Вы находитесь на странице: 1из 29

A Case Study On

Typhoid Fever

_____________________________________________

In partial Fulfillment of the Course


Requirement in Nursing Care Management

______________________________________________

______________________________________________

Submitted by:
Mario Bruce Samson
Al Gino B. Borinaga
Submitted to:
Mae karyl Pogio RN. M.A.N

Introduction
Typhoid fever, also known as Tipos (in laymens term), is one of the most common
worldwide illness most specifically in third world country such as ours, this is a question of sanitation
since this disease is transmitted through ingestion of food or water which is improperly prepared and
contaminated with the feces of an infected person, that contains the bacterium Salmonella enterica,
serovar Typhi. The said bacteria perforates through the intestinal wall and grows best at 37 C/99 F
human body temperature.
Typhoid fever is characterized by:
a slowly progressive fever as high as 40 C (104 F)
profuse sweating, gastroenteritis
nonbloody diarrhea.
less commonly, a rash of flat, rose-colored spots may appear.
Common causes of transmission are flying insects most specifically flies feeding on feces
that may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions.
A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms, but capable of
infecting others. Diagnosis is made by any blood, bone marrow or stool cultures and the Widal test.
Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Typhoid does not
affect animals and therefore transmission is only from human to human. The rediscovery of oral
rehydration therapy in the 1960s provided a simple way to prevent many of the deaths of diarrheal
diseases in general. Where resistance is uncommon, the treatment of choice is a fluoroquinolone such as
ciprofloxacin otherwise; a third-generation cephalosporin such as ceftriaxone or cefotaxime is the first
choice.
The student nurse personally chose this case study because as one of the persons living in
a developing country, where handwashing and proper sanitation are not well practiced by some people,
are at risk of acquiring typhoid fever. Moreover, the student felt that this study is important to her because
this usually inflicts children particularly toddlers in which his son is.
This study will help the nursing profession by providing information about the proper
management and care for patients with Typhoid fever. It will also educate the people, especially those
with Typhoid Fever and vulnerable individuals to seek medical care in order to prevent the illness. It will
increase awareness about the importance of having a healthy lifestyle and clean environment. This study
will elaborate the inter relatedness of environment, life style habits and acquiring Typhoid Fever.

Through this, the student nurse would be able to formulate a plan of care for the patient
and formulate a health teaching plan to lay a foundation and minimize difficulties in the future. This study
is not limited to the patients with Typhoid Fever only, but it is for all people who are interested in Typhoid
Fever.
The student nurse expects a lot from this case study, even if she couldnt really tackle the
deepest part of the illness, she expect to gain more knowledge about the disease. The student nurse also
expects to raise concern and awareness to everyone that typhoid fever is a communicable disease in
which everyone is at risk of acquiring. However, it is greatly preventable with enough knowledge and
understanding about the disease and with proper practicing handwashing and sanitation in our respective
homes. The treatments and the different psychotherapy are important factors that she also wants to know
as part of her job as a student nurse. From this study, she expect to have a better understanding about
typhoid fever, learn skills especially with the care of these patients as well as nursing responsibilities that
are involved in this care.

Objectives
GENERAL OBJECTIVES:
After 3 weeks of giving holistic nursing care to the patient, the student nurse will be able
to acquire knowledge, attitude and skills about the care for pediatric patients with typhoid fever.
SPECIFIC OBJECTIVES:
After 8 hours of giving holistic nursing care to the patient, the student-nurse will be able
to:
1. make thorough nursing assessment of the patient to be able to come up with an apposite plan
of care.
2. explain the pathophysiology of Typhoid fever
3. identify the causes of Typhoid fever.
4. recognize the possible symptoms of Typhoid fever as manifested by the patient.
5. develop an individualized plan considering client characteristics or the situation and setting a
specific, measurable, attainable, realistic and time bounded plan that reflect the onset, date of
problem identified.
6. list ways on preventing Typhoid fever.
7. site the importance of preventions, medication compliance and positive attitude to early
healing.
8. render appropriate nursing care to the patient to promote wellness and optimum level of
functioning.
9. medicate properly and accurately the prescribed medications and to be able to identify its
action and drug information.
10. endorse proper health behaviors in relevance to her care and age through play therapy

GENERAL OBJECTIVES:

After 3 weeks of giving holistic nursing care or student nurse-patient-significant others


interaction, the patient as well as the significant others will be able to acquire knowledge, attitude, and
skills in the proper management with typhoid fever.

SPECIFIC OBJECTIVES:
After 8 hours of giving holistic nursing care, the patient and the significant others will be
able to:
1. understand awareness of the disease.
2. identify the risk factors of typhoid fever
3. explain the causes of typhoid fever
4. recognize own symptoms of typhoid fever.
5. learn and understand why laboratory examinations are being done.
6. know and understand the treatments of typhoid fever.
7. demonstrate proper management with the signs and symptoms manifested.
8. enumerate drugs or medications necessary with the care through understanding of drug
information and precautions regarding its use.
9. show proper diet and exercise and stress its importance in promoting health and preventing
further complications.
10. display proper hygiene techniques and stress its importance in promoting health and preventing
further complications.

Nursing Assessment
Personal History
Patients Profile

Name: P.E.
Age: 66 years old
Civil Status: widowed
Religion: Roman Catholic
Date of Admission: January 22, 2015
Room Number: room X-42 communicable ward
Complaints: Fever, cough
Impression/Diagnosis: Typhoid fever
Physician: Dr. Neda Labtic
Family/Individual Information, Social and Health History
Mrs. P.E. is a Filipina, his mother died right after delivery due to some complications. He
lives at Sitio sausan san remegio together with his son and daughter, who looks after her. She sometimes
forgets to wash her hands prior to eating.
7 days prior to admission, Mr. Miao had an intermittent fever (38-39C), with no
abdominal pain and no nausea and vomiting, condition was tolerated. The next day, patient still has fever
accompanied by productive cough, yellow phlegm, difficult to expectorate and with abdominal pain.
Patient was then brought by her S.O. to a private medical doctor and was prescribed by some
medications. Fever was then decreased but still with persistent cough. Patient was told to come back after
5 days. After 5 days, patient still has fever and the private doctor requested a Salmonella test, after the test
went positive, the doctor made a request for admission at Ormoc Sugarcane Planters Association-Farmers
Medical Center.
A case of Mrs. P.E., 66 years old female was admitted at Vicente Sotto Memorial Medical
Center on January 22, 2015 for fever of about 7 days already. On admission, his Salmonella test revealed
positive for salmonella typhi anti-09 antibodies.

Diagnostic results
Diagnostic Test

Normal Value

Patients Result

Significance

HEMATOLOGIC
EXAM:
Date: July 17, 2010
Hemoglobin

11.5 - 16.5 g/dl

10.70 g/dl

Decreased, Infection

MCH

27 - 32 pg

27.90 pq

Normal

MCHC

32 - 36 g/dl

34.80 g/dl

Normal

Hematocrit

41.5 - 50.4 %

30.7%

Decreased, Infection

WBC

5 - 10 x 10^9/uL

10.60x10^9/uL

Increased, Infection

Granulocytes

35 - 80 %

90.6 %

Increased, Infection

Lymphocytes

20 - 40 %

34.3 %

Normal

Mid

2 - 15 %

5.1 %

Normal

Eosinophils

2%

Basophils

1%

Monocytes

3%

Granulocytes

1.2 - 8 x 10^9/uL

6.40 x 10^9/uL

Normal

Lymphocytes

0.5 5 x 10^9/uL

3.60 x 10^9/uL

Normal

Mid

.10 - 1.5 x 10^9/uL

.60 x 10^9/uL

Normal

RBC

4.8-5 x 10^12/L

3.83 x 10^12/L

Decreased, Infection

MCV

80 100 fl

80.10 fl

Normal

RDWR

11-16 %

12.60 %

Normal

RDWA

30 160 fl

51.90 fl

Normal

Platelet count

150 - 450 x 10^12/L

337.10 x 10^12/L

Normal

MPV

8 11 fl

6.40 fl

Normal

PDW

.10 9.99 fl

8.40 fl

Normal

PCT

.09 9.99 fl

.21 fl

Normal

LPCR

.10 9.99 %

9.10 %

Normal

SALMONELLA TEST:

Igm Positive

positive typhoid fever

Date: July 17, 2010

-acute Typhoid

MICROBIOLOGY
SECTION:

Fever
URINALYSIS:
Date: July 17, 2010
I. Macroscopic
Color

Light straw or yellow

Yellow

Normal

Albumin

Negative

Negative

Normal

Sugar

Negative

Negative

Normal

Transparency

Clear

Slightly Turbid

Normal

pH

4.0-8.0

6.0

Normal

Specific Gravity

1.007-1.030

1.080

Increased, Infection

II. Microscopic
Pus Cells

1-2

RBC

0-1

Squamous Cells

few

Bacteria

few

Mucus Threads

few

Crystals
Amorphous nitrites
STOOL EXAM:
Date: July 17, 2010

few

Color

Yellow

Yellow brown

Typhoid fever

Consistency

Formed

Watery

diarrhea

Mucus

negative

Slightly mucoid

intestinal infection;
typhoid fever

1. Present Profile of Functional Health Patterns


Health Perception/ Health Management Pattern

Before admission, Mrs. P.E. is a healthy grandmother, She is not conscious about health
practices such as washing hands before eating. Her Siblings verbalizes that she is healthy that is without
any major illnesses. Upon P.E. admission, She also becomes very sensitive because of his present
condition. She is afraid that the health personnel might inject and hurt her. Mrs.P.E. has fever and his
body temperature ranges from 38-39C. To manage such condition, his aunt performs tepid sponge bath
and he has an antipyretic PRN for temperature greater than 38C.

Nutritional-Metabolic Pattern
Mrs. P.E. has a big appetite before admission, he usually ate vegetables and during
mealtime he eats vegetables and rice and sometimes dried fish. During his admission here in VSMMC
Mrs. P.E. is on diet as tolerated. Her S.O. gives her rice, fish, vegetables and some fruits. But, Marlou
only eats a little because he has decreased in appetite due to her condition. He only eats a maximum of 4
tablespoons per meal. However, he drinks a lot of water. He experiences abdominal pain.
Elimination Pattern
Mrs. P.E. defecates once a day and have not encountered problems in urinary elimination
prior to admission. He cannot really control her elimination pattern well that is why he is still wearing
diapers and he urinates more often. He can consume 4-5 diapers in one shift. Sometimes, he is constipated
because he cannot defecate within 2 days.
Activity/ Exercise Pattern
Before admission, Mrs. P.E. is a very active who spends most of her time cleaning the
house. Now the patients movements seemed weak. She keeps on lying down. Sometimes, she sits up on
his bed or asks his aunty to cuddle him. He moves slowly every time he eats or does something.She is
assisted by her S.O. every time he attempts to sit up. Her past time inside his room is just watching other
patients since there is no television.
Cognitive / Perceptual Pattern
Prior and during admission, Mrs. P.E. still functions and thinks his age. She love to read
newspapers. But only during hospitalization she always on bed lying

Rest / Sleep Pattern

During admission, sometimes the patients sleep is disturbed due to abdominal pain and
feeling of cold whenever she would have fever again. She also wakes up every time a health personnel
comes the room. Prior to admission, she never had problems with sleep because she sleep early at night.
Self perception pattern
Before admission the patient thinks she is loved and cared by her S.O. and feels secure.
During admission the patient thinks that she really needs more attention from her S.O. because he is not
feeling very well. She knows that she has an illness and thus he must not be left by his SO thinking that
he would be worse if she is left by the S.O.
Coping Stress Tolerance Pattern
Before and during admission, his coping mechanism is to sleep every time she doesnt
feel well. And when there are things done to her that she doesnt like, she read newspaper as a way of
coping.
Value Belief Pattern
The Patients values and beliefs is basically the same before and during admission. She
does pay much attention on praying, She can recite the Prayer before meals and Prayer before sleep. He
goes to mass every Sundays, but there are times that they cant attend mass due to some uncontrolled
circumstances. She doesnt blame God with his hospitalization.

Pathophysiology and Rationale

Normal Anatomy and Physiology of Affected organ


The Digestive System
The organs of the digestive system together perform a vital function of preparing food for
absorption and use by the million of body cells. Most foods when eaten is in a form that cannot reach the
cells (because it cannot pass through the intestinal mucosal into the bloodstream) nor could it be used by
the cells even if it could reach them. It must, therefore, be modified as both to chemical and physical
composition of food so that it can be absorbed and utilized by the cells is known as digestion and is the
function of the digestive system.
Mouth (Buccal Cavity)
The following structures form the buccal cavity: the cheeks (side walls), the tongue and
its muscle (floor), and the hard and soft palates (roof). Of these, only the palates and the tongue are
important. The palate consists of portions of four bones: two maxillae and two palatines. The soft palate
which forms the portion between the mouth and the nasopharynx and is named fauces. Suspended from
the midpoint of the posterior of the arch is small cone-shaped process the uvula.

Pharynx
Food passes from the mouth to esophagus by way of the pharynx
Esophagus
The esophagus, a collapsible tube about 25cm (10 inches) long, extends from the pharynx
to the stomach piercing tho the diaphragm in this descent from the thoracic to the abdominal cavity. It
also lies posterior to the trachea and the heart.
Stomach
Just below the diaphragm, the digestive tube dilates on elongated pouch-like structure,
the stomach, the size of which varies according to several factors, notably the gender and amount of
distention. In general, the female stomach is usually more slender and smaller than the male stomach. For
sometime after a meal, the stomach enlarges because of distention of walls, but as food leaves, the walls
partially collapsed, leaving the organ about the size of a large sausage. Sphincter muscle consist of
circular fibers so arrange that there is an opening they are contracted. The cardiac sphincter guards the
opening of the esophagus into the stomach into the first part of the small intestine (duodenum).
Gallbladder

The gallbladder is an active storage shed, which absorbs mineral salts and water received
from the liver and converts it into a thick, mucus substance called "bile," to be released when food is
present in the stomach. The gallbladder is a small, pear-shaped sac which is situated just below the liver
and is attached to it by tissues. It stores bile and then releases it when food passes from the stomach to the
duodenum (the first part of the small intestine) to help in the process of digestion.
Small intestine
Chemical digestion of foods begins in the small intestine. The small intestine is able to
process only a small amount of food at one time. The pyloric sphincter controls food movement into the
small intestine from the stomach and prevents the small intestine from being overwhelmed. Enzymes,
produced by the intestinal cells and more importantly by the pancreas and ducted into the duodenum
through the pancreatic duct, complete the chemical breakdown of foods in the small intestine.
Large intestine
The large intestine is about 5 feet long extends from the ileocecal valve to the anus. Its major
function is to dry out the indigestible food residue by absorbing water and to eliminate this residue from
the body as feces. It frames the small intestine on three sides and has the following subdivisions: cecum,
appendix, colon, rectum, and anal canal. .(Source: Elaine Marieb, Human Anatomy and Physiology 2006)

PATHOPHYSIOLOGY OF TYPHOID FEVER

Predisposing Factors:
Age
Gender
Medical History
Geographical area

Precipitating Factors:
contaminated foods
unsanitary food
preparation
unsanitary
environment

Ingestion of food or fluids contaminated by S.typhi


Bacteria invades the Payers patches of the intestinal wall in
the small intestines where it attach (incubation period is first 714 days after ingestion)

Bacteria will then injects toxins known as the effector proteins


into the intestinal cells and interrupts with the cellular proteins
& lipids & manipulate their function resulting in
phagocytization of the epithelial cell membrane until it is
engulf down into the inferior part of the host cells where
macrophages is present.

The bacteria induced macrophage apoptosis, breaking out


into the bloodstream and cause systemic infection. The
bacteria induced macrophage apoptosis, breaking out into the
bloodstream and cause systemic infection

TYPHOID FEVER

Signs
Non bloody Diarrhea
Slow progressive Fever
Decreased Appetite
Transient skin rash (rose spots)
Profuse sweating

Leukopenia
Positive Widal test

Symptoms
Body Malaise
Abdominal Pain
Headache
Cough
Weakness

Medical Management:

Administration of Analgesics
Admonistration of Antipyretics
Administration of Antibiotics
(Ceftriaxone)

Nursing Management:

Perform tepid sponge bath

Disease Process of Typhoid Fever


Typhoid fever is a bacteremia in which the organism gains access to the blood stream
through the bowel, principally through the infected peyers patches of lymphoid tissue in the lower portion
of the ileum. The first week these patches are swollen: the second week they form sloughs, which are
often bile colored; the third week the sloughs separates and leaves an ulcerative surface, which then starts
to heal by granulation.
Since the organism reaches all parts of the body through the bloodstream, almost all
organs at time may show pathologic changes being those due to toxemia and high fever. Commonly,
however, the heart, liver, spleen, muscle, and mesenteric lymph glands may be either red or swollen, or
else broken down into messy masses. The muscles are flabby granular. The urine may be milky in
appearance with the peculiar opalescence, which is due to the presence in it of millions of typhoid bacilli.
The causative organism invades the bloodstream by way of lymphatic tissues and is
carried to all parts of the body. Early symptoms may vary, may be vague with headaches, anorexia and
malaise. As the disease progresses, there are joint pains, abdominal discomfort, vomiting and usually
constipation although they may be diarrhea. Cough and bronchitis occur in about 50% of the cases.
During the first week, the body temperature rise in step ladder pattern until it reaches about 104. Wherein
remains until near the end of the 3rd week, after which it falls by lysis. The temperature is irregular, with 2
remissions in the morning. (Source: Smeltzer and Bare,2004)

Classical and Clinical Signs and Symptoms of Typhoid fever


Classical Symptoms
Body Malaise

Decreased
Anorexia

Appetite

Fever (intermittent)

Abdominal Pain

Clinical Symptoms
Manifested: patient keeps
of lying in bed and seldom
moves around. He needs
his auntys assistance
whenever she wants to sit
up from his bed.

Manifested: patient only


eats three spoons to five
spoons of food per meal.

Manifested: patients
temperature fluctuates
from 38-39C to 36C

Manifested: Abdominal
pain of 5/10 pain scale,
guarding behavior, facial
grimace

Rationale
Illness can deplete a
persons energy to such
degree that it becomes
difficult for the person to
deal with day-to day life.
(Source: Lemone & Burke,
Medical surgical Nursing,
Chapter 24, page 639)
Loss of appetite occurs
as a result of the decreased
metabolic rate and the
increased catabolism that
company
immobility
(Source: Lemone & Burke,
Medical surgical Nursing,
Chapter 24, page 640)
The body temperature
alternates
at
regular
intervals between periods
or subnormal. (Source:
Lemone & Burke, Medical
surgical Nursing, Chapter
24, page 639)
Abdominal spasm is
induced to limit mucosal
injury
adding
in
stimulation of increased
peristalsis. Perforation and
destruction of mucosal
lining of the intestinal wall
can lead to persistent
inflammation
(Source:
Monahan,
Medical
surgical Nursing, Chapter
30, page 1708)
Tissue
damage
and
inflammation causes loss
of absorption due to
damaged villi causing an

Diarrhea

Manifested: Consumes 4-5


diapers per shift due to
watery stools

increase
in
water,
electrolytes, mucus, blood,
and serum to be pulled into
the
intestine
from
immature
crypt
cells
(Source: Lemone & Burke,
Medical surgical Nursing,
Chapter 24, page 639)

Nursing Interventions
Care Guide of Patients with Typhoid Fever
The patient must be isolated until at least 3 negative stool cultures, 24 hours apart and has been
secured. Strict asepsis must be carried out. All stool, urine, and vomitus must be disinfected
unless disposal of in a municipal sewage system. The rectal thermometer should be taken to
conserve the patients strength and to avoid chilling the patient. Antipyretic drug should be
administered for fever. The skin must be protected by frequent turning of the patient and proper
positioning, since it is susceptible to skin infection. Mouth care should be given at regular
intervals. The patient should be encouraged to take adequate fluids by mouth. If fluids are
administered parenterally, caution must be exercised, since overloading the vascular system may
lead to cardiovascular complications. Abdominal distention should be guarded against, since it
thins the intestinal walls and may contribute to hemorrhage or perforation of intestinal ulcers.
Small low enemas may be given and glycerine suppositories or mineral oil to avoid constipation.
All stools must be examined for evidenced of blood and any bright blood must be reported at
once. The patient should be examined for bladder distention and retention of urine. During acute
stage, the patient is drowsy and lethargic and incontinence may occur. The patient should be in a
quiet pleasant surroundings and visitors reduced to a minimum. (Source: Lemone & Burke, 639)

Nursing Assessment

Body
Part

PHYSIOLOGIC
I

Head:
Hair

Black, evenly distributed,


shoulder level

Scalp

White, no dandruff

Forehead

Smooth, fair skin

Face

No deformities, brown
colored skin, dry, good skin
turgor

Eyebrow

Evenly distributed, black in


color, parallel

Eyelash

Slightly curved outward

Eyelids

Intact, able to open and


close

Conjunctiva

Absence of nodules

No lumps, no
tenderness

No masses

Pale pink color, no


inflammation, moist, no
accumulation of secretions.

Sclera

White, small veins are


visible

Pupils

Round, reactive to light and


accommodation.
Parallel, symmetrical

External eyes
Nose

Smooth, proportional to the


face

Lips

Pink, dry, presence of some


cracks and peelings

No lump, no
secretions
Rough

Symmetrical
Ears

Flexible

Dark pink, no ulceration


Gums

No masses

Tongue

Smooth, pinkish, no
ulceration

Uvula

Located at the midline, not


inflamed

Resistant

Yellowish in color
Teeth

Intact to gums

Hard palate

Located anteriorly with


ruggae

Soft palate

Posteriorly located, moist,


no lesions, no ulcerations

Neck

No scars, no lesions, good


skin turgor, evenly
distributed skin color

Chest

No scars, no lesions, no
deformities.
RR:22breaths/min

Hard

Carotid pulse:
120 bpm
No nodules, no pain

Dull sound on
bony
prominence;
resonant on
intercostals
spaces.

Heart rate: 80
bpm

Pain upon palpation


(intermittent)

Resonant on
all four
quadrants.

Bowel
sounds:
Hyperactive
bowel sounds
14/min every
4 seconds
loud gurgling
sounds.

No hairs, no lesions, smooth


Abdomen

21
Nursing Care Plans

Defining
characteristic

Nursing
Diagnosis

Scientific
Basis

Objectives

Subjective
cues
gitugnaw
kuno siya. As
verbalized by
the SO.

Altered
Thermoregulat
ion: Fever
related to on
going infection

Fever is the
most
common sign
of a systemic
response to
injury and it
is most likely
caused by
endogenous
pyrogens
released from
neutrophils
and
macrophages,
a specialized
form of
leukocytes.
These
substances
reset the
hypothalamic
thermostat
which
controls body
temperature
and produce
fever.

After 8 hours
of nursepatient
interaction, the
patient will be
able to:

objective
Cues:
- body
temperature of
38.5 C
- flushed skin
- skin warm to
touch
- teary eyes
- cracked lips
-Positive
Salmonella
typhi stool
exam result

1. manifest a
lowered
temperature as
evidenced by
body
temperature
from 38.5 C
to 36.5 C

Nursing
Actions

Measures to:
1. decrease
body
temperature
a. provide dry
clothing and
bed linens
b. remove
excessive
clothing and
covers.
c. reduce
physical
activity
d. provide
adequate foods
and fluids

Source:
Brunner &
Suddarths
Medical
Surgical
Nursing

Rationale

- to increase heat
loss through
conduction
- to lower
temperature

- to limit heat
production
- to meet the
increase
metabolic
demands and
prevent
dehydration
- to increase heat
loss through
conduction

e. provide
tepid sponge
bath

f. provide oral
hygiene

- to keep the
mucous
membranes
moist. They
become dry and
cracked as a
result of
excessive fluid
loss
- to maintain

21

22
patients comfort

g. provide
additional
cooling
mechanisms
like cooling
mattress, cold
packs

- drugs that
reduce the level
of fever

-to treat
underlying cause

22

23
Subjective
cues
Sakit kuno
iyaha tiyan,
as verbalized
by SO
objective
Cues:
-Grimace
face
-Guarding at
the
abdominal
area
-Pain started
yesterday
accompanied
by diarrhea,
located at the
abdominal
area for 8-10
seconds with
a pain scale
of 5,
characterized
by colicky
pain. It is
aggravated
by walking
and is
relieved by
bowel
movement. It
is treated
with
Paracetamol
as pain relief.

Alteration in
comfort: Acute
Pain related to
inflammation
of gastric
mucosa
secondary to
Typhoid Fever

Salmomella
Gastroenteriti
s is
characterized
by initial
symptoms of
nausea and
vomiting
followed by
abdominal
cramps and
diarrhea
which is
accompanied
by fever. The
diarrhea
varies from
loose watery
stools to
bloody
purulent
cholera like
stools.

After 8 hours
of nursepatient
interaction, the
patient will be
able to:
2. experience
increased
comfort
concerning
pain as
evidenced by
lowered pain
intensity from
5/10 to 2/10.

Measures to:
2. increase
patients
comfort:

-to promote
proper lung
expansion.

a. Keep at rest
in SemiFowlers
Position.

- To alleviate pain
by promoting
nonpharmacological
pain management

b. Encourage
verbalization
of feelings
about pain.

c. Provide
Additional
Comfort
Measures such
as touch.
d. Instruct the
patient to use
diversional
activity such
as play
therapy.

Source:
Oxford
Textbook of
Medicine
volume 3
By:David A
Warrell p 661

e. use puppets
to demonstrate
procedures.

Salmomella

23

-To reduce pain


especially when
moving.

- Refocuses
attention,
promotes
relaxation and
may enhance
coping abilities
-to enhance
understanding
and reduce
anxiety or fear
level.
-Relief of pain
facilitates
cooperation with
other therapeutic
interventions.

24
Subjective
cues
Magsige man
siya ug
kalibang, as
verbalized by
the SO
objective
Cues:
-Consumed 34 diapers due
to watery
stools at 100cc
per defecation
-Stool exam
results on p.11
-dry lips
-hyperactive
bowel sounds

Fluid Volume
Deficit related
to diarrhea
secondary to
Typhoid Fever

Gastroenteriti
s is
characterized
by initial
symptoms of
nausea and
vomiting
followed by
abdominal
cramps and
diarrhea
which is
accompanied
by fever. The
diarrhea
varies from
loose watery
stools to
bloody
purulent
cholera like
stools.

After 8 hours
of nursepatient
interaction, the
patient will be
able to:
3. maintain
hydration
balance.

3. maintain
fluid balance:
a. Assess for
the signs of
dehydration
including skin
turgor, oral
mucosa, etc.
b. Encourage
the client to
increase the
fluid intake.
c. Monitor I &
O and IV
fluids q4h

- This will
provide a data
that could be used
to evaluate the
proper
intervention that
the client needs.
-To reduce the
dryness of the
oral mucosa
-To determine if
IV fluid and
electrolyte
replacement are
needed
-To reduce stress
and anxiety

d. Keep a quiet
environment
and calm
activities.

Source:
Oxford
Textbook of
Medicine
volume 3
By:David A
Warrell p 661

e. Provide
health
teachings on
avoidance of
dehydration.
conducive for
sleeping

24

-To promote
awareness on
related factors

25
Drug Therapeutic Record
Drug/ Dose/
Frequency/
Route

Classifications/
Mechanism of
Action

Ceftriaxone

Classification:

Indications:

500g IVTT

Antibiotics

q12h

Mechanism of
Action:

Uncomplicated
gonoccocal vaginitis
UTI
Lower Respiratory
Tract Infection
Septicemia

Meningitis
Peri-operative
prevention
Acute bacterial
otitis media
Neurologic
complication

- binds to 50 S
ribosomal sub
unit, which
interferes with
or inhibits
protein
synthesis
promoting
osmotic
instability
usually
bactericidal.

Indications/
contraindications/
side effects

Principles

CNS: headache,
depression, dizziness,
fever
CV: phlebitis
Skin: pain,
induration,
tenderness at

25

Inject deep
into large
muscle for
IM such as
gluteus
maximus.
Obtain
culture
may
before
giving first
dose

Medications
taken at
ordered
dose,date
and time.
Desired
effects
obtained.

Tell
patient/SO
to report
any signs
of adverse
reactions.
Perform
tepid
sponge
bath for
fever.

Before
giving
drug, ask
Increase
patient if
fluids
he is
allergic to Give drug
penicillins/
with food
cephalosp
horins.

Use
cautiously
in
breastfeedi
ng women

Not to
exceed
with
recommen
ded dose.

Side Effects:

GI: Nausea,
vomiting, diarrhea,
abdominal pain,
colitis, glossitis

Monitor
Vital Signs

Care

Contraindications:

Hema:
thrombocytopenia,
leucopenia.

Evaluation

of

Hypersensitivity
to cephalosporins
severe renal
disease
severe hepatic
disease
minor infections.

Treatment

26
injection site, rash,
pruritus

Paracetamol

Classification:

Indications:

(tempra
syrup) 5ml q4
hours PRN
for T = 38C

Antipyretics
Analgesics

Fever
mild pain

Mechanism of
Action:

Contraindication:

- antipyretic
action results
from inhibition
of prostaglandin
in the Central
Nervous
System; may
block pain
impulses
peripherally that
occur in
response to
inhibition of
prostaglandin
synthesis.

Hypersensitivity
Anemia
Hepatic or severe
renal disease

Side Effects:
Hema: leucopenia,
neutropenia,
hemolytic anemia
CNS: drowsiness

GI: nausea, vomiting,


abdominal pain,

hepatotoxicity,
INTEG: rash
urticaria

26

Not to
exceed
with
recommen
ded dose;
acute
poisoning
with liver
damage
may result
Use liquid
form for
children &
pts with
difficulty
in
swallowin
g.
In
children,
dont
exceed 5
doses in
24 hours.

Carefully
check
over-thecounter
products

Give drug
with food

Give with
full glass
of water
With food
or milk to
decrease
gastric
symptoms.
Increase
fluids
Monitor
V/S
Avoid
usage of
multiple
preparatio
ns
containing
acetameno
phen.
Perform
Tepid
Sponge
Bath

Medications
taken at
ordered
dose,date
and time.
Desired
effects
obtained.

27
Evaluation and Recommendation
The prognosis of the patient is good because she is responding to the treatment and
nursing interventions positively. Improvements have been noticed in the patient, such as increase food
intake, afebrile for 2 days now, increased activity tolerance and compliance of medication intake. The
patient was advised not to eat foods or drinks from unsanitary area or container.

Thus, the student nurse recommends having a continuous care of the client. The family
should support the patient in all aspects since this is the time when the client needs his family so much.
The client should take vitamins and eat lots of fruits and vegetables. Prevention of any other disease
depends on the client herself.

27

28
Evaluation and Implication

Nursing Practice:
Nursing action should be based on standard nursing practice developed through the basic
foundation of biological and psychological sciences. This case study will provide more emphasis on the
treatment of typhoid fever. It is designed to improve and assist individuals to the performance of nursing
care to patient with typhoid fever. The student nurse should have an attitude of caring characterized by a
free and easy environment. This may mean rendering holistic nursing care effectively and efficiently. It is
important to emphasize the good of the positive aspects in what the patient is capable of doing.

Nursing Education:
This case study will enhance and broaden the knowledge, expertise and ideas about
typhoid fever through the information gathered. It will also contribute to the important facts when we talk
of communicable nursing and will provide a concrete example in the other related studies during
discussion. One can also compare and actual situation with basic information and may come to appreciate
mans unique being.

Nursing Research:
This case study will enhance research regarding initiating a holistic nursing care to a
patient with typhoid fever. There has always been a need to know more about nursing measures to be
rendered. Through this case study, more works will be instilled towards the patient with typhoid fever.
Researchers may be inspired to continue to research, more comprehensions and extensive study especially
with complications and their response to the care given.

28

29

Bibliography
Books:
Billings, Diane McGovern. Medical- Surgical Nursing. The C.V. Mosby Company. 11830 Westline
Industrial Drive, TS. Louis, Missouri. 1987.
Black, Joyce M. Luckmann and Sorensens Medical-Surgical Nursing. 4 th edition. W.B. Saunders
Company. 1993
Bullock, Barbara L. Pathophysiology. 4th edition. Lippincott Williams and Wilkins Company.
Philadelphia, Pennsylvania. 2001
Holloway, Nancy M. Medical-Surgical Care Planning. 3rd edition. Springhouse Corporation. Springhouse,
Pennsylvania. 1999
Kozier, Barbara, et al. Fundamentals of Nursing. 5th edition. Addison Longman Inc. Singapore. 1998
Merch, et al. The Merck Manual. 16th edition. Merck Research Laboratories. New Jersey.1992
Hockenberry, Marilyn J. Wongs Essentials of Pediatric Nursing. 7 th edition. Mosby, Elsevier Inc.,
Philippines. 2005
Marieb, Essentials of Human Anatomy and Physiology 7th Edition, Pearson Education Inc., San
Francisco, 2003
Doenges, Moorhouse and Geissler-Murr, Nurrses Pocket Guide Diagnoses,

Interventions and

th

Rationale 9 Ed, Tabers Publisher, Philadelphia, Pennsylvania, 2004

Internet:
Microsoft Encarta Encyclopedia 2002. 1993-2001 Microsoft Corporation. All rights reserved.
www.innerbody.com
http://en.wikipedia.org/wiki/Typhoid_fever

29