DYSENTERY ppt.pptx

Medicine

1. DYSENTERY BY NORAH NTABO BSC NRS-UNZA

2. INTRODUCTION Dysentery is a blood diarrheal disease; I t is a notifiable infectious disease commonly caused by bacillary or amoebic dysentery, T ransmitted through oral feacal root and M ost prevalent in unhygienic areas like nursing homes. In Zambia the incidence of dysentery is 7 per 1000

3. GENERAL OBJECTIVE At the end of the lecture/ discussion students should be able to acquire knowledge in dysentery, so that they can use the knowledge to identify, treat and prevent the occurrences of dysentery in the communities.

4. SPECIFIC OBJECTIVES At the end of this lecture/discussion students should be able to: 1.Define dysentery 2.List the causes of Dysentery 3.Mention the two main types of dysentery 4.Describe of management of bacillary and amoebic dysentery

5. DEFINITION Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhoea containing blood and mucus in the faeces characterised by fever, abdominal pain, and rectal tenesmus caused by any kind of infection (Basavanthappa B.T. 2005) .

6. CAUSES T he main causative organisms of dysentery are: Shigella species Entamoeba hystolytica Salmonella species

7. Types of dysentery 1.Bacillary dysentery or shigellosis 2.Amoebic dysentery or amoebiasis

8. Bacillary Dysentery /Shigellosis DEFINITION Bacillary dysentery is an acute inflammation and ulceration of large intestines characterized by small frequent bowel movements consisting of blood and mucous in stool caused by shigella . (Beer M.H etal , 2006).

9. CAUSES Bacillary dysentery is caused by non-motile gram negative bacteria of the genus Shigella. Shigella is in 4 strains: Shigella flexneri Shigella boydii Shigella dysenteriae Shigella sonnei

10. Predisposing factors These are best summarized by the 6 F’s which are Formites , Food, Faeces, Fingers , Fluids and Flies . If these are well taken care then the problem is solved. The predisposing factors include; Poor feeding methods, example, use of dirty feeding bottles for infants, eating unboiled and improperly prepared foods.

11. Predisposing factors cont … Poor personal hygiene especially hand hygiene(hand washing, long unkempt finger nails and so forth) Poor source, treatment and storage facilities for water to drink Poor sanitation - Rubbish pits or dumping sites; Sewerage lines. Overcrowding

12. EPIDEMIOLOGY It is most prevalent in unhygienic areas of the tropics, But because it is easily spread, sporadic outbreaks are common in all parts of the world. Occurs among confined populations, such as those in nursing homes, large institutions subject to overcrowding

13. MODE OF TRANSMISSION The route of transmission of shigella is fecal oral route. The bacilli are excreted in faeces and through poor sanitation and bad hygiene, food and water can then become contaminated. Flies also frequently cause contamination of food and are prevalent mode of spread of dysentery. INCUBATION PERIOD The incubation period of shigella is 1 - 7 days.

14. PATHOPHYSIOGY When the bacillus enters the GIT, it invades the large intestine causing inflammation of the mucosa leading to ulceration and bleeding of the mucosa Stool would be blood stained and mucoid. In the later stage, pus forms due to infection. Adjacent lymph nodes may be affected resulting into fever

15. SIGNS AND SYMPTOMS

16. SIGNS AND SYMPTOMS Sudden onset of s/s Fever which results from infection and inflammatory reaction. S/s of dehydration such as loss of skin turgor, as a result of diarrhoea. Dehydration may or may not be present in this condition because patient passes small amount of stool, but it’s the frequency which is increased. Abdominal discomfort: This may be due to irritation of the mucosal lining of the GIT by the bacteria and usually it is an early symptom of dysentery.

17. S/S CONT…. Nausea and Vomiting: This may be due to irritation of mucosal lining of the GIT (stomach). Colic abdominal pains: May be due to inflammatory reaction in the mucosal lining of the large intestines. Bloody diarrhoea - This may be due to damage of the mucosal lining of the large intestines during inflammation. Damage to the mucosal lining may also cause damage to the capillaries.

18. S/S CONT…. The passage of bloody diarrhoea is usually accompanied by Urgency and tenesmus. (Urgency is the urge to open bowels at very frequent intervals even if small amounts of stool are passed and tenesmus is a painful ineffective straining to empty the bowels

19. MANAGEMENT Aims 1.To correct electrolyte and fluid imbalance 3.To identify and eliminate the causative organism 3.To prevent and manage complications

20. INVESTIGATIONS Microscopic examination of a fresh stool specimen Rectal swab for culture and sensitivity. Stool should be cultured within a few hours of collection. Detection of the organism in stool confirms diagnosis. Immunofluorescent techniques to detect organism in stool. Sigmoidoscopy reveals a red, bleeding mucosa with patches of necrotic membrane which may separate to leave ulcerated areas.

21. FLUID THERAPY Fluid and electrolyte replacement Oral rehydration is usually required to restore fluid and electrolyte imbalances. However, each patient should be assessed for the degree of dehydration and the appropriate fluid replacement therapy given.

22. DRUGS Antibiotics are administered to shorten the duration of illness and prevent relapse. Any of the following are given while waiting for result of culture and sensitivity: Nalidixic acid 1g PO qid for 7 to 14 days Ciprofloxacin 500mg PO BD for 5 days Co- otrimoxazole ( Septrin ; Trimethoprime -Sulfamethoxazole ) 960mg PO BD for 5/7 Ampicillin 500mg qid for 5 days

23. AMOEBIC DYSENTERY/AMOEBIASIS DEFINITIONS Amoebiasis is an infection of the large intestines caused by Entamoeba hystolytica, a single celled parasite (Berkow et al, 1997).

24. CAUSE The cause of amoebic dysentery is entamoeba hystolytica PREDISPOSING FACTORS Refer to bacillary dysentery EPIDEMIOLOGY Entamoeba histolytica has a worldwide distribution and is endemic in most countries with poor sanitation and low socioeconomic conditions. Use of night soil for agricultural purposes favours the spread of the disease. The organism is acquired when cysts are ingested.

25. MODE OF TRANSMISSION Faecal-oral route; vectors such as flies, cockroaches and rodents are capable of carrying cysts and contaminate food and water INCUBATION PERIOD It may take 2 weeks or years. Human beings are the principal reservoirs/carriers .

26. PATHOPHYSIOLOGY Ingested cysts enter the alimentary tract through the mouth to the stomach where they eccyst during digestion. Motile trophozoites are released which multiply, invade and ulcerate the intestinal mucosa of the large bowels, forming flask like ulcers. Some of the amoeba goes through the mesenteric artery and reach the liver causing total destruction of the liver resulting in amoebic hepatocellular necrosis and then liver abscess.

27. SIGNS AND SYMPTOMS On set is gradual and associated with abdominal discomfort. Mildly loose stools (diarrhoea) with or without blood and mucus. Diarrhoea may alternate with constipation. Tenderness may develop over the caecum, transverse colon or sigmoid Fever may be present Abdominal pains that may be on and off. If there is hepatic amoebiasis , there would be body malaise, swinging temperature, sweating, and enlarged tender liver. Foul-smelly stool. Weight loss in chronic cases.

28. INVESTIGATIONS Stool for m/c/s History of blood stained stool. Physical inspection will reveal dehydration. Rectal swab culture. Blood for Hb . Sigmoidoscopy will review ulcers. Liver scan will review Liver abscess.

29. TREATMENT Flagyl 200-400mg tids Septrin 960mg bd x 5-7 days Furamide [ diloxanidefuroate ] 500mg tds for 10 days For Hepatic Amoebiasis give Flagyl and Chloroquine 600mg od for 2 days and then 300mg od for 21 days. Panadol 1 gram tds x3/7 Intravenous fluids [Ringers Lactate)

30. NURSING CARE Aims 1.To prevent further spread of infection 2.To replace lost fluids and electrolytes 3.To prevent complications such as shock 4.To identify any contacts

31. ENVIRONMENT Admit patient in an isolation room away from other patients to prevent spread of infection to other people. The room should be well lit for easy observation and ventilated environment to promote air circulation. Patient should be nursed near the toilet for convenience. Equipment such as drip stands, intravenous set and observations tray should be within patient’s environment.

32. OBSERVATION Observe general condition of patient. Monitor vital signs such as temperature, pulse, respirations and blood pressure frequently. The frequency of vital sign observations depends on patient’s condition. Monitor the intake and output and record on the fluid balance charts. Monitor stool for amount, consistency and color and report. Observe for any signs of dehydration such as loss of skin elasticity, sunken eyes, and thirsty and dry mucus membranes of the mouth.

33. INFECTION PREVENTION Isolate patient away from other patients to prevent spread of infection. People who come in contact with this patient should observe isolation techniques such, putting on gowns and masks whenever they enter the room, washing hands before and after attending to the patient. Restrict visitors because they can also get the infection.

34. IP cont … The linen which is used by the patient should be disinfected with JIK 1:6 and should be labeled “infectious” before sending it to the laundry. It should not be mixed with other linen from the wards. All utensils used by patient should be disinfected Administer prescribed medication to treat the causative organism.

35. NUTRITION Give some copious drinks Light mixed diet free from irritants. If patient is unable to take food and fluids orally commence him/her on intravenous fluids. Maintain strict intake and output. Record intake and output, time commenced IVF, type of fluid and date started.

36. HYGIENE Assisted /bed bath can be given depending on the condition of the patient to promote comfort, self esteem and to remove dirty. Assist the patient with oral care to prevent complications of a dirty mouth such as mouth infections and also promote salivation as the patient’s mouth can be dry due to excessive loss of fluids .

37. HYGIENE cont … Change linen whenever soiled and disinfect the linen with Jik 1:6 before sending to the laundry. Ensure perineal area is cleaned

38. PSYCHOLOGICAL CARE Patients with dysentery may feel as if they have been neglected. The nurse needs to give proper psychological care to allay anxiety. Explain the disease process to patient which should include the cause, mode of transmission, signs and symptoms, treatment and complications.

39. PSYCHOLOGICAL CARE cont … Explain to the patient the reason for isolation which is prevention of spread of infection. Explain also to the significant others on why they are not allowed to visit the patient. Any procedure which is done to patient should be explained to gain his/her cooperation. Allow patients to ask questions and answer them truthfully.

40. MEDICATION Administer prescribed drugs as prescribed and observe for side effects. Administer fluids according to patient’s condition.

41. ELIMINATION Observe intake and output and record. Observe stool for amount, contents and odor . Provide bed pan in the initial stage but as condition improves, encourage patient to go to the toilet.

42. PREVENTION AND CONTROL OF DYSENTERY We have discussed the mode of transmission and predisposing factors of dysentery. From our discussion, how can dysentery be prevented?

43. Dysentery can be prevented by doing the following measures: Improved Environmental Sanitation: measures include: Provision of safe and adequate water supply. Safe and adequate disposal of human excreta through use of pit latrines or toilets Food safety against faecal contamination Provision of information, education and communication about dysentery. Discourage use of untreated human excreta for manure.

44. Prevention cont … Early Diagnosis and Treatment of Cases and Carriers Prompt detection and appropriate and adequate treatment of both cases and carriers Regular screening of food handlers

45. Prevention cont … Improved Personal and Communal Hygiene Adequate hand washing with soap under running water after using the toilet and before handling and eating food. Use of pit latrines or toilets for defaecation. Children should not be allowed to defaecate on the ground. Toilet training pots should be used and disinfected after use. Children’s stools should be disposed off in the toilet or pit latrine Boil water for drinking and for washing vegetables and fruits. Avoid eating raw vegetable and fruit salads.

46. COMPLICATIONS Perforation of the colon Peritonitis Rectal prolapse Haematogenous dissemination of the shigellas (rare) causing abscesses and meningitis Toxic megacolon Hemiplegia Encephalopathy Septicaemia Hyponatraemia Reiter’s syndrome Liver abscess

47. SUMMARY Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhoea containing blood and mucus in the faeces with fever, abdominal pain, and rectal tenesmus caused by infection. The main types of dysentery are Bacillary dysentery or shigellosis and Amoebic dysentery or amoebiasis . They are both treated using antibiotics like flagyl or Nalidixic and nursed in isolation/ revise barrier.

48. ASSINGMENT Read and write notes on Reiter’s syndrome and Toxic megacolon

49. REFRRRENCES Basavanthappa B.T, (2005), Medical Surgical Nursing, New Delhi, Jaypee Brothers, India. Beer M.H etal , (2006).The Merck manual of diagnosis and therapy, 18th Edition, Merck & Co.Inc , USA. Berkow.R , et al (1997), The Merck Manual of Medical Information, Merck Research Laboratories, New Jersey. Smeltzer etal , (2010). Bruuner and Suddarth Medical-Surgical Nursing, 10th Edition, Elsevier, Missouri Cahill , M. (1998), Diseases , Springhouse Corporation, Pennsylvania .

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