Poliomyelitis

Definition
  • is an acute infectious disease caused by any of the three types of Poliomyelitis virus which affects chiefly the anterior horn cells of the Spinal cord and the medulla, cerebellum and midbrain.
  • Characterized by two febrile episodes, a minor and major illness separated by a remission of one or two days followed by varying degrees of muscle weakness or occasionally a progressive Paralysis that ends fatally.
  • Other names:  Acute Anterior Poliomyelitis; Heine-Medin Disease: Infantile Paralysis.

polio

Etiology and Epidemiology
  • the causative virus is poliovirus (Legio Debilitants)
  • there are 3 distinct serelogic types of poliovirus (with no cross Immunity)
    1. Type I – is the most paralytogenic or the most frequent cause of Paralytic poliomyelitis, both epidemic and endemic.
    2. Type II – the next most frequent.
    3. Type III – the least frequently associated with paralytic disease.
Types of Poliomyelitis

1) Spinal

  • Cervical
  • Thoracic
  • Lumbar

2) Bulbar

  • Cranial nerves
  • Circular System
  • Respiratory System

3) Bulbo-spinal

4) Polioencephalitis

PERIOD OF COMMUNICABILITY:
  • Most contagious a few days before and after the onset of symptom when the virus is found in the oropharynx for about a week, and in large quantities in the small bowel, and continues to be in feces up to about 3 months.
Mode of Transmission:
  • Fecal-oral route
  • Oral route through pharyngeal secretion
  • Contact with infected persons
INCUBATION PERIOD:
  • – Usually 7-14 days, with a range of 5-35 days, for paralytic and non-paralytic forms; 3-5 days for the minor illness.
Signs and symptoms
  • General discomfort or uneasiness (malaise)
  • Headache
  • Red throat
  • Slight fever
  • Sore throat
  • Vomiting
NONPARALYTIC POLIOMYELITIS
  • Back pain or backache
  • Diarrhea
  • Excessive tiredness, fatigue
  • Headache
  • Irritability
  • Leg pain (calf muscles)
  • Moderate fever
  • Muscle stiffness
  • Muscle tenderness and spasm in any area of the body
  • Neck pain and stiffness
  • Pain in front part of neck
  • Pain or stiffness of the back, arms, legs, abdomen
  • Skin rash or lesion with pain
  • Vomiting
PARALYTIC POLIOMYELITIS
  • Fever 5 – 7 days before other symptoms
  • Abnormal sensations (but not loss of sensation) in an area
  • Bloated feeling in abdomen
  • Breathing difficulty
  • Constipation
  • Difficulty beginning to urinate
  • Drooling
  • Headache
  • Irritability or poor temper control
  • Muscle contractions or muscle spasms in the calf, neck, or back
  • Muscle pain
  • Muscle weakness that is only on one side or worse on one side
    • Comes on quickly
    • Location depends on where the spinal cord is affected
    • Worsens into paralysis
  • Sensitivity to touch; mild touch may be painful
  • Stiff neck and back
  • Swallowing difficulty

poliomyelitis

Medical Management
  1. medication and treatment
    • Analgesic- for relieving pain
    • Antipyretic- to relieve fever
  2. Polio Vaccine
    • Salk Vaccine
    • Sabin Vaccine-
Surgical Management
  1. Muscle and tendon transplantation
    • Operation of Tendons
      1. tenotomy
      2. myotomy
      3. fasciotomy.
  2. Arthrodesis- fusion of bones across a joint space by surgical means, which eliminates movement, usually performed to eliminate pain over a joint.
  3. Osteotomy- cutting of bone into 2 parts followed by realignment of ends to allow healing
  4. 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.
Nursing management
  1. Maintain a patent airway, and keep a tracheotomy tray at the patient’s bed side.
  2. Encourage a return to mild activity as soon as possible.
  3. Prevent fecal impaction by giving enough fluids to ensure an adequate daily urine output of low specific gravity.
  4. Provide tube feedings when needed.
  5. Provide good skin care, reposition the patient often, and keep bed linens dry.
  6. To alleviate discomforts, use foam rubber pads and sandbags or light splints as ordered.
  7. Wash hands thoroughly after contact with the patient or any of his secretions and excretions.
  8. Frequently check blood pressure, especially if the patient has bulbar poliomyelitis.
  9. Assess bladder retention that cause muscle paralysis.
  10. Have the patient wear high-top sneakers or use a footboard to prevent foot drop.
  11. Provide emotional support to the patient and his family.
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