Module 6

• Ascariasis


  Infection by a parasite roundworm
• Ascaris Lumbricoide


  • Elongated, cylindrical worms that are tapered at the oral portion and pointed at the anal end
  • Appear creamy and pinkish yellow when fresh
• Mode of transmission

  1. Contaminated fingers put into the mouth

  2. Ingestion of food and drinks contaminated with embryonated eggs
• Epidemiology


  • Occurs worldwide, but common in poorly sanitized areas
  • Most affects children (4 to 12 years old)
  • Philippines have 70-90% of infection rate in poor areas
• Most prevalent form of parasitism in the Philippines
• High incidence in children with poor nutritional status
• Pathogenesis

  1. Ingestion of contaminated water or eating raw vegetables, especially if "night soil" is used

  2. Ascaris hatches and releases larvae

  3. Larvae penetrate the intestinal wall and reach the lungs through the bloodstream

  4. Larvae migrate to bronchioles, the bronchi, trachea and epiglottis
• Developmental stage


  Symptomatology
• Developmental stages

  • Embryonated Ova
  • Larval stage
  • Adult stage
• Complications

  • Biliary tract obstruction
  • Hepatic abscess and cholangitis
  • Intestinal obstruction, perforation, peritonitis
  • Malnutrition due to damage of the intestinal mucosa
• Nursing intervention

  • Isolation is not needed
  • Preventive measures must be enforced
  • Handwashing before handling foods, washing of all fruits and vegetables that are eaten raw
  • Availability of toilet facilities
  • Importance of personal hygiene
  • Proper disposal of diapers
• Common nursing diagnosis

  • Self-care deficit
  • Altered nutrition: less than body requirement
  • Alteration in bowel elimination
  • Fear
  • Pain and discomfort
  • High risk for infection
• Prevention

  • Improved sanitary and hygienic practices
  • Improved nutrition
  • Deworming must be advised
  • When travelling to areas where sanitation and hygiene are poor, avoid water or food that may be contaminated
• Bacillary Dysentery

  Acute bacterial infection on the intestines characterized by diarrhea and fever and is associated with the passing out of bloody-mucoid stools accompanied by tenesmus
• Shigella group of bacteria


  • Short, non-motile, gram-negative organisms
  • Four serologic groups: Shigella Flesneri (Group B), Shigella Boydii, Shigella Connei, Shigella Dysenteriae
  • Considered as the most infectious
  • Their habitat is exclusively the GIT of man
  • They develop resistance against antibiotics
  • They rarely invade the blood stream
• Incubation period

  7 hours to 7 days, average of 3 to 5 days
• Period of communicability

  The patient is capable of transmitting the microorganism during the acute infection until the feces are negative of the organism<|>Some patients remain carriers for a year or two
• Mode of transmission

  1. Ingestion of contaminated food and or water, or milk

  2. Flies, or other objects contaminated by the feces of the patient

  3. Fecal-oral route
• Pathogenesis

  1. After the incubation period, the organism invades the intestinal mucosa and causes inflammation

  2. Dirty, green, fibrinous sloughing areas or ulcers are formed

  3. Stool may contain pus, mucus, and blood
• Clinical Manifestations

  • Fever, especially in children
  • Tenesmus, nausea, vomiting, and headache
  • Colicky or cramping abdominal pain associated with anorexia and body weakness
  • Diarrhea with bloody-mucoid stools that are watery at first
  • Rapid dehydration and loss of weight
• Complications

  • Rectal prolapse, particularly in undernourished children
  • Respiratory complications, such as cough and pneumonia
  • Non-suppurative arthritis and peripheral neuropathy
• Nursing managements

  • Maintain fluids and electrolyte balance to prevent profound dehydration
  • Keep the patient warm and comfortable
  • Restrict food until nausea and vomiting subsides
  • Isolation carried through medical aseptic technique
  • Personal hygiene must be maintained
  • Excreta must be properly disposed
  • Concurrent and terminal disinfection must be employed
  • Return to normal activities must be gradual because relapse may occur as a result of fatigue
• Common nursing diagnosis

  • Pain and discomfort
  • Fear
  • Alteration in bowel elimination
  • Altered nutrition: less than body requirement
  • Anxiety
  • Altered body temperature
• Methods of prevention and control

  • Sanitary disposal of human feces
  • Sanitary supervision of processing, preparation, and serving of food
  • Hand washing facilities
  • Fly control and protection against fly contamination
  • Isolation during acute stage
  • Protection and purification of public water supply
  • Person with infection should be discouraged to handle food for public consumption
• Botulism


  Rare but serious paralytic illness caused by a potent neurotoxin by the bacterium Clostridium botulinum
• Clostridium botulinum

  • Gram (+), spore-forming, anaerobic organism whose natural habitat is the soil
  • The spore can withstand boiling for several hours
  • Botulinum toxin is the most potent toxin known to man
• Human forms of botulism

  • Foodborne botulism (classical)
  • Wound botulism (cutaneous botulism)
  • Infant botulism
• Pathogenesis

  The toxin is disseminated to peripheral cholinergic synapses and blocks acetylcholine causing impaired autonomic and voluntary neuromuscular transmission
• Clinical characteristics

  • Flaccid paralysis (descending paralysis)
  • Somatic musculature is affected, may have generalized weakness
• Neurological symptoms

  • Diplopia and blurred vision
  • Ptosis, xerostomia, dysphagia and dysarthria
• Classic symptoms


  • Diplopia, blurred vision, Ptosis, dry mouth, Dysarthria, dysphagia, Muscle weakness
  • In infants with botulism, appear lethargic, feed poorly, and are usually constipated
• Complications

  • Pneumonia
  • UTI
  • Pulmonary embolism
  • Decubitus ulcer
  • Flexion contractures
• Nursing diagnosis

  • Impaired physical mobility
  • Potential impairment of skin integrity
  • Alteration in bowel elimination
  • Pain and discomfort
  • Altered nutrition: less than body requirement
  • Anxiety
• Prevention and Control

  • Health education through proper food preparation especially on home canning
  • Don't give infants foods with honey
  • Promptly report suspected cases or an outbreak of foodborne botulism