Question

1. What is pathognomonic sign? What are the pathognomonic signs of measles, german measles and chicken pox and its definition and location? Can you make a short reaction on the video posted on COVID19?

2. Have you seen patient with PTB in your community? How do you deal with it? Will you please tell me about RA 3573?

3. Define Disturbances in Oxygen Exchange and Utilization- Obstructive Disorders of the Lungs

4. Explain Restrictive Disorders of the Lungs

5. Have you been exposed to do immunization in your community duty, what vaccines have you seen and what were your experiences?

6. Do you think the patient will die in AIDS or will die in opportunistic infections. If in AIDS why and if it is opportunistic infections, what are those?

7. What are the differences and similarities of Candidiasis and Chlamydia? Why Infectious Mononucleosis is called kissing disease?

8. What is RA 9482 and its salient points? As a nursing student, to prevent rabies, what to you is responsible pet ownership?

Answer 1

1. Pathognomic sign is the characteristic feature of a particular disease or the presence of a particular sign that confirms the diagnosis of a particular disease.

Measles is a vaccine preventable viral disease that spreads through droplet transmission. Signs of measles is a triad manifestation of cough, coryza and conjunctivitis. After 3 days of these symptoms koplik spots appears which are small white spots inside the mouth and these spots are pathognomics for measles. Globally around 14 lakh death occurred due to measles in 2018.

German measles is otherwise called as rubella, it is also a vaccine preventable contagious disease. Mild fever, lymph node enlargement, joint pain, testicular swelling, red rashes (not as bright as in measles) which begins on the face and then extends to the trunk and then to the arms and legs (rashes disappears also in the same sequence). Rashes and lymphadenopathy are main clinical manifestations of rubella. Both measles and rubella occurs world wide and early vaccination can prevent the occurrence.

Chicken pox is a contagious disease caused by varicella virus and occurs in people who are not vaccinated or who didn't have a previous incidence of this disease. The pathognomic sign of chicken pox is a rash that changes to an itchy fluid filled blister that turns into scabs. These blisters are found all over the body. Fever, tiredness, loss of appetite and head ache are additional manifestation. This disease is also present globally.

2. Tuberculosis is a bacterial infection caused by mycobacterium tuberculosis that mainly spreads through the infected droplets through air. A nurse must screen the patient to confirm the diagnosis of TB, if he/she exhibits symptoms of tuberculosis. A sputum sample culture and a chest X ray to identify consolidation may help to confirm the presence of TB. As Tuberculosis is a notifiable disease as per Public Health Act, Control of disease 1984. So the case must be informed to the concerned authority. Determine the contacts (especially family members in household) of the patient who needs to be screened too. Nurse must also educate the patient as well as those who are at risk of developing the disease, that TB is curable by proper treatment with anti TB medicines. Educate about the DOTS regimen and its multi drug therapy as well as the time and course of treatment regimen. The patient should also be taught about methods to prevent the spread of disease including respiratory isolation. Periodic follow up also needs to be done to identify the adherence with treatment schedule as well as disease prognosis.

Act No.3573 is concerning to the Community Heath Nursing services in the Philippines Department of heath. It is a law on reporting of communicable diseases. It has mainly 4 sections, section 1 is about prophylactic inoculation to suppress or prevent communicable diseases. Section 2 is about notifying the Philippines health service department about the communicable disease cases by any health professional who possess knowledge about an active case of any communicable disease. Section 3 defines a communicable disease that is reportable as any person who is sick due to the given diseases in the act. Few diseases mentioned in the act were Actinomycosis, Poliomyelitis, Diphtheria, Plague, Measles, Pneumonia, Tuberculosis and Typhoid. Section 4 explains about the penalty for those who violate this law.

3. An obstructive lung disease is characterized by airflow limitation due to iinflamed and an easily collapsible airway. Examples of obstructive lung disease are Asthma, COPD, bronchiectasis, bronchitis. In obstructive lung diseases the ability of the alveoli to inflate and deflate may be compromised and the alveolar walls gets damaged permanently that leads to compromised gas exchange at the alveoli. So the amount of oxygenated blood in the systemic circulation decreases causing decreased oxygen saturation and signs of cyanosis. Need for oxygen with activities nay exacerbate the symptoms of shortness of breath.

4.Restrictive Disorders of the Lungs are group of respiratory disorders that may be due to extra pulmonary, parenchymal or pleural causes that leads to restriction of the lung expansion that may result in decreased lung volume, inadequate ventillation and increased work of breathing.

5. DPT, Oral polio vaccines, MMR, TT vaccination for pregnant ladies etc are some vaccinations provided at community level. All the vaccines are stored in cold chain containers in which the temperature ranges from 2 to 8⁰ C.

DPT is a combination of vaccines for diphtheria, pertussis and tetanus. These are killed vaccines. It is given from 6 weeks to 6 years in a series of 5 doses. This vaccine should not be freezed and should be separately kept from other vaccines. Polio Vaccine contains a live attenuated virus. It needs to be administered for children up to 6 years in 4 divided doses as per the immunization schedule. MMR is administered in 2 divided doses starting at 12 to 15 months and second dose to be given at 4 to 6 years.

6. Mostly people with AIDS die due to opportunistic infection. AIDS virus gradually weakens and destroys the immune system. In a healthy adult opportunistic infection are suppressed by the active immune system. But in AIDS the weak immune system may not be able to fight back the otherwise harmless microbes leading to debilitating illness and death. Early diagnosis and treatment with antibiotics may increase the life span. Prophylactic antibiotics may also help. Common infections(opportunistic) that may occur in an AIDS patient is Pneumocystis Jiroveci pneumonia, tuberculosis, salmonellosis, various fungal and parasitic infections, Viral infections like CMV, herpese zoster etc. AIDS can also lead to cancers like lymphoma, Kaposi sarcoma, cervical or anal cancer. AIDS can also cause severe muscle wasting called wasting syndrome.

7.

Similarities	Differences
Both Chlamydia and Candida can cause common sexually transmitted diseases	Chlamydia is a bacteria.Candida albicans belongs to the yeast family that is a type of fungus.
When not treated promptly both may lead to pelvic inflammatory disease.	Chlamydia may cause an STD or a particular type of pneumonia. Main sites where Candida albicans infects are skin and mucus membrane. It infects other parts of body too in case of weak immune system.
Both chlamydia and candida are opportunistic pathogens	Chlamydia is an intracellular parasite that lives inside the cells of the host whereas Candida is an extracellular parasite.
Chlamydia and Candida infections are curable with prompt treatment.	Chlamydia has prokaryotic cells and Candida is a type of eukaryotic cell

The virus that causes Mononucleosis is mainly transmitted through saliva and so kissing an infected individual may predispose to getting infected. Hence it is called as kissing disease. The disease also spreads by sharing the food utensils and water glasses used by an infected person.

8.  RA 9482 is anti rabies act. The salient features includes mass vaccination of dogs, establishing a central database of registered and vaccinated dogs, conducting an education campaign regarding rabies and its preventive measures, providing pre exposure treatment to dog bite victims as well as individuals at risk. It also includes free routine immunization and pre exposure prophylaxis to children between 5 to 14 years who are residing in high risk areas. Act also stresses on responsible pet ownership.

Responsible pet ownership means an individual who owns a pet (dog) must take responsibility in immunizing his/her pet on a periodic basis and protecting other members of society from getting bite by an infected dog. In case a biting incidence occurs they must inform the concerned authorities and keep their dogs under observation to rule out rabies infection.