GENERAL RULES AND SAFETY
METHODS
• Employ standard (universal) precautions
in handling blood and body fluid, safe use
& disposal of sharps, and comply with
hand disinfection.
• Handwashing / hand hygiene and
disinfection remain the major measures to
prevent lab acquired infection.
• All specimens must be treated as
infectious, hence leaking or contaminated
samples and requests forms must be
rejected (hospital or community setting).42
 THINGS TO REMEMBER
• STANDARD / UNIVERSAL PRECAUTION
• Used on foreseen risks, unknown cases
through the proper use of PPE, Hand
Hygiene, Waste Segregation, Sharps safety,
Environmental cleaning

WASH HANDS!

Use Proper PPE!

 5 Moments for Hand Hygiene

1.before touching a
patient,
2.before clean/aseptic
procedures,
3.after body fluid
exposure/risk,
4.after touching a
patient
5.after touching
patient surroundings.
44
2.Patient Placement
– A private room is important to
prevent direct- or indirect-contact
transmission when the source patient
has poor hygienic habits,
contaminates the environment, or
cannot be expected to assist in
maintaining infection control
precautions to limit transmission of
microorganisms.
– In the wards, cohorting is used to
prevent cross contamination among
‘clean’ and ‘dirty’ cases. Patients
infected by the same microorganism
usually can share a room
• SOUCE ISOLATION - to prevent
infected patients from infecting
others (manual exclusion of infected
patient)
• REVERSE ISOLATION – to prevent
susceptible patients from being
infected.
• The methods of physical protection
are:
• Barrier nursing (strict contact
precaution)
• Segregation into single rooms and/or
cohorting
• Mechanical ventilation (removing
bacteria from the patient’s room and
by excluding bacteria present in the
outside air from the room.)
NEGATIVE: to allow air to flow into the isolation room (airborne)
but not escape from the room, as air will naturally flow from areas
with higher pressure to areas with lower pressure.
POSITIVE: for patients with compromised immune
systems. Air will flow out of the room instead of in, so
that any airborne microorganisms (e.g., bacteria) that
may infect the patient are kept away (OR, CSSR).
3.Transport of Infected
Patients
– Limiting the movement and
transport of patients infected
with virulent or
epidemiologically important
microorganisms
4.Effective use of PPE
– Using medically approved face
masks, Respiratory Protection
(N95 or higher, HEPA filter
masks) , Eye Protection, Face
Shields, gowns, boots and other
apparel.
Let’s focus on the relevant, and
common infections in the
country. Can you give
examples?
50
 Influenza Sore Eyes Pneumonia

Pulmonary TB Hepatitis A Hepatitis B

Measles Chickenpox Dengue

Typhoid Meningococcemia Leptospirosis

FLU/INFLUENZA RED/SORE EYES
 NURSING DIAGNOSIS
FLU/INFLUENZA CONJUNCTIVITIS
• Ineffective Airway • Acute Pain r/t
Clearance inflammation of the
Tracheobronchial conjunctiva
and nasal secretions • Disturbed body
• Hyperthermia r/t image r/t change in
influenza viral the eyelid (swelling /
infection edema
• Impaired Gas • Risk for injury
Exchange r/t limits of vision
53
 PNEUMONIA PTB
– May or may not be – Caused by a bacteria
caused by a bacteria. – cough >2wks, chest
– Presence of fluid in the pain
lung; rusty sputum – Weight loss, low grade
fever, night sweats.
– Caused by fatigue,
malnutrition, exposure – Coughing out of blood
to extremes in – Presence of
temperature, wrong scars/nodules in lungs
positioning, or result (XRAY).
of underlying illness. – Needs compliance to
– Cough, chills, colds, treatment.
DOB, fever, back pain – May progress as MDR-
TB.
– Transmitted via
droplet. – Transmitted airborne.
– Incubation: 4-12 wks
– Incubation: 1-3 days
Pneumonia
• When an
individual has
pneumonia, the
alveoli are filled
with pus and
fluid, which
makes breathing
painful and limits
oxygen intake.
Hint: Pneumonia vs PTB in
Radiologic Study
Pulmonary TB Pneumonia

56
 NURSING DIAGNOSIS
PNEUMONIA PTB
• Ineffective Airway • Ineffective Airway
Clearance r/t Tracheal Clearance r/t Thick,
bronchial viscous, or bloody
inflammation, edema secretions
formation, increased • Risk for Infection r/t
sputum production Inadequate primary
• Impaired Gas defenses, decreased
Exchange r/t Alveolar- ciliary action/stasis of
capillary membrane secretions
changes • Imbalanced Nutrition:
(inflammatory effects) Less Than Body
• Hyperthermia requirements r/t fatigue
 PTB Phases or Disease Process
1. Inhalation. TB begins when a
susceptible person inhales
mycobacteria and becomes infected.
2. Transmission. The bacteria are
transmitted through the airways to
the alveoli, and are also transported
via lymph system and bloodstream
to other parts of the body.
3. Defense. The body’s immune
system responds by initiating an
inflammatory reaction and
phagocytes engulf many of the
bacteria. 58
 PTB Phases or Disease Process
4. Protection. Granulomas new
tissue masses of live and dead
bacilli, ate surrounded by
macrophages, which form a
protective wall.
5. Ghon’s tubercle. They are then
transformed to a fibrous tissue
mass, the central portion of
which is called a Ghon tubercle.
6. Scarring. The bacteria and
macrophages turns into a cheesy
mass that may become calcified
and form a collagenous scar. 59
 PTB Phases or Disease Process

7. Dormancy. At this point, the

bacteria become dormant, and
there is no further progression of
active disease.
8. Activation. After initial exposure
and infection, active disease may
develop because of a
compromised or inadequate
immune system response.

60
 Treatment of Pulmonary TB
• Pulmonary tuberculosis is treated
primarily with antituberculosis agents
for 6 to 12 months.
• First line treatment. First-line
agents for the treatment of
tuberculosis are isoniazid
(INH), rifampin (RIF), ethambutol (
EMB), and pyrazinamide.
• Active TB. For most adults with active
TB, the recommended dosing includes
the administration of all four drugs
daily for 2 months, followed by 4
61
months of INH and RIF.
 Treatment of Pulmonary TB
• Active TB. For most adults with active
TB, the recommended dosing includes
the administration of all four drugs
daily for 2 months, followed by 4
months of INH and RIF.
• Latent (dormant) TB. Latent TB is
usually treated daily for 9 months.
• Treatment guidelines--
Recommended treatment guidelines
for newly diagnosed cases of
pulmonary TB have two parts: an
initial treatment phase and a
62
continuation phase.
 Treatment of Pulmonary TB
• Initial phase. The initial phase
consists of a multiple-medication
regimen of
INH, rifampin, pyrazinamide,
and ethambutol and lasts for 8 weeks.
• Continuation phase. The continuation
phase of treatment include INH
and rifampin or INH and rifapentine,
and lasts for an additional 4 or 7
months.
• Prophylactic isoniazid. Prophylactic
INH treatment involves taking daily
63
doses for 6 to 12 months.
 MDR-TB and XDR-TB
• Extensively drug
resistant TB (XDR TB) is a rare
type of MDR TB that is resistant to
isoniazid and rifampin, plus any
fluoroquinolone and at least one of
three injectable IV/IM second-line
drugs (i.e., - amikacin,
kanamycin, or capreomycin)
• Only treated in DOH certified PMDT
treatment hubs usually in tertiary
hospitals) by a dedicated RN and MD
 Relationship goals:
TB and HIV
• Per CDC, People living with HIV are more
likely than others to become sick with TB.
Worldwide, TB is one of the leading
causes of death among PLHIV.
• PLHIV or newly Dx HIV cases are to be
tested for PTB mandatorily (CXR, AFB)
• HACT prophylaxis includes AZT + INH
• A person who has both HIV infection and
TB disease has an AIDS-defining
condition together with correlated CD4
 Simple Formulas applied in
empiric clinical practice
• PNM + HIV reactive test = AIDS
• PNM + HIV non-reactive test = PNM
• TB + HIV reactive test = AIDS
• TB + HIV non-reactive test = TB
2015 data
from WHO
and AIDS
research
organizations

66
Review: Viral Hepatitis Strains

A B C D E G
 HEPATITIS A HEPATITIS B
– Food-borne – Blood-borne
– Develops RUQ pain in – Develops RUQ pain
in the abdomen
the abdomen
– May or may not
– Jaundice (yellowish have Jaundice)
discoloration of the skin – Loss of appetite,
and sclera-eyes) weight loss, fatigue
– Loss of appetite, weight – May have
loss, fatigue abdominal
enlargement.
– Transmitted via saliva or – Transmitted only
sharing utensils, or thru blood, and can
contaminated food. be passed when you
are exposed.
– Incubation: 15-50 days
– Incubation: 45-160
days
 NURSING DIAGNOSIS
HEPATITIS A HEPATITIS B
• Acute Pain r/t swelling of liver and portal vein
• Imbalanced Nutrition Less Than Body
Requirements r/t abdominal discomfort or
impaired food absorption and metabolism
• Ineffective breathing pattern r/t intra-
abdominal fluid collections, ascites decreased
lung expansion
• Fatigue r/t chronic inflammatory process
• Risk for the transmission of infection r/t
infectious nature of the virus agent
Types of Viral Hepatitis (How many?)
A B C
Source Feces Blood, body Blood, body fluids
fluids
MOT Fecal- Childbirth, Needles,
Oral needles, blood transfusion
sex, BT (sex, childbirth)

Incub- 10-50 d 50-180 d 40-120 d

ation
Prevent Vaccine Vaccine No vaccine available
-ion Immuno- Blood donor
Immuno- screening, risk
globulin
globulin management,
education
 Types of Viral Hepatitis (How many?)
D E G
Source Blood, body Feces Blood
fluids
MOT Needles, sex, BT Fecal- Blood
(requires HBV Oral transfusion
co-infection) (requires HBV,
HCV, or HIV co-
infection)
Incub- 2-12 wks 2-9 wks 14-120 d
ation

Prevent HBV Vaccine Ensure Blood donor

-ion safe screening
drinking 71
water
72
 MEASLES CHICKENPOX
– Fine rashes – Rashes and blisters
– Red eyes, fever – Fever, Itchy
rashes/blisters
– Coryza/ flu
– Loss of appetite
– Sore throat/
– Infectious until
exudative tonsils. crusting phase.
– Can be immunized. – First lesion develops
– Reportable case. in areas covered w/
– Treated with clothes.
antibiotic and Vit. A – Active immunization.
– Transmitted airborne. – Transmitted
airborne.
– Incubation: 7-18 days
– Incubation: 14-21
days
 NURSING DIAGNOSIS
MEASLES CHICKENPOX
• Risk for impaired skin • Hyperthermia r/t
integrity related to viral infection
raking pruritus
process
• Acute pain r/t
• Impaired Skin
inflammation and
Integrity r/t rashes and
burning sensation in
mechanical factors (e.g.
the eyes
stress, tear, friction)
• Risk for
• Risk for
Infection Transmission
Infection Transmission
r/t contagious nature
r/t contagious nature of
of organism
organism 74
Smallpox vs. Chickenpox
Smallpox Chickenpox
Prodrome (early Sx) yes minimal or none
Distribution out to in in to out
Lesions painful/ deep pruritic / superficial
Progression synchronous asynchronous
Palms / Soles yes no

The most identifiable difference between smallpox and

chickenpox is distribution and progression of rash.
Distribution:
Smallpox: Centrifugal - starts centrally moves outward
Chickenpox: centripetal - starts peripheral, moves central
Smallpox vs. Chickenpox
 RUBELLA VS RUBEOLA
Rubella Rubeola
(german measles) (typical measles)
• light red (almost pink) • reddish-brown rash
rash • can become a serious
• milder disease that only illness that lasts
lasts around 3 days – 2 several days and can
weeks cause other serious
• Virus infects lymph permanent
nodes and skin complications
• Rubeola is an extremely • Virus infects
contagious virus via respiratory system
Droplet • Rubeola is an
extremely contagious77
virus via Airborne
 Basics of Dengue
• Mosquito-borne viral infection (female A.
aegypti and A. albopictus mosquitoes)
• The infection can be asymptomatic and often
causes flu-like illness, and has 4 subtypes:
DEN-1, DEN-2, DEN-3 and DEN-4.
• Dengue is found in tropical and sub-tropical
climates worldwide, mostly in urban and
semi-urban areas.
• There is no specific Tx for dengue/ severe
dengue. Dengue prevention and control
depends on effective vector control measures.
79
DENGUE FEVER TYPHOID FEVER
– Caused by mosquito. – Caused by contact
– Incubation: 4-7 days. (fecal-oral).
– Fever, rashes, loss of – From contaminated
appetite food or water source
– may or may not have – May have rashes
bleeding, – Ladder-like fever
– vomiting, abdominal (on/off)
pain, muscle pains – vomiting/ diarrhea,
– decreased platelets. abdominal pain, loss
of appetite
– Needs hydration and
fast detection of – Needs hydration and
symptoms. antibiotic treatment
After several days, usually 3-7 days after the onset of
symptoms, the patient may display the warning signs of
severe dengue. These warning signs typically
accompany a decrease in temp. (below 380C) & include:
• Severe abdominal pain
• Rapid breathing DHF
• Persistent vomiting Danger
• Blood in vomitus
• Fluid accumulation in the body
Signs
• Mucosal (gums & nose) bleeding
Tx Plans:
• Liver enlargement
IVF v/v
• Rapid decrease in platelet count BT/Plt
• Lethargy, restlessness Transfusion
• Increase in Hct., Decrease in Plt. O2 Therapy
Typical DHF Pathophysiology

82
 Phases of DHF

• FEBRILE PHASE
– Sudden high grade fever lasting usually
2-7 days (can be with: skin erythema,
myalgia, flu-like Sx, sore throat, N/V,
conjunctival infection, headache)
– Its quite difficult to differ Dengue Fever
from non-dengue febrile cases in early
febrile phase, suggested: lab
correlation.
– Symptom detection is critical, likewise
early laboratory support especially
when supported with epidemic alerts.
83
 Phases of DHF
• CRITICAL (DHF) PHASE
– About 1/3 of Px with dengue develop DHF
marked by inc Hct (the %vol. of RBC)
– Occurs usually when fever subsides likely
around 37.5 0C to 38 0C or less- and
remains this plateau on Day 3 to Day 7
– The most common Sx is acute abdominal
pain in the advent of hypovolemic shock
– Untreated shock leads to metabolic
acidosis & hypoperfusion AEB inc Hct &
dec Plt
– Sx plasma leakage: dec WBC + dec Plt,
dec BP, lethargy, cyanosis, lasting for 84
24-48 Hrs
 Phases of DHF

• RECOVERY PHASE
– When px survives 24-48 Hrs of critical
phase, recovery starts 48-72 Hrs.
– Some px experiences pruritus
– Bradycardia & ECG changes are common
due to vascular fluid reabsorption
– WBC and Plt start to rise and stabilize
– Even at this phase, watch out for
recurrence of: Abdominal pain, Bleeding,
rapid Temp fall – refer ASAP
– White islands in the sea of red may
occur - generalized confluent petechial
85
rash which does not blanch upon pressure
 NURSING DIAGNOSIS
DENGUE FEVER TYPHOID FEVER
• Hypovolemic shock • Acute pain related to
related to hemorrhage inflammation of the
• Deficient Fluid Volume r/t small intestine
increased capillary • Imbalanced Nutrition:
permeability, bleeding, Less than body
vomiting and fever.
requirements r/t
• Imbalanced Nutrition: nausea, vomiting and
Less than body
no appetite
requirements r/t nausea,
vomiting • Deficient Fluid
• Risk for bleeding r/t Volume r/t vomiting,
thrombocytopenia LBM and fever
WHO grounds on DHF Immunization
• Dengvaxia® (CYD-TDV) developed by Sanofi
Pasteur was licensed in December 2015 and
has now been approved by regulatory
authorities in 20 countries for use in endemic
areas in persons from 9-45 years of age.
• The live attenuated vaccine CYD-TDV has
been shown in clinical trials to be efficacious
and safe in persons who have had a previous
dengue virus infection (seropositive
individuals), but carries an increased risk of
severe dengue in those who experience their
first natural dengue infection after vaccination
(seronegative individuals). 87
Q: Is Dengue preventable by vaccine?
• the Philippines start administering the
world's first dengue tetravalent vaccine
called “Dengvaxia” to high-risk
children led by DOH last Feb 11, 2016.
• Per DOH, Dengvaxia will help protect a
child against dengue caused by dengue
virus serotypes 1,2,3, and 4.
• The start: Children nine (9) years and
older enrolled in Grade IV for the school
year 2015-2016 in public schools in
Regions III, IV-a, and NCR will be
vaccinated. Other areas to follow.
 1st Dengue Vaccine launched in PHL
At private clinics, each
anti-dengue
dose costs between P4,000
and P5,500. It is initially
given for FREE by DOH on
high risk areas only.

Vaccine Route: subcutaneous injection

in the upper arm (deltoid area).
NOT INDICATED for: Children less than nine (9) years
of age and adults above 45 years of age; Pregnant and
lactating women, HIV and immune compromised Px, and
89
those with allergic tendency to its contents.
ZIKA Virus: The Threat is Real
• An emerging infection. Same insect
vector as Dengue & Chikungunya
• Zika is spread mostly by the bite of
an infected Aedes species mosquito
(Ae. aegypti and Ae. albopictus).
These mosquitoes bite during the
day & night.
• Zika can be passed from a pregnant
woman to her fetus (microcephaly).
Infection during pregnancy can
cause certain birth defects.
• There is no vaccine or medicine for
Zika virus or infection.
 Zika Signs and Symptoms
• Fever
• Rash
• Joint pain
• Conjunctivitis (red eyes)
• Other symptoms include:
– Muscle pain
– Headache
• Consider Travel History
• Zika is usually mild with symptoms
lasting for several days to a week.
• Once a person has been infected,
he or she is likely to be protected
from future infections.
 The Zika Vectors
Aedes aegypti primarily bites humans. It
is an efficient vector because of several
properties:
• It likes to live near human habitation
• It bites humans indoors
• It tends to bite multiple people in a
single bloodmeal, which increases its
ability to acquire and transmit the virus
• Aedes albopictus is somewhat less
efficient, as it bites other animals in
addition to humans.
92
93
94
• Gram (+), secretes a powerful toxin which
damages the heart, CNS, kidney, spleen
etc., and may cause death thru bacteremia.
• Pathognomonic sign: grayish false
membrane, and it may block the air
passages. Surgery may be necessary to
prevent asphyxiation.
• Manual removal or wiping off of the
pseudomembrane is NOT advised—as it
may increase systemic ill-effects of the
toxin (drainage to the bloodstream).
 NURSING DIAGNOSIS
DIPHTHERIA ZIKA VIRUS DSE.
• Hyperthermia r/t the • Acute pain r/t
release of an bacterial infection
exotoxin. and disease process
• Impaired gas (myalgia, headache)
exchange r/t OR • Imbalanced
Ineffective airway
Nutrition: Less than
clearance r/t
body requirements
pseudomembranous
membrance r/t nausea, vomiting
and no appetite
96
MENINGOCOCCEMIA LEPTOSPIROSIS
– Caused by Gm(-) – Caused by bacteria,
neisseria meningitidis leptospira; Rats are
– Droplet infection main hosts, but pigs,
– Increased rates in rabbits, cattles can
smokers also be reservoirs.
– High grade fever for – Can infect through
first 24H, weakness, open wounds
joint pains, – Fever, headache,
hemorrhagic rashes, muscle pains,
nausea, vomiting, vomiting, chest pain,
sensorial changes, calf & leg pains
dyspnea – Incubation: 7-19
– Incubation: 2-10 days days
 NURSING DIAGNOSIS
MENINGOCOCCEMIA LEPTOSPIROSIS
• Risk for • Acute pain r/t
Infection Transmission r/t bacterial infection and
contagious nature of
disease process
organism
(myalgia, headache)
• Acute Pain r/t fever, neck
pain, headache, • Impaired skin
• Activity integrity r/t presence
Intolerance related of rashes as part of
to fatigue and malaise disease process
• Anxiety related to
treatment and risk of
death
• Brain surrounded
by pus (the yellow-
greyish coat
around the brain,
under the dura
lifted by the
forceps), the result
of bacterial
meningitis and/or
meningococcemia

99
MENINGOCOCCEMIA
by N. meningitidis

100
 RECURSIVE
• Confirmatory Test for Measles
• Serum IgG and IgM
• Confirmatory Test for HIV-AIDS
• Western Blot
• Confirmatory Test for Meningococcemia
• CSF Culture and Sensitivity
• 2 Correlated Confirmatory Tests for PTB
• Sputum AFB test with CXR
 OTHER COMMON CD’s
Tetanus
• The tetanus bacteria are everywhere in the
environment and is commonly found in soil, dust
and manure (vector and fomites); and not
transmitted from human to human
• In unvaccinated individuals, tetanus is contracted
through a cut or deep wound which becomes
contaminated with the organism
• Tx: tetanus toxoid-containing vaccine and tetanus
immune globulin (TIG) or antitoxin
• A tetanus booster shot is recommended every 10
years after the completion of a 3-dose series
• Transmitted via vector (soil) = Contact precaution
103
 OTHER COMMON CD’s
Mumps
• a disease caused by a virus. You can catch
mumps through the air from an infected
person's cough or sneeze.
• Complication: inflammation of the brain and
tissues that cover the brain and spinal cord
(encephalitis/meningitis). Or, they may have
inflammation of the testicles, ovaries/breasts.
• Acetaminophen or ibuprofen can ease fever and
pain.; MMR vaccine recommended-- MMR shot at
12 through 15 months old range
• Airborne precaution needed (single room required)
 OTHER COMMON CD’s
Hand, Foot and Mouth Disease
• a viral infection caused by a strain of Coxsackie
virus. It causes a blister-like rash, involves the
hands, feet and mouth. (Hand, foot & mouth
disease is different than foot-and-mouth
disease, which is an infection of cattle, pigs,
sheep, goats)
• occurs in children under 10 years of age, but
occasionally can occur in young adults.
• S/Sx: fever, poor appetite, runny nose and
sore throat at 5 days post exposure.
• Virus’ reservoir is stool; Contact Prec needed.
 Common CD’s in Clinical &
Nursing Practice
Hand, Foot and Mouth Disease
• a viral infection caused by a strain of Coxsackie
virus. It causes a blister-like rash, involves the
hands, feet and mouth. (Hand, foot & mouth
disease is different than foot-and-mouth
disease, which is an infection of cattle, pigs,
sheep, goats)
• occurs in children under 10 years of age, but
occasionally can occur in young adults.
• S/Sx: fever, poor appetite, runny nose and
sore throat at 5 days post exposure.
• Virus’ reservoir is stool; Contact Prec needed.
Hand, Foot and Mouth Disease (HFMD) has
no vaccine and is addressed on symptom-
based Tx (paracetamol, calamine, etc.)

107
 Common CD’s in Clinical &
Nursing Practice
MRSA
• Methicillin Resistant Staph aureus inf occur in
people who've been in hospitals or other health
care settings, such as nursing homes, etc.
• causes atypical skin infections
& sepsis to pneumonia to bloodstream inf.
• The affected area might be: Warm to the touch,
Full of pus / drainage, Px has fever
• Precaution: Standard, Contact, Strict hand hygiene
and proper waste disposal & body hygiene
• It's now resistant to
methicillin, amoxicillin, penicillin, oxacillin
• Tx: TMP-SMX (Bactrim), clindamycin, minocycline,
or doxycycline & at severe cases, DOC: Vancomycin
 MRSA signs: There’s a development of a
serous, yellow-brown exudate, & dries into
a golden crust.
The bullae (filled with cloudy fluid) rupture and heal
with the formation of a honey-colored crust.
 Common CD’s in Clinical &
Nursing Practice
MDRE (Multi Drug Resistant Enterococcus)
• Enterococci (normal flora in GIT) is a
leading causes of nosocomial bacteremia,
SSI and UTI and people who've been in
hospitals, and Healthcare setting.
• Commonly caused by Enterococcus faecalis
• Resistant to PenG, ampicillin
• Tx: gentamycin or streptomycin, with the
DOC as: vancomycin or ciprofloxacin
• Precaution: Standard, Contact, Strict hand
hygiene and proper waste disposal & body
hygiene
 Common CD’s in Clinical &
Nursing Practice
Food-borne Infections
• These different diseases have many
different symptoms, so there is no specific
"syndrome“ (e.g. LBM, stomach pain, nausea,
fever, etc) that is foodborne illness.
• Common foodborne germs are:
– Campylobacter, Clostridium perfringens
– Escherichia coli, Salmonella, Shigella, Vibrio cholerae
• Raw foods of animal origin are the most
likely to be contaminated (eggs, milk, etc)
• Prevention: effective cooking, storing and
processing of food and proper hygiene
with HW adherence.
 Common CD’s in Clinical &
Nursing Practice
Rabies Infection
• vaccine-preventable viral disease
that affects the CNS, particularly causing
inflammation in the brain.
• Incubation: typically 1–3 months, others <1
week to >1 year, dependent upon location
of rabies entry & rabies viral load.
• S/Sx: hyperactivity, excited behaviour,
hydrophobia
• MOT can also occur when infectious
material – usually saliva – comes into direct
contact with human mucosa
• The dog will die regardless of whether it bites someone or
not (re: fallacy on death of dogs dying after biting humans)
 Common Parasitic Disorders
Pediculosis Scabies
• Lice infestation • Contagious mite
• Transmitted by infestation which
contact or sharing causes a
of combs, hats, etc. hypersensitivity rxn
• Pruritis- most • Transmitted by close
prominent symptom and prolonged contact
• Can result in • Epidermal ridges: skin
secondary infection between fingers,
• Lindane palms and volmar
aspect of wrists
• Wash clothing and • Confirmed by skin
linens scraping
• Environment clean- • Lindane/topical sulfur
up
• Launder clothes and
bed linens
 Skin Infections
Bacterial Infections (most common)
• Usually start at the hair follicle
– Folliculitis: superficial infection of upper
portion of follicle caused by staph
– Furuncles: infection caused by staph is
deeper in hair follicle (boil)
• Cellulitis is a generalized non-follicular
infection of the deeper tissues caused by
either staph or strep bacteria
• Can spread infection to other parts by
scratching
• Usual DOC: Augmentin, Cloxacillin, Clinda
 Skin Infections: Interventions
Non-surgical
• Meticulous skin care
– Antibacterial soaps or baths
– Astringent compresses
• Isolation precautions
– Minimize spread of microorganisms
– handwashing
• Drug therapy
– Topical medications (antibacterial, antifungal)
– Acyclovir for viral infections (topical or oral)
• Surgical Management
– Not indicated except for I&D of furuncles or
when lesion progresses to full-thickness in
immunocompromised person
WHO Rabies PEP & Categories

116
 Common CD’s in Clinical &
Nursing Practice
Malaria
• a mosquito-borne (P. falciparum, 70%; P. vivax,
20%) disease caused by a parasite. People with
malaria often experience fever, chills, and flu-like
illness. Left untreated, Px may die.
• Per WHO, Present in rural areas <600 m (1,969 ft)
except none in the 22 provinces of Aklan, Albay,
Benguet, Biliran, Bohol, Camiguin, Capiz, Catanduanes,
Cavite, Cebu, Guimaras, Iloilo, Northern Leyte,
Southern Leyte, Marinduque, Masbate, Eastern Samar,
Northern Samar, Western Samar, Siquijor, Sorsogon,
and Surigao Del Norte. None in M. Manila & other
urban areas. Resistant to Chloroquine per CDC/WHO
• PEP: Atovaquone-proguanil, doxycycline,
or mefloquine
 Man can manipulate his environment to
prevent illnesses, & change his behaviour
118
to reduce exposure to diseases agents.
119
Next topic:
Emerging & Re-Emerging Diseases
 Facts about emerging
infections (EI vs REI)
• EI’s are newly identified & previously
unknown infectious agents that cause
public health alarm; REI’s are
previously controlled or suppressed
and resurfaced in the recent history
• Top Contributor: International travel &
commerce
• 2/3rd of the EI’s originate from animals-
wild & domestic
• Humans themselves penetrate/ modify
unpopulated regions- come closer to
animal reservoirs/ vectors (Yellow
fever, Malaria)
 AH1N1, SARS, MERS CoV, Ebola
• A-H1N1: is a respiratory disease caused by
the type A influenza virus.
• SARS: Severe acute respiratory syndrome
is a viral respiratory illness caused by a
coronavirus.
• MERS CoV: Middle East Respiratory
Syndrome is a viral respiratory disease
caused by a coronavirus that was first
identified in Saudi Arabia
• Ebola Virus Disease (EVD), formerly
known as EBV hemorrhagic fever, is a
severe, often fatal illness in humans, mostly
from monkeys & bats.
When is this PPE used?

Respirator
FIT-TEST
 A- MERS SARS EBOLA
H1N1 CoV
Source Animals Animals Animals Animals:
(s) (esp. (esp. (esp. Bats,
poultry) camels) camels) Monkeys
*Asia *MidEas *Asia/ME *Afr/Liberia
t
Primar Respir Respir Respir Blood,
y Mode a tory a tory a tory Respi.
of drople drople drople droplets
Trans-
missio
tsAirb tsAirb tsAirb , urine,
n orne orne orne saliva,
(cough/ (cough/ (cough/
sneeze) sneeze) sneeze) sweat,
Guess what scenario….?

• A.) MERS
CoV
• B.) Ebola
• C.) TB
• D.) H1N1
 A- MERS SARS EBOLA
H1N1 CoV
Hand Hand Hand Hand hygiene;
Preven- hygiene; hygiene; hygiene; Strict Contact
tion and N95 mask N95 mask N95 mask & respiratory
Respira Respira Respira precaution
Control
tory prec + tory prec. tory prec. + Surveillance
Surveillance + + Surveillance
Surveillance

Signs / DOB, cough, DOB, cough, DOB, Severe

Symptoms Pneumoniac Pneumonia, vomiting, bleeding,
hills, diarrhea, weakness, Pneumonia,
vomiting, fatal PneumoniaS
DOB,
sore throat infection udden death
meningitis,
paralysis,
coma
RJJambongana, BScN, RN,
MN, PHICNA JBLCF-Bacolod |
 Can you still recall our
discussion last time about STIs
and its treatment?
 HERPES 2 (Genital herpes)

MOT: sexual and skin-to-skin contact with

infected lesions at genitals / mouth / anus
 HERPES 2 (Genital herpes)

• Genital herpes is an infection

of the genitals, buttocks, or
anal area caused by herpes
simplex virus (HSV). Most
genital herpes is caused by
HSV type 2. Yet as people
begin to have sex at younger
ages the herpes type 1 virus
has increasingly been shown
to also cause genital herpes.
 Gonorrhea

CURABLE!
CFT + AZT

MOT: sexual contact and skin-to-skin contact

with infected genitals / mouth / anus
 Gonorrhea S/Sx
• Gonorrhea is caused by Neisseria
gonorrhoeae
• Gonorrhea symptoms in men
• Greenish yellow or whitish discharge
from the penis
• Burning when urinating
• Burning in the throat (due to oral sex)
• Painful or swollen testicles
• Swollen glands in the throat (due to
oral sex)
• In men, symptoms usually appear two
to 14 days after infection.
 Syphilis

MOT: sexual, skin-to-skin with chancres

infecting the genitals / mouth / anus
 Primary stage
Syphilis
• Syphilis is a sexually transmitted
infection (STI) caused by the
bacterium Treponema pallidum
• Primary stage: One of the first
signs is a painless open sore
called a chancre. Because
syphilis is usually spread when
people have sexual contact,
chancres are often found in
the mouth, the anus, or the
genital area.
 Primary stage
Syphilis
• Primary stage : A skin rash and
other symptoms may show up 2 to
12 weeks after a person is
infected. At this stage, it is very
easy to spread the infection
through contact with the mouth,
the anus, the genitals, or any area
where there is a skin rash.
• Usually, there is pathognomonic
atypical rashes on palms and
soles of the feet as well.
 Latent & Tertiary
stage Syphilis
• Latent stage: After the rash
clears, a person may have a
period with no symptoms or the
"hidden stage”. This stage may
be as short as 1 year or last from
5 to 20 years.
• Late (tertiary) stage: it can cause
other serious health problems.
These can include blindness,
problems with the nervous
system and the heart, and mental
disorders
Human Papilloma: Genital
Warts
CD SAMPLE QUESTIONS
A new RN applies for a post in the NICU of a
hospital. He looks healthy, no fever and no
respiratory symptoms assessed yet with a value of
7.0 x 109 per liter (L) in his WBC result, yet upon
testing his nasal cavity for possible infection, there
was MRSA inoculated after 5-days, which among
the following statements best describes this
occurrence?
A. The presence of MRSA is the inoculation of normal skin
flora in the nasal cavity AEB by his WBC results
B. The nurse has an ongoing infection due to presence of
MRSA as evidenced by his significant WBC results
C. The nurse’s nasal cavity is under bacterial colonization
which is evidenced by the microbial lab result
D. This is a normal occurrence as MRSA is part of the
normal flora of the skin and the nasal cavity; it is
expected that he may have MRSA culture results.
CD SAMPLE QUESTIONS
A type of infection which refers to previously
controlled occurrences that has been declared
cured and controlled by health authorities, but had
resurfaced in the recent years. It has been thought
that in the modern times, this could be a potent
tool as well for health threat and life destruction
among exposed large populations.
A. Emerging Infections
B. Re-Emerging Infections
C. Pandemic Infections
D. Pandemic/Global Bioterrorism or
Pandemic Biological Warfare
Infections
 General Formula:
Human Immuno-
Acquired Immune
deficiency Virus
Deficiency Syndrome

HIV AIDS
The Causative agent The Disease
A retrovirus type Caused by HIV
Genus Lentivirus Progressed HIVD
HIV – The Virus
HIVD – The disease CD4 of < 300 (PHL)
Type 1 and Type 2 Symptomatic
CD4 of > 300 (PHL) (+) AIDS Def. Con’s
Can be Asymptomatic
Blood-borne/STI Blood-borne/STI
Test: HIV Screening / Test: Western Blot
Western Blot (ELISA Test)
The virus attacks certain unit in the immune system called
CD4, which are cells that help the body to fight certain
diseases & infections—making the body weak and vulnerable
to opportunistic infections. HIV causes or may lead to AIDS.
Morbidity and Death among AIDS cases are not due to the
virus itself but on the opportunistic infections brought about
by lowered CD4 of immune compromised patients.
On HIV Testing/Screening – HIV Proficient Med Tech performs
it. Results are kept confidential.
A HACT Nurse/ HIV Proficient RMT performs the pre/post test
counseling for patients and/or folks.
– SCREENING is NOT a CONFIRMATORY HIV/AIDS test.
 R.A. 8504
Philippine AIDS Prevention
and Control Act of 1998

2 7 13 22 38

PHL: 38 x 30 days = 1,140/mo. x 12 = 13,680/yr. (New cases

only); In Western Visayas alone, that is:
1 new HIV case in every 15 hours (Mar 2017 data)
1 new HIV case in every 11 hours (Mar 2018 data)
1 new HIV case in every 9 hours (July 2019 data)
Q: Is the test mandatory?
Q: What to test? HIV-1 or HIV-2?
Q: Where do we avail free &
confidential testing?
The CD4 Cells are specific soldier cells for immune
related infections

WBC Visible in conventional

(White Blood Cells) CBC Test
(N) = 5 to 10 x10 9/L

Part of the Immune

Helper T-Cells System Complex; can be
quantified
by specific Ig Assays

Visible only thru

CD4 CD4 Count/Test
CD4 (N) = > 800 units
 The HIV virus can be spread in
different ways such as:

Unprotected sexual contact, congenital,

BT, injectables, organ donation, blood
exposure
 How does HIV screening works?
• Go to the accredited Treatment Hub (free) or private
hospital (Price at P250 to P350) or other public
facility (Price at P150 to P250).
• Request for HIV Screening
• Pre test counselling
• Confidential Blood Extraction and Analysis
• Post test counselling (after 1-2 hrs)
• If REACTIVE: referral to the HACT MD
• Re-extraction of serum sample for RITM-SACCL
• 7-10 days TAT for MNL to Region 6
• Send back of final confirmatory test
• Re evaluation, CD4 testing and referral
• Start of free ARV thru the Tx Hub based on CD4
• Monthly free checkups and CD4 count
General rule: There is NO specific S/Sx for HIV Infection, to
get tested is the BEST way to check occurrence

• Some people may experience a flu-like illness within 2 to 4

weeks after infection (Stage 1 HIV infection). But some people
may not feel sick during this stage. Flu-like
symptoms include fever, chills, rash, night sweats, muscle
aches, sore throat, fatigue, swollen lymph nodes, or mouth
ulcers (US-CDC, 2018).
• Most people infected with HIV experience a short, flu-like illness
that occurs 2-6 weeks after infection. After this, HIV may not
cause any symptoms for several years. It's estimated up to 80% of
people who are infected with HIV experience this flu-like illness
(CDC).
Tip: usually, all atypical infections may be suspected, if the patient has
underlying risky behaviors / predisposing acts
 HACT Protocols for
Government Hospitals
• SHAP Code Patients (HIV +)
– Patients who were tested or screened
within the same hospital and are
treated in the same institution where
the HACT is.
• PHAP Code Patients (HIV +)
– Patients who were tested from other
hospitals or referral clinics the same
hospital and are treated in the same
institution where the HACT is.
• Both are eligible for PHIC Z-Package 148
(devastating chronic illnesses)
Update: National HIV Registry (Mar 2019)
DOH Study on Adolescent High Risk
Behavior

Male/ Transgenders
having Sex with Males

Female / Sex Workers

People Who Inject Drugs

HIV is the same as AIDS and now, has cure
MYTH
Piercings in the genitals will increase one’s FACT
likelihood of acquiring STIs/HIV
If you had STIs like gonorrhea, genital
herpes-2 or syphilis, the higher you are
suspected to also have HIV infection.
FACT
If you had an HIV reactive result taken from
a hospital, it is definite you have HIV(+). MYTH
The anatomy of the rectum (rectal tissue) is
more susceptible/prone to HIV infection
FACT
Condom usage should be paired with
Lubrication (e.g. generous amount of KY Jelly) FACT
TIPS ON PREVENTION AND MANAGEMENT OF HIV
 ELISA/
Screening Western Blot
(hosp/RHU): (SACCL/RITM)

NON-REACTIVE NEGATIVE
Start ARV/ART
asap.
Atrophic candidiasis

Pseudomembranous
candidiasis

Kaposi’s Sarcoma
(below)

158
 Pneumocystis Pneumonia
• Pneumocystis pneumonia (PCP) is a
serious illness caused by the
fungus Pneumocystis jiroveci. PCP is
one of the most frequent and severe
opportunistic infections in people with
weakened immune systems, particularly
people with HIV/AIDS.
• The symptoms of PCP are fever, dry
cough, shortness of breath, and fatigue.
• Dx: Bronchial lavage, Sputum C/S,
CXR, Polymerase chain reaction
(PCR) is also used to detect P.
jirovecii DNA in clinical specimens
 Pneumocystis Pneumonia
PCP requires treatment that must be
taken for 3 weeks. The best form of
treatment for PCP is trimethoprim
sulfamethoxazole (TMP-SMX) via IV

Smicroscopic mear of
bronchoalveolar lavage material
Aka Pneumocystis carinii.
 Other common opportunistic
Infections in HIV/AIDS patients

• Candida specie (yeast)

– Thrush, vaginitis, esophagitis
– Can be detected on C/S
• Cryptococcus neoformans (yeast)
– Fungal Inf, Meningitis, Pneumonia
– Can be detected on C/S (yeast)
• Cytomegalovirus (CMV)
– Retinitis, pneumonia
– Can be detected on C/S 161
Epstein-Barr or Infectious
Mononucleosis
Common S/Sx of EBV on HIV cases
(transmitted via droplet of saliva)
• sore throat (tonsillopharyngitis) – most
common and poses much discomfort
• extreme fatigue
• Fever, Rash, head ache and body aches
• swollen lymph nodes in the neck &
armpits
• ↑ white blood cells (lymphocytes) with
atypical presentation
• fewer than normal neutrophils or Plt.
 PrEP (Pre- Exposure
Prophylaxis)
• PrEP is when people at very high risk
for HIV take HIV medicines daily to
lower their chances of getting
infected., PrEP is approved for daily
use to help prevent an HIV-negative
person from getting HIV from a
sexual or injection-drug-using
partner who’s positive.
• Usually, by CDC guidelines, a
combination of two HIV medicines
(tenofovir and emtricitabine), or
depending on the case, as prescribed
• Common reported PEP Side effects:
upset stomach, loss of apetite
 PEP (Post Exposure Prophylaxis)

• PEP must be started within 72

hours after a possible exposure.
The sooner you start PEP, the
better; every hour counts.
• Starting PEP as soon as possible after
a potential HIV exposure is important.
• If you’re prescribed PEP, you’ll need
to take it once or twice daily for 28
days.
• Usually: Lamivudine, Tonofivir,
Efavirenz depending on the case,
add emtricitabine per CDC
guidelines.
 RECURSIVE
• A subtype of pneumonia most likely
present in immune compromised
AIDS host patients:
• Pneumocystis jiroveci or
Pneumocystis carinii pneumonia
• A process or test to accompany N95
mask or respirator usage to ensure
proper size choice and effective
filtration of aerosol.
• N95 Fit Testing / Fit Test
 PEP If you’re HIV-negative or
don’t know your HIV status, and
in the last 72 hours you:
• think you may have been
exposed to HIV during sex (for
example, if the condom broke),
• shared needles and works to
prepare drugs (for example,
cotton, cookers, water), or
• were sexually assaulted,
• talk to your health care provider
or an emergency room doctor
about PEP right away.
 Brief review on PEP for HCWs
• Consult to an ID Specialist is recommended
• PEP to start immediately within 72H from injury
• The HCW should be advised to report and seek
medical evaluation for any acute febrile illness
that occurs within 12 weeks after the exposure.
• Seronegative HCWs should be retested 6 weeks
post-exposure and on a periodic basis thereafter
(e.g., 12 weeks and 6 months after exposure)
– the first 6-12 weeks (1 ½ to 3 months)
after exposure, when most HIV infected
persons are expected to
seroconvert (may yield negative HIV
test result)
 NURSING DIAGNOSIS
FOR HIV/AIDS
• Imbalanced Nutrition: Less Than Body
Requirements r/t Inability or altered ability
to ingest, digest and/or metabolize
nutrients: nausea/vomiting
• Risk for Infection r/t Inadequate primary
defenses: broken skin, traumatized tissue
• Fatigue r/t Decreased metabolic energy
production, increased energy requirements
• Anxiety r/t Threat to self-concept, threat of
death, change in health/socioeconomic
status & role functioning
NURSING DIAGNOSIS FOR STIs/STDs
• Sexual dysfunction
• Sexuality patterns, ineffective
• Body image, disturbed
• Sexual dysfunction:
• “The state in which a person experiences a
change in sexual function that is viewed as
unsatisfying, unrewarding, inadequate”
• Sexuality patterns, ineffective: “Expressions of
concern regarding own sexuality” (NANDA)
• Body image, disturbed: “confusion in mental
picture of one’s physical self” (Ackley)
• r/t physical, psychological, cognitive/perceptual ,
170
cultural, spiritual changes
CD SAMPLE QUESTIONS
Nurse Kyle is assigned in the ward of his
rural health unit. He was doing his
morning care among his patients. What
is the best PPE to utilize when
encountering and/or caring for a case of
MRSA in the wound—as you were
ordered to change his linens?
A. Sterile gloves
B. No precaution needed
C. Clean gloves with clean gown
D. N95 mask with fit testing
171
CD SAMPLE QUESTIONS
Which among these disease is
not included in the Six vaccine-
preventable diseases were
initially included in the
Philippine Expanded Program of
Immunization?
A. Measles
B. Pneumococcal Infections
C. Pertussis
D. Tuberculosis
172
CD SAMPLE QUESTIONS
• A patient who is pregnant for the first
trimester had a recent travel to
Singapore was admitted due to fever,
chills, joint pains and rashes which
lasted for 3 days now. The ER Physician
suspected a case of Zika Infection. What
would be the best precaution to apply in
this case being the nurse in charge?
– Droplet Precaution
– Source Isolation
– Standard Precaution
– Reverse Isolation 173
BONUS: Global Threat of Antimicrobial Resistance

174
BONUS: Global Threat of Antimicrobial Resistance

Without effective
antimicrobials for
prevention and treatment
of infections, medical
procedures such as
organ transplantation,
cancer chemotherapy,
diabetes management
and major surgery (for
example, caesarean
sections or hip
replacements) become
very high risk. 175
WHO and CDC released
Global Threats

176
WHO and CDC released
Global Threats

177
WHO and CDC released
Global Threats

178
WHO and CDC released
Global Threats

179
 SOLUTION TO Drug-Resistance
• At home: Proper and rational use of
prescribed antibiotics. Antibiotics
should be taken only when needed and
on prescribed time & duration.
• At the hospital: Antimicrobial
stewardship is a coordinated program
that promotes the appropriate use of
antimicrobials (including antibiotics).
• Universal: Antibacterial for bacterial
disease, and not for viral infection.
Practice proper hand hygiene.
181
Too shy to ask Questions? Ping me.
0998-4299939
rotsenrn@gmail.com
Rotsen J. Jambongana, RN, MN, CICN PHICNA

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