Waterborne and food borne disease

Waterborne and food borne disease

1. Typhoid fever.

This is a serious disease caused by the typhoid bacillus. The bacteria are swallowed with contaminated food and water. The bacteria flourish in the Payers patches (Lymphoid tissue) of small intestine where ulceration develops. The incubation period is 1 to 3 weeks.

Signs and Symptoms:

1.     High fever, which continues for more than a week.

2.     Coated tongue

3.     Headache and malaise

4.     A comparatively slow pulse (bradycardia) (Pulse rate is usually faster with other types of fever)

5.     constipation or diarrhea .

6.     The abdomen may become swollen and tender,

7.     Rashes in the abdomen

Diagnosis:

1.     Widal test

2.     Blood culture

3.     Presence of typhoid bacilli in the stools.

Treatment and nursing care:

1.     Bed rest

2.     Capsule Chloromphenical will be given as per prescription.

3.     Soft nutritious food (non-residual diet)

4.     Plenty of fluids.

5.     Careful observation of vital signs,

6.     Watch for complications such as internal hemorrhage or intestinal perforation.

7.     Before discharge, the stool test must be negative; otherwise the patient will be a carrier of the disease.

Preventive and control measures:

1.     Early identification and proper treatment

2.     Isolate the patient,

3.     Disinfect stools, urine and soiled articles.

4.     Immunise the contact persons with typhoid vaccine.

5.     Make sure about safe drinking water, safe food especially

6.     milk   and milk products and control of flies

2.Cholera:

This is an acute communicable disease, caused by Vibrio Cholera.

The incubation period is from a few hours to 2 days. The organisms are swallowed with contaminated food and water. In the small intestine they quickly multiply and produce a toxin which causes the intestinal wall to secrete a great deal of water and salts.

Signs and symptoms:

1.     Severe diarrhea and vomiting (the stools looks like rice water)

2.     Severe dehydration

3.     The pulse is very weak and rapid and blood pressure is low (hypotension).

4.     The infected person complains of severe thirst

5.     Painful cramps in legs and abdomen.

6.     Sunken eyes

7.     Urine output is low (oliguria) ,

8.     In severe conditions the infected patient may collapse

Diagnosis:

A patient with rice-water stools should be suspected of having cholera. A stool specimen should be collected and sent immediately to the laboratory for confirmation of diagnosis.

Treatment and nursing care:

1.     Isolate the infected person from others immediately

2.     Rehydrate the patient with adequate intravenous fluids

3.     Administer antibiotics as per doctors prescription

4.     Monitor vital signs (pulse respiration, temperature and blood pressure) every hour

5.     Watch for the urine output

6.     The patient should be encouraged to take rice congee, buttermilk and plenty of oral fluids to replace fluid loss.

7.     If a child is breast fed, feeds should be continued

Preventive and control measures:

1.     Surveillance- investigation of all cases of diarrhoea.

2.     Immediate notification of suspected cases.

3.     Isolation of the patient, with special care to disinfect stools, and vomit

4.     If a person dies, the body should be wrapped in a sheet soaked in 2% Lysol and disposed off by burning.

5.     Sanitation measures-Chlorination of all water sources,

6.     Advice to drink boiled water and Safe food practice (food hygiene) - protected from flies and proper hand washing.

7.     Immunise the community with cholera vaccine during an outbreak of cholera.

8.    Educate the community on ways of  preventing cholera.

3.Infectious hepatitis:

This is a viral that affects the liver. It often comes on epidemic. The virus enters the body through contaminated water and food. The incubation period is 15 to 20 days.

Signs and symptoms:

1.     Loss of appetite,

2.     Nausea and vomiting

3.     Fever and fatigue

4.     Mild abdominal pain

5.     Hepatomegaly (enlarged liver)

6.     Yellowish discoloration of conjunctiva

7.     Urine turns to dark yellow

  Treatment and nursing care:

1.     Complete bed rest

2.     Advise to drink a lot of liquids rich in glucose, vitamins and minerals (Orange, sugarcane, lemon juice, glucose water etc)

3.     Antibiotics and other drugs are not advised in treatment of infectious hepatitis as they may cause more damage to the liver.

4.     Easily digestible - fat and protein free diet should be given

Preventive and Control Measures:

1.     The sick person' s stools must be carefully disposed of to avoid spread of disease.

2.     The person attending the patient must wash hands well after each contact to prevent cross infection.

3.     Safe drinking water and better sanitation will help to get rid of infectious hepatitis from the community.

4.Acute gastroenteritis

It is an acute diarrheal disease caused by bacterial infection, or sometimes due to a viral infection.

The incubation period is 1-7 days. It may be as short as 6 hours.

Signs and symptoms:

1.     Sudden onset of diarrhoea (watery stools)

2.     Abdominal cramps.

3.     Nausea and vomiting

4.     Mild fever.

5.     Dehydration may be severe.

Treatment and nursing care:

If there is a delay in getting medical aid, the nurse should try to prepare oral rehydration fluid as follows.

a.     Boiled water, 1 liter (4 cups)

b.     Glucose powder 20gms or 8 level teaspoons.

c.      Common salt (Sodium chloride) 2 gm or ½ level teaspoon.

d.     Baking soda (Sodium bi-carbonate) 2 gm or ½ level teaspoon.

e.      Potassium chloride, 1½ gm or ½ level teaspoons.

The amount of fluid loss must be replaced, either by mouth or by intravenous fluids immediately. Adults and older children should have plenty of clear fluids such as coconut water, sweetened tea without milk etc. As the patient recovers, a bland diet with well-boiled rice, biscuits, etc may be given.

Babies may have rice water or oral rehydration fluid in small sips and every 5 to 10 minutes and should continue feeding.

Antibiotics such as ampicillin or tetracycline may be given as per doctor' s prescription.

Preventive and Control Measures:

1.     Isolation and strict rules to prevent cross- infection in hospitals.

2.     Maintain cleanliness of food, water and milk.

3.     Fly control, and protection of food.

4.     Breastfeeding for babies. If the baby is fed with formula feeds, fluids and all utensils used must be boiled.

5.     Sanitary disposal of faces.

5.Dysentery:

It is an infectious disease in which the patient passes stools with mucus and blood. The infectious microorganisms enter the body through the contaminated food and water and causes inflammation of the bowels. It may be bacillary dysentery or amoebic dysentery.

    A.Bacillary Dysentery

It is caused by bacteria which are swallowed in food, water or milk contaminated through flies or by direct contact with faeces of infected persons. It may occur in epidemics. It is dangerous in infants and in very old people.

The incubation period is 1-7 days.

Signs and symptoms:

1.     Fever, vomiting and abdominal pains.

2.     The patient always wants to have a motion

3.     Blood stained and mucous stool is passed.

4.     There may be dehydration.

5.     There is an urge to pass stools always

Diagnosis:

A stool specimen for microscopic study to identify the causative organisms.

Treatment and nursing care:

1.     Replace fluid loss by oral rehydration fluid.

2.     Infants should continue breast feeding.

3.     The doctor may order Antibiotics.

Preventive and control Measures:

1.     Isolation of patient, and disinfections of faces and soiled articles.

2.     Sanitary disposal of faeces.

3.     Safe drinking water.

4.     Fly control and protection of food.

5.     Food hygienic especially in preparing and handling food

B. Amoebic dysentery:

It is caused by a parasite called Entamoeba Hystalytica. It enters the body through contaminated food and water.

The incubation period is 3 to 4 weeks.

Signs and symptoms:

1.     Blood and mucus passed in large stools alternating with constipation.

2.     Dull pain on the right side of the abdomen.

3.     The persons will become anaemic

4.     Sometimes there is an acute attack of diarrhea.

5.     The infected person may develop liver abscess.

Diagnosis:

It is by the presence of E.H (warm) specimen of faces examined amoebae or cysts in a fresh with a microscope.

Treatment and nursing cure:

Tablet Metroniadazole as per prescription.

Preventive and control measures:

Same as given for bacillary dysentery,

Carriers should be identified and treated

C. Poliomyelitis:

This is also called infantile paralysis because it more often affects children and causes paralysis. It is caused by a virus, which enters the body through contaminated food and water and attacks the nerves.

The incubation period  4-7 days,

Most children are infected with poliovirus at sometime, but most of them have no symptoms. Some children have a few days of fever and painful muscles and then recover. Some get a meningeal type of which lasts a few days and they recover in most cases.

Signs and Symptoms:

1.     Polio is usually recognized only when the child stops walking and one of the legs are weak.

2.     Before this manifestation the child may have had a cold and fever, neck stiffness and mild diarrhoea for a few days.

3.     Paralysis may affect one or both legs, arms and in severe

a.     cases also    the diaphragm causing difficulty with breathing.

4.     The paralysis stops getting worse when the fever stops.

5.     Some patients' recover completely in about 6 weeks, but many are left with permanent paralysis and perhaps deformity.

Treatment and nursing care:

1.     There is no specific treatment for poliomyelitis.

2.     If the child has pain, give him aspirin, or paracetemol.

NO injections are allowed.

The infected person should be kept at bed rest with the affected limb supported, and splinted if necessary.

After 10 days the mother should be taught to do passive exercise for five minutes for 5 times a day.

If paralysis continues, arrange for physiotherapy.

Preventive and control measures:

Oral polio vaccine (O.P.V) for all infants and children according to the National Immunisation Schedule:

a.     Sanitary latrines and safe drinking water for all.

b.     Isolation of cases and disinfection.

c.      Search for polio cases especially among children.

d.     During an epidemic, avoid surgery of children' s nose and throat, and avoid D.P.T vaccine ( Diptheria polio and tetanus) immunization.