RESPIRATORY DISEASES

Tuberculosis o Highly susceptible: HIV positive,

o Is considered as the deadliest disease immunosuppressed, underweight,
and remains as a major public health undernourished, substance abusers, DM.
problem. o The most hazardous period for
o A highly infectious disease caused by development of clinical disease is the
the tubercle bacilli. first 6-12 months after infection.
o Common among malnourished o Risk of developing the disease is highest
individuals living in crowded areas. in children under 3 years old.
Infectious Agents o Reactivation of long latent infections
o Mycobacterium account for a large proportion of cases of
o Mycobacterium Africanum (Humans) clinical disease in older persons.
o Mycobacterium bovis (cattle) Methods of Control
Mode of Transmission (Preventive Measures)
o Airborne droplet method through  Prompt diagnosis and treatment of
coughing, singing, or sneezing. infectious cases.
o Direct invasion through mucus membranes  BCG vaccination of newborn,
or breaks in the skin may occur but is infants, and grade 1/school entrants
extremely rare.  Educate the public in mode of spread
o Bovine tuberculosis results from exposure and methods of control and the
to tuberculosis cattle, usually by importance of early diagnosis.
unpasteurized milk or dairy products. • Improve social conditions such as
o Extrapulmonary TB other than laryngeal, overcrowding.
is generally not communicable. • Make available medical, laboratory
Signs and symptoms and x-ray facilities.
o Cough of 2 weeks or more • Provide public health nursing and
outreach services for home
o Fever
supervision.
o Chest or back pains National Tuberculosis Control Program
o Hemoptysis or recurrent blood-streaked o Vision: A country where TB is no
sputum longer a public health problem
o Significant weight loss o Mission: Ensure that TB DOTS services
o Night sweating are available, accessible, and affordable
o Fatigue to the communities in collaboration
o Body malaise with the LGUs and other partners
o Shortness of breath o Goal: To reduce prevalence and mortality
Period of Communicability from TB by half by the year 2015
o As long as viable tubercle bacilli are being (Millennium Development Goal)
discharged in the sputum. o Targets
o Untreated or inadequately treated patients 1. Cure at least 85% of the sputum
maybe sputum-positive intermittently for smear-positive TB patient
years. discovered.
o The degree of communicability depends 2. Detect at least 70% of the estimated
on the number of bacilli discharged, the new sputum-smear positive TB
virulence, and adequacy of ventilation. cases.
Exposure to UV light. NTP Objectives and Strategies
o Effective antimicrobial chemotherapy o Objective A: Improve access to and quality
usually reduces communicability to of services provided to TB patients, TB
insignificant levels within days to a few symptomatic, and communities by health
weeks. care institutions and providers.
o Children with primary tuberculosis are o Strategies
generally not infectious. 1. Enhance quality TB diagnosis.
Susceptibility and Resistance 2. Ensure TB patients’ treatment
compliance.

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 3. Ensure public and private health care  Pulmonary TB symptomatics shall
providers’ adherence to the be asked to undergo other diagnostic
implementation of national standards tests (X-ray and culture)
of care for TB patients.  Since DSSM is the primary
4. Improve access to services through diagnostic tool, no TB diagnosis
innovative service delivery shall be made based on the results of
mechanisms for patients living in other exams.
challenging areas.  Only trained medical technologists
o Objective B: Enhance the health-seeking or microscopists shall perform
behavior on TB by communities, especially DSSM.
the TB symptomatic.
o Strategies 2. Treatment
1. Develop effective, appropriate, and  Aside from clinical findings,
culturally responsive IEC/ treatment of all TB cases shall be
communication materials. based on a reliable diagnostic
2. Organize barangay advocacy groups. technique (DSSM)
o Objective C: Increase and sustain support  Domiciliary treatment shall be the
and financing for TB control activities. preferred mode of care.
o Strategies 3. Patients with the ff. conditions shall be
1. Facilitate implementation of TB- recommended for hospitalization
DOTS Center certification and  Massive hemoptysis
accreditation  Pleural effusion obliterating more
2. Build TB coalitions among different than one-half of a lung field.
sectors.  Miliary TB
3. Advocate for counterpart input from  TB meningitis
LGUs  TB Pneumonia
4. Mobilize/ extend other resources to  Those requiring surgical intervention
address program limitations. or with complications.
o Objective D: Strengthen management
(technical and operational) of TB control  All patients shall be supervised (No
services at all levels. patient shall initiate treatment unless the
o Strategies patient and DOTS facility staff have
1. Enhance managerial capability of all agreed upon a case holding mechanism for
NTP program managers at all levels. treatment compliance
2. Establish an efficient data  The national and local government units
management system for both public shall ensure provision of drugs to all
and private sectors. smear-positive TB cases.
3. implement a standardized recording There are 2 formulation of anti-TB drugs:
and reporting system. 1. Fixed-dose combination (FDCs)- two
4. Conduct regular monitoring and or more first-line anti-TB drugs are
evaluation at all levels. combined in one tablet. There are
5. Advocate for political support 2-,3-, or 4- drug fixed dose
through effective local governance combinations.
Key Policies 2. Single drug formulation (SDF)- each
1. Case finding drug is prepared individually. INH,
 Direct Sputum Smear Microscopy Ethambutol, and pyrazinamide are in
(DSSM) shall be the primary one tablet form while rifampicin is in
diagnostic tool in NTP case finding. capsule form.
 All TB symptomatic identified shall  Quality of FDCs must be ensured. FDCs
be asked to undergo DSSM for must be ordered according to WHO-
diagnosis before start of treatment. prescribed strength and standard of
(Contraindication for sputum collection quality.
is hemoptysis)  Treatment shall be based on
recommended category of treatment
regimen.

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 Isoniazid
Empty stomach
Peripheral neuropathy
Avoid alcohol.
Hepatotoxic
Nephrotoxic
Increase intake of Vitamin B6
(pyridoxine)
Pyrazinamide
Before meals
Monitor signs and symptoms of liver
impairment.
Anorexia, fatigue, dark urine,
photosensitivity
Causes hyperuricemia.
Ethambutol
Not affected by food
Report visual disturbances.
Public Health Nursing Responsibilities
Hepatotoxic
(Adult TB)
Not recommended for children, can
o Together with other NTP staff/
cause optic neuritis.
workers, manage the procedures for Streptomycin
case finding activities. After meals
o Assign and supervise a treatment Report oliguria
partner for patients who will undergo Ototoxic
DOTS. Neurotoxic
o Supervise RHMidwife to ensure Nursing management
proper implementation of DOTS. o Maintain respiratory isolation.
o Maintain and update the TB o Administer medicines as ordered.
Register o Educate patient about the disease.
o Facilitate requisition and o Stop smoking.
distribution of drugs and other NTP o Cough or sneeze into tissue paper and
supplies.
dispose secretions properly.
o Provide continuous health education
o Provide a well-balanced diet (high
to all TB patients placed under
calorie.
treatment and encourage family and
o Allow rest periods.
community participation in TB
o Caution the patient who is taking
control.
o In coordination with the physician, contraceptive that the contraceptive may
become less effective while she’s taking
conduct training of health workers.
rifampicin.
o prepare, analyze, and submit the
Prevention and control
quarterly reports to the Provincial
o Submit all babies for BCG
Health Office or City Health Office
immunization.
Treatment modalities
o Avoid overcrowding.
o Short-course chemotherapy: 6-month
o Improve nutritional and health status.
treatment (izoniazid, Rifampicin,
Pyrazinamide, and Ethambutol) Diphtheria
Rifampicin  Description
Empty stomach o It is an acute febrile infection of the
Body fluid discoloration (red orange) tonsil, throat, nose, larynx or wound
Hepatotoxic marked by patches of grayish
Nephrotoxic membranes from which the
Permanent discoloration of contact diphtheria bacillus is readily
lenses cultured.

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 o Nasal diphtheria is commonly Clinical Manifestations
marked by one sided nasal discharge o Bull-neck formation (swelling of the soft
and excoriated nostrils. tissues of the neck)
o Non- respiratory or cutaneous o Exudates forming the membrane are
diphtheria appears as localized grayish in appearance
punched out ulcers. o Fatigue/ malaise
Etiologic Agent : o Slight sore throat
Corynebacterium diphtheria (Klebs- o Breathing difficulty
Loeffler bacillus) o Husky voice
Source of Infection o Swelling of the palate
o Discharges and secretions from o Low-grade fever
mucus surface of nose and Diagnostic Tests
nasopharynx and from skin and other oSwab from the nose and throat
lesions oSchick Test
o Reservoir- Man
 Involves giving an injection of 0.1
Mode of Transmission ml. of dilute diphtheria toxin
o Contact with a patient or carrier or intradermally
with articles soiled with discharges  Area is checked in 3-4 days and the
of infected persons reaction is documented
o Milk has served as a vehicle  Positive test is indicated by
Incubation Period inflammation or induration at the
o Usually 2 to 5 days, occasionally point of injection. This indicates that
longer the client lacks antibodies to
Period of Communicability diphtheria
o Variable until virulent bacilli has o Virulence Test
disappeared from secretions and
lesions; usually 2 weeks and seldom o Moloney Test
more than 4 weeks  A test to detect a high degree of
Types sensitivity to diphtheria toxoid and is
Nasal given intradermally
 With foul-smelling Treatment Modalities
serosanguinous secretions from o Penicillin
the nose o Anti-toxin
Tonsillar o Erythromycin
 Low fatality rate
Susceptibility, Resistance & Occurrence
 Lesions are confined to the
o Infants born of mothers who had
tonsils only but tend to spread
over the pillars, into the soft diphtheria infection are relatively
palate and uvula immune but the immunity disappears
Nasopharyngeal before the 6th month.
 Cervical lymph nodes are swollen o Recovery from an attack of
 Neck tissues are edematous diphtheria is usually but not
 Marked degree of toxemia necessarily followed by persistent
Laryngeal immunity
 Most commonly found in children o Immunity is often acquired through
ages 2 to 5 years old unrecognized infection
 It is considered as most severe and o 2/3 or more of the urban cases are in
more fatal type due to anatomical children under 10 years of age
reason Methods of Prevention and Control
 There is moderate hoarseness; voice o Active immunization of all infants (6
is diminished until it is finally absent weeks) and children with 3 doses of
Wound/ cutaneous DPT toxoid administered at 4-6
 Affects the mucous membrane and weeks intervals and then booster
any break in the skin doses following year after the last

4|P a g e PAHUNAO, REYZEL MAE

 dose of primary series and another o Crowding and closed association
dose on the 4th or 5th year of age with patients facilitate spread.
o Pasteurization of milk
o Education of parents
o Active immunization of all infants Incubation Period
and children with 3 doses of DPT o 7-10 but not exceeding 21 days
o Reporting of the case to the Health Period of Communicability
Officer for proper medical care o In early catarrhal stage, paroxysmal
PHN Responsibilities cough confirms provisional clinical
o Preventive education diagnosis 7 days after exposure to 3
o Observe correct technique for taking weeks after onset of typical
nose and throat cultures for paroxysms
diphtheria Clinical Manifestation
o Teach procedures of disposal by o Violent coughing
burning of nose and throat o Nose bleeding
discharges and uneaten food as o Distended neck veins
concurrent disinfection o Periorbital edema
o Encourage early prophylactic o Conjunctival hemorrhage
immunization of infants and children Complications
Nursing Care o Bronchopneumonia- most dangerous
o Follow prescribed dosage and correct o Convulsion
technique in administering antitoxin o Umbilical hernia
infections o Otitis media
o Comfort of the patient should always o Severe malnutrition and starvation
be in mind Diagnostic Tests
o Isolation technique o Nasopharyngeal swab (Positive for
o Absolute bed rest for at least 2 weeks B. pertussis)
o Soft diet, small frequent feedings o Sputum culture
o Ice collar applied to the neck o CBC (Leukocytosis)
o Chest Radiography may reveal
Whooping Cough (Pertussis) infiltrates or edema with atelectasis.
 Description Treatment Modalities
o It is an acute infection of the o Supportive therapy
respiratory tract characterized by  Fluid and electrolyte replacement
repeated attack of spasmodic  Adequate nutrition
coughing which consists of a series  Oxygen therapy
of explosive expirations. Producing a o Antibiotics
crowing sound, “the whoop”, and  Erythromycin
usually followed by vomiting.  Ampicillin
o Coughing may last for several weeks o Hyperimmune convalescent serum/
and occasionally 2-3 months gamma globulin
Etiologic Agent Susceptibility, Resistance and
o Haemophilus Pertussis Occurrence
o Bordet Gengou Bacillus o Susceptibility is general,
o Bordetella pertussis or pertussis predominantly a childhood disease,
bacillus the incidence being highest under 7
Source of Infection years of age and mortality highest in
o Discharges from laryngeal and infants, particularly under 6 months
bronchial mucous membrane of of age.
infected persons o One attack confers definite and
Mode of Transmission prolonged immunity.
o Direct spread through respiratory and o Second attack occasionally occurs.
salivary contacts

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 o A very prevalent and common  Description
disease among children everywhere o Acute highly communicable disease
regardless of race, climate or characterized by abrupt onset with
geographic location. fever which last 1 day to 6 days, chilly
Methods of Prevention and Control sensation or chills, aches or pains in the
o Routine DPT immunization of all back and limbs with prostrations.
infants which can be started at 1 ½ o Respiratory symptoms include coryza,
months of life and given at monthly sore throat and cough
intervals in 3 consecutive months. Etiological Agent
o This constitutes the primary o Influenza A,B,C
injections. Source of infection
o Booster dose is to be given at the age o Discharges from the mouth and nose
of 2 years and again at 4 to 5 years of of infected persons
age Mode of Transmission
o The patient should be segregated oBy direct contact, through droplet
until after 3 weeks from the infection,
appearance of paroxysmal cough. oby articles freshly soiled with discharged
PHN Responsibilities of nose and throat of infected person
o Explain clearly to parents the oAirborne
dangers of whooping cough and the Incubation Period
need for active immunization against o Short, usually 24 to 72 hours
the disease in infancy. Period of Communicability
o Direct or guide parents to resources o Probably limited to 3 days from clinical
of the community where this service onset
is available as in health centers, Clinical manifestations
private physicians and health clinics oChilly sensation
o Observe patients for signs of oHyperpyrexia
complications and report oSevere aches and pains usually at the
immediately to physician for back associated with severe sweating.
desirable treatment oVomiting
o Observe general nursing oSore throat
responsibilities in communicable oCoryza and cough
disease care Complications
Nursing Care o Hemorrhagic pneumonia
o Isolation and medical asepsis
o Encephalitis
o Suction equipment should be present
o Myocarditis
at bedside
o Sudden infant death syndrome
o Provide warm bath
Diagnostic Procedures
o Keep the bed dry and free from
 Blood examination
soiled linens  Usually normal but leucopenia has
o I and O should be closely monitored been noted
o Care should be focused on  Viral culture (oropharyngeal
prevention and other complications: washing or swabbing during the first
special attention to diet is needed if few days of illness
patient vomits after cough  Viral serology
paroxysms  Complement Fixation Test
o Teach parents how to pick up the  It is an immunological medical test
infant or child during paroxysmal that can be used to detect the
cough, giving abdominal support presence of either specific antibody
o General care of nose and throat or specific antigen in a patient’s
discharges serum

Influenza - (La Grippe)

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  Chest Radiography may reveal o An acute infectious disease of the
bilateral symmetrical interstitial lungs usually caused by the
infiltrates indicative of pneumonia pneumococcus resulting in the
 Arterial blood Gas testing may consolidation of one or more lobes of
reveal hypoxemia in severe cases either one or both lungs
 Laboratory Tests may reveal Etiologic Agents
leucopenia, lymphopenia and o Streptococcus pneumonia
thrombocytopenia o Staphylococcus aureus
Susceptibility, Resistance and Occurrence o Hemophilus influenza
o Universal but of varying degrees as o Pneumococcus of Friedlander
shown by frequent unapparent and o Majority of cases due to Diplococcus
typical infection during epidemics pneumoniae
o Occurrence is variable, in o Viruses
pandemics, local epidemics and as
sporadic cases, often unrecognized
by reason of indefinite clinical
symptoms
o Infection produces immunity of Predisposing Causes
unknown duration to the type and o Fatigue
subtype of infecting virus. o Overexposure to inclement weather
Methods of Prevention and Control (extreme heat or cold)
o Education of the public as to sanitary o Exposure to polluted air
hazard from spitting, sneezing and o Malnutrition
coughing
Incubation Period
o Avoid use of common towels,
o 2 to 3 days
glasses and eating utensils
Mode of Transmission
o Active immunization with influenza
o Droplet infection
vaccine
o Indirect contact (fomites)
o Avoid crowded places
Signs and Symptoms
PHN Responsibilities
o Rhinitis/ common cold
o Isolate patient during the acute stage
o Chest indrawing
o Report cases to local health officer
o Rusty sputum
o During epidemics, patients should be
o Productive cough
instructed to go to bed at the
beginning of the attack and not to o Fast respiration
return to work without the approval o High fever
of the physician o Vomiting at times
Nursing Care o Convulsions may occur
o Keep patient warm and free from o Flushed face
drafts in bed o Dilated pupils
o Keep patient away from persons o Severe chill in young children
suffering from respiratory tract o Pain over affected lung
infections to prevent pneumonia o Highly colored urine with reduced
o TSB for fever chlorides and increased urates
o Cover the nose and mouth while Complications
sneezing and coughing o Emphysema- a condition in which
o Teach the burning method or the air sacs of the lungs are damaged
disposal of contaminated tissues and and enlarged, causing breathlessness
newspaper o Endocarditis or pericarditis
o Clothing soiled with throat and nose o Pneumococcal meningitis
discharges should be boiled for 30 o Otitis media in children
minutes before laundering o Jaundice
Pneumonia o Abortion
 Description

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 Diagnostic Test  Soil associated with infected animals
o Based on history and clinical s/s or contaminated bone meal used in
o Dull percussion noted on affected gardening.
side (lung) Incubation Period
o Chest X-ray o Inhalation anthrax (1 to 7 days)
o Sputum analysis usually within 48 hours
o Blood/ serologic exam o Cutaneous anthrax 1 to 7 days rarely
Management up to 7 weeks
o Bed rest o Ingestion (1 to 7 days)
o Adequate salt, fluid, calorie, and Clinical Manifestations
vitamin intake Cutaneous anthrax
o TSB for fever  Most common (over 90% of cases)
o Frequent turning from side to side  Infection through skin
o Antibiotics based on Care of Acute  Over a few days a sore, which begins
as a pimple, grows, ulcerates, and
Respiratory Infection (CARI) of the
forms a black scab, around which are
DOH
purplish vesicles.
Prevention and Control
 Systemic symptoms may include
o Prevent common colds, influenza
rigor, headache, and vomiting.
and other respiratory infections  The sore is usually diagnostic; 20%
o Immunization with pneumonia of cases are fatal.
vaccine Inhalational Anthrax
o Eliminate contributory factors such  Spores are inhaled, with subsequent
as exposure to cold, pollution, and invasion of mediastinal lymph nodes.
physical conditions of fatigue or  Abrupt onset of the flu-like illness,
alcoholism rigors, dyspnea, and cyanosis
Anthrax followed by shock and usually death
 Other Terms over the next 2 to 6 days.
o Wool sorter’s Disease- a pulmonary Intestinal Anthrax
form of anthrax that results from the  Occurs following ingestion of meat
inhalation of spores of the bacterium from infected animals and is
Bacillus anthracis in the wool of manifested as violent gastroenteritis
contaminated sheep with fever, vomiting, bloody stools
o Ragpicker’s disease- and then septicemia. The prognosis
o Malignant pustule is poor.
o Malignant edemia Diagnostic Tests
 Description o Polymerase Chain Reaction (PCR) –
o It is an acute bacterial disease Definitive test for B. Anthracis
usually affecting the skin, but which o Swabs from cutaneous lesions
may very rarely involve the o Nasal swabs (inhalational anthrax)
oropharynx, lower respiratory tract, o Blood cultures
mediastinum or intestinal tract o Lymph nodes or spleen aspirates
Etiologic Agent o CSF shows characteristic bacilli on
o Bacillus anthracis staining with polychrome methylene
Mode of Transmission blue.
o Cutaneous infection is by contact o Chest radiography may show fluid
with: surrounding the lungs or widening of
 Tissues of animals (cattle, sheep, the mediastinum.
goats, horses, pigs, and others) dying Treatment Modalities
of the disease o Antibiotics
 Contaminated hair, wool or products  Doxycycline
made from them such as drums or  Ciprofloxacin
brushes.  Penicillin

8|P a g e PAHUNAO, REYZEL MAE

 o Treatment of cutaneous anthrax is o It is an infectious disease of birds
oral antibiotics for 7 to 10 days. ranging from mild to severe forms of
o The length of treatment for GI illness.
anthrax is 60 days, but safety has not Sources of Infection
been evaluated beyond 14 days. o Viruses that normally infect only
Complications birds and less commonly pigs
o Cutaneous anthrax Incubation Period
 Septicemia o 3 to 5 days
o Inhalational anthrax Clinical manifestations
 Hemorrhagic meningitis o Fever
 Pleural effusion o Body weakness/ muscle pain
 Mediastinitis o Cough
 Shock o Sore throat
 Acute respiratory distress o May have difficulty of breathing in
syndrome severe cases.
o GI anthrax o Sore eyes
 Hemorrhage Susceptibility, Resistance and Occurrence
 Shock o All birds are susceptible to infection,
Nursing Considerations but domestic poultry flocks are
o Obtain culture specimen before especially vulnerable to infections
starting antibiotic therapy. that can rapidly reach epidemic
o Supportive measures are geared population.
toward the type of anthrax exposure. Control measures
o Teach the patient and family that o Rapid destruction, proper disposal of
anyone who has been exposed to carcasses and quarantining and
anthrax must see a doctor rigorous disinfection of farms.
immediately. o Restrictions on the movement of live
o Instruct the patient to take antibiotics poultry
as prescribed and until completed. Nursing Care
o Instruct the patient with cutaneous o Isolation precaution
anthrax not to scratch at the lesions. o Infection control
o Alcohol-based hand sanitizers do not o Early recognition of cases of highly
kill anthrax spores, wash hands with pathogenic avian influenza during
soap and water. outbreak among poultry
Prevention
o Pretreatment of animal products and Severe Acute Respiratory Syndrome
good occupational health cover are (SARS)
the mainstays of control.  Earliest known case (Guangdong
o Animals believed to have died of Province, China, November 2002
anthrax should be disposed of under  Outbreak and worldwide
supervision. surveillance (March 12, 2003)
o Mass vaccination of animals may  First case in the Philippines (April
reduce diseases spread. 11, 2003)
o Non- cellular vaccines for human use Etiologic Agent
are available for individuals at risk o Human coronavirus
from occupational exposure. Mode of Transmission
o Workers handling potentially o Droplet contact
infectious raw material should be Incubation period
aware of the risks. o Mean incubation period is 5 days
(range 2-10 days) and may reach up
Bird Flu (Avian Influenza) to 14 days.
 Description Clinical Manifestations
o Prodromal Phase

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  Fever >_ 38 degrees Celsius o WATER SUPPLY
 Chills o FOOD ESTABLISHMENT
 Malaise o MARKETS AND ABATTOIRS
 Myalgia o PUBLIC LAUNDRY
 Headache o SCHOOL SANITATION AND
o Respiratory Phase HEALTH SERVICES
 Dry, non-productive cough with or o INDUSTRIAL HYGIENE
without respiratory distress o PUBLIC SWIMMING OR
 Hypoxia BATHING PLACES
 Crackles o REST AREAS, BUS TERMINALS,
 Dullness on percussion
BUS STOPS, AND SERVICE
 Decreased breath sounds on physical
STATIONS
examination.
o CAMPS AND PICNIC GROUNDS
Preventive Measures and Control
o Screen patients for travel history, o DANCING SCHOOLS, DANCE
symptoms, or close contact with HALLS AND NIGHT CLUBS
cases o INDUSTRIAL HYGIENE
o Isolation of suspected probable case o PUBLIC SWIMMING OR
o Barrier nursing technique for BATHING PLACES
suspected and probable case o REST AREAS, BUS TERMINALS,
Nursing care BUS STOPS, AND SERVICE
o Maintain isolation measures. STATIONS
o Utilize personal protective o CAMPS AND PICNIC GROUNDS
equipment (PPE) o DANCING SCHOOLS, DANCE
o Apply principles of hand wash HALLS AND NIGHT CLUBS
Ethical Considerations in Community Health o INDUSTRIAL HYGIENE
Nursing: Public Health Laws o PUBLIC SWIMMING OR
Republic Act 7305 BATHING PLACES
“THE MAGNA CARTA OF PUBLIC o REST AREAS, BUS TERMINALS,
HEALTH WORKERS” BUS STOPS, AND SERVICE
o The State shall instill health STATIONS
consciousness among our people to o CAMPS AND PICNIC GROUNDS
effectively carry out the health o DANCING SCHOOLS, DANCE
programs and projects to the HALLS AND NIGHT CLUBS
government essential for the growth REPUBLIC ACT NO. 8749
and health of the nation. PHILIPPINE CLEAN AIR ACT OF 1999
 Objectives  The State shall promote and protect
o to promote and improve the social the global environment to attain
and economic well-being of the sustainable development
health workers, their living and while recognizing the primary
working conditions and terms of responsibility of local government
employment; units to deal with environmental
o to develop their skills and problems.
capabilities in order that they will be REPUBLIC ACT No. 6675
more responsive and better equipped "Generics Act of 1988. “
to deliver health projects and  AN ACT TO PROMOTE,
programs; and REQUIRE AND ENSURE THE
o to encourage those with proper PRODUCTION OF AN
qualifications and excellent abilities ADEQUATE SUPPLY,
to join and remain in government DISTRIBUTION, USE AND
service. ACCEPTANCE OF DRUGS AND
PRESIDENTIAL DECREE No. 856 MEDICINES IDENTIFIED BY
“CODE ON SANITATION” THEIR GENERIC NAMES
 This includes the ff:

10 | P a g e PAHUNAO, REYZEL MAE

  To promote, encourage and require provide free medical care to paupers.
the use of generic terminology in the Towards this end,
importation, manufacture,  The State shall provide
distribution, marketing, advertising comprehensive health care services
and promotion, prescription and to all Filipinos through a socialized
dispensing of drugs; health insurance program that will
 To ensure the adequate supply of prioritize the health care needs of the
drugs with generic names at the underprivileged, sick, elderly,
lowest possible cost and endeavor to persons with disabilities (PWDs),
make them available for free to women and children and provide free
indigent patients; health care services to indigents.
 To encourage the extensive use of Republic Act No. 7719
drugs with generic names through a “National Blood Service Act”
rational system of procurement and o Promotes voluntary blood donation
distribution to provide sufficient supply of safe
 To emphasize the scientific basis for blood and to regulate blood banks.
the use of drugs, in order that health This act aims to inculcate public
professionals may become more awareness that blood donation is a
aware and cognizant of their humanitarian act.
therapeutic effectiveness; and o This act aims to inculcate public
 To promote drug safety by awareness that blood donation is a
minimizing duplication in humanitarian act.
medications and/or use of drugs with RA 11332
potentially adverse drug interactions. Repealing the RA 3573, Law on reporting
REPUBLIC ACT No. 11223 communicable diseases
“Universal Health Care Act “  Also known as the Mandatory
 An Act Instituting Universal Health Reporting of Notifiable Diseases and
Care for All Filipinos, Prescribing Health events of Public Health
Reforms in the Health Care System, Concern Act
and Appropriating Funds  List of Notifiable Diseases in PH
 This act seeks to: o Category 1 – Immediately reportable
o Progressively realize universal health diseases/syndromes/events
care in the country through a 1. Acute flaccid paralysis “hot
systemic approach and clear case”
delineation of roles of key agencies 2. Anthrax
and stakeholders towards better 3. Human avian influenza
performance in the health system; 4. Severe acute respiratory
and syndrome (SARS)
o Ensure that all Filipinos are 5. Adverse event following
guaranteed equitable access to immunization (AEFI)
quality and affordable health care 6. Any disease outbreak
goods and services, and protected 7. Any clustering of patients with
against financial risk. similar disease, symptoms or
REPUBLIC ACT No. 10606 syndromes
Amending RA 7875, National health 8. Meningococcal disease
Insurance Act of 1995 Immediate reporting upon laboratory
 Also known as National Health confirmation
Insurance Act of 2013 1. Poliomyelitis
 The State to adopt an integrated and 2. Cholera
comprehensive approach to health 3. Measles
development which shall endeavor to 4. HIV/AIDS (HIV Registry)
make essential goods, health and o Category 2 – Weekly reportable
other social services available to all diseases/syndromes/events
the people at affordable cost and to 1. Acute bloody diarrhea

11 | P a g e PAHUNAO, REYZEL MAE

 2. Acute hemorrhagic fever REPUBLIC ACT No. 9502
syndrome Amending RA 8293, RA 6675, RA 5921
3. Acute viral hepatitis  RA 8293- THE INTELLECTUAL
4. Acute flaccid paralysis PROPERTY CODE
5. Bacterial meningitis  RA 6675- THE GENERICS ACT
6. Cholera  RA 5921- THE PHARMACY LAW
7. Dengue  Also known as "Universally
8. Diphtheria Accessible Cheaper and Quality
9. Influenza Medicines Act of 2008".
10. Japanese encephalitis  AN ACT PROVIDING FOR
11. Leptospirosis CHEAPER AND QUALITY
12. Malaria MEDICINES
13. Neonatal tetanus  The State to protect public health
14. Non-neonatal tetanus and, when the public interest or
15. Paralytic shellfish poisoning circumstances of extreme urgency so
16. Pertussis require, it shall adopt appropriate
17. Rabies measures to promote and ensure
18. Typhoid and paratyphoid access to affordable quality drugs
fever and medicines for all.
REPUBLIC ACT No. 9994 REPUBLIC ACT No. 10821
Further amending RA 7432, AN ACT TO AN ACT MANDATING THE
MAXIMIZE THE CONTRIBUTION OF PROVISION OF EMERGENCY RELIEF
SENIOR CITIZENS TO NATION AND PROTECTION FOR CHILDREN
BUILDING, GRANT BENEFITS AND BEFORE, DURING, AND AFTER
SPECIAL PRIVILEGES AND FOR DISASTERS AND OTHER
OTHER PURPOSES EMERGENCY SITUATIONS
 Also known as “Expanded Senior  Also known as “Children’s
Citizens Act of 2010” Emergency Relief and Protection
 AN ACT GRANTING Act”
ADDITIONAL BENEFITS AND  The State to protect the fundamental
PRIVILEGES TO SENIOR rights of children before, during, and
CITIZENS. after disasters and other emergency
 the State to promote a just and situations when children are gravely
dynamic social order that will ensure threatened or endangered by
the prosperity and independence of circumstances that affect their
the nation and free the people from survival and normal development.
poverty through policies that provide Republic Act 9262
adequate social services, promote "THE ANTI-VIOLENCE AGAINST
full employment, a rising standard of WOMEN AND THEIR CHILDREN ACT
living and an improved quality of OF 2004“
life.  The State values the dignity of
REPUBLIC ACT NO. 9165 women and children and guarantees
Repealing RA 6425, Dangerous drugs act full respect for human rights. The
of 1972 State also recognizes the need to
 Also known as "Comprehensive protect the family and its members
Dangerous Drugs Act of 2002" particularly women and children,
 The State to safeguard the integrity from violence and threats to their
of its territory and the well-being of personal safety and security.
its citizenry particularly the youth, REPUBLIC ACT No. 10121
from the harmful effects of AN ACT STRENGTHENING THE
dangerous drugs on their physical PHILIPPINE DISASTER RISK
and mental well-being, and to defend REDUCTION AND MANAGEMENT
the same against acts or omissions SYSTEM, PROVIDING FOR THE
detrimental to their development and NATIONAL DISASTER RISK
preservation. REDUCTION AND MANAGEMENT

12 | P a g e PAHUNAO, REYZEL MAE

 FRAMEWORK AND RELATED PRODUCTS,
INSTITUTIONALIZING THE PENALIZING VIOLATIONS.
NATIONAL DISASTER RISK  Also known as "National Code
REDUCTION AND MANAGEMENT of Marketing of Breastmilk
PLAN, APPROPRIATING FUNDS Substitutes, Breastmilk
THEREFOR AND FOR OTHER Supplements and Other Related
PURPOSES. Products"
 Also known as the "Philippine  Aim of the Code is to contribute
Disaster Risk Reduction and to the provision of safe and
Management Act of 2010“ adequate nutrition for infants by
 the State to Uphold the people's the protection and promotion of
constitutional rights to life and breastfeeding and by ensuring
property, Adhere to and adopt the the proper use of breastmilk
universal norms, principles and substitutes and breastmilk
standards of humanitarian assistance supplements when these are
and the global effort on risk necessary, on the basis of
reduction, and Incorporate adequate information and
internationally accepted principles of through appropriate marketing
disaster risk management in the and distribution.
creation and implementation of REPUBLIC ACT NO. 10354
national, regional and local AN ACT PROVIDING FOR A
sustainable development and poverty NATIONAL POLICY ON RESPONSIBLE
reduction strategies, policies, plans PARENTHOOD AND REPRODUCTIVE
and budgets HEALTH
REPUBLIC ACT No. 10028  Also known as "The Responsible
AN ACT EXPANDING THE Parenthood and Reproductive
PROMOTION OF BREASTFEEDING Health Act of 2012″
 Amending for the purpose  The State recognizes and guarantees
REPUBLIC ACT NO. 7600, "AN the human rights of all persons
ACT PROVIDING INCENTIVES including their right to equality and
TO ALL GOVERNMENT AND non-discrimination of these rights,
PRIVATE HEALTH the right to sustainable human
INSTITUTIONS WITH development, the right to health
ROOMING-IN AND which includes reproductive health,
BREASTFEEDING PRACTICES the right to education and
AND FOR OTHER PURPOSES" information, and the right to choose
 Also known as "Expanded and make decisions for themselves in
Breastfeeding Promotion Act of accordance with their religious
2009“ convictions, ethics, cultural beliefs,
 The State adopts rooming-in as a and the demands of responsible
national policy to encourage, protect parenthood.
and support the practice of REPUBLIC ACT No. 10152
breastfeeding. It shall create an AN ACT PROVIDING FOR
environment where basic physical, MANDATORY BASIC IMMUNIZATION
emotional, and psychological needs SERVICES FOR INFANTS AND
of mothers and infants are fulfilled CHILDREN
through the practice of rooming-in  REPEALING FOR THE PURPOSE
and breastfeeding. PRESIDENTIAL DECREE No. 996,
EXECUTIVE ORDER NO. 51 AS AMENDED.
 ADOPTING A NATIONAL  Also known as the "Mandatory
CODE OF MARKETING OF Infants and Children Health
BREASTMILK Immunization Act of 2011"
SUBSTITUTES,  The mandatory basic immunization
BREASTMILK for all infants and children provided
SUPPLEMENTS AND under this Act shall cover the

13 | P a g e PAHUNAO, REYZEL MAE

 following vaccine-preventable DISTRIBUTION AND
diseases ADVERTISEMENTS OF TOBACCO
(a) Tuberculosis; PRODUCTS AND FOR OTHER
(b) Diphtheria, tetanus and PURPOSES
pertussis;  Also known as the "Tobacco
(c) Poliomyelitis; Regulation Act of 2003.“
(d) Measles;  the State to protect the populace
(e) Mumps; from hazardous products and
(f) Rubella or German measles; promote the right to health and instill
(g) Hepatitis-B; health consciousness among them
(h) H. Influenza type B (HIB); REPUBLIC ACT No. 11036
and An Act Establishing a National Mental
(i) Such other types as may be Health Policy for the Purpose of Enhancing
determined by the Secretary of the Delivery of Integrated Mental Health
Health in a department circular. Services, Promoting and Protecting the
REPUBLIC ACT No. 10666 Rights of Persons Utilizing Psychosocial
AN ACT PROVIDING FOR THE Health Services, Appropriating Funds
SAFETY OF CHILDREN ABOARD Therefor and Other Purposes
MOTORCYLES  Also known as the "Mental Health
 Also known as "Children’s Safety Act.“
on Motorcycles Act of 2015“  The state affirms the basic right of
 the State to defend the right of all Filipinos to mental health as well
children to assistance, including as the fundamental rights of people
proper care and nutrition, and special who require mental health services.
protection from all forms of neglect,  The state commits itself to
abuse, cruelty, exploitation, and promoting the well-being of people
other conditions prejudicial to their by ensuring that; mental health is
development. valued, promoted and protected;
PRESIDENTIAL DECREE No. 603 mental health conditions are treated
“THE CHILD AND YOUTH WELFARE and prevented; timely, affordable,
CODE” high quality, and culturally-
 The Child is one of the most appropriate mental health case is
important assets of the nation. made available to the public; mental
Every effort should be exerted to health service are free from coercion
promote his welfare and enhance and accountable to the service users;
his opportunities for a useful and and persons affected by mental
happy life. health conditions are able to exercise
 The Code shall be known as the the full range of human rights, and
Child and Youth Welfare Code. participate fully in society and at
It shall apply to persons below work free from stigmatization and
twenty-one years of age except discrimination.
those emancipated in accordance REPUBLIC ACT 9003
with law. "Child" or "minor" or AN ACT PROVIDING FOR AN
"youth" as used in this Code, ECOLOGICAL SOLID WASTE
shall refer to such persons. MANAGEMENT PROGRAM,
 Rights of the Child. - All CREATING THE NECESSARY
children shall be entitled to the INSTITUTIONAL MECHANISMS AND
rights herein set forth without INCENTIVES, DECLARING CERTAIN
distinction as to legitimacy or ACTS PROHIBITED AND PROVIDING
illegitimacy, sex, social status, PENALTIES, APPROPRIATING FUNDS
religion, political antecedents,  Also known as the "Ecological Solid
and other factors. Waste Management Act of 2000.”
Republic Act No. 9211  The State to adopt a systematic,
AN ACT REGULATING THE comprehensive and ecological solid
PACKAGING, USE, SALE waste management program.

14 | P a g e PAHUNAO, REYZEL MAE

 REPUBLIC ACT No. 9482 REPUBLIC ACT – an act passed by the
AN ACT PROVIDING FOR THE Congress of the Philippines, while the
CONTROL AND ELIMINATION OF form of government is Republican
HUMAN AND ANIMAL RABIES, government.
PRESCRIBING PENALTIES FOR • Republic Act 349 – Legalizes the
VIOLATION THEREOF AND use of human organs for surgical,
APPROPRIATING FUNDS medical and scientific purposes.
 also known as the "Anti-Rabies Act • Republic Act 1054 – Requires the
of 2007” owner, lessee or operator of any
 The State to protect and promote the commercial, industrial or agricultural
right to health of the people. establishment to furnish free
Towards this end, a system for the emergency, medical and dental
control, prevention of the spread, and assistance to his employees and
eventual eradication of human and laborers.
animal Rabies shall be provided and • Republic Act 1080 – Civil Service
the need for responsible pet Eligibility
ownership established. • Republic Act 1082 – Rural Health
Republic Act No. 9275 Unit Act
 AN ACT PROVIDING FOR A • Republic Act 1136 – Act
COMPREHENSIVE WATER recognizing the Division of
QUALITY MANAGEMENT AND Tuberculosis in the DOH
FOR OTHER PURPOSES • Republic Act 1612 – Privilege
 Also known as the "Philippine Clean Tax/Professional tax/omnibus tax
Water Act of 2004." should be paid January 31 of each
 The State shall pursue a policy of year
economic growth in a manner • Republic Act 1891 – Act
consistent with the protection, strengthening Health and Dental
preservation and revival of the services in the rural areas
quality of our fresh, brackish and • Republic Act 2382 – Philippine
marine waters. Medical Act which regulates the
practice of medicines in the
RA 10354 Philippines
AN ACT PROVIDING FOR A • Republic Act 2644 – Philippine
NATIONAL POLICY ON RESPONSIBLE Midwifery Act
PARENTHOOD AND REPRODUCTIVE • Republic Act 3573 – Law on
HEALTH reporting of Communicable Diseases
 Also known as "The Responsible • Republic Act 4073 – Liberalized
Parenthood and Reproductive treatment of Leprosy
Health Act of 2012″ • Republic Act 4226 – Hospital
 The State recognizes and guarantees Licensure Act requires all hospital to
the human rights of all persons be licensed before it can be operative
including their right to equality and • Republic Act 5181 – Act
non-discrimination of these rights, prescribing permanent residence and
the right to sustainable human reciprocity as qualifications for any
development, the right to health examination or registration for the
which includes reproductive health, practice of any profession in the
the right to education and Philippines
information, and the right to choose • Republic Act 5821 – The Pharmacy
and make decisions for themselves in Act
accordance with their religious • Republic Act 5901 – 40 hours work
convictions, ethics, cultural beliefs, for hospital workers
and the demands of responsible • Republic Act 6111 – Medicare Act
parenthood. • Republic Act 6365 – Established a
Philippine Health Care Laws National Policy on Population and

15 | P a g e PAHUNAO, REYZEL MAE

 created the Commission on • Republic Act 7719 – National Blood
population Service Act of 1994
• Republic Act 6425 – Dangerous • Republic Act 7875 – National
Drug Act of 1992 Health Insurance Act of 1995
• Republic Act 6511 – Act to • Republic Act 7876 – Senior Citizen
standardize the examination and Center of every Barangay
registration fees charged by the • Republic Act 7877 – Anti-sexual
National Boards, and for other harassment Act of 1995
purposes. • Republic Act 7883 – Barangay
• Republic Act 6675 – Generics Act Health workers Benefits and
of 1988 Incentives Act of 1992
• Republic Act 6713 – Code of • Republic Act 8042 – Migrant
Conduct and Ethical Standards for Workers and Overseas Filipino Act
Public Officials and Employees of 1995
• Republic Act 6725 – Act • Republic Act 8172 – Asin Law
strengthening the prohibition on Republic Act 8187 – Paternity Leave
discrimination against women with Act of 1995
respect to terms and condition of • Republic Act 8203 – Special Law
employment on Counterfeit Drugs
• Republic Act 6727 – Wage • Republic Act 8282 – Social Security
Rationalization Act Law of 1997 (amended RA 1161)
• Republic Act 6758 – Standardized • Republic Act 8291 – Government
the salaries Service Insurance System Act of
• Republic Act 6809 – Majority age is 1997 (amended PD 1146)
18 years old • Republic Act 8344 – Hospital
• Republic Act 6972 – Day care Doctors to treat emergency cases
center in every Barangay referred for treatment
• Republic Act 7160 – Local • Republic Act 8423 – Philippine
Government Code Institute of Traditional and
• Republic Act 7164 – Philippine Alternative Medicine
Nursing Act of 1991 • Republic Act 8424 – Personal tax
• Republic Act 7170 – Law that Exemption
govern organ donation • Republic Act 8749 – The Philippine
• Republic Act 7192 – Women in Clean Air Act of 1999
development nation building • Republic Act 8981 – PRC
• Republic Act 7277 – Magna Carta Modernization Act of 2000
of Disabled Persons • Republic Act 9165 –
• Republic Act 7305 – The Magna Comprehensive Dangerous Drugs
Carta of public Health Workers Act 2002
• Republic Act 7392 – Philippine • Republic Act 9173 – Philippine
Midwifery Act of 1992 Nursing Act of 2002
• Republic Act 7432 – Senior Citizen • Republic Act 9288 – Newborn
Act Screening Act
• Republic Act 7600 – Rooming In PRESIDENTIAL DECREE – An
and Breastfeeding Act of 1992 order of the President. This power of
• Republic Act 7610 – Special the President which allows him/her to
protection of children against abuse, act as legislators was exercised during
exploitation and discrimination act the Marshall Law period.
• Republic Act 7624 – Drug • Presidential Decree 46 – An act
Education Law making it punishable for any public
• Republic Act 7641 – New officials or employee, whether of the
Retirement Law national or local government, to
• Republic Act 7658 – An act receive directly or indirectly any
prohibiting the employment of gifts or valuable things
children below 15 years of age

16 | P a g e PAHUNAO, REYZEL MAE

• Presidential Decree 48 – Limits immediate injury, illness and
benefits of paid maternity leave disability.
privileges to four children • Presidential Decree 651 – All births
• Presidential Decree 69 – Limits the and deaths must be registered 30
number of children to four (4) tax days after delivery.
exemption purposes • Presidential Decree 825 – Providing
• Presidential Decree 79 – Population penalty for improper disposal
Commission garbage and other forms of
• Presidential Decree 147 – Declares uncleanliness and for other purposes.
April and May as National • Presidential Decree 851 – 13th
Immunization Day Month pay
• Presidential Decree 148 – • Presidential Decree 856 – Code of
Regulation on Woman and Child Sanitation
Labor Law • Presidential Decree 965 –
• Presidential Decree 166 – Requiring applicants for Marriage
Strengthened Family Planning License to receive instruction on
program by promoting participation family planning and responsible
of private sector in the formulation parenthood.
and implementation of program • Presidential Decree 996 – Provides
planning policies. for compulsory basic immunization
• Presidential Decree 169 – for children and infants below 8
Requiring Attending Physician years of age.
and/or persons treating injuries • Presidential Decree 1083 –
resulting from any form of violence. Muslim Holidays
• Presidential Decree 223 – • Presidential Decree 1359 – A
Professional Regulation Commission law allowing applicants for
• Presidential Decree 442 – Labor Philippine citizenship to take
Code Promotes and protects Board Examination pending their
employees self-organization and naturalization.
collective bargaining rights. • Presidential Decree 1519 –
Provision for a 10% right differential Gives medicare benefits to all
pay for hospital workers. government employees
• Presidential Decree 491 – Nutrition regardless of status of
Program Presidential Decree 539 – appointment.
Declaring last week of October every • Presidential Decree 1636 –
as Nurse’s Week. October 17, 1958 requires compulsory
• Presidential Decree 541 – Allowing membership in the SSS and self-
former Filipino professionals to employed
practice their respective professions • Presidential Decree 4226 –
in the Philippines so they can Hospital Licensure Act
provide the latent and expertise PROCLAMATION – an official
urgently needed by the homeland declaration by the Chief Executive /
• Presidential Decree 568 – Role of Office of the President of the
Public Health midwives has been Philippines on certain programs /
expanded after the implementation of projects / situation
the Restructed Health Care Delivery • Proclamation No.6 – UN’s goal of
System (RHCDS) Universal Child Immunization;
• Presidential Decree 603 – Child and involved NGO’s in the immunization
Youth Welfare Act / Provision on program
Child Adoption • Proclamation No. 118 –
• Presidential Decree 626 – Professional regulation Week is June
Employee Compensation and State 16 to 22
Insurance Fund. Provide benefits to • Proclamation No. 499 – National
person covered by SSS and GSIS for AIDS Awareness Day Proclamation

17 | P a g e PAHUNAO, REYZEL MAE

 No. 539 – Nurse’s Week – Every
third week of October Other Important Information
• Proclamation No. 1275 – Declaring • Administrative Order 114 –
the third week of October every year Revised/updated the roles and functions
as “Midwifery Week” of the Municipal Health Officers,
Public Health Nurses and Rural
LETTER OF INSTRUCTION – An Midwives
order issued by the President to serve • LOI Convention 149 – Provides the
as a guide to his/her previous decree or improvement of life and work
order. conditions of nursing personnel.
• LOI 47 – Directs all school of
medicine, nursing, midwifery and
allied medical professions and social
work to prepare, plan and implement
integration of family planning in
their curriculum to require their
graduate to take the licensing
examination.
• LOI 949 – Act on health and health
related activities must be integrated
with other activities of the overall
national development program.
Primary Health Care (10-19-79)
• LOI 1000 – Government agencies
should be given preference to
members of the accredited
professional organization when
hiring
EXECUTIVE ORDER – an order
issued by the executive branch of the
government in order to implement a
constructional mandate or a statutory
provision.
• Executive Order 51 – The Milk Code
• Executive Order 174 – National Drug
Policy on Availability, Affordability,
Safe, Effective and Good Quality drugs
to all
• Executive Order 180 – Government
Workers Collective Bargaining Rights
Guidelines on the right to Organize of
government employee.
• Executive Order 203 – List of regular
holidays and special holidays
• Executive Order 209 – The Family
Code (amended by RA 6809)
• Executive Order 226 – Command
responsibility Executive Order 503 –
Provides for the rules and regulations
implementing the transfer of personnel,
assets, liabilities and records of national
agencies whose functions are to be
devoted to the local government units.
• Executive Order 857 – Compulsory
Dollar Remittance Law

18 | P a g e PAHUNAO, REYZEL MAE

 INTEGUMENTARY DISEASES Lepromin test is negative but the skin
A. Leprosy lesions contain large amount of
o Hansen’s Disease Hansen’s bacilli
o Is an ancient disease and is a leading Slow involvement of the peripheral
cause of permanent physical disability nerves, with some degree of anesthesia
among the communicable diseases. and loss of sensation and gradual
o A chronic mildly communicable disease destruction of the nerves
that mainly affects the skin, the o Tuberculoid Leprosy
peripheral nerves, the eyes and mucosa Affects the peripheral nerves and
of the upper respiratory tract sometimes the surrounding skin,
o Is a chronic systemic infection especially on the face, eyes, and testes
characterized by progressive cutaneous as well as the nerves and the skin
lesions Lepromin test is positive, but the
organism is rarely isolated from the
Signs and Symptoms
lesions
Early Signs and Symptoms Macules are elevated with clearing at
o Change in the skin color- either the center and more clearly defined
reddish or white than in the lepromatous form
o Loss of sensation on the skin lesion o Borderline (Dimorphous)
o Decrease /loss of sweating and hair Has the characteristics of both
growth over the lesion lepromatous and tuberculoid leprosy
o Thickened and or painful nerves Susceptibility
o Muscle weakness or paralysis of o Children especially 12 years old and
extremities below are more susceptible
o Pain and redness of the eyes Diagnostic test
o Nasal obstruction or bleeding o Slit Skin Smear
o Ulcers that do not heal o Blood test (RBC, ESR, Albumin,
b. Late signs and symptoms Cholesterol levels)
o Loss of eyebrow (madarosis) Prevention
o Inability to close eyelids o Avoidance of prolonged skin-to-skin
(lagophthalmos) contact especially with a lepromatous
o Clawing of fingers and toes case
o Contractures o Children should avoid close contact with
o Sinking of the nose bridge active, untreated leprosy case
o Enlargement of the breast in males or o BCG vaccination
gynecomastia o Good personal hygiene
o Chronic ulcers o Adequate nutrition
Infectious Agent o Health Education
o Mycobacterium leprae an acid fast, rod- Management and Treatment
shaped bacillus which can be detected by o Ambulatory chemotherapy through the
Slit Skin Smear (SSS) use of Multi-drug therapy
Method of Transmission o Domiciliary treatment as embodied in
o Airborne – inhalation of droplets/ spray RA 4073 which advocates home
from coughing and sneezing of untreated treatment.
leprosy patient. o RA 4073 treatment of leprosy in
o Prolonged skin to skin contact government skin clinic, RHU or by duly
Incubation period licensed physician
o It varies from few months to many years Treatment Modalities
o Lepromatous patients may be infectious o Sulfone Therapy
for several years o Rehabilitation, Recreational and
occupational therapy
Three distinct forms o Multiple Drug Therapy
o Lepromatous leprosy  Multibacillary (Rifampicin,
Most serious type Clofazimine, Dapsone)
Most infectious o Infectious type
Causes damage to the respiratory tract, o Duration of treatment (24 to 30
eyes and testes as well as the nerve of months)
the skin

19 | P a g e PAHUNAO, REYZEL MAE

  Paucibacillary (Rifampicin and disease, symptomatology and its
Dapsone) transmission.
o Tuberculoid and Indeterminate o Advocate healthful living through
o Non-infectious types proper nutrition, adequate rest, sleep
o Duration of treatment (6-9 and good personal hygiene.
months) o BCG vaccination esp. of infants and
children

B. Rubeola (Measles)
 Description: it is an acute contagious
and exanthematous disease that usually
affects children who are susceptible to
upper respiratory tract infection
 Etiologic Agent: Filterable virus of
measles (Paramyxoviridae)
 Source of Infection: Secretion of nose
and throat of infected persons
 Mode of transmission:
o Droplet spread / direct contact with
infected persons
o Indirect contact (articles with secretions)
o Airborne
 Incubation period: 8 to 13 days,
usually about 10 days
 Period of Communicability: starts
before the prodrome and lasts until 4
days after the rash appear
 Clinical manifestations
o Koplik’s spots- pathognomonic
sign
o Pre-eruptive stage
 Fever
 Catarrhal
symptoms-
(rhinitis,
conjunctivitis,
photophobia,
coryza)
 Stimson’s line
(red line in the
lower conjunctiva
 Nursing Management o Eruptive Stage
o Isolation and medical asepsis should  Macula-papular
be carried out rash
o Full, nutritious diet  High grade fever
o Give analgesics, sedatives and  Anorexia and
antipyretic as needed irritability
o Provide emotional support during  Throat is red and
treatment extremely sore
o Provide skin care and assist with o Convalescence Stage
treatment and rehabilitation of  Rashes fade away
affected extremities  Fever subsides
o For eye dryness, patient may use  Desquamation
tear substitute daily and protect their begins
eyes  Symptoms
 PHN Responsibilities subside and
o Health education of patients, families appetite is
and community on the nature of the restored
 Diagnostic Procedures

20 | P a g e PAHUNAO, REYZEL MAE

 o Nose and throat swab o MMR vaccine (15
o Urinalysis months); 2nd Dose (11 to 12
o Blood exams (single raised years old)
IgM or rise in IgG)  PHN Responsibilities
 Treatment Modalities o Emphasize the need for
o Anti-viral drug immediate isolation when
(Isoprenosine) early catarrhal symptoms
o Antibiotics appear
o Oxygen inhalation o If immune serum of
o IV fluids globulin is available
 Complications (gamma Globulin), explain
o Bronchopneumonia this to the family and refer
o Otitis media to physician or clinic
o Pneumonia giving this service
o Observe closely the patient
o Nephritis
for complications during
o Encephalitis
and after the acute stage
 Susceptibility, Resistance and
o Teach, demonstrate, guide
Occurrence
and supervise adequate
o All persons are susceptible
nursing care indicated
o Babies born of mothers
o Explain proceedings, in
who had the disease before
proper disposal of nose and
the baby is born are
throat discharges
immune for the first
o Teach concurrent and
months of life
terminal disinfection
o Permanent acquired
 Nursing Care
immunity- is usually after
o Protect eyes of patients
attack of measles
from glare of strong light
 Methods of Prevention and
as they are apt to be
Control
inflamed.
o Avoid exposing children to
o Keep the patient in an
any person with fever or
adequately ventilated room
with acute catarrhal
but free from drafts and
symptoms.
chilling to avoid
o Isolation of cases from
complications of
diagnosis until about 5-7
pneumonia
days after the onset of the
o Teach, guide and supervise
rash
correct technique of giving
o Disinfection of all articles
sponge bath for comfort of
soiled with secretion of
patient.
nose and throat
o Check for corrections of
o Encouragement by health
medication and treatment
department and by private
prescribed by physician
physician of administration
of measles immune
C. Varicella (Chicken pox)
globulin to susceptible
 Description:
infants and children under
o acute infectious disease of
3 years of age in families
sudden onset with slight
or institutions where
fever, mild constitutional
measles occurs
symptoms and eruptions
o Live attenuated and
which are macula-papular
inactivated measles virus
for a few hours, vesicular
vaccines have been tested
for3-4 days and leaves
and are available for use in
granular scabs
children with no history of
o Lesions are more on
measles, at 9 months of age
covered than on exposed
or soon thereafter
parts of the body and may
appear on scalp and

21 | P a g e PAHUNAO, REYZEL MAE

 mucous membrane of disease by the time they are
upper respiratory tract. 15 years of age.
 Etiologic Agent: Human (alpha) o Not common in early
herpesvirus 3 (varicella- zoster infancy
virus), a member of the Herpesvirus o Methods of Prevention and
group Control
 Source of Infection o Case over 15 years of age
o Secretion of respiratory should be investigated to
tract of infected persons. eliminate possibility of
o Lesions of the skin are of smallpox.
little consequences o Report to local authority.
o Scabs themselves are not o Isolation
infective o Concurrent disinfection of
 Mode of Transmission throat and nose discharges.
o Direct contact or droplet o Exclusion from school for
spread 1 week after eruption first
o Indirect through articles appears and avoid contact
freshly soiled by with susceptible
discharges of infected o Vaccine- Varicella- zoster
persons immune globulin (VZIG).
o Airborne It should be given within
 Incubation Period 10 days of exposure
o 2-3 weeks, commonly 13
to 17 days
 Period of Communicability
o Not more than one day D. Scabies
before and more than 6 Description
days after the appearance  It is a highly transmissible skin
of the first crop of vesicles. infection that is characterized by
 Diagnostic Test burrows, pruritus, and excoriations
o Isolation of the virus from with secondary bacterial infection.
the vesicular fluid within Scabies Burrows
the first 3 to 4 days of the o Another hallmark of
rash scabies is the appearance of
o Serum antibodies is present track-like burrows in the
in 7 days after onset skin.
 Congenital varicella results in: o These raised lines are
o Hypoplastic deformities usually grayish-white or
and scarring of limbs skin-colored.
o Retarded growth o They are created when
o CNS and ophthalmic female mites tunnel just
manifestations under the surface of the
 Nursing considerations skin.
o Strict isolation o After creating a burrow,
o Tell the patient not to each female lays 10 to 25
scratch the lesions eggs inside.
o Teach the client and the  Etiologic Agent: Sarcoptes scabiei
family how to apply topical var hominis
antipruritic medications  Source of Infection: Human skin
correctly  Mode of Transmission
 Susceptibility, Resistance and o Skin to skin contact
Occurrence o Direct contact with fomites
o Universal among those not  Incubation Period
previously attacked. Severe o The itch mite may burrow
in adults. An attack confers under the skin and lay ova
long immunity within 24 hours of an
o Second attacks are rare. original contact
Probably 70% have the  Period of Communicability

22 | P a g e PAHUNAO, REYZEL MAE

 o This disease is o Terminal disinfection
communicable for the should be carried out
entire period that the host  Prevention and Control
is infected o Good personal hygiene
 Clinical Manifestations o Avoid contact with
o Intense itching that infected person
becomes more severe at o All members of the
night household, including close
o Burrows (lesions) seen in contact should be treated
the webs of the fingers, o
wrists, and elbows E. Impetigo
o Burrows in  Description
immunocompromised, A highly contagious
infants, young children and superficial infection of the skin characterized
elderly appears in face, by the formation of bullae (large, fluid-
neck, scalp and ears filled blisters) from original vesicles. The
 Complications bullae rupture, leaving raw, red areas. The
o Persistent pruritus exposed areas of the body, face, hands, neck
o Intense scratching can lead and extremities are most frequently
to excoriation, tissue involved.
trauma and secondary  Etiologic Agent: Staphylococci,
bacterial infection streptococci, or multiple bacteria
 Diagnostic Procedures  Mode of transmission
o Superficial scraping and o Direct contact
examination under low- o Contact with contaminated
power microscope of towels and other fomites
material from a burrow  Incubation period
 Treatment Modalities o Streptococcal infection- 1
o Aqueous Malathion lotion to 3 days
o Permethrin dermal cream o Staphylococcus infection-
left on the skin for 8 to 12 4 to 10 days
hours  Medical Management
o Benzyl Benzoate Systemic antibiotic
o Sulfur in petrolatum o For nonbullous impetigo
o Ivermectin – anti-  Benzathrine
helminthic drug is effective penicillin
in resistant cases  Oral penicillin
o Antipruritic emollient or  Cloxacillin
topical steroid for itching (Cloxapen)
 Nursing Interventions  Dicloxacillin
o Patient’s fingernails should (Dycill)
be cut short to minimize o For penicillin allergic
skin breaks during clients
scratching  Erythromycin
o Proper education on the o Topical Antibiotic
application of medicines  Mupirocin
o Contaminated clothing or (Bactroban)
beddings should be dry- o Antiseptic
cleaned or boiled  Povidone-iodine
o Advise patient to report (Betadine)
any skin irritation  Nursing Management
o Advise family member and o Soak lesion in soap
other people who had close solution to remove the
contact with the patient be central site of bacterial
checked for possible growth and give the topical
symptoms and be treated antibiotic an opportunity to
accordingly reach the infected site
o Practice contact precaution o Wear gloves when
providing patient care

23 | P a g e PAHUNAO, REYZEL MAE

 o Bathe at least once daily o Intractable neurologic pain
with bactericidal soap  Diagnostic Procedures
o Promote cleanliness and o Differentiation of herpes
good hygiene practices zoster from herpes simplex
o Have a separate towel and virus though fluorescent
wash cloth light
o Advice infected people to o Tissue culture technique
Avoid contact with other o Smear of vesicle fluid
people until the lesions o Microscopy
heal  Medical Management
o o Antiviral therapy-
F. Herpes Zoster: Shingles Acyclovir
 Description o Analgesics to control pain
o It is an acute unilateral and o Anti-inflammatory
segmental inflammation of  Nursing Interventions
the dorsal root ganglia o Airborne and contact
caused by infection with precautions
the herpes varicella-zoster, o Its vesicles rupture, apply a
which also causes cold compress as ordered
chickenpox. Usually occurs o To minimize neuralgic
in adults pain, administer analgesics
 Causative agent: Varicella virus as ordered and evaluate
 Incubation Period: unknown, but it their effects
is believed to be 13-17 days o Instruct the patient to avoid
 Period of Communicability scratching the lesions
o Communicable a day o Keep the patient
before the appearance of comfortable and maintain
the first rash until 5-6 days meticulous hygiene
after the last crust o Encourage sufficient bed
 Mode of Transmission
rest and give supportive
o Airborne
care
o Droplet  Prevention
o Direct contact o Vaccination against
 Clinical Manifestations Varicella
o Begins with fever and o Avoid exposure to patient
malaise with varicella infection
o Severe deep pain, pruritus,
and paresthesia (burning or G. Pediculosis
pricking sensation that is  Description
felt in the hands, legs or o Any human infestation of
feet) or hyperesthesia lice
usually on the trunk and o May occur anywhere on
occasionally on the arms the body
and legs  Types
o Small, red, nodular skin o Pediculosis capitis- Lice
lesions (Unilateral) erupt feed on the scalp and rarely
on the painful areas up to 2 on the skin under the
weeks after first symptoms eyebrows, eyelashes and
o Vesicles filled with fluid or beard
pus o Pediculosis corporis- Lice
o Cranial nerve involvement live next to the skin in
 Complications clothing seams
o Generalized central o Pediculosis pubis- Lice
nervous system infection are found primarily in
o Acute transverse and pubic hairs but may extend
ascending myelitis to the eyebrows, eyelashes
(inflammation of the white and axillary or body hair
matter or gray matter of the  Mode of Transmission
spinal cord)

24 | P a g e PAHUNAO, REYZEL MAE

 o Head-to-head contact o Secondary bacterial
o Fomites infections
o Sexual activity o If left untreated,
 Incubation Period: 3 to 7 days pediculosis may result in
 Clinical Manifestations dry, hyperpigmented,
o Pruritus (most common thickly encrusted, scaly
symptom of infestation) skin with residual scarring
o Tickling sensation of  Nursing Considerations
something moving in the o Contact precautions should be
hair may be noticed maintained until treatment is
o Head lice and their nits are complete to prevent spreading
most common found the infection
behind the ears and on the o Have the patient’s fingernails
hairs of the neck and cut short to prevent skin breaks
occiput and secondary bacterial
o Body lice are found on infections caused by scratching
clothing seams o Be alert for possible adverse
o Pubic lice will be found reactions to treatment with an
attached to the base of the antiparasitic, including
pubic hair and the sensitivity reactions and, in
infestation generally results some cases, central nervous
in severe itching system toxicity
 Diagnostic Tests o To prevent self-infestation,
o Wood’s light examination avoid direct contact with the
(Fluorescence of the adult patient’s hair, clothing and bed
lice) sheets
o Microscopic examination o Use gloves, a gown, and a
(presence of nits on the protective head covering when
hair shaft) administering delousing
 Treatment Modalities treatment
o Permethrin (Elimite) / o After each treatment, inspect the
Pyrethrin (Rid Mousse) patient for remaining lice and
o Initial treatment of choice eggs
o Topical insecticide o Teach the patient and family
o For pediculosis capitis & how to inspect and identify lice,
pediculosis pubis eggs and related lesions
 Fine-tooth comb o Instruct the patient and family
dipped in vinegar about the use of the creams,
 Washing hair with lotions, powders and shampoos
ordinary shampoo that eliminates lice
o Oral anti- helminthic o Instruct the patient in the proper
(ivermectin, Levamisole, application of lindane, which
albendazole) are effective can be absorbed by the skin and
against head lice cause CNS complications
infestation
o Prevention of head H. German Measles: Rubella/ Three-day
reinfestation Measles
o Clothes and bed linens  Description
must be washed in hot o It is a mild viral illness
water, ironed or dry caused by rubella virus
cleaned o It causes mild feverish
o Storing clothes or linens illness associated with
for more than 30 days or rashes and aches in joints
placing them in dry heat of o It has a teratogenic effect
60 degrees Celsius kills on the fetus
lice  Etiologic Agent: Rubella Virus
 Complications  Mode of Transmission
o Excoriation

25 | P a g e PAHUNAO, REYZEL MAE

 o Direct person to person  Birth of a live child who
contacts by respiratory may have one or multiple
droplets birth anomalies such as:
o Transplacental Cleft palate, talipes and
transmission in congenital eruption of teeth
rubella Talipes = Club foot
 Incubation Period: 2-3 weeks (talipes equinovarus) is a
 Clinical Manifestations deformity of the foot and ankle that a baby
o Prodromal can born with. It
 Low grade fever is not clear exactly what causes talipes (club
 Headache foot)
 Malaise  Cardiac defects (patent
 Mild coryza ductusarteriosus, atrial
 Conjunctivitis septal defect)
 Post-auricular,  Eye defects (glaucoma,
sub-occipital and retinopathy,
posterior cervical micropthalmia)
lymphadenopathy  Ear defects
which occur on  Neurologic (Microcephaly,
the 3rd to 5th day mental retardation,
after onset psychomotor retardation,
o Eruptive Period vasomotor instability)
 Forchheimer’s  Diagnostic Tests
spot (pinkish rash o Clinical observation
on the soft palate) o Cell cultures of the throat,
 Eruption appears blood, urine and
after the onset of cerebrospinal fluid to
adenopathy confirm the presence of the
 Children usually virus
present less or no o Convalescent serum that
constitutional shows a fourfold rise in
symptoms antibody titers supports the
 The rash may last diagnosis
for one to five  Treatment Modalities
days and leaves o Acetaminophen for fever
no pigmentation and joint pain
nor desquamation o Isolation
 Testicular pain in  Complications
young adults o Encephalitis
 Transient o Neuritis
polyarthralgia and o Arthritis
polyarthritis may o Arthralgia
occur in adults o Rubella syndrome
and occasionally manifested by:
in children  Microcephaly
o Congenital Rubella  Mental retardation
 Classic Congenital Rubella  Cataract
Syndrome  Deaf-mutism
 Intrauterine growth  Heart disease
retardation  Nursing Considerations
 Infant has low birth weight o Provide comfort
 Thrombocytopenic purpura o Make sure female patients
known as blueberry
understand how important
muffin skin
it is to avoid exposure to
Blueberry muffin skin
this disease when pregnant
 Intrauterine Infection
o Report confirmed cases of
 May result in spontaneous
rubella to local public
abortion
health officials

26 | P a g e PAHUNAO, REYZEL MAE

 o Warn the patient about
possible mild fever, slight
rash, transient arthralgia
and arthritis
o If lymphadenopathy
persists after the initial 24
hours, suggest a cold
compress to promote
vasoconstriction and
prevent antigenic cyst
formation
o Patient’s room must be
darkened to avoid
photophobia
o Patient’s eyes should be
irrigated with warm saline
to relieve irritation
o Good ventilation is
necessary
 Prevention
o Administration of live
attenuated vaccine (MMR)
o Pregnant women should
avoid exposure to patients
infected with rubella virus
o Administration of immune
Serum Globulin one week
after exposure to rubella

27 | P a g e PAHUNAO, REYZEL MAE