Bedside Clinic 2007

What is typhoid fever? Typhoid fever is a bacterial infection of the intestinal tract and occasionally the bloodstream. It is an uncommon disease with only 30-50 cases occurring in New York each year. Most of the cases are acquired during foreign travel to underdeveloped countries. The germ that causes typhoid is a unique human strain of Salmonella called Salmonella typhi. What are the signs and symptoms of typhoid fever? The incubation period is usually 1-2 weeks and the duration of the illness is about 4-6 weeks. The patient experiences: • poor appetite • headaches, • generalized aches and pains, • fever, and • lethargy • Body malaise Persons with typhoid fever usually have a sustained fever as high as 103 to 104 degrees Fahrenheit (39 to 40 degrees Centigrade). Chest congestion develops in many patients and abdominal pain and discomfort are common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications. About 10% of patients have recurrent symptoms (relapse) after feeling better for one to two weeks. Relapses are actually more common in individuals treated with antibiotics.

How is typhoid fever spread? Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers , recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in their feces (stool). You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding S. Typhi or if sewage contaminated with S. Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage. Once S. Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

Patients Profile Name: Shiela Acero Age: 29 years old Sex: Female Status: MArried Religion: Roman Catholic Home address: House Redeemer, Butuan City

History of Illness Two days prior to admission patient had been experiencing fever associated with body malaise and frontoparietal headache. She just took Paracetamol.

One day prior to admission patient had notice a rashes on her back and along to the extremities and so she decided to be admitted and have a proper management of her condition.

Reason for admission Patient was admitted at November 4,2007,Sunday a7 9:15am and was accompanied by family members, she was ambulatory. With chief complaints of fever, headache and body malaise. She was seen and examined by Dr. Daisy Galbo and advised to have a laboratory test and examinations to properly confirm the cause of her illness.

Patients Condition Upon Receiving 11/6/07 > receive patient lying on bed wake. 4:00pm > with IVF #5 d5IMB 1Liter at 30gtts/nin infusing well at right cephalic vein at the level of 900cc. > initial vital signs taken and recorded; a febrile T - 5.7’C P – 70bpm R – 21cpm BP – 100/80 > she was responsive upon interaction. > patient was in good grooming. IVF Classification D5 IMB ( dextrose in 5% multiple balance maintenance) • Hypertonic solution • Indicated to replace fluid and electrolytes and provide glucose.

Diagnostic test:  Blood Count Result

Normal level (female)

Readings

WBC

2,600

5,000 - 10,000/uL

Increased

Hemoglobin

12.8

11.00 – 16.0 g/dL

Normal

Hematocrit

38.8

38 – 47%

normal

 Tubex Test Tubex test for Salmonella typhi was (+)  Urinalysis Color

Yellow

Transparency

Slightly Hazy

Ph

6.0

Specific Gravity

1.010

Medications Generic Name Brand Name Classification Action

Acetaminophen Paracetamol Nonopioid Analgesic and Antipyretics Drug may relive fever through action of the central action in the hypothalamic heat regulatory center Indication Mild Pain and Fever Adverse Effects Hypoglycemia, rash Teaching Tell patient to take drugs as prescribed by doctor Generic Name Brand Name Classification Action Indication Adverse Effects Teaching

Cetirizine hydrochloride Zyrtec Antihistamines Long acting non-sedating antihistamines Chronic urticaria Fatigue, dizziness, headache  Tell patient to drink coffee or tea to reduce drowsiness if not contraindicated.  Ice chips may relieve dry mouth

Generic Name Brand Name Classification Action Indication Adverse Effects Teaching

Ceftriaxone sodium Rocephin Cephalosporins Inhibits cell wall synthesis, usually bactericidal Infections Fever, headache, rash Tell patient to report discomfort on IV insertion

Health Teachings  Advised patient to wash hands always before and after eating or going to the bath  Encourage to cut or shorten fingernails to prevent lodging of bacteria.  Encourage patient to frequently changed bed linens at least every two days and dispose it properly  Advised patient to eat fruits rich in vitamin C like oranges important for her health.  Advised patient to loosen blankets or wear only comfortable and thin dress if fever is noted to help cool of body temp.  Advised her to properly cooked the food and wash it properly before cooking it.  Advised her not to eat foods that are unattended or had been contaminated by flies.

Nursing Care Plan for Typhoid Fever

Problem: Knowledge Deficient regarding on the disease transmission. Diagnosis: Knowledge Deficient related to lack of information to the disease secondary to statement of misconception. Diagnosis Subjective: Patient verbalized of “ I don’t know where I get the disease, basta dili man pud ko hilig mag kaon sa gawas” Objective: She was avoiding to ask question upon Interaction or unknowledgeable when ask about her condition.

Goal 1. After initial interaction patient will be able to know the disease process of her condition.

Intervention

Implementation

Independent Actions:

1. She will be encourage to say something or talk about what she knew of her condition. • Important to assess her level of understanding. 2. She will be 2. She will be explained able to and discussed all the verbalize necessary information understanding on how she could have of her possibly get the condition, after disease. initial • Important to clarify her interaction. mind and be more informed about its mode of transmission. 3. Discuss and demonstrate to her the proper preventative

Evaluation Goal Met:

•

She will be guided by asking questions on the history of her condition PTA.

•

Pictures regarding Typhoid Fever will be used to make it more informative and easy to understand.

•

She will be encouraged to

Patient was able to verbalized understanding of her condition and the disease process itself and its proper preventative measures.

measures of the disease like correct hand washing and proper handling of foods. • Necessary so that she will be able to have a base knowledge of the proper prevention and self management. 4. Significant others will be informed about the disease and its proper prevention. • Important to prevent possible re-occurrence of the disease and provide a safe and proper care to their affected family members. Dependent Actions: She will be advised to take medications as prescribed by the physician.

have a return demonstration and a discussion to properly assess her learning on proper hand washing and handling of food.

•

Significant others will also be allowed to have a demonstration regarding on the correct hand washing and preparation of food.