dengue.pptx for nursing students it is usd

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1. GUESS MY TOPIC IT IS CAUSED BY BITE OF AN FEMALE AEDES AEGYPTI MOSQUITO

2. DENGUE

3. Dengue viruses are spread to people through the bite of an infected  Aedes  species ( Ae .   aegypti   or   Ae . albopictus ) mosquito. Almost half of the world’s population, about 4 billion people, live  in areas with a risk of dengue . Dengue is often a leading cause of illness in areas with risk. DEFINITION

4. Each year, up to 400 million people are infected by a dengue virus. Approximately 100 million people get sick from infection, and 40,000 die from severe dengue. Dengue is caused by one of any of four related viruses: dengue virus 1, 2, 3, and 4.  A person  can be infected with dengue multiple times in their life. INCIDENCE

5. It is predominantly an urban disease due to close proximity in high densities of susceptible host(humans)-overcrowding Inadequate basic infrastructure-unreliable water supply eg : storing water in containers Increase solid waste discarded which provide larval habitats in urban areas EPIDEMIOLOGY

6. MODE OF TRANSMISSION

7. Incubation period is 4 to 7 days May be asymptomatic or from mild febrile to severe After the incubation period ,the illness begins and followed by 3 phases Febrile Critical Recovery pathophysiology

8. Stages of dengue fever

9. Sudden high fever>102 f usually last 2 to 7 days Clinical signs - rashes, myalgia , arthralgia , headache, retro-orbital pain, anorexia, nausea and vomitting Mild hemorrhagic manifestations: petichiae and mucosal bleeding, positive tourniquet test Lab test- full blood count- progressive decrease in wbc platelets Febrile phase

10. Occurs after 3 rd to 5 th day of fever, last about 24 to 48 hrs Rapid decrease in body temperature Onset of plasma leak into the pleural and abdominal cavities which leads to intravascular fluid depletion. Severe plasma leakage may lead to hemorrhagic shock organ dysfunction such as hepatitis, encephalitis,myocarditis may occur during this phase. 2. Critical phase

11. Evidence of plasma leakage- increase in hematocrit values >40% in females and >46% in females. Hemodynamic instability Lab results: decrease in platelet < 1 lakh, wbc <4000,albumin <3 . 3g /dl Increase in- AST >40U/L( Enzyme released by liver)

12. Clinical warning signs with possibility of complications: abdominal pain Persistent vomitting Restlessness with altered level of consciousness Hemodynamic instability-prolonged capillary refillment >2 sec,cool peripheries, tachycardia, weak pulse volume Mucosal bleed, tender/ enlarged liver,ascities

13. Plasma leakage stops Reabsorption of extravascular fluid General well being improve Haemodymically patient is stabilized WBC, Platelet level and hematocrit stabilizes 3.Recovery phase

14. Classification of dengue

15. 1. Undifferentiated (non-classical) dengue Non-specific febrile illness that does not meet the criteria for classical dengue fever, dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS). Recover fully Doesn’t require hospitalization

16. Classical dengue fever Acute febrile illness with two or more of the following:     • Headache     • Retro-orbital pain     • Myalgia     • Leukopenia     • Arthralgia     • Rash     • Hemorrhagic manifestations (positive tourniquet test, petechiae , ecchymosis , purpura , hematemesis , melena , or bleeding from the nose, gum, urinary tract, rectum, vagina, injection sites or other locations).

17. Dengue hemorrhagic fever (DHF) All of the following must be present:     • Fever or history of acute fever, lasting 2–7 days, occasionally biphasic     • Hemorrhagic manifestations     • Thrombocytopenia (<100,000 platelets/mm 3 )     • Evidence of plasma leakage due to increased vascular permeability manifest as either fluid accumulation (e.g. peripheral edema, pleural effusion, pericardial effusion, pulmonary edema, or ascites , diagnosed clinically or radiologically ) or hemoconcentration (rise in hematocrit [HCT] ≥20% of the patient's baseline level or a drop in HCT ≥20% of the baseline level following rehydration.

18. Dengue shock syndrome (DSS) DHF with circulatory failure manifest as either:     • Narrow pulse pressure (<20 mmHg) and rapid and week pulse; Or:     • Hypotension for age, cold and clammy skin, and restlessness. Severe abdominal pain hemoptysis

19. Severe dengue fever (SDF) Patients with any of the following features: -Severe plasma leakage leading to:     • Shock     • Fluid accumulation leading to respiratory distress -Severe bleeding as evaluated by clinician -Severe organ involvement:     • Liver: AsT or AlT > = 1000 IU/L     • CNS: impaired consciousness.     • Heart and other organs. When to consider severe dengue

20. Febrile phase - dehydration due to poor oral intake from anorexia , vomitting , high fever can also lead to neurological disturbances like febrile seizures. Critical phase- plasma leakage- hypovolemic shock,severe haemorrhage , organ impairment to liver,kidneys etc.. Recovery phase- hypervolemia if inappropriate fluid management. Shall we recollect?

21. 1.Tourniquet Test How to do a Tourniquet Test     1. Take the patient's blood pressure and record it, for example, 100/70.     2. Inflate the cuff to a point midway between SBP and DBP and         maintain for minutes. (100 + 70) ÷ 2 = 85 mm Hg     3. Reduce and wait 2 minutes.     4. Count petechiae below antecubital fossa . See image at right.     5. A positive test is 10 or more petechiae per 1 square inch Diagnostic evaluation

22. NON SRUCTURAL PROTEIN 1(NS1 ANTIGEN ) DENGUE IGM,IgG RAPID COMBO TEST- 15 to 20 minutes,94%accurate

23. Complete blood count-decrease in hb wbc platelet count,hematocrit will be increased Liver function test-decrease in albumin increase in AST &ALT(>1000U/L) Coagulation profile-increase in prothrombin thrombin>14 sec ABG analysis-metabolic acidosis in shock Blood urea nitrogen-increased Chest xray - ultrasound

24. No specific medications for dengue fever Symptomatic & supportive management 1.Mild analgesic and antipyretic in febrile phase 2.Plenty of Oral fluids; if not tolerated, intravenous fluids for 24–48 h (0.9% saline or Ringer lactate) at maintenance. 3. In case of severe bleeding, give fresh whole blood 20 ml/kg as a bolus – Give Platelet Concentrate/platelet rich plasma when platelet counts are below 10,000/ mm3 . – After blood transfusion, continue fluid therapy at 10 ml/kg/h and reduce it stepwise to bring it down to 3 ml/kg/h and maintain it for 24-48 hrs management

25. Avoid Aspirin NSAIDS CORTICOSTERIODS

26. PREVENTION

27. • Absence of fever for at least 24 hours without the use of anti- pyretics . • No respiratory distress from pleural effusion , ascites or ARDS • Increasing trend in platelet count with a value > 50000/ cu.mm. • Return of appetite • Good urine output • Minimum of 2 to 3 days after recovery from shock • Visible clinical improvement CRITERIA FOR DISCHARGE

28. Deficient fluid volume Hyperthermia Risk for bleeding Imbalanced nutrition NURSING MANAGEMENT

29. For the prevention of dengue disease caused by dengue virus serotypes 1, 2, 3 and 4. DENGVAXIA is approved for use in individuals 6 through 16 years of age with laboratory-confirmed previous dengue infection and living in endemic areas. Dengue Tetravalent Vaccine, Live

30. Guess my next topic

31. PLAGUE

32. The bacterium which causes plague was first isolated in Time: 1894 Place: Hong Kong By: Andre Yersin , a French bacteriologist The bacteria was later named after him, Yersinia pestis Egypt 70,000 dead within 2 years Great Pestilence/Black Death 1346, Europe 30+ million dead 1890, China12.5 million dead history

33. infectious disease  caused by  Yersinia pestis , a  bacterium   transmitted  from  rodents  to humans by the bite of infected fleas DEFINITION

34. Bubonic plague The most common form of the plague is  bubonic plague . It’s usually spread by the bite of an infected flea. In very rare cases, you can get the bacteria from material that has come into contact with a person who has the infection. Bubonic plague infects your lymphatic system (a part of the  immune system ), causing  inflammation  in your lymph nodes. Untreated, it can move into the blood (causing septicemic plague) or to the lungs (causing pneumonic plague). TYPES

35. Pneumonic plague When the bacteria spread to or first infect the lungs, it’s known as pneumonic plague — the most lethal form of the disease if untreated. When someone with pneumonic plague coughs, the bacteria from their lungs are expelled into the air. Other people who breathe that air can also develop this highly contagious form of plague, which can lead to an epidemic . Pneumonic plague causes severe  pneumonia  and respiratory failure. If not treated, most people with pneumonic plague die within days. Pneumonic plague is the only form of the plague that can be transmitted from person to person

36. Septicemic plague When the bacteria enter the bloodstream directly and multiply there, it’s known as septicemic plague .  When they’re left untreated, both bubonic and pneumonic plague can lead to septicemic plague. leading to  gangrene  and organ failure

37. Bubonic plague and septicemic plague are transmitted primarily by the bite from infected fleas, although, transmission can occur by bites or scratches from infected wild rodents and cats, or contact with tissue from infected animals. Bubonic plague is rarely spread from person-to-person. Pneumonic plague occurs when a person inhales the plague bacteria. Pneumonic plague is far more contagious because it can be spread from person-to-person through the air by sneezing or coughing. Mode of transmission

38. Bubonic plague is the most common variety of the disease. It's named after the buboes (swollen lymph nodes), which typically develop within a week after an infected flea bites you. Signs of plague can be found in the groin, armpit or neck. They are about the size of a chicken egg, and are tender or warm when touched. Other symptoms may include: Sudden feelings of fever and chills Headache Fatigue or malaise Muscle aches Clinical features

39. Abdominal pain, diarrhea and vomiting Bleeding from your mouth, nose or rectum, or under your skin Blackening and death of tissue (gangrene) in your extremities, most commonly your fingers, toes and nose ,where mortality is high and it is called black dead Septicemic plague occurs when the plague bacteria multiplies in your bloodstream. Septicemic plague

40. Symptoms and signs can begin within a few hours after infection, and may include: Cough, with bloody sputum Difficulty breathing High fever Nausea and vomiting Weakness Pneumonic plague

41. Blood culture Culture of lymph node aspirate  (fluid taken from an affected lymph node or bubo) Sputum culture Chest x-ray Diagnostic evaluation

42.  Plague can be a very severe disease in people, with a case-fatality ratio of 30%-60% if left untreated. • Drug of choice: • Streptomycin (30 mg/kg I.M. in divided doses every 12 hours) reduces mortality to approximately 5%. • Gentamicin (more widely available than streptomycin) also appears to be effective. • To prevent relapses, antibiotic treatment should be continued for 10 days or for at least 3 days after defervescence and clinical recovery. management

43. Chemoprophylaxis   Contacts of patients with suspected septicemic plague with pulmonary involvement. • Regimen: • Tetracycline(500 mg p.o ., q.i.d .) or doxycycline (100 mg p.o ., b.i.d .). • Streptomycin (20 mg/kg/day I.M. in two divided doses) trimethoprim-sulfamethoxazole (40 mg/kg p.o ., b.i.d .) can be used for children younger than 8 years.

44. Dr Haffkine developed plague vaccine in 1897 , the first vaccine developed in India. Adults and children greater than or equal to 11 years old: The primary series consists of 3 doses of vaccine. The first dose, 1.0 ml, is followed by the second dose, 0.2 ml, 4 weeks later. The third dose, 0.2 ml, is administered 6 months after the first dose. vaccination

45. Reduce rodent habitat around your home, work place, and recreational areas. Remove brush, rock piles, junk, cluttered firewood, and possible rodent food supplies, such as pet and wild animal food. Make your home and outbuildings rodent-proof. Rat mat,sprays Use flea control spray on your pet. prevention

46. Early identification and prompt treatment Pneumonic plague- airway management, Isolation, disinfection of sputum and aseptic precautions Surveillance Nursing management

47. Programmes related to dengue and plague 5 nursing process for dengue and plague Assignments