UNITARY EVENTS

“THYPOID FEVER”

Topic : Thypoid Fever

Title : “Increase student knowledge about typhoid fever”

Date : Wednesday, February 28𝑡ℎ 2018

Time : 1.00 pm – 1.50 pm (1 x 50 minutes)

Place of performance : Class Room

Target : The college student

Sub Topic :

1. the basic concept of typhoid fever theory

A. Purpose

1. General instructional purpose

After getting the counseling for 50 minutes, it is hoped the extension target

can understand about typhoid fever

2. Special Instructional Goals

After getting the counseling for 50 minutes, it is expected that the

extension target can:

1) Understand and be able to explain again the definition of Thypoid Fever

2) Understand and be able to recall Thypoid Fever Disease

B. The place

Class Room

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C. Time

The event will take place on :

 Wednesday, February 28𝑡ℎ 2018

 1.00 pm – 1.50 pm (1 x 50 minutes)

D. Target

The College student

E. Extension Organizer

The counselor organizer “Increase student knowledge about typhoid fever”

is a fourth semester student of Nursing Science Program Faculty of Medicine,

Sam Ratulangi University of Manado.

A. Implementation of Activities

No. Time Extension Workers Participant Activities

1. 5 minutes Foreword :

- Say hello to the target - The goal of greeting

- introduce yourself to - Target listening.

the target.

- explains the topic of - Target listening.

counseling.

- explain the purpose of - Target listening.

counseling.

- -explain - Target listening

implementation time.

2. 40 minutes Implementation:

(30 minutes Submission of Material

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 of material, - Distribution of leaflets - Target receive a given leaflet

10 minutes on target.

of - Presenters probe a little - The goal of exploring what they

questioning) information on targets know about Thypoid disease

regarding Thypoid fever

Disease

Presenters explain material

- Target pay attention to explanations
on: Thypoid Fever Disease
and look at the material

- Question and answer

- Moderator open question - Goals ask questions.

and answer session. - Target pay attention to given

- The Presenter answers answers.

the target questions.

3. 5 minutes End

Evaluation

- Evaluation by some - The objective answers the evaluation

giving question to the question

target

- provide conclusions of - The goal of listening to the

outreach results. conclusions presented by the

moderator.

Termination

- End with greetings - Answering greetings

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F. Method

1. Lecture

2. Discussion

G. Media

1. Leaflet

H. Place settings

2 2 2

2 2 2

description of the image :

1. Presented

2. Participants

I. Group organizing

The presenter of the material : Olievia Hardnata

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J. Evaluation

1. Structure Evaluation

The activity plan is prepared three days before the activity by conducting

material consultation to be delivered during the counseling. Facilities such

as leaflets are prepared no later than two days prior to implementation.

2. Process Evaluation

a. Activities go on time

b. the target is very enthusiastic with the material

c. the target of asking questions and the speaker can answer the

question correctly

3. Outcome evaluation

extension target capable:

1) Understand and be able to explain again about typhoid fever

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Theoretical basis:

1.1 DEFINITION
Typhoid fever is a systemic infectious disease caused by
Salmonella thypi are still widely found in various developing countries
which are mainly located in the tropics and subtropics. This disease is also
an important public health problem because of its spread is closely related
to urbanization, population density, environmental health, water and
sanitation to poor hygiene standards as well as the food processing
industry still low (Simanjuntak,c.h., 2009).

1.2 ETIOLOGY
Salmonella thypi by Salmonela is Gram negative bacteria, have
flagella, not berkapsul, do not form spores, facultative anaerobe.Have
somatic (O) antigen which comprises oligosakarida, flagelar antigen (H)
consisting of proteins and antigens (K) envelope consisting of
polosakarida.Have a complex lipopolysaccharide makromolekuler that
form the outer layer of the cell wall and is called endotoxin.Salmonella
thypi can also obtain the R-factor plasmids that are associated with
resistance to multiple antibiotic.(Nanda, Nic-Noc,2013)

1.3 SIGN AND SYMPTOMS

Signs and symptoms of thypoid fever as follows (Nanda NIC-
NOC.2013):
˗ Symptoms in children: Incubation between 5-40 days with
an average of 10-14 days.
˗ Fever rises until the end of the first week
˗ Fever falls in the fourth week, unless the fever is untreated
will cause shock, Stupor and coma.
˗ The rash appears on days 7-10 and lasts 2-3 days
˗ Headache
˗ Abdominal pain
˗ Bloated
˗ Nausea vomiting
˗ Diarhea
˗ Constipation
˗ The webbed tongue (dirty in the middle, edges and red tips)
˗ Hepatomegaly and Splenomegaly

1.4 PATHOPHYSIOLOGY
Salmonella germs come in with food / drinks. After being in the
small intestine then invaded the lymphoid tissue of the small intestine
(especially Plaque Peyer) and mesenteric lymphoid tissue. After causing

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 local inflammation and necrosia, the germs through the lymph vessels
enter the bloodstream (primary bacteria occurs) leading to organs
especially the liver and lymph. Non-phagocytic germs will multiply in the
liver and lymph so that the organ is enlarged with pain in the palpation.
At the end of the incubation period (5-9 days) the bacteria returns
to the blood (secondary bacteria) and spreads throughout the body
especially into the lymphoid glands of the small intestine, giving an oval-
shaped ulcer above the Peyer Plaque. Tukak can cause intestinal bleeding
and perforation. During this bactericidal period, the bacteria secrete
endotoxins that have a role to help local inflammatory processes in which
these germs develop.
Typhoid fever is caused by Salmonella Typhosa and its endotoxin
stimulates the synthesis and release of pyrogens by leukocytes in inflamed
tissues. This pyrogenic substance will circulate in the blood and affect the
thermoregulatory center in the hypothalamus that causes symptoms of
fever. (PPNI Klaten, 2009)

1.5 DIAGNOSTIC EXAMINATION

According to widodo 2007 Examinatioof supporting clients with
typhoid is a laboratory examination, which consists of:
 Examination of leukocytes
In some of the literature revealed that there were typhoid fever
leukopenia and relatively limposistosis but in fact leukopenia was not
often encountered.In most cases of typhoid fever, the number of
leukocytes in the blood banks of the preparations are at normal limits
even sometimes there are leukocytes although no complications or
secondary infections.Therefore, an examination of the number of
leukocytes is not useful for the diagnosis of typhoid fever.
 Widal test
The widal test is an agglutination reaction between the antigen and
the antibody (aglutinin). Aglutinin specific to salmonella thypi is
present in serum clients with typhoid also present in people who have
been vaccinated. The antigens used in the widal test are salmonella
suspensions that have been switched off and processed in the
laboratory. The purpose of this widal test is to determine the presence
of agglutinin in the serum of clients suspected of typhoid. As a result
of infection by salmonella thypi, the client makes antibodies or
aglutinin namely:
˗ Aglutinin O, which is made up of O antigen stimulation
(derived from the body of the germ).
˗ Aglutinin H, which is made due to stimulation of H antigen
(derived from germ flagellum).
˗ Aglutinin Vi, which is made due to Vi antigen stimulation
(derived from germicide)

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 Of the three agglutinins only agglutinins O and H are determined
titernya for diagnosis, the higher the titer the greater the client
suffering from typhoid.

1.6 COMPLICATION
Complications caused by typhoid fever usually only occur in
people who haven't been treated with appropriate antibiotics or who
weren't treated straight away. In such cases, about 1 in 10 people
experience complications, which usually develop during the third week of
infection. The two most common complications in untreated typhoid fever
are:
˗ internal bleeding in the digestive system
˗ splitting (perforation) of a section of the digestive system or
bowel, which spreads the infection to nearby tissue

1.7 MANAGEMENT
The principles of managing typhoid fever still adhere to a
management trilogy that includes: rest and treatment, diet and supportive
therapy (both symptomatic and supportive), and antimicrobial
administration.
 Diet and Complementary Therapies
˗ Maintain your calorie intake
˗ Give a free diet low in fiber in people with asymptomatic
meteorismus diet of porridge, and a strain on sufferers with
meteorismus. This is done to avoid any complications of
bleeding bowel perforation and cerna channels. Nutrition also
noted sufferer in order to improve the State of public and speed
up the healing process.
˗ fluid adequat to prevent dehydration due to vomiting and
diarrhea
 Granting of Antimicrobial
˗ with a dose of chloramphenicol 500 mg 4 x per day
˗ Ampisillin and Amoksisilin, the ability to lower fevers lower
than chloramphenicol, with doses of 50-150 mg/kgBB for 2
weeks.
˗ Trimetroprim-sulfamethoxazole (TMP-SMZ) can be used
orally or intravenously at a dose of 160 mg in adults TMP plus
SMZ 800 mg twice daily at adulthood.The third generation of
Sefalosforin, that is with a dose of ceftriaxon 3-4 grams in 100
cc dekstrosa provided for ½ an hour, once a day given perinfus
during 3-5 days.

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 1.8 PREVENTION
Two basic actions can protect you from typhoid fever:
˗ Avoid risky foods and drinks
o If you drink water, buy it bottled or bring it to a
rolling boil for 1 minute before you drink it. Bottled
carbonated water is safer than uncarbonated water.
o Ask for drinks without ice unless the ice is made
from bottled or boiled water. Avoid popsicles and
flavored ices that may have been made with
contaminated water.
o Eat foods that have been thoroughly cooked and that
are still hot and steaming.
o Avoid raw vegetables and fruits that cannot be
peeled. Vegetables like lettuce are easily
contaminated and are very hard to wash well.
o When you eat raw fruit or vegetables that can be
peeled, peel them yourself. (Wash your hands with
soap first.) Do not eat the peelings.
o Avoid foods and beverages from street vendors. It is
difficult for food to be kept clean on the street, and
many travelers get sick from food bought from
street vendors.

˗ Get vaccinated against typhoid fever

In the UK, two vaccines are available that can
provide some protection against typhoid fever. These
involve either having a single injection or taking
three capsules over alternate days. Vaccination is
recommended for anyone planning to travel to parts of the
world where typhoid fever is widespread (see below). It's
particularly important if you're planning to live or work
closely with local people. However, as neither vaccine
offers 100% protection, it's also important to follow some
precautions when travelling. For example, you should only
drink bottled or boiled water, and avoid foods that could
potentially be contaminated. In the UK, the two main
vaccines available to prevent typhoid fever are :
˗ Vi vaccine – given as a single injection
˗ Ty21a vaccine – given as three capsules to
take on alternate days
The vaccines work by stimulating your body to
create antibodies (infection-fighting proteins) that prevent
you getting ill if you become infected with the typhoid
bacteria. It's important to remember that none of the

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 typhoid vaccines are 100% effective, and you should
always take precautions when eating food and drinking
water abroad. As the Ty21a vaccine contains a live sample
of Salmonella typhi bacteria, it isn't suitable for people with
a weakened immune system, such as people with HIV or
those receiving certain types of treatment, such
as chemotherapy. It also isn't usually recommended for
children under six, whereas children can have the Vi
vaccine from two years of age.

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