communicable disease final

i

Clinical Manifestatio

ns

muscle aches,eye pain with bright lights, followed by chills and fever.Watering and redness of the eyes occurs

Disease Process

CAUSATIVE AGENT:

Leptospira pyrogenes L.

macilae (commonly found ) L. canicola

Period of communicability

: none but leptospira are found in the

patients urine between 10 to 20 days after

onset

INCUBATION PERIOD: 6 to

15 days

DIAGNOSTIC EXAM

total WBC count slightly elevated with neutrophilia.Rising titer of leptospiral antibodies is found from the second week onwards.Increased erythrocyte sedimentation rate (about 60 mm).throbocytopenia

.

Urinalysis with proteinuria.

Hematuria and casts.

MEDICATIONS

PENICILIN G – drug of choice.

TETRACYCLINES (Doxycycline)

PATHOPHYSIOLOGY

Predisposing Factor:Dirty environment, age, seasons, males,

geographic areas↓

Rodents, wild animals↓

Infected urine or carcasses ↓

Man↓

Incubates for 6 to 15 days↓

Profileration and widespread dissemination↓

Organ systems are affected↓

Leptospirosis↓

Complications:Pneumonia

Optic NeuritisPeripheral neuritis

Definition:

(WEIL’S DISEASE, MUDFEVER, SWINEHERD’S DISEASE,CANICOLAFEVER)

- infection carried by animal both domesticated and wild whose excreta is

contaminated or food which is ingested or inoculated thru skin or mucus membrane

Nursing Management:isolation of patient: urine must be properly disposed

Darken the patient’s room because light is irritating to the eyes of the patient.Observe meticulous skin care to ease pruritus.

health teachings: keep a clean environment


nsNUCHAL RIGIDITY

-pathognomonic sign

Neck shoulder and back stiffnessOpisthotonusPositive Kernig and Brudzinski’s sign

Disease Process

CAUSATIVE AGENT: Neisseria meningitidis ( other strains: Haemophilus influenza – common in young children, Streptococcus pneumonia – common in adults, Straphylococcus aureus )PERIOD COMMUNICABILITY-until meningococci are no longer present in the mouth and nasal discharges.INCUBATION PERIOD : 3 – 6 daysMODE OF TRANSMISSION : respiratory droplets

DIAGNOSTIC EXAM:

CBC with differential- elevated white blood cell count, neutrophilsBlood cultures- may indicate organismLumbar puncture with CSF cultures- elvated cell count, may indicate organism

MEDICATIONS

Mannitol

Dexamethasone

Dilantin/phenytoin

Pyretinol/encephabo L

PATHOPHYSIOLOGY

bacteria↓

Increased body temperature and increased WBC count

↓

crossing to the blood-brain barrier(since it has no WBC for immunity infection

progresses)↓

meninges, inflammatory response /reaction

↓

Edema in the meninges

↓

affects the intracranial nerves

↓

Brudzinzki’s sign Kernig’s sign ,Photophobia

↓

increased ICP > pain the head

Definition:

is an acute infection of the meninges usually caused by pneumococci, streptococci,

Haemophilus influenza, or aseptic agents (usually viral).

Nursing Management:

Isolate the patient – quiet and darkened roomPrevent stress provoking factors Prevent injury during episodes of convulsionsMaintain fluid and electrolyte balanceProvide balanced diet, low fat


ns

Mild fever and malaiseRash – start from the truck and spread to other parts, progression completed in 6 to 8 hours

macule – lesion that is flat

papule – an elevated lesion

vesicle – filled with clear fluid

crust – a scab lesions caused by secretions of a vesicle drying on the skinpustule – vesicle affected and filled with pus

Disease Process

MODE OF TRANSMISSION: direct thru droplet infection or airborn; indirect thru linen and fomites.

INCUBATION PERIOD : 10 to 21 days

DIAGNOSTIC EXAM:

Examination of vesicle fluid under electron microscope( shows round particles )Scrapings of the floor of the vesicles colored by Giemsa. ( Tzanck smear )( shows multinucleated giant cells )Four fold rise in antibody titreDetection of viral DNA by PCRFluorescent Antibody to Membrane Antigen

MEDICATIONS

Acyclovir/zovirax

Diphenhydramine (Benadryl)

PATHOPHYSIOLOGY

Inhalation of contaminated respiratory droplet↓

Infection in the conjunctivae or the mucosa of the upper respiratory tract

↓Viral proliferation in regional lymph nodes

↓Primary viremia

↓2nd viral replication in the internal organs

↓Secondary viremia

↓Infection of cells of the malpighian layer

↓Intercellular & intracellular edema/vesicles

↓

Pre-eruptive manifestations; Mild fever and malaise. Eruptive stage; Rash starts from the

trunk., Appearance of rashes through following

stages: macule, papule, vesicle, pustule, crust, All stages are present simultaneously before all

are covered with scabs, known as “Celestial map”.

Definition:

-Highly contagious disease caused by herpes virus characterized by vascular

eruptions on the skin and mucous membrane.

Nursing Management:

Isolation until crust have fallen off

Calamine lotion over rashes

Antipyretics – for fever.

Handwashing and cutting of fingernails


ns

>Presence of NEGRI BODIES in brain tissues (round or oval bodies found in the cytoplasm of neurons in animal with rabies

Disease Process

2 TYPES OF RABIES VIRUS:a. STREET VIRUS - natural virus invading / transmitted in the salivab. FIXED VIRUS – do not usually invade the salivary glands with constant incubation period of 4 to 6 days

INCUBATION PERIOD:a.In dogs and cats - 1 week to 7 ½ monthb.In man - 4 to 8 weeks

MODE OF TRANSMISSION: contamination of a bite/scratch or other break in the skin from saliva

DIAGNOSTIC EXAM:

1. History of exposure – bites2. Development of characteristic symptoms3. Microscopic exams – presence of NEGRI BODIES in brain tissue and saliva4. Flourescent rabies antibody (fra) techique

MEDICATIONS

LYSSAVA

VERORAB

PATHOPHYSIOLOGY

Rabies virus transmission via animal bites↓

Virus travels along the nerves to the spinal cord and to the brain

↓Virus multiplication happened

↓

Travels alomg other nerves to the salivary glands and into the saliva

↓

Short period of depression, restlessness, malaise and fever

Paralysis in the lower legs, spasm of the muscles, in the throat and voice box

Coma and death

Definition:

(LYSSA, HYDROPHOBIA ) - severe viral infection of the CNS that is communicated to human in the

saliva of infected animals or human caused by rabies virus (RHABDOVIRUS) – filterable virus and

inactivated by sunlight

Nursing Management:

Treatment of wound with soap and water or zephiran betadine

Isolate patient – provide restful, quiet and semi dark environment

Cover IVF with paper bag – no sight of water

Provide comfort


nsA.PRODROMAL PHASE•P. falciparum – fatigue, vague abdominal pains, muscle aches, highly colored urine, orthostatic hypotension, hepatomegaly an spleenomegaly•P. vivax – headache, photophobia, muscle aches, anorexia, nausea and vomiting•P. ovale and P. malariae – not significant

Disease Process

MODE OF TRANSMISSION:

1.Person to person thru bites of an infected mosquito

2.Parenterally – blood transfusion or contaminated syringes and needles

3.Mingling of infected maternal blood with that of the infant during delivery

4.Transplacental ( congenital malaria ) – very rare

INCUBATION PERIOD (varies depending on greater or lesser resistance of individual )DIAGNOSTIC

EXAM:

urine reveals small amounts of protein

liver function tests reveals elevated transaminase level and increase in indirect serum bilirubin

MEDICATIONS

4 Aminoquinolines (Choloroquine, Aminodiaquine and Quimine )

Primaquine –pyrimethamine-SULFADOXINE (FANSIDAR) – safest during pregnancy.

PATHOPHYSIOLOGY

female Anopheles mosquito bites, injecting saliva containing sporozoites

↓sporozoites enter liver cells and multiply

↓sporozoites change to merozoites

↓

merozoites are released from the liver and enter the bloodstream

↓merozoites attack red blood cells

↓multiply in RBC’S

↓

RBC’s burst and release the merozoites which invade other RBCs and cause recurring chills and

fever

Definition:

( MARSH FEVER)- an acute or chromic disease caused by protozoa

plasmodia transmitted to man by the bite of infected female anopheles mosquito ( Anopheles minimus flavirostris ) which is a night biting and

breeds in flowing clear and shaded stream

NURSING MANAGEMENT:

IsolationSupportive care

PREVENTION:Eliminate breeding places of

mosquitoesAdvise travelers of high risk areas

Screening of windows

s


ns

Pathognomonic sign:PseudomembraneIrritating nasal discharge usually serosanguenousBullneck apperanceDyspnea

Disease Process

common in children 6

months to 5 years ( rare

below 6 mos. due to immunity passed from the

mother )MODE OF

TRANSMISSION:

1.Direct contact of mouth

secretions2.Indirect thru toys an clothing

that are contaminatedINCUBATION

PERIOD: 2 to 6 days

PERIOD OF COMMUNICABI

LITY

1 to 2 days in treated patients

DIAGNOSTIC EXAM:

Nose and throat swab

Shick’s test -reveals local

circumscribed area of redness

usually 4 to 3 cm in diameter-

Maloney’ s test- reveals

erythema

MEDICATIONS

Penicillin (Permapen)

erythromycin (E-mycin)

PATHOPHYSIOLOGY

causative agent : Cornybacteruim diptheriae↓

Enters the body via direct and indirect contact↓

Produces exotoxin↓

Absorbed into the mucous membranes↓

Causes destruction of the epithelium↓

Inflammatory response takes place↓

Accumulation of inflammatory cells, necrotic epithelial cells, and organism debris, which form

the characteristic adherent grey pseudomembrane

↓Attempts to remove the pseudomembrane result

in bleeding and expose an inflamed

Definition:

characterized by formation of pseudomembranre commonly in the faucial area and tonsils by the

exotoxin produced by Corynebacterium diphtheriae (KLEBS-LOEFFLER BACILLUS)

NURSING MANAGEMENT:

CBR – prevent complicationsOral hygiene

Maintain fluids an d electrolytesAdequate nutrition

Ice colar – relieve pain


ns

A.CATARRHAL STAGE ( last about 1 to 2 weeks )-nasopharyngeal secretions-wheezing and cough-low grade fever-stage of hypercommunicabilityB.PAROXYSMAL STAGE-beginning at the end of 2nd week and last for 4 to 6 weeks-spasmodic cough – whoop which is provoked by eating, crying and exertion-subconjunctival hemorrhage – rupture of capillaries

Disease Process

MODE OF TRANSMISSION:

-direct contact from droplet spread from infected child during incubation period and catarrhal stage

PERIOD OF COMMUNICABILIY: days after exposure to 3 weeks after of typical paroxysms

INCUBATION PERIOD : 7 to 14 days ( dis. is only about 6 weeks )DIAGNOSTIC

EXAM

Nasal swab and sputum cultures shows B. pertussis only

WBC-is usually increased

fluorescent antibody screening of nasopharyngeal smears- positive for Pertussis

MEDICATIONS

Penicillin

Erythromycin (Erythrocin)

chlorampenicol

PATHOPHYSIOLOGY

B. pertussis is transmitted by droplets↓

Attach to pharyngeal epithelial cells ↓

Release number of antigens, toxins, and other substances

↓Triggers the immune system

↓nasopharyngeal secretions,wheezing

and cough

Definition:

-characterized by repeated attacks or spasmodic coughing which consist of a series of explosive

expiration, typically ending in a long drawn force

inspiration which produces the characterized crowing sound the “whoop” & usually followed by

vomiting.

NURSING MANAGEMENT

CBR

Increase fluid intake – not during attacksAbdominal binders – to prevent abdominal

herniaNo large nipples – to prevent aspiration

No feeding during attacksStrict isolation

High calorie/ bland dietProper positioning


ns

general malaise, anorexia , easy fatigability, apathy, irritability, indigestiontachycardia, dyspnea, cyanosisfever – late in the afternoon night sweats – acute exudates involvement ( advanced cases )loses weightmalaisehemoptysis

Disease Process

Tuberculosis:CAUSATIVE AGENT: Mycobacterium tuberculosisMODE OF TRANSMISSION: droplet infectionINCUBATION PEROID: 2-10 weeks

DIAGNOSTIC EXAM:

Sputum acid – fast bacilli staining

RESULTS OF SPUTUM MICROSCOPY O negative for bacilli+- 1 – 4 bacilli++- 5 – 10 bacilli+++ - 10 – 20 bacilli++++ - more than 20 bacilliChest x-raymantoux test

MEDICATIONS

Rifampicin

Isoniazid

PyrazinamideEthambutolStreptomycin

PATHOPHYSIOLOGY

Repeated close contact w/ infected,Occupation,Indefinite substance abuse via

IV,recurrence of infection↓

Exposure or inhalation of infected Aerosol through droplet nuclei (exposure to infected clients by

coughing,sneezing, talking)↓

Tubercle bacilli invasion in the apices of theLungs or near the pleurae of the lower lobes

↓Bronchopneumonia develops in the lung tissue

↓Necrotic Degeneration occurs

↓drainage of necrotic materials into the

tracheobronchial tree↓

Lesions may calcify (Ghon’s Complex)and form scars and may heal

over a period of time↓

Tubercle bacilli immunity develops↓

Acquired immunity leads to further growth of bacilli and development of active infection

↓Dyspnea, chest tightness, hemoptysis, cracklesNon-productive/productive cough.HemoptysisChest painChest tightnessCrackles

Definition:

is a bacterial infection caused by a germ called Mycobacterium tuberculosis. The

bacteria usually attack the lungs, but they can

also damage other parts of the body

NURSING MANAGEMENT

CBRadequate nutritionambulatory chemotherapynpo – hemoptysisoxygen inhalationblood transfusioncoagulants - vit. k and hemostan


ns

Sudden onset of hyperpyrexia and headache, patient is flushed and acutely illAnorexia, nausea and vomiting severe abdominal pain and tendernessHepatomegaly – 50 to 60 % of cases

Disease Process

MODE OF TRANSMISSION

: bite of an infected Aedes

aegypti mosquito which

is day biting with limited

flying movement

INCUBATION PERIOD: 4 to 6

daysHEMORRHAGIC

FEVER – is a result of:•Increase capillary

fragility – strong immune complex

reaction that produce toxic substance like

histamine, bradykinin,

which damage capillary wall

DIAGNOSTIC EXAM:

Positive tourniquet test ( rumpel leed test ) – increase capillary fragility.

hematologic exam – decrease Platelet determination count (150,000 to 400,000/cu.mm )

Hemagglutination-inhibition test – most frequently used

MEDICATIONS

Paracetamol (acetaminophen)

PATHOPHYSIOLOGY

Predisposing factor:Bite of aedes aegypti mosquito carrying a virus

↓Virus goes into the circulation

↓Infect cells and general cellular response

↓

Initiates destruction on the platelet↓

Potential for haemorrhage↓

Stimulates intense inflammatory response↓

Release of exogenous pyrogens↓

Increase WBC (Neutrophils and macrophages)↓

Release of endogenous pyrogens↓

Reset of hypothalamic thermostat↓

fever

Definition:

acute tropical disease characterized by severe pain in the eye and in the joints and bones an accompanied by an initial erythema caused by

dengue virus and transmitted by mosquito

Aedes aegypti

NURSING MANAGEMENT

Epistaxis – ice compress on bridge of nose, let patient bite something

Gum bleeding – ice chips, bristle toothbrush

GI bleeding – observe signs of bleeding, place o NPO. Avoid highly seasoned food

DO NOT GIVE ASPIRIN – causes platelet degeneration and may cause further bleeding.


ns

>lockjaw or trismus

>boardlike abdomen

>photophobia – eyes partially close

>laryngeal / pharygeal spasm

>irritability and restlessness

>convulsions

Disease Process

MODE OF TRANSMISSION – direct and indirect contamination of wound, umbilical stump in newborn

INCUBATION PEROD: 3 days to 3 weeks with average of 10 days

PERIOD OF COMMUNICABILITY: not transmitted persons to person directly

DIAGNOSTIC EXAM:

CSF is normal

Blood exam – normal or slightly elevated WBC ct.

MEDICATIONS

PEN G Na

Diazepam (Valium)

Baclofen (Lioresal)

PATHOPHYSIOLOGY

deep penetrating wound↓

Clostridium tetani↓

Produces the neurotoxin tetanospasmin(TS) at the site of tissue injury

↓TS binds to the motor nerve ending and

then moves by retrograde axonal transport to the CNS

↓binds to GABA and blocks presynaptic

release of GABA↓

muscle spasm

Definition:

infectious disease caused by an anaerobic bacteria(cannot leave in the presence of

oxygen) which produces a potent exotoxin

2 FORMS:

NURSING MANAGEMENT

Proved quiet semi dark environmentMinimal handlingPrepare tongue depressionsMaintain an adequate airwayClosely guard the patientSupport during spasm and convulsionsNo restraintsAdequate fluid and electrolytes

High calorie liquid to soft diet


ns

Fever, malaise, and anorexia.Nausea, vomiting, abdominal discomfort, fever and chills.Jaundice, dark urine, and pale stools.

Disease Process

Incubation Period:

The incubation period is 50 to 189 days or two to five months with a mean equal to 90 days.

Period of Communicability:

latter part of the incubation period and during the acute phase. The virus may persist in the blood for many years.

Mode of Transmission:

Hepatitis B can be directly transmitted by person to person contact via infected body fluids.

It can be transmitted though contaminated needles and syringes.

Transmission can occur through infected blood or body fluids introduced at birth.

It can also be transmitted through sexual contact.

DIAGNOSTIC EXAM:

elevated serum transferase levels, AST and ALT

low blood levels of albumin

an abnormally long prothrombin time

MEDICATIONS

Entecavir (Baraclude)

Lamuvidine (Epivir)

Peginterferon Alfa 2a (Pegasys)

PATHOPHYSIOLOGY

the virus enters a new host↓

infect liver cells (hepatocytes)↓

inflammation↓

decrease liver function↓

scarring or fibrosis occurs↓

Fever, malaise & anorexia, Nausea, vomiting, abdominal discomfort, fever and chills, Jaundice,

dark urine, and pale stools.Fulminant hepatitis; Fatal and manifested by

severe symptoms such like ascites and bleeding

Definition:

is the inflammation of the liver caused by hepatitis B virus.

NURSING MANAGEMENT

Encourage frequent small feedings of high-calorie, low-fat dietencourage eating meals on a sitting position to decrease pressure on the livermonitor intake and outputprovide frequent oral fluids as toleratedpromote periods of rest during symptomatic phase


ns

change in skin color-either reddish or whiteloss of sensation on the skin lesionulcers that do not healloss of eyebrow-madarosiscontractures

Disease Process

MODE OF TRANSMISSION: prolonged skin to skin contact, fomites and droplet infection

INCUBATION PERIOD : 1 to 5 years or more (variable )

PERIOD OF COMMUNICABILITY : as long as there are open lesions

DIAGNOSTIC EXAM:

Mean- from mucocutaneous lesions

Lepromin Skin Test – has cross sensitivity to tuberculosis infection and BCG vaccinationMitsuda Reaction – more useful for the determination of the type of disease and prognosis

MEDICATIONS

Dapsone

(Avlosuflon)

Rifampin (Rifadin)

Clofazimine

(Lamprene

)

Minocycline

(Minocin)

PATHOPHYSIOLOGY

M. Leprae attacks the peripheral nerves↓

Ulnar, radial, posterior-popliteal, anterior-tibial, and facial nerves

↓Bacilli damage the skin’s fine nerves

↓Cause anesthesia, anhidrosis, and

dryness↓

If they attack a large nerve trunk, motor nerve damage, weakness, and pain

occur↓

Peripheral anesthesia, muscle paralysis, atrophy

Definition:

-chronic mildly communicable disease with insidious outset affecting the skin, mucus

membranes and nervous tissue and eventually producing deformities and caused by

Mycobacterium leprae (Hansen’s bacillus )

NURSING MANAGEMENT

IsolationMaintain balance nutrition, sleep and restHelp the family to understand and accept to remove social stigmaGood personal hygienceHandling of infants and young ones should be avoided


ns

fever and malaiselymphadenopathyEranthem: discrete rose spots on soft palateExanhem: Variable; begins on face spreads quickly over entire body

Disease Process

MODE OF TRANSMISSION : airborne droplet nuclei or close contact

INCUBATION PERIOD: 10 to 21 days

PERION OF COMMUNICABILITY: entire course of illness

DIAGNOSTIC EXAM:

Hemagglutination-inhibition test (hi)

Complement – fixation test (cf)

ELISA ( Enzyme Linked Immunosorbent Assay )

MEDICATIONS

Ibufrofen (Advil)

naproxen (Anaprox)

Ketoprofen (Actron)

PATHOPHYSIOLOGY

Contact with the infected person↓

Maternal viremia↓

Fetal viremia↓

Disseminated infection involving many fetal organ

↓Intrauterine growth retardation, blueberry

muffin skin, lethargy and hypothermia↓

Causative agent spreads through the cells and the blood

↓Mild feverish illness associated with rash

and aches and joint

Definition:

-caused by rubella virus and characterized exanthem and fever with minimal

complications but has teratogenic effect on offspring during pregnancy

NURSING MANAGEMENT

darkened room to relieve photophobiadiet: should be liquid but nourishingwarm saline solution for eyes to relieve eye irritationfor fever: TSB and antipyreticsprevent spread of infection, respiratory inhalation


nsFever and extreme coldness (chills shivering, shaking (rigor))Nasal congestionBody aches, especially joints and throatFatigueIrritated, watering eyesReddened eyes, skin nose etcPetechial Rash

Disease Process

Direct transmission,

when an infected person sneezes mucus directly into the

eyes, nose or mouth of

another person

Airborne route, when someone

inhales the aerosols

produced by an infected person

coughing, sneezing or

spitting

Hand-to-eye, hand-to-nose, or hand-to-mouth transmission, either from

contaminated surfaces or from direct personal contact such as a hand-shake

DIAGNOSTIC EXAM:

flu test-positive

molecular test result-has influenza virus

viral culture- positive

MEDICATIONS

Amantadine (symmetrel)

rimantadine

(flumadine)

oseltamivir

(Tamiflu)

zanamivir

(Relenza)

PATHOPHYSIOLOGY

virus attaches to host↓

viral RNA enters host cell↓

viral RNA replicates within host cell↓

new virus particles are released and assembled↓

binding and destruction of epithelial cells from nasopharynx and alveoli

↓local inflammatory response

↓systemic body reaction(fever, muscle pain etc.)

Definition:

is a viral infection that affects mainly the nose, throat, bronchi and, occasionally, lungs. Infection

usually lasts for about a week, and is characterized by sudden onset of high fever, aching muscles,

headache and severe malaise, non-productive cough, sore throat and rhinitis.

NURSING MANAGEMENT

administer analgesics, antipyretics, and decongestants, as ordered.

Follow droplet and standard precautions.Provide cool, humidified air but change the water daily to prevent pseudomonas superinfection.

Encourage the patient to rest in bed and drink plenty of fluids.

Administer I.V. fluids as ordered.Administer oxygen therapy if warranted.Regularly monitor the patient’s vital signs,

including his temperature.


ns

anorexia and irritabilityprurituslethargyKOPLIK SPOTS- pathognomonic signeruption on the skin; maculopapular rashes (red in color )

Disease Process

MODE OF TRANSMISSION :-droplet infection OR AIRBORNE.-indirect thru contaminated articles with respiratory secretions

INCUBATION PERIOD: 10 to 22 days

PERIOD OF COMMUNICABILITY : 5h day of incubation period until the day of the rash

DIAGNOSTIC EXAM:

multinucleated giant cells in smears of nasal mucosalow white blood cell count and relative lymphocytosis in PBmeasles encephalitis- raised protein, lymphocyte in CSF

MEDICATIONS

Vaseline

Penicillin

ribavirin (Virazole)

PATHOPHYSIOLOGY

measles virus transmitted via droplet s infects epithelial cells of the nose and conjuctivae virus multiplies extends to regional lymph nodes continues to replicate on epithelial and reticuloendothelial infections become established on the skin and other tissues including the respiratory tract Koplik’s spot may develop in buccal mucosa rashes develop virus can be found in bone, skin, respiratory tract and other organs viraemia gradually decreases viraemia and presence of virus in tissue and organs ceases

Definition:

( RUBEOLA ,7 DAY MEASLES, MORBILLI, & RED MEASLES )

-Contagious exanthematous disease of acute onset-Caused by measles virus ( paramyxovirus –

filterable virus )

NURSING MANAGEMENT

SYMPTOMATIC AND SUPPORTIVEEye-care – wash face and avoid direct sunlightOral hygieneSkin-care – no strong soaps and alcoholAnti-pyretics for feverHypoallergenic dietVitamin A as ordered – to protect the

epithelial lining of the resp. tract, GIT and eyes.

Catanduanes State CollegesCOLLEGE OF HEALTH SCIENCES

Department of NursingVirac, Catanduanes

Submitted by:Patricia Dawn G. Molina

BSN 3A

Submitted to:Dr. Alvin C. Ogalesco Ed.D

Professor

February 14, 2012

communicable disease final

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