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 antibiotic-
resistant 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)

celcius)

8:00 am 38.1 97 23

After 30 mins. 37.8

After 30 mins. 38.2

BT (degree PR (bpm) RR (bpm/cpm)

celcius)

12:00 nn 37 95 25

PATHOPHYSIOLOGY
NURSING CARE PLAN

Assessmen Diagnosis Planning Intervention Rationale evaluation

t

Subjective Hyperthermi After 30 Independent After 30

: a r/t mins. To 1 : mins to 1
-for
increase hour of hr of
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metabolic nursing nursing
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rate, illness. interventions intervention
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, the pt. -fever , the
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BT: 38.1 fever

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RR:23
:
-to
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paracetamol
the
given as
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the doctor.
.

-
administered
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doctor.
 Case study
(Typhoid fever)

Jennifer de guzman

Ms. Maria Christine Bautista,RN,MAN

(clinical instructor)