Typhoid Fever

OBJECTIVES •GENERAL OBJECTIVE This case study aims to identify and determine the general health problems and needs of the patient with an admitting diagnosis of typhoid Fever. This also intends to help patient promote health and medical understanding of such condition through the application of the nursing skills. •SPECIFIC OBJECTIVES -To raise the level of awareness of patient on health problems that he may encounter. -To facilitate patient in taking necessary actions to solve and prevent the identified problems on his own. -To help patient in motivating him to continue the health care provided by the health workers. -To render nursing care and information to patient through the application of the nursing skills.

OVERVIEW •

Fever from bacterial food poisoning.

•

An acute systemic febrile infection caused by SALMONELLA TYPHI, a serotype of SALMONELLA ENTERICA.

•

Serious infection marked by intestinal inflammation and ulceration; caused by Salmonella typhosa ingested with food or water.

INTRODUCTION A gastrointestinal condition mainly in the developing world. It is caused by a bacterial infection, usually as a form of food poisoning. Typhoid fever is unrelated to the similarly named typhus (a tick-borne infection). DEFINITION Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized countries. However, it remains a serious health threat in the developing world. Typhoid fever spreads through contaminated food and water or through close contact with someone who's infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea. When treated with antibiotics, most people with typhoid fever feel better within a few days, although a small percentage may die of complications. Vaccines against typhoid fever are available, but they're only partially effective. Vaccines are usually reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.

SIGNS AND SYMPTOMS FIRST STAGE Once signs and symptoms do appear, you're likely to experience: •

Fever, often as high as 103 or 104 F (39 or 40 C)

•

Headache

•

Weakness and fatigue

•

A sore throat

•

Abdominal pain

•

Diarrhea or constipation

•

Rash

Children are more likely to have diarrhea, whereas adults may become severely constipated. During the second week, you may develop a rash of small, flat, rose-colored spots on your lower chest or upper abdomen. The rash is temporary, usually disappearing in two to five days. SECOND STAGE If you don't receive treatment for typhoid fever, you may enter a second stage during which you become very ill and experience: •

Continuing high fever

•

Either diarrhea that has the color and consistency of pea soup or severe constipation

•

Considerable weight loss

•

Extremely distended abdomen

The typhoid state By the third week, you may: •

Become delirious

•

Lie motionless and exhausted with your eyes half-closed in what's known as the typhoid state

IMPROVEMENT Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week to 10 days. But signs and symptoms can return up to two weeks after your fever has subsided.

TREATMENTS AND DRUGS Antibiotic therapy is the only effective treatment for typhoid fever. Commonly prescribed antibiotics In the United States, most doctors prescribe ciprofloxacin for nonpregnant adults. Women who are pregnant and children most often receive ceftriaxone (Rocephin) injections, because ciprofloxacin has been associated with problems in these groups. All of these drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria.

Problems with antibiotic resistance In the past, the drug of choice was chloramphenicol. Doctors no longer commonly use it, however, because of severe side effects, a high relapse rate and widespread bacterial resistance. In fact, the existence of antibioticresistant bacteria is a growing problem in the treatment of typhoid, especially in the developing world. In recent years, S. typhi also has proved resistant to trimethoprim-sulfamethoxazole and ampicillin. Supportive therapy Other treatment steps aimed at managing symptoms include: •

Drinking fluids. This helps prevent the dehydration that results from a prolonged fever and diarrhea. If you're severely dehydrated, you may need to receive fluids through a vein in your arm (intravenously).

•

Eating a healthy diet. Non bulky, high-calorie meals can help replace the nutrients you lose when you're sick.

NURSING INTERVENTION INDEPENDENT: -Monitor patient temperature degree and pattern. -Observe for shaking chills and profuse diaphoresis -Wash hands with anti-bacterial soap and after each care of activity and encourage proper hygiene. -Provide tepid sponge baths and avoid the use of ice water and alcohol. -Monitor for signs of deterioration of condition or failure to improve with therapy. COLLABORATIVE: -administer antipyretics as prescribed. -administer antibiotics as prescribed.

CLIENT PROFILE Name: N.P. Address: P-1 Rosario, Santiago city Age: 9 y/o Religion: Roman Catholic Room: PW2 Chief complaint: fever Diagnosis: t/c typhoid fever Admission: December 1, 2009 Time: 11:15 am

11 FUNCTIONAL GORDONS

1. Health Management Pattern •Before: Health for him is wealth and it is very important for him because he’s too young. He also believes that being able to perform her daily activities signifies good health. •During: He still believes that Health is wealth and we should treasure it for a lifetime because being unhealthy will affect our whole way of living according to his mother. 2. Nutritional metabolic pattern •Before: he eats regularly three times a day and drinks at least 8 to 10 glasses of water daily. •During: he cannot eat well due to loss of appetite and worrying too much on his situation but she always drinks 6-7 glass of water. 3. Elimination pattern •Before: he urinates 3-4 times a day and stool one times a day.

•During: accdg. To his mother, he urinates 4-5 times a day and stool twice a day. 4. Activity exercise pattern •Before: he considered exercise his daily activities in the school like playing with his classmates and walking to go home. •During: he is always in his bed and he has no exercise. 5. Cognitive perceptual pattern •Before and during: he is a grade 3 student in Rosario elementary school. According to his mother, he can perform well his activities in school. But in times of decision making, his mother is the one deciding for him.

6. Sleep rest pattern •Before: he sleeps 8pm-6am; 10hours of sleep normal accdg. to his mother. •During: he can easily sleep because she feels bored at the same time because of his condition. 7. Self-perceptual pattern •Before: he felt happy and fulfilled by doing her responsibilities as a son to his parents and a brother to his siblings. He always plays with his neighbors and siblings. • During: he felt sad because he can’t do what he wants like playing and he won’t able to go school because of his condition. 8. Role relationship pattern •Before: he had a good relationship to his parents,siblings,classmates,playmates and to his teacher. •During: he cannot perform his role as a child. 9. Sexually and reproductive pattern •Before: he has no yet activities about sexually things.

•During: the same.

10. Coping stress management •Before: When he got problem he always go to his parents, accdg. to his mother. •During: having his mother and family at his side still the best coping management. 11. Value belief pattern •Before: The client is Roman Catholic. •During: Not attending masses, but he always pray with his mother.

VITAL SIGNS December 1, 2009 BT (degree

PR (bpm)

RR (bpm/cpm)

97

23

PR (bpm)

RR (bpm/cpm)

95

25

celcius) 8:00 am

38.1

After 30 mins.

37.8

After 30 mins.

38.2

BT (degree celcius) 12:00 nn

37

PATHOPHYSIOLOGY

NURSING CARE PLAN

Assessmen

Diagnosis

Planning

Intervention

Subjective

Hyperthermi

After 30

Independent

:

a r/t

mins. To 1

:

increase

hour of

metabolic

nursing

Rationale

evaluation

t

“mainit ang pakiramda m ko”as verbalized by the

-v/s taken

After 30 -for baseline data

rate, illness. interventions

mins to 1 hr of nursing intervention

, the pt.

-fever

, the

temperature

pattern

temperatur

may aids

e of the

will subside

-monitored

patient.

from 38.1

pt.

in

to 37.

temperature

diagnosing reduced

.

underlying from 38.1

Objective:

disease.

-flushed

-may help

skin,

reduce

warmed to

fever

touch.

to 37.

v/s: T:37 PR:95

-TSB done. -v/s taken

-to

as follow:

reduce fever

BT: 38.1 PR:97 RR:23

pt. was

Collaborative : paracetamol given as ordered by the doctor.

administered antibiotics as prescribed by the doctor.

-to control the spread of infections .

RR:25

Case study (Typhoid fever)

Jennifer de guzman

Ms. Maria Christine Bautista,RN,MAN (clinical instructor)