References

http://en.wikipedia.org/wiki/Bubonic_plague
http://simple.wikipedia.org/wiki/Bubonic_plague
http://www.nlm.nih.gov/medlineplus/ency/article/000596.htm
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001622/
http://voices.yahoo.com/bubonic-plague-causes-symptoms-treatment-prevention-3986122.html
http://plague.emedtv.com/bubonic-plague/bubonic-plague-causes.html
http://rarediseases.about.com/cs/bubonicplague/a/111602.htm
http://plague.emedtv.com/bubonic-plague/bubonic-plague-transmission.html
http://www.cdc.gov/plague/diagnosis/index.html
http://health.nytimes.com/health/guides/disease/plague/overview.html
http://books.google.com.ph/books?id=YPJ5HPC4FPYC&pg=PT426&lpg=PT426&dq=nursing+intervention+of+bubonic+plague&source=bl&ots=u253S1HmYS&sig=zymlBPpDL4dxETNDTz3GVgEkNW4&hl=en&sa=X&ei=dFEnUf6CHdGeiQfLj4DgBQ&ved=0CCsQ6AEwADgU

Bubonic Plague Nursing Intervention

• Administer medications, I.V. fluids, and oxygen as ordered and needed.

•  Use standard precautions.

•  Provide adequate nutrition.

• Maintain a patent airway and adequate oxygenation.

•  Apply warm, moist compresses to buboes.

• Provide meticulous skin care.

• Prevent further injury to necrotic tissue areas.

• Institute seizure precautions.

•  Report suspected plague cases to local public health department.

Prevention of Bubonic Plague

Rat control and watching for the disease in the wild rodent population are the main measures used to control the risk of epidemics. A vaccination is available for high-risk workers, but its effectiveness is not clearly established.

There is no vaccine for the plague but there are measures that can help your body resist the plague if you've been exposed. These measures are only needed if you've been exposed to someone with the plague, have been bitten by a flea in an area known to have had recent plague outbreaks or plan to travel to an area known to have had recent plague outbreaks.

If you live in an area where plague outbreaks occur you may help prevent the plague by not coming into contact with sick or dead animals, rodent proofing your home, attempt to keep your pets flea free and take precautions such as insect repellent and watching children and pets closely while outdoors.

Treatment for Bubonic Plague

People potentially infected with the plague need immediate treatment and should be given antibiotics within 24 hours of the first symptoms to prevent death. Other treatments include oxygen, intravenous fluids, and respiratory support. People who have had contact with anyone infected by pneumonic plague are given prophylactic antibiotics. Using the broad-based antibiotic streptomycin has proven to be dramatically successful against the bubonic plague within 12 hours of infection.

Plague is a very serious illness, but is treatable with commonly available antibiotics. The earlier a patient seeks medical care and receives treatment that is appropriate for plague, the better their chances are of a full recovery.

People in close contact with very sick pneumonic plague patients may be evaluated and possibly placed under observation. Preventive antibiotic therapy may also be given, depending on the type and timing of personal contact.

If a doctor even thinks that you could have the bubonic plague you are immediately admitted to the hospital and put in an isolation room. You are then given very powerful antibiotics. These are administered either intravenously (through the veins) or intramuscularly (through the muscles). The antibiotics are given for a full 7 to 10 days. The most effective antibiotics used are called streptomycin and gentamicin. People who have been exposed to a person with the bubonic plague, even if they have no symptoms, still need to be treated with antibiotics. These antibiotics are oral, taken for 7 days and will help prevent the person from coming down with the plague.

People with the plague need immediate treatment. If treatment is not received within 24 hours of when the first symptoms occur, death may occur.

Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague. Oxygen, intravenous fluids, andrespiratory support usually are also needed.

Patients with pneumonic plague should be strictly isolated from caregivers and other patients. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

Diagnosis of Bubonic Plague

Plague is a plausible diagnosis for people who are sick and live in, or have recently traveled to, the western United States or any other plague-endemic area. The most common sign of bubonic plague is the rapid development of a swollen and painful lymph gland called a bubo. A known flea bite or the presence of a bubo may help a doctor to consider plague as a cause of the illness.

In many cases, particularly in septicemic and pneumonic plague, there are no obvious signs that indicate plague. Diagnosis is made by taking samples from the patient, especially blood or part of a swollen lymph gland, and submitting them for laboratory testing. Once plague has been identified as a possible cause of the illness, appropriate treatment should begin immediately.

Pathophysiology of Bubonic Plague

Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, Xenopsylla cheopis (the rat flea). In very rare circumstances, as in the septicemic plague, the disease can be transmitted by direct contact with infected tissue or exposure to the cough of another human. The fleas are often found on rodents such as rats and mice, and seek out other prey when their rodent hosts die. The bacteria began its life harmlessly living in the digestive tracts of mammals. The ability to propagate was dependent only upon its ability to travel from mammal host to mammal host. The bacteria remained harmless to the flea, allowing the new host to spread the bacteria. The bacteria form aggregates in the gut of infected fleas and this results in the flea regurgitating ingested blood, which is now infected, into the bite site of a rodent or human host. Once established, bacteria rapidly spread to the lymph nodes and multiply.

Y. pestis bacilli can resist phagocytosis and even reproduce inside phagocytes and kill them. As the disease progresses, the lymph nodes can haemorrhage and become swollen and necrotic. Bubonic plague can progress to lethal septicemic plague in some cases. The plague is also known to spread to the lungs and become the disease known as the pneumonic plague, This form of the disease is highly communicable as the bacteria can be transmitted in droplets emitted when coughing or sneezing.

Mode of Transmission of Bubonic Plague

Yersinia pestis (the bacteria that causes plague) is often found in animals such as rats and prairie dogs. Bubonic plague transmission usually occurs through bites from infected rodent fleas, direct contact with infected tissue or bodily fluids, or inhaling infected droplets. The disease is spread most commonly through the bites of infected fleas. Bubonic plague transmission from person to person is extremely rare.

An Overview of Bubonic Plague Transmission

Yersinia pestis is found in animals throughout certain parts of the world, most commonly in rats, but occasionally in other wild animals, such as prairie dogs.Plague transmission from these infected animals generally occurs in one of three ways:

·         Bites from infected rodent fleas

·         Direct contact with infected tissue or bodily fluids

·         Inhaling infected droplets.

Bubonic Plague Transmission Through Bites

Bubonic plague transmission to humans or animals is usually through the bites of infected rodent fleas (see Plague and Animalsfor other animals that can transmit plague). During rodent plague outbreaks, many animals die, and their hungry fleas seek out other sources of blood to survive. People and animals that visit places where rodents have recently died from plague risk being bitten by infected fleas.

This method of plague transmission accounts for about 85 percent of the human cases of plague.

House cats also are susceptible to plague. Infected cats become sick and may directly transmit plague to people who handle or care for them. Also, dogs and cats may bring plague-infected fleas into the home.

Bubonic Plague Transmission Through Inhaling Droplets

Inhaling droplets expelled by the coughing of a plague-infected person or animal (especially house cats) can result in plague of the lungs (a condition called pneumonic plague). Pneumonic plague transmission from person to person is uncommon, but sometimes results in dangerous epidemics that can spread quickly. However, this type of plague has not been seen in the United States since 1924.