Latest posts

Communicable Diseases (Chronic)

Chronic

1. Tuberculosis

  • TB is a highly infectious chronic disease that usually affects the lungs.
Causative Agent: Mycobacterium Tuberculosis

Sign/Symptoms:
  • cough
  • afternoon fever
  • weight loss
  • night sweat
  • blood stain sputum
Prevalence/Incidence:
  • ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines
  • Sixth leading cause of mortality (with 28507 cases) in the Philippines.
Nursing and Medical Management
  • Ventilation systems
  • Ultraviolet lighting
  • Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine
  • drug therapy
Preventing Tuberculosis
  • BCG vaccination
  • Adequate rest
  • Balanced diet
  • Fresh air
  • Adequate exercise
  • Good personal Hygiene
National Tuberculosis Control Program – key policies
  • Case finding – direct Sputum Microscopy and X-ray examination of TB symptomatics who are negative after 2 or more sputum exams
  • Treatment – shall be given free and on an ambulatory basis, except those with acute complications and emergencies
  • Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB patients.
DOTS (Direct Observed Treatment Short Course)
  • Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-negative PTB with extensive parenchymal involvement (moderately- or far advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.)
    • Intensive Phase (given daily for the first 2 months) - Rifampicin + Isioniazid + pyrazinamide + ethambutol.
    • If sputum result becomes negative after 2 months, maintenance phase starts. But if sputum is still positive in 2 months, all drugs are discontinued from 2-3 days and a sputum specimen is examined for culture and drug sensitivity. The patient resumes taking the 4 drugs for another month and then another smear exam is done at the end of the 3rd month.
    • Maintenance Phase (after 3rd month, regardless of the result of the sputum exam)-INH + rifampicin daily
  • Category 2-previously-treated patients with relapses or failures.
    • Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol on the 3rd month. If sputum is still positive after 3 months, the intensive phase is continued for 1 more month and then another sputum exam is done. If still positive after 4 months, intensive phase is continued for the next 5 months.
    • Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+ rifampicin+ ethambutol
  • Category 3 – new TB patients whose sputum is smear negative for 3 times and chest x-ray result of PTB minimal
    • Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide
    • Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin

2. Leprosy
  • Sometimes known as Hansen's disease
  • is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium
  • Gerhard Armauer Hansen
  • Historically, leprosy was an incurable and disfiguring disease
  • Today, leprosy is easily curable by multi-drug antibiotic therapy
Signs & Symptoms

Early stage (CLUMP)                                              Late Stage (GMISC)
Change in skin color                                        Gynocomastia
Loss in sensation                                            Madarosis(loss of eyebrows)
Ulcers that do not heal                                    Inability to close eyelids (Lagopthalmos)
Muscle weakness                                            Sinking nosebridge
Painful nerves                                                Clawing/contractures of fingers & nose

Prevalence Rate
  • Metro Manila, the prevalence rate ranged from 0.40 – 3.01 per one thousand population.
Management:
  • Dapsone, Lamprene
  • clofazimine and rifampin
  • Multi-Drug-Therapy (MDT)
  • six month course of tablets for the milder form of leprosy and two years for the more severe form
Leprosy Control Program
  • WHO Classification – basis of multi-drug therapy
    • Paucibacillary/PB – non-infectious types. 6-9 months of treatment.
    • Multibacillary/MB – infectious types. 24-30 months of treatment.
  • Multi-drug therapy – use of 2 or more drugs renders patients non-infectious a week after starting treatment
    • Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single dose of ROM regimen
    • For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 blister packs taken monthly within a max. period of 9 mos.
  • All patients who have complied w/ MDT are considered cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain.
  • Responsibilities of the nurse:
    • Prevention – health education, healthful living through proper nutrition, adequate rest, sleep and good personal hygiene;
    • Casefinding
    • Management and treatment – prevention of secondary injuries, handling of utensils; special shoes w/ padded soles; importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time to time; mental & emotional support
    • Rehabilitation-makes patients capable, active and self-respecting member of society.

No comments