poliomyelitis
TRANSCRIPT
POLIOMYELITIS
> Also called:
- Infantile Paralysis-Heine-Medin Disease
>Affects children below ten (10) years of age
Less risk for people above ten (10) years Old
Causative Agent
VirusLegio debilitans
Type 1 – BrunhildeType 2 – Lansing
Type 3 – LeonIf Brunhilde
Gives permanent immunityIf Lansing or Leon
Gives temporary immunity
Important Concepts!When Brunhilde infects you, Leon or Lansing will no longer affect
you!
In the Philippines, the most prominent type is Brunhilde!
Mode of Transmission
>Droplet
In early stage of infection, virus if found at nasopharyngeal secretions
>Fecal-Oral RouteIn late stage of transmission, virus is found
at the mouth
Portal of EntryGastrointestinal Tract
Pathophysiology
>Legio debilitans goes to the nasopharynx or the mouth>If in the nasopharynx, it goes to the tonsils and causes:
-Sore throat-Fever and chills
-Headache with body malaise>If at the mouth, it goes to the Peyer’s patches and
causes:-Abdominal pain
-Anorexia-Nausea and Vomiting
-Diarrhea or Constipation
STAGES of POLIOMYELITIS
1ST Stage: Invasive Stage or Abortive StageAll the abovementioned signs and symptoms will appear
Patient recoversDisease process is aborted
But there will be instances when disease process will not be aborted
Tonsils Peyer’s Patches ▼ ▼
Cervical Mesenteric Lymph Lymph Nodes Nodes
▼▼▼ ▼▼▼ B L O O D S T R E A M
▼▼▼ Central Nervous System
2nd Stage: Pre-paralytic Stage of PoliomyelitisCentral Nervous System is already involved but there will be no
paralysis
Signs and Symptoms:Once in the CNS, microorganism will cause:
Sever muscle painDo not keep on turning or holding patient
Do not do massageNo positioning will relieve patient
Instead, what would relieve the patient would be:Application of warm packs
AnalgesicsNever administer Morphine
Once in the CNS, the microorganism will also cause:Stiffness of the hamstring
Patient will be positive for HOYNE’S Sign and exhibit a HEAD DROP
To check for Hoyne’s SignLift shoulders of patient when lying supine or extend
head of patient beyond the edge of the bedIf head of patient drops, he is said to be positive (+) for
Hoyne’s Sign
Once in the microorganism is in the CNS, the patient would elicit a POKER SPINEOphistotonus with head retractionSitting position cannot be assumed
Therefore, patient will assume a TRIPOD POSITION
Central Nervous System ▼▼▼
ParalysisConcept!
From the CNS, the patient will experience paralysis.This leads to the third (3rd) stage of the disease
3rd Stage: Paralytic StagePresence of paralysis
Characteristics of Paralysis:Flaccid
SoftFlabbyLimp
Important Concept!Flaccid Paralysis is PATHOGNOMONIC SIGN of Poliomyelitis
Three (3) Types of Paralysis
1. Bulbar TypeCranial nerves are affected
9Th cranial nerve (Glossopharyngeal Nerve) and 10th cranial nerve (Vagus Nerve) affectations give rise to:
Respiratory problemsVocal cord swelling / paralysis
Excessive salivationAspiration
Regurgitation
2. Spinal TypeMost common type of paralysis Affects ANTERIOR HORN CELLS
Affects MOTOR FUNCTIONParalysis of extremities
Paralysis of intercostal muscles leads to DIFFICULTY OF BREATHING
Exams and TestsThe health care provider may find signs of meningeal irritation (similar to meningitis), such as stiff neck or back stiffness with
difficulty bending the neck. The person also might have difficulty lifting the head or lifting the legs when lying flat on the back, and
their reflexes might be abnormal.Tests include:
Routine CSF examinationTest for levels of antibodies to the polio virus
Viral cultures of throat washings, stools, or cerebrospinal fluid (CSF)
Medical Mgmt:Treatment
The goal of treatment is to control symptoms while the infection runs its course.
People with severe cases may need lifesaving measures, especially breathing help.
Symptoms are treated based on how severe they are. Treatments include:- Antibiotics for urinary tract infections
- Medications (such as bethanechol) for urinary retention- Moist heat (heating pads, warm towels) to reduce muscle pain and spasms- Pain killers to reduce headache, muscle pain, and spasms (narcotics are not
usually given because they increase the risk of breathing difficulty)- Physical therapy, braces or corrective shoes, or orthopedic surgery to help
recover muscle strength and function
3. Bulbo-Spinal TypeCombination of Bulbar and Spinal types
Patient has cranial nerve affectations and anterior horn cell affectations
Important Concepts!!!
Not all patients will develop paralysisIf patient is non-paralytic,He has GOOD PROGNOSIS
Diagnostic Tests
1. Lumbar PunctureLaboratory results would reveal:Increased White Blood Cell levels
Increased Protein levelsNormal Sugar levels
2. Muscle TestingTo determine what specific muscle is affected
3. ElectromyelogramTo determine extent of muscle involvement
4. Stool ExaminationPerfomed at the late stage
About ten (10) days after being affected5. Nasopharyngeal Examination
Performed at the early stage
Medical ManagementSymptomatic
Causative agent is viralIf there is respiratory paralysis
Place patient in a MECHANICAL VENTILATORUse the IRON LUNG MACHING
This works on the principle of Negative Pressure BreathingNo tracheostomy tube needed (tracheostomy tube or endotracheal tube
work on the principle of Positive Pressure Breathing)Capsular in shape
With glass windowsWith metal plate
Works on electricityDuring brownout or power shortages, operate the machine manually
It has a steering wheel, which can be manipulated manuallyPatient stays in the Iron Lung Machine for months
Surgical managementa. Muscle and tendon transplantation
Operation of Tendonstenotomy- division of tendonmyotomy- division of muscle
fasciotomy- operation on deep fascia the most useful procedure in the surgical treatment of
poliomyelitis are operations that restore stability to failed joints.
b. Arthrodesis- fusion of bones across a joint space by surgical
means, which eliminates movement, usually performed to
eliminate pain over a joint.c. Osteotomy- cutting of bone into 2 parts followed by realignment of
ends to allow healing
d. Operation to equalized the leg length discrepancy After poliomyelitis, growth affected leg is slowed down as
much 6 to 7 cm by disuse, atrophy and diminished blood flow to the
limb. The degree of shortening depends of the severity of the paralysis and the age at which
paralysis begins.
Orthotic devices:1. Hook’s corset
Prevent deformity2. Long leg brace
To provide needed support3. Oppenens Splints
Prevent weakening of muscles4. Mobile arm support
To increase hand function
Nursing Care for PoliomyelitisSymptomatic and SupportivePsychological Aspect of Care
Use empathy
Preventive Measures1. Immunization
Vaccine given:Oral Polio Vaccine (OPV) or Sabin
Dose:Two (2) to three (3) drops
Route:Oral
Number of Doses:Three (3)Interval:
Four (4) weeksWhen given:
1st Dose – at six (6) weeks old2nd Dose – at ten (10) weeks old
3rd Dose – at fourteen (14) weeks oldImportant Concepts!!!
Do not feed child for thirty (30) minutes after administration of OPV
Rationale:For better absorption
If child vomits, REPEAT!!!If child has diarrhea
Give OPVBut do not record it
Not all of the vaccine may be absorbed properlyWhen OPV 3 is given four weeks after, record it as OPV 2
Integrated Management of Childhood Illnesses (IMCI)
Tell mother also that she should be very careful in handling stool of child because this vaccine
eliminates virus to the stoolIf significant others at home are
immunocompromisedDo not administer OPV
Due to feces of childRather give, IPV or Inactivated Polio Vaccine /
SALK
Dose:0.5 ccRoute:IntramuscularNumber of Doses:Three (3)Interval:Four (4) weeksWhen given:1st Dose – at six (6) weeks old2nd Dose – at ten (10) weeks old3rd Dose – at fourteen (14) weeks old
Rationale:Because stool of child may contain the virus if OPV is given
. Avoid mode of transmissionProper disposal of nasopharyngeal
secretionsCover mouth when coughing
Do not put anything through the mouth