POLIOMYELITIS

• Poliomyelitis


  It is an acute communication disease caused by the poliovirus
• Other Terms


  • Polio
  • Infantile Paralysis
• Etiologic Agent


  Poliovirus Types 1, 2 and 3
• Mode of Transmission


  Direct contact with infected oropharynges secretions or feces
• Incubation Period


  7 to 14 days
• Clinical Manifestations


  • Fever
  • Headache
  • Vomiting
  • Lethargy
  • Irritability
  • Pains in the neck, back, arms, legs and abdomen
  • Muscle tenderness, weakness an spasms in the extensors of the neck, back, hamstring and other muscles during range-of-motion exercises
  • Loss of superficial and deep reflexes
  • Positive Kernig's and Brudzinski's signs
  • Hypersensitivity to touch
  • Urinary retention
  • Tripod (arms extended behind for support when sitting up)
  • Hoyne sign (head falls back when surprise and shoulders are elevated)
  • Inability to raise the legs a full 90 degrees from a supine position
  • Diplopia
  • Dysphasia
  • Difficulty chewing
  • Inability to swallow or expel saliva
• Diagnostic Tests


  • Viral culture Stool sample
  • Convalescent serum antibody titers four times greater than acute titers support the diagnosis
  • CSF pressure and protein levels may be slightly increased, and the white blood cell count elevated initially, thereafter mononuclear cells constitute most of the diminished number of cells
  • Electromyographic findings in early poliomyelitis show a reduction in the recruitment pattern and a diminished interference pattern due to acute motor axon fiber involvement
  • Fibrillations develops in 2 to 4 weeks, and fasciculations also may be observed
• Treatment Modalities


  • Analgesics (No Morphine)
  • Moist heat application
  • Bed rest is necessary only until extreme discomfort subsides
  • Physical therapy
  • Braces
  • Corrective shoes
• Complications


  • Respiratory failure
  • Pulmonary edema
  • Pulmonary embolism
  • Urinary Tract Infection
  • Urolithiasis
  • Atelectasis
  • Pneumonia
  • Cor Pulmonale
  • Paralytic shock
• Nursing Considerations


  • Observe the patient for paralysis and other neurologic damage
  • Maintain patent airway
  • Check blood pressure frequently
  • Provide an adequate, well-balanced diet
  • Good skin care and frequent repositioning
  • Inform ambulatory patients about the needs for careful handwashing
  • Instruct the patient or caregivers about measures need to manage symptoms and prevent complications
• Prevention


  Administration of Oral Polio Vaccine<|>Boosters are required at 10-years intervals for travel to endemic areas