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MA’AM MAGNO’S LECTURE TOPIC PART 4 NOVEMBER 2010 RESPIRATORY INFECTIONS Lower Respiratory Tract I. BRONCHITIS- inflammation of the mucous membrane of the bronchial tree II. BRONCHOPNEUMONIA- bronchitis and pneumonia III. EPIGLOTTITIS- inflammation of epiglottis; HAEMOPHILUS INFLUENZAE TYPE B IV. LARYNGITIS- inflammation of the larynx or voice box Upper Respiratory Tract Infections I. DIPHTHERIA- affects the pharynx, larynx, nose/nasal septum - Causative agent: CORYNEBACTERIUM DIPHTHERIAE Strains of the causative agent: 1. Gravis (severe)- produces the most severe and greatest number of fatal cases in Europe. 2. Mitis (mild)- produces lesions extending to the larynx and lungs but are rarely the cause of death. 3. Intermedius (intermediate)- related to gravis but has the tendency to bleed. - Microorganisms in the URT produce cytotoxins which usually start in the nose - Types: a. Nasal diphtheria With foul-smelling serosanguinous secretions from the nose b. Faucial diphtheria Severe pharyngitis affecting the fauces caused by C. diphtheriae c. Laryngeal diphtheria Most commonly found in children ages 2 to 5 years old Considered as the most severe and more fatal type due to anatomical reason Respiration is increased because less air is brought to the lungs due to the narrowing of the air passages There is moderate hoarseness; the voice is diminished until it is finally absent. d. Pharyngeal diphtheria More severe type Cervical lymph nodes become swollen Neck tissues are edematous that result in the appearance of a “bull’s neck” Has a marked degree of toxaemia Breath is usually fetid(smelly) e. Wound or cutaneous diphtheria Affects the mucous membrane and break on the skin - Diagnostics: a. Nose and throat swab and culture b. Checking of pseudomembrane o Presence of a greyish white membrane (in laryngeal and pharyngeal diphth.)- pathognomonic sign of diphtheria o Do not attempt to remove the membrane because it may cause massive bleeding.

Part 4- MAM MAGNO

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Page 1: Part 4- MAM MAGNO

MA’AM MAGNO’S LECTURE TOPIC PART 4 NOVEMBER 2010

RESPIRATORY INFECTIONS

Lower Respiratory Tract

I. BRONCHITIS- inflammation of the mucous membrane of the bronchial treeII. BRONCHOPNEUMONIA- bronchitis and pneumoniaIII. EPIGLOTTITIS- inflammation of epiglottis; HAEMOPHILUS INFLUENZAE TYPE BIV. LARYNGITIS- inflammation of the larynx or voice box

Upper Respiratory Tract Infections

I. DIPHTHERIA- affects the pharynx, larynx, nose/nasal septum- Causative agent: CORYNEBACTERIUM DIPHTHERIAE

Strains of the causative agent:1. Gravis (severe)- produces the most severe and greatest number of fatal cases in Europe.2. Mitis (mild)- produces lesions extending to the larynx and lungs but are rarely the cause

of death.3. Intermedius (intermediate)- related to gravis but has the tendency to bleed.

- Microorganisms in the URT produce cytotoxins which usually start in the nose- Types:

a. Nasal diphtheria With foul-smelling serosanguinous secretions from the nose

b. Faucial diphtheria Severe pharyngitis affecting the fauces caused by C. diphtheriae

c. Laryngeal diphtheria Most commonly found in children ages 2 to 5 years old Considered as the most severe and more fatal type due to anatomical reason Respiration is increased because less air is brought to the lungs due to the narrowing

of the air passages There is moderate hoarseness; the voice is diminished until it is finally absent.

d. Pharyngeal diphtheria More severe type Cervical lymph nodes become swollen Neck tissues are edematous that result in the appearance of a “bull’s neck” Has a marked degree of toxaemia Breath is usually fetid(smelly)

e. Wound or cutaneous diphtheria Affects the mucous membrane and break on the skin

- Diagnostics:a. Nose and throat swab and cultureb. Checking of pseudomembrane

o Presence of a greyish white membrane (in laryngeal and pharyngeal diphth.)- pathognomonic sign of diphtheria

o Do not attempt to remove the membrane because it may cause massive bleeding.

o Increase fluid intake for 2-5 days.- Modes of Transmission:

a. Direct contactb. Indirect contact

- Clinical Manifestations:1. Fatigue2. Malaise 3. Slight sore throat4. Febrile at 38’C5. If extensive, febrile 40’C and above6. Grayish-white pseudomembrane7. Enlargement of lymph nodes8. Breathing difficulty9. Stridor- noise during exhalation10. Husky voice11. Increased hoarseness12. Increased WBC and RBC counts13. PE: increased tissue damage14. Cervical adenitis15. In severe cases, the entire neck becomes swollen with edema extending to the chest.16. Nasal drainage/secretions

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17. Swelling of the palate- Treatment:

1. Penicillin2. DAT or Diphtheria Antitoxin

a. Skin testing is necessary before the administration of antitoxin.b. Fractional doses are given in positive cases, with the following schedule:

0.05 ml (1:20 dilution) – SubQ 0.05 ml (1:10 dilution) – SubQ 0.10 ml undiluted – subQ 0.20 ml undiluted – subQ 0.50 ml undiluted – IM 0.10 ml undiluted – IV

The above doses are given at 15 minutes interval if no reaction is noted. If there is any, the remaining dose is given after an hour.*** if no reactions, give through IV (desensitization)

3. Erythromycin- 40mg/kg bw in 4 doses x 7 to 10 days4. Supportive therapy:

a. Maintenance of adequate nutritionb. Maintenance of adequate fluid and electrolyte balancec. Bed restd. Oxygen inhalatione. In presence of laryngeal obstruction, emergency tracheostomy is usually done

- Nursing Management:1. Provide small frequent feedings usually on a soft diet.2. Give foods rich in Vitamins A and C to maintain the alkalinity of blood.3. Ice collar 4. Proper isolation and disposal of respiratory discharges.5. Patient must be advised to take absolute bed rest for at least 2 weeks.

II. STREPTOCOCCAL PHARYNGITIS- Causative agent: GROUPS A&B HEMOLYTIC STREPTOCOCCUS- Modes of transmission: droplet- Incubation period: few hours to several days- May be caused by either bacterial or viral (self-limiting)- VIRAL CAUSATIVE AGENTS:

a. Adenovirusesb. Influenzac. Epstein-Barr

- BACTERIAL AGENT: streptococcus- Clinical Manifestations:

1. Pain2. Fever greater than 38’C3. Dysphagia4. Malaise secondary to increased BMR5. Lymphadenopathy6. Exudates from lymph7. Hoarseness of voice8. Tonsillitis leading to otitis media9. Abdominal pain10. Headache11. Myalgia 12. Nausea and vomiting13. Scarlatiniform rash or palatal petechiae

- Complications:1. Peritonsillar abscesses/Quinsy

o Pus formation behind tonsilso Associated with swelling and assymetric deviation of uvula

2. Painful swallowing3. Thickening of voice4. Drooling 5. Tonic contraction of masseter6. Acute glomerulonephritis7. Rheumatic fever

- Diagnostics:a. Throat swab- gold standard for the diagnosis of Strep. pharyngitisb. CBC

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c. Isolation of microorganismd. Culturee. RADT- Rapid Antigen Detection Testing

- Treatment:1. Antibiotics

a. Amoxicillinb. Penicillin c. Erythromycin d. Cefuroxime

2. Antipyretics - Surgical interventions:

a. I&D- Incision and Drainage If with sore throat, done in sitting position.b. Tonsillectomy for chronic infection

- Discharge instructions:a. Follow religiously therapeutic regimen.b. Take warm saline gargles.c. Take lozenges.d. Antiseptics. e. Be aware of possible complications.f. Dispose discharges properly.g. Perform proper hand washing.h. No aspirin.

III. PERTUSSIS- Whooping cough- Paroxysms of cough, highly contagious- Causative agent: BORDETELLA PERTUSSIS- Repeated attacks of spasmodic coughing which consists of a series of explosive expirations,

typically ending in a long-drawn forced inspiration which produces the whoop and usually followed by vomiting

- Gliary- substance that causes paroxysms.- Incubation period: 7-14 days- Spasmodic coughing causes:

1. Painful abdomen2. Intraconjunctival haemorrhage3. Umbilical hernia

- Always ends with a whoop every after expiration- Modes of transmission:

a. Direct contactb. Droplet c. Ingestiond. Indirect contact

- Microorganisms attach to ciliated epithelium (nasal cavity) then multiply Produce cytotoxins which start the infection process Excessive production of secretions Complications: Pneumonia; at risk for aspiration

- Types of Manifestations:1. Classic/Catarrhal Stage : 7-14 days after exposure/ most communicable stage

a. Cough b. Sneezingc. Low grade feverd. Runny nosee. Mucoid rhinoriaf. Lacrimationg. Dry bronchial cough

2. Paroxysmal Stage : a. Episodes of paroxysms occurb. Coryza and cough end with a whoopc. Sneezingd. Runny nosee. Low grade feverf. Rapid 5-10 coughs in one expirationg. Cough is provoked by:

o Cryingo Eatingo Drinkingo Physical exertion

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h. Convulsion due to intracranial haemorrhage3. Convalescent Stage :

a. Gradual recovery from the disease

*** In adolescents with chronic cough, advise them to conduct sputum exam.

- Nursing Interventions:a. Encourage mothers to have their children immunized with DPT (3 doses).b. Nasopharyngeal culture via swab for diagnostics.c. Observe respiratory isolation.d. Have prophylactic treatment:

o Erythromycino TMP-MSZ

e. Increase oral fluid intake.f. Nutrient intake.g. Administer cough suppressants during night time to promote rest.

***attacks at night.- Complications:

1. Interstitial pneumonia- inflammation of bronchioles secondary to invasion of microorganisms

2. Atelectasis secondary to fluid accumulation in the pleural cavity3. Convulsion due to hypoxemia4. Umbilical hernia- common among children5. Otitis media6. Bronchopneumonia- inflammation of terminal bronchioles7. Severe malnutrition and starvation due to persistent vomiting and inadequate sleep

and rest.

VIRAL INFECTIONS

I. ACUTE VIRAL RHINITIS- Coryza, runny nose, colds- Catarrhal in stage- Purulent with secondary infection- may be either viral or bacterial in infectious process

Coryzacommon coldsacquired in crowded placesself-limiting disease occurs between 2-4 days

- Clinical manifestations:a. Runny noseb. Teary eyedc. Sneezingd. Coughinge. Profused dishcargesf. Erythematous and bloggy nose In severe cases,

1. Chills2. Fever3. Sore throat4. Sinuses clogged with secretions5. Hypernasality- congested paranasal sinuses6. Low grade fever7. Headache8. Chacitis (?)9. Sinusitis 10. Otitis media

- Causative agents: a. ADENOVIRUSESb. CORONA VIRUSES

*** cannot acquire immunity due to several strains causing coryza- Modes of transmission:

a. Dropletb. Coughingc. Sneezingd. Fomites

- Hyperactivity of goblet cells due to inflammation process

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- No anticolds for treatment- Medications:

1. Decongestants 2. Lozenges

- Nursing interventions:1. Increase fluid intake especially when feeling dry.2. Rest.3. TSB if fever occurs.4. Avoid crowded places.5. Brisk walking- 30-35 minutes a day

- Exposure to allergens causes colds

II. INFLUENZA- An acute viral infectious disease that affects the respiratory system- Has many strains- There are 4 or 5 vaccines available for this disease.- A.K.A. Flu/La Grippe- A highly contagious viral disease with the following prodromal manifestations:

1. Coryza 2. Fever 3. Headache4. Malaise

- Causative agents: RNA CONTAINING MXOVIRUSES (Types A, A-prime, B, and C)- Influenza A- outbreaks of influenza worldwide; 72 hours- Modes of Transmission:

a. Direct contactb. Airborne

- Rapid replication of viruses causes extensive infection at neighboring tissues- Necrosis occurs due to cytotoxins- Shedding of ulcer formation occurs- Ciliated cells are the last to recover from wound healing- Common manifestations:

1. Rhinorrhea2. Cough3. Colds

- Manifestations secondary to bacterial infection:1. Sinusitis2. otitis media3. pneumonia 4. tracheobronchitis

- Clinical Manifestations:1. Substernal burning2. Sore throat

***Systemic Manifestations***a. Feverb. Chillsc. Malaised.e. Muscle achesf. Fatigue

- Diagnostics:a. History b. CXR- diffusions and densitiesc. Sputum exam- rule out viral or bacterial caused. CBC- decrease in WBC

- Treatment:1. Immunization- Vaccine specific ABC Influenza2. Antiviral drugs- prophylactic treatment for patients exposed to the disease

a. Amantadine b. Remantadine c. Remactane – reduces multiplication of viruses, and the manifestationsd. Ribavirin- e.g. Tamiflu, Octylamine

3. Analgesics- e.g. Acetaminophen4. Antitussives- suppress cough

- Nursing Diagnoses:1. Ineffective breathing pattern related to tenacious secretions from tracheobronchial

tree2. Ineffective airway clearance

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3. Fluid volume deficit4. Hyperthermia secondary to excessive pyrogen production

- Nursing interventions:Tell the client the following things to do:

a. Stay at homeb. Drink plenty of fluidsc. Follow religiously therapeutic regimend. Sponge bath with tepid watere. Isolate patient to decrease risk of infecting othersf. Limit strenuous activitiesg. Watch out for complications

- Nursing discharge plan:1. Emphasize importance of immunization.2. Emphasize importance of resting particularly during the disease.3. Increase fluid intake.4. Take the appropriate meds (OTC).5. Hygiene

Lower Respiratory Tract Infections

I. PNEUMONIA- An acute infectious disease caused by pneumococcus, associated by general toxaemia and a

consolidation of one or more lobes of either one or both lungs- Caused by: BACTERIA, VIRUSES, PROTOZOA, YEAST,(FUNGI)- Protozoal agents usually affect HIV patients- Most common microorganisms: BACTERIA, VIRUSES- It is an acute nonspecific infection affecting the alveoli and tissue of the lungs- Clinical manifestations:

1. Fever 2. Productive cough3. Acute stabbing chest pain4. Chills5. SOB6. Chest retractions with rusty sputum- pathognomonic signs7. Diaphoresis8. Convulsions

- Air sacs or alveoli are filled with exudates, inflammatory cells, and fibrin- Five main causes of pneumonia:

1. Bacteria 2. Viruses3. Mycoplasma4. Fungi 5. Various chemicals

- Causative agents : G(+,-)1. STREPTOCOCCUS PNEUMONIAE2. STAPHYLOCOCCUS AUREUS3. HAEMOPHILUS INFLUENZAE4. KLEBSIELA PNEUMONIAE or Friedlander’s bacilli

- G(+) : S. pneumonia- G(-) : S. aureus, H. influenza, Klebsiela, Mycoplasmas, Fungi, Atypical mycobacterium,

Chlamyida- Classifications of Pneumonia

A. Community-acquired pneumonia- acquired in the course of one’s daily life --- at work, at school, or at the gym; developed in less than 36 hours

O Most common cause: S. pneumoniaO Other causes:

1. H. influenza2. Legionella

B. Nosocomial pneumonia- develops while the client is in the hospitalO Causative agents:

1. S. aureus2. Klebsiela 3. P. aeruginosa4. E. coli5. Enterobacter group

C. Aspiration pneumonia- occurs when a foreign matter is inhaled into the lungs, most commonly when a gastric content enters the lungs after vomiting

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D. Pneumonia caused by opportunistic organisms- strikes people with compromised immune system (AIDS/HIV), with TB, malnourishes

- Microorganisms inhaled or ingested cause the inflammation process.- End result: exudate formation filled alveoli with serous fluids, PMNs- Have CXR to assess for consolidation (hard tissues, alveoli), or having stabbing chest pain

with retractions.- Nursing Diagnoses:

1. Impaired gas exchange2. Impaired breathing pattern3. Ineffective airway clearance4. Activity intolerance5. Sleep pattern disturbance6. High risk for infection7. Altered tissue perfusion8. Altered nutrition: less than body requirements9. Altered body temperature

- Diagnostics:a. Gram staining- institutes proper antibiotic therapyb. Sputum C&S- chooses effective antibiotics best for clientc. CBC- determines extent of infectiond. ABG- evaluates gas exchangee. Pulse oximetry-measures oxygen saturation in arteries; NV: 95-100%f. CXR- consolidation; TBg. Fiber optic bronchoscopy- employed only if physician desires cytologic exam; last

resort- Treatment:

1. Antibiotics which are organism specific and eradicate causative agentsa. S. pneumonia:

O IV penicillinO AmoxicillinO DoxycyclineO ErythromycinO Cefazolin O Vancomycin O Fluoroquinolones

b. S. aureus:O Penicillinase resistant penicillinO VancomycinO MethicillinO Cephalexin O Erythromycin O Clindamycin

c. M. pneumonia:O Erythromycin O Azithromycin O Doxycycline O Clarithromycin O Fluoroquinolones

d. Klebsiela:O 3rd generation cephalosporinsO Aminoglycosides O Metronidazole O Imipenem cilastatin

e. P. cariniiO Climetropine O TMP-SMZ/ Trimethoprim-Sulfamethoxazole

2. Other drugs:a. Bronchodilatorsb. Expectorantsc. Pain relievers

- Nursing interventions:1. Increase fluid intake2. Incentive spirometry3. Suctioning if coughing is ineffective4. Autotherapy- diffusion of gases along membranes5. Chest physiotherapy

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6. Proper disposal of secretions 7. Monitor vital signs closely and watch for danger signs like:

a. Marked dyspneab. Thread, small and irregular pulsec. Delirium with extreme restlessnessd. Cold moist skine. Cyanosis and exhaustion

8. Control temperature by doing cooling measures.

II. TUBERCULOSIS- Chronic and recurrent - A mycobacterial infection- Causative agent: MYCOBACTERIUM TUBERCULOSIS- Formation of tubercles which tends to go caseation, necrosis, and/or calcification- Mycobacterium bovis- from cows- Mycobacterium africanum- from human- Incubation period: 2-10 weeks- Modes of transmission:

a. Droplet infectionb. Airborne c. Direct contactd. Indirect contacte. Food contamination f. Through skin lesion

- Risk for infection: affected by the following:1. Characteristic of infectious person2. Extent of air contamination3. Duration of exposure4. Susceptibility of the host5. Number of microbes in the sputum6. Frequency of coughing7. Prolonged contact to persons with TB8. Decreased socio-economic status9. Homeless10. Alcoholism 11. Injection drug users12. HIV

- Classifications:A. Class 0

not been exposed to disease Negative reaction to tuberculin skin test

B. Class 1 individual with positive exposure to TB no manifestations no treatments with prophylactic treatment Ghon complex Negative reaction to tuberculin skin test

C. Class II Positive to diagnostic procedures No symptoms experienced INH/Isoniazid is the prophylaxis Positive reaction to tuberculin skin test Negative bacteriologic studies Fibrocaseous cavitary lesion

D. Class III Frank case of TB SCC (short course chemotherapy)

1. INH2. Rifampicin 3. Pyrazinamide

E. Class IV Post treated cases Not communicable

F. Class V Atypical cases Positive to S/S Negative to diagnosis

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Ethambutol- to prevent exhaustion- Lungs are the areas of focus in this disease- Clinical Manifestations:

1. Chest pain2. Blood tinged sputum3. Fatigue 4. Weight loss5. Anorexia 6. Low grade afternoon fever/night fever- decreased resistance; increased virulence of

microorganisms- Organisms encapsulate alveoli then hibernate in tissues- Miliary TB- a.k.a extrapulmonary TB or disseminated tuberculosis

Affects the meninges of the brain, bones, reproductive organs- Tubercle formation in the cavitaries causing ulceration and shows haziness and no blood flow

in CXR, chees-like substance/Swiss cheese- If TB becomes reactivated, it will become a full blown TB.- Complications:

1. Empyema 2. Injury to visceral pleura causing effusion in the pleaural cavity3. Bronchopleural fistula 4. Pneumothorax caused by ruptured visceral pleura, tension during coughing 5. Affectations:

a. GITb. GUTc. Kidneys d. Meninges- TB meningitise. Bones- f. Bone marrows

- Diagnostics:a. PPD Skin Test- done at the dorsal portion of the forearm

Intradermally 0.5cc syringe Reading: 48-72 hours Result: Induration (elevated hardened skin)

Less than 5mm- negative5-9mm- positive but asymptomatic10-15mm- acquired at birth15-18mm- common among Filipinos

b. Multiple puncture test- if positive, vesicle formsc. Sputum examd. AFB analysis- confirmatory test for TBe. CXRf. C&Sg. Polymerase chain reaction- easily identifies TB from DNA

- Essentials prior to medication administration:1. Liver function test

Checks if patient has normal hepatic functions For Rifampicin, INH

2. Vision exam Determines optic neuritis For EMB, Myambutol

3. Audiometric exam Rhine’s and Webber’s tests Ototoxicity For aminoglycosides, streptomycin

- Treatment: 1. Isoniazid/INH- Anti-Koch’s

First line of drug to treat TB ACOD (before meals once a day) Taken with Rifampicin (A/E: hepatotoxicity)

2. Rifampicin Taken with INH ACODPO

3. Pyrazinamide or PZA Taken with INH and Rifampicin (SCC) Administration for the first 2 months of treatment Allows short term course of therapy

4. EMB, Myambutol Substitutes for INH

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Taken when patient is resistant to INH A/E: ototoxicity

5. Streptomycin Eradicates microorganisms Effective in treating mycobacterial infections

- DOTS- Directly Observed Treatment/Therapy Short course- Nursing interventions:

1. Respiratory isolation2. Cover nose and mouth when sneezing3. Nutrition 4. Quit smoking5. Compliance to therapeutic regimen6. Rest 7. Sputum examination8. Avoid crowded places9. Immunizations

III. SEVERE ACUTE RESPIRATORY SYNDROME- Originated in China - AH1N1- from Mexico- Clinical Manifestations:

1. Cough 2. Chest pain3. Fever 4. SOB5. Hypoxia 6. DOB

- Epidemiologic Criteria:1. Sudden onset of temperature 38’C and above2. History of patient 3. Recent travel 4. Contacts

- Modes of transmission:a. Direct contactb. Droplet c. Casual and social contacts d. Fomites

- Treatment: no treatment. Empiric therapy.- Diagnostics:

a. Serology- determines antibodies to new corona virusb. CXR- interstitial pneumonia consolidationc. Pulse oximetryd. CBCe. Enzymatic studies- AST, ALTf. Sputum examg. Blood culture

- Home care:1. Prevention

a. Cover nose and mouthb. Limit interaction outside homec. Hand washingd. Don’t share eating utensils with others

GIT INFECTIONS

Functions of GIT:

1. Digestion2. Absorption3. Metabolism4. Elimination

- Transient microorganisms are either ingested or resident- Some are destroyed by HCl acid or resident flora

Terms:

1. Colitis- inflammation of colon

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2. Dysentery- frequency of watery stool3. Enteritis- inflammation of the mucosal lining of the small intestine 4. Gastritis- inflammation of the lining of the stomach5. Hepatitis- inflammation of the liver; caused by viral or toxic agents

I. GASTROENTERITIS- Via contaminated food and water- Exotoxins released damage the mucosal lining of the stomach and small intestines- Ulceration of the mucosa due to invasion of ulcers- Enterotoxins- cause damage to the neighboring tissues- Causative agents:

1. Staphylococcus 2. C. perfringens3. C. botolinum- from contaminated canned goods4. E. coli5. Vibrio cholera

- Enter via micro/macrocirculation- Water and fluid into the colon increase causing hypermotility- Clinical manifestations:

1. Anorexia 2. N&V3. Abdominal pain4. Cramping5. Borborygmic sounds6. Diarrhea7. Malaise 8. Headache9. Weakness 10. Dry mucous membranes11. Orthostatic hypotension12. Tachycardia13. Fever

- Types:A. Traveller’s diarrhea- caused by E. coli and H. pylori

Inc. Period: 48-72 hours Hyperexcretion of water into the lumen of large intestines Abrupt onset of diarrhea characterized by watery stool Mgt.: antidiarrheals- Loperamide (single dose)

B. Staphylococcal- from food poisoning or food inadequately cooked like:1. Pasta2. Noodles Manifestations:

a. Cramping abdominal painb. Intestinal obstruction- stimulates the vomiting center (area postrema) of

the brain by the enterotoxins causing VOMITINGc. Hypogastric paind. Diarrhea

Mgt.: F&E replacementC. Botulism

Inc. Period: 1.5 hours- 8 days Enterotoxins affect the neuromuscular blockade and cause progressive

paralysis Clinical Manifestations:

a. Diplopia- pupils dilate and fixateb. Dysphagiac. Progressive cephalocaudal paralysis/weaknessd. GI manifestatione. Respiratory failure (possible complication)

Mgt.:a. Gastric lavage- induces patient vomitb. Respiratory management and supportc. Antitoxins

D. Cholera Caused by VIBRIO CHOLERAE Inc. period: 1-3 days Increased fluid production to the lumen of the small intestines Rice watery stool- pathognomonic sign Non odorous stool

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Manifestations:a. Vomiting b. Thirstc. Oliguriad. Muscle cramps

Mgt. :a. IVFb. Tetracycline – 1c. TMP-SMZ

E. Salmonelliasis Caused by S. TYPHII/TYPHOSA Inc. Period: 8-48 hours Superficial affectation on the mucosa of the intestine No ulcer formation Manifestations:

1. Abdominal pain2. N&V3. Low grade fever 4. Chills 5. Cramping

Antibiotics:1. TMP-SMZ2. Ciprofloxacin

F. Shigellosis or Bacillary Dysentery Bloody flux Caused by S. FISERI/DYSENTERAE (most fatal) Local tissue invasion: distal lumen Manifestations:

1. Diarrhea with severe abdominal pain2. Tenesmus

Mgt.:1. F&E replacement2. Correct acidosis3. Antibiotics- TMP-SMZ, Ciprofloxacin

Diagnostics:1. Stool exam2. Gram staining of vomitus3. Serum toxin level- botulism4. Assess serum osmolality- electrolytes and base balances5. ABG analysis6. Sigmoidoscopy

Interventions:1. ORESOL

1 tbsp. salt1 tbsp. baking soda4 tbsps. Granulated sugar1L of waterFlavouring extract

2. IVF3. Place on NPO4. Institute bowel rest5. Gastric lavage6. Hand washing7. Appropriate use of antidiarrheals

INCLUDE:

1. Herpes Zoster 2. Measles 3. Chicken pox