Gil P.

Soriano, RN, MHPEd

Zika Virus
Dengue Fever
Malaria
 is spread mostly by the bite of an infected Aedes species mosquito (Aedes
aegypti and Aedes albopticus) that bites during the day and night.
It can be passed from a pregnant woman to her fetus. Infection during pregnancy
can cause certain birth defects.
There is no vaccine or medicine for Zika.

Incubation Period
3 to 12 days
 Mode of Transmission
Bite of an infected mosquito
Sexual contact
Vertical transmission
Blood transfusion

Clinical Manifestation
Fever
Arthralgia
Retroocular headache
Conjunctivitis
Maculopapular rash

Diagnosis
Presence of Zika virus in the blood, urine and saliva of infected person
Serologic testing
PCR
 Treatment
Symptomatic

Nursing Management
Provide comfort measure to patient
Instruct to increase oral fluid intake of patients
Give analgesics to reduce fever and pain except
aspirin and other non-steroidal anti-inflammatory
drugs (NSAIDS) until dengue can be ruled out to
reduce the risk of bleeding.
Complication
Guillain-Barre syndrome
 aka Breakbone fever, Hemorrhagic fever, Dandy fever, Infectious
Thrombocytopenic Purpura

Acute febrile disease caused by infection with one of the serotypes

of dengue virus,
Etiologic Agent/Vector
Flaviviruses 1, 2, 3, 4, a family of togaviridae

Incubation Period
3 to 14 days
 Bite of an infected mosquito, principally Aedes aegypti
Aedes aegypti is a day-biting mosquito (they appear two hours after sunrise and
two hours before sunset)
It breeds in areas of stagnant water
It has limited, low-flying movement
It has fine white dots at the base of the wings and white bands on the legs

Aedes albopticus may contribute to the transmission of the dengue virus in rural
areas
Other contributory mosquitoes:
Aedes polynensis
Aedes scutellaris simplex
 Period of Communicability
Patients are usually infective to the mosquito from a day before the febrile period to the
end of it.
The mosquito becomes infected from day 8 to 12 after the blood meal and remains
infective throughout its life

Sources of Infection
Infected Persons-the virus is present in the blood of patients during the acute phase of the
disease and will become a reservoir of the virus, sucked by mosquitoes, which may then
transmit the disease
Standing Water-any stagnant water in the household and its premises are usual breeding
places of these mosquitoes

Incidence
Age-occur at any stage, but common among children and peaks between four to nine
years old
Sex-Both sexes can be affected
Season-It is more frequent during the rainy season
Location-Dengue fever is more prevalent in urban communities
 DENGUE IS AN ALL YEAR ROUND DISEASE IN THE PHILIPPINES.

MARCH OF 2012, DOH RELEASED

ADMINISTRATIVE ORDER NO. 2012-0006
OR THE REVISED DENGUE CLINICAL
CASE MANAGEMENT GUIDELINES 2011.
DENGUE WITHOUT WARNING SIGNS
Probable Dengue: Confirmed Dengue
Lives in or travels to dengue-endemic Viral culture isolation Polymerase Chain
area, with fever, plus any two of the Reaction
following:
a) Headache
b) Body malaise
c) Myalgia
d) Arthralgia
e) Retro-orbital pain
f) Anorexia
g) Nausea
h) Vomiting
i) Diarrhea
j) Flushed skin
k) Rash
AND Laboratory test, at least CBC
(leukopenia with or without
thrombocytopenia) and/or dengue NS1
Antigen test or dengue 1gM anti-body test
(optional)
DENGUE WITH WARNING SIGNS SEVERE DENGUE

Lives in or travel to dengue Lives in or travel to dengue

endemic area, with fever lasting endemic area, with fever lasting
2-7 days, plus any of the 2-7 days, plus any of the above
following: clinical manifestations for
Abdominal pain dengue with or without warning
Tenderness signs plus any of the following:
Persistent vomiting Severe plasma leakage leading to
Clinical signs of fluid accumulation shock or fluid accumulation with
Mucosal bleeding respiratory distress, severe
Lethargy bleeding severe organ impairment:
Restlessness Liver AST or ALT> or equal to
Liver enlargement 1000, CNS- seizures, impaired
Laboratory: increase in Hematocrit consciousness.
decreasing platelet count. Heart-myocarditis, kidneys-renal
failure.
 Diagnostic Test
Torniquet test
Platelet count
Hemoconcentration
Occult Blood
Hgd determination

Treatment
Symptomatic
Analgesic except aspirin
IV therapy
Blood transfusion
Oxygen therapy
Sedatives
 Take the patient's blood pressure and
record it, for example, 100/70.
Inflate the cuff to a point midway
between SBP and DBP, and maintain for
5 minutes, (100 + 70) 2 = 85 mm Hg
Reduce and wait 2 minutes.
Count petechiae below antecubital
fossa. - A positive test is 10 or more
petechiae per 1 square inch.
 Patient should be kept in a mosquito-free environment to avoid further
transmission of infection
Keep patient at rest during bleeding episodes
Monitoring of vital signs
Observe for signs of shock, such as slow pulse, cold, clammy skin, prostration and
fall of blood pressure
Trendelenburg position to provide greater blood volume to the head part
Isolation is not required
 Nursing Diagnosis
Altered body temperature
Fear
Anxiety
Knowledge deficit
Activity intolerance

Prevention
Health education
Early detection and treatment
Treat mosquito nets with insecticides
House spraying is advised
Eliminate vector by:
Changing water and scrubbing sides of flower vases once a week
Destroy breeding places of mosquitoes by cleaning surroundings
Keeping the water container covered
Avoid hanging too many clothes inside the house
Case finding
 Dengue hemorrhagic fever
Metabolic acidosis
Hyperkalemia
Tissue anoxia
Hemorrhage into the CNS or adrenal glands
Uterine bleeding may occur
Myocarditis

Dengue encephalopathy
Increase restlessness
Apprehension
Disturbed sensorium
Convulsions
Hyporeflexia
 Is an acute and chronic parasitic disease transmitted by the bite of mosquitoes and
in confined mainly to tropical and subtropical areas

Etiologic Agent
Protozoa of genus plasmodia
Plasmodium falciparum (malignant tertian)- most serious malarial infection
and most common in the Philippines
Plasmodium vivax (benign tertian)- non-life threatening except for the very
young and very old, manifested by chills every 48 hours on the 3rd day and
onward especially if untreated
Plasmodium malariae (quartan)- less frequently seen, non-life threatening,
fever and chills occur every 72 hours usually on the 4th day after onset
Plasmodium ovale-rare type of specie
Plasmodium knowlesi- Found in South-East Asia and causes malaria in lon-
tailed macaques (Macaca fascicularis), but it may also infect humans, either
naturally or artificially.
 Vector is female Anopheles mosquito
Breeds in clear, flowing and shaded streams, usually in the
mountains
Bigger in size than ordinary mosquitoes
Brown in color, night-biting mosquito
Does not bite a person in motion
Assumes a 36 degree position on walls, trees, curtains and the like

Incubation Period
12 days for P. falciparum and P. knowlesi
14 days for P. vivax and ovale
30 days for P. malariae

Period of Communicability
An untreated or insufficiently treated may be the source of
mosquito infection for more than 3 years in P. malariae, 1 to 2 years
in P. vivax and not more than 1 year in P. falciparum
 Mode of Transmission
Bite of infected female Anopheles mosquito
It can be transmitted parenterally through blood transfusion
On rare occasions, it is transmitted from share contaminated needles
Vertical transmission is a rare case

Clinical Manifestation
Paroxysms with shaking chills
Rapidly rising fever with severe headache
Profuse sweating
Myalgia, with feelings of well-being in between
Splenomegaly, hepatomegaly
Orthostatic hypotension
Paroxysms may last for 12 hours and may attack daily or every 2 days
In children
Fever may be continuous, convulsions and GIT symptoms are prominent and
splenomegaly is present
In cerebral malaria
Severe headache, vomiting and changes in sensorium and Jacksonian or grand mal seizure may
occur
 Diagnosis
Malarial smear
Rapid Diagnostic Test
Treatment
Anti-malarial drugs
Chloroquine
Quinine
Sulfadoxine for the resistant P. falciparum
Primaquine for relapses of P. vivax and ovale
Erythrocyte exchange transfusion for rapid
production of high levels or parasites in the blood
Nursing Management
Close monitoring, take note of I and O to prevent pulmonary edema
Daily monitoring of patients serum albumin, BUN, creatinine and parasitic
count
Determine ABG and plasma electrolyte
TSB, alcohol rubs and ice cap on the head help bring temperature down
Application of external heat and hot drinks during the chilling stage are
helpful
Provide comfort and psychological support
Encourage the patient to take plenty of fluids
Watch for neurologic toxicity like muscular twitching, delirium, confusion,
convulsion and coma
Evaluate the degree of anemia
Wof signs of bleeding
 Nursing Diagnosis
Altered body temperature
Activity intolerance
Knowledge deficit
Altered nutrition: less than body requirement
Prevention and Control
Case reporting and case finding
Destruction of breeding sites
Spraying of insecticides at home
Mosquito nets should be used
Insect repellents
People living in malaria infested areas should not donate blood for
at least 3 years
Blood screening
 Mondejar-Navales, D. (2014). Handbook of Common
Communicable and Infectious Diseases. South Triangle,
Quezon City: C & E Publishing, Inc.
Smeltzer, S., Bare, B., Hinkle, J. & Cheever. (2008). Brunner &
Suddarths Textbook of Medical-Surgical Nursing. Lippincott
William & Wilkins
Kwann-Gett, T., Kemp, C. & Kovarik, C. (2009). Infectious and
Tropical Diseases: A Handbook for Primary Care. Singapore:
Mosby Elsevier