University of the Cordilleras

College of Nursing

I. General Profile/Information
Name: GSC
Age: 14 y/o
Birth Date: June 11, 1995
Sex: Male
Civil Status: Child
Address: Carael, Dagupan City, Pangasinan
Religion: Roman Catholic
Nationality: Filipino
Date and Time of Admission: April 22, 2010/ 10:30 am
Admitting Diagnosis: T/C enteric fever

II. Chief Complaint/s

On and off fever for one month

III. History of Present Illness

Condition started one month prior to admission when patient developed on and
off fever with no accompanying signs and symptoms. The patient self medicated with
chloramphenicol for three weeks and paracetamol from the onset of fever. On April
18,2010, the patient consulted at private clinic and was advised to continue
chloramphenicol and given with rapidol. Condition persisted hence admitted.

IV. Past Medical History

There is no previous hospitalization. The patient sometimes has coughs and colds
but he does self medication for management. Fever is also a common illness
experienced by the patient and he usually takes paracetamol to relieve it. The patient
has no known allergies to drugs and foods.

V. Social and Environmental History

The patient is the third child among the 7 children. His father is a fisherman while
his mother is a housewife.
The place of the patient is situated near coastal waters. They have fishing as their
main source of income thus; the patient is exposed in contaminated water.
According to the mother of the patient, they boil their drinking water but we
found out that they don’t continue to boil it for at least 15 minutes.
The mother also stated that the patient is fond of eating street foods especially
fishballs, kikiams and palamig bought from street vendors.

VI. Family History

The patient has no family history of hypertension, diabetes mellitus and asthma.
The client is the third child out of six. His father is a farmer and so as his mother.

VII. Physical Examination

A. General Survey
 Client is groomed and changes his clothes every time he perspires. He is
conscious, coherent and shows good attitude towards nursing interventions. He is
weak in appearance but not irritable and has poor skin turgor.

B. HEENT
Head- Patient`s head is symmetrical and no noted abnormalities.
Eyes- Client`s eyes are reactive to light, he can open and dilate both. His eyelashes
are well distributed, with parallel eye movement. His pupils are round, regular, and 3-
5mm equal in both eyes. No mass upon palpation and with pale palpebral
conjunctiva.
Ears-Ears are symmetrical with same color of patient`s face. Smooth in texture and
both in same color. No discharges were noted and able to respond to soft and loud
verbals.
Nose-Client can distinguish different kind of smell such as; fragrance, foul odor, sour
smell and others. He can inhale and exhale thoroughly and clearly. No discharges and
deformity were noted.
Throat-No obstruction were noted and can easily swallow foods and drinks.

C. Respiratory System
The patient’s respiration is normal which is 24 cycles per minute characterized by
regular breathing pattern. Lung expansion is symmetrical. There are no presence of
adventitious sounds like crackles, wheezes, pleural friction rub and stridor upon
auscultation.

D. Cardiovascular System
His pulse rate is normal which is 90 beats per minute which is in children is 60 –
100 beats per minute. He is not in any cardiovascular distress and his pulse is in
regular rhythm. He has a low hemoglobin count which is 107 g/dL and the normal
hemoglobin count for male is 140 – 170 g/dL prior to hemoglobin test done on April
22, 2010. He also has a low level of hemotacrit count which is 35 vol % while the
normal hematocrit count is 40 – 50 vol % in which is done in CBC (complete blood
count) prior to admission.

E. Gastrointestinal System
The physician Dr. S. ordered a DAT diet (Diet as Tolerated) for the patient
because of his illness but he has a good appetite. He has normal patterns of intake of
fluid which is 6-8 glasses of water a day. He perspires once in a while and urinates for
at least 45ml/hr. No constipation, diarrhea and abnormal bowel sound noted. He has a
regular bowel movement characterized by brown semi-solid stool. Client’s abdomen
is flat, soft and tender.

F. Genito-Urinary System
There is no presence of bladder distension and tenderness. The bladder when
palpated is firm. There is no presence of lumps or masses.
The patient has no difficulty in urinating and the urine is amber in color. He
urinates for about three times a day. He voids when he feels the urge to urinate.
According to his urinalysis there is presence of pus cells which shows infection.

G. Musculo-skeletal System
He moves slowly and needs assistance in performing activities of daily living
because of body weakness felt by the patient. Muscle tone is symmetrical. Joints can
move to its full potential.
H. Integumentary System
The patient has dark brown complexion. He has flushed and warm to touch skin.
He has poor skin turgor. Upper and lower extremities have minimal scars, lower
extremities skin is rough. The patient’s nails are dirty. He doesn’t have dandruff or
lice seen on his hair. The patient takes a bath after two days.
 VIII. Diagnostic Examinations

DATE OF DIAGNOSTIC DESCRIPTION SIGNIFICANCE RESULTS NORMAL VALUES IMPLICATION OF

PROCED PROCEDURE THE FINDING
URE

04/22/10 URINALYSIS
CBC The determination
analysis of urine,
of the The CBC
Serves as baseline
is used astoa Color-yellow 107 g/L
Hemoglobin- - yellow
M: 140-170
color
g/L - -Normal
Decreased
using physical,chemical
quantity of each type of determine
broad screening
abnormal
test to
and microscopical
blood cell in a given
tests, to constituent
check for such
of the
disorders
urine toas Transparency-51
WBC- 5.0 x 10/L -clearx 10/L
5-10 - -normal
Normal
determine
sample of blood,
the proportions
often detect any
anemia, infection,
possibleand
cause
Albumin-(+)35
Hematocrit: - >60
M: 40-50
yr. 3.4-4.8
vol % g/dl - -normal
Decreased
of its normal
including the constituents
amount of of the other
many fever.diseases.
and to detect the
hemoglobin, alcohol, DIFFERENTIAL <60yr. 3.5-5 g/dl
drugs, sugarand
hematocrit, andthe
other COUNT:
abnormal constituents.
proportions of various Segmenters: .56 .50-.70 - Normal
white cells.
Sugar-(-) -1.0003-1.029
.20-.40 - -elevated
Normal
Lymphocyte: .32
Specific gravity-1.020
Eosinophils: .03 .02-.04 - Normal
MICROSCOPIC:
Monocyte: .09 .02-.08 - Elevated
epithelial cell-few -none to few -normal
Platelet count:201 x 10/L 150-400 x 10/L - Normal
Amorphous -none to few
substance-few
-normal
Pus cell-1-2
-none to few -normal
Mucus thread-(-)
-none -normal
Crystal(-)
-none to few -normal
DATE DIAGNOSTI DESCRIPTIO SIGNIFICANC RESULT IMPLICATIO
C N E N
PROCEDUR
E
04/22/1 WIDAL`S Presumptive A test involving 1:2 1:4 1:8 1:6 1:32 Positive of
0 TEST serologic test agglutination of 0 0 0 0 0 typhoid fever.
for enteric typhoid bacilli
fever. when they are T. O ++ + +/- - -
mixed with
serum
containing T. H ++ + +/- - -
typhoid.d
antibodies from
an individual P.T. +/- - - - -
having typhoid A
fever; which
may be used to P.T. +/- - - - -
detect the B
presence of
Salmonella
typhi and S.
paratyphi

IX. Medical Diagnosis

Typhoid Fever
X. Comprehensive Pathophysiology and Management
Precipitating Factors
Predisposing Factors
1. Washing of hands
1. Geographical area
inadequately
2. Age (14 y/o)
2. Drinking unpurified
water
Ingestion of foods or 3. Eating street foods
fluids contaminated
with Salmonella typhi
bacteria
Bacteria enter the
stomach and survive a

Bacteria invades the Payer’s patches of

the intestinal wall in the small
intestines where it attach (incubation
period is first 7-14 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

Macrophages & intestinal

Perforation and
epithelial cells then attract T
destruction of mucosal
cells & neutrophils with
lining of the intestinal
interleukin 8 (IL-8 causing
wall can lead to
inflammation of the intestinal
persistent inflammation
Hyperthermia
The bacteria is within
the macrophages
and survives
Medication Bacteria spread via the
: lymphatics while inside the
macrophages
Increase in
metabolic rate The bacteria induced
macrophage apoptosis,
breaking out into the
Fluid volume bloodstream and cause
systemic infection

Management: Body weakness Risk for Risk for

>increase fluid imbalanced Contamination
nutrition: less
intake
Activity than body Medication:
>maintain
Vitamins and Chloramphenic
prescribed IV Minerals: ol
>lysine + Vitamin
B complex + iron
XI. Treatment and Management
A. Drug study
Dosage
Start and Mechanism of Nursing
Trade Name Generic Name Classification Side Effects
Completion of Action Considerations
Medication
Thought to produce Hematologic: >Use cautiously in
Dosage: 366mg To analgesia by hemolytic anemia, patients with long
38.5oc and 1 tab Q2 blocking pain leucopenia, term alcohol use
for To 38.5 impulses by neutropenia, because therapeutic
inhibiting synthesis pancytopenia doses cause
Date started: of prostaglandin in Hepatic: jaundice hepatotoxicity in
04/22/2010 the CNS or of other Metabolic: these patients.
substances that hypoglycemia >Use liquid form for
Nonopioid analgesic
synthesize pain Skin: rash, urticaria children and patients
receptors to who have difficulty
Tylenol Acetaminophen Antipyretic
stimulation. The swallowing.
drug may relieve >Advise parents that
fever through central drug is only for
actionin the short-term use; urge
hypothalamic heat them to consult
regulating center. prescriber if giving
to children for longer
than 5 days or adults
for longer than 10
days.
 Inhibits bacterial CNS: Confusion, >monitor patient for
Dosage: 500mg 1cap protein synthesis by delirium, headache, signs and symptoms
TID x 14 days binding to the 50s mild depression, of superinfection
subunit of the peripheral >Instruct patient and
Date started: ribosome; neuropathy with So to notify
04/24/10 bacteriostatic. prolonged therapy prescriber if adverse
Dichloroacetic acid
EENT: decreased reactions occur,
derivative
Chloramphenicol visual acuity especially nausea,
Pentamycetin
sodium succinate GI: diarrhea, vomiting, diarrhea,
Miscellaneous anti-
glossitis, nausea, fever, confusion,
infectives
vomiting, stomatitis sore throat, or mouth
Hematologic: sores.
aplastic anemia, >Instruct patient to
thrombocytopenia report signs and
Hepatic: jaundice symptoms of
superinfection.
Cefizox Ceftriaxone sodium Third generation Third generation CNS: fever >Contraindicated in
cephalosporin Dosage: 1gm IV q12 cephalosporin that CV: phlebitis, patients
inhibits cell wall thrombophlebitis hypersensitive to
Anti-infectives Date Started: synthesi, promoting GI: diarrhea, colitis, durg or other
04/23/10 osmotic instability; nausea, anorexia cephalosporins
usually bactericidal. Respiratory: > If large doses are
dyspnea given, therapy is
Skin: maculopapular prlonged, or patient
and erythematous is high risk, monitor
rashes, urticaria patient for signs and
symptoms of
superinfection.
>Tell patient and SO
to report adverse
reactions and signs
and symptoms of
superinfection
 promptly
>Instruct patient to
report discomfort at
the IV site.
>Tell patient to
notify prescriber
about loose stools or
diarrhea.
Lysine + Vit. B Vitamins and Lysine: required in GI: nausea, > tell patient not to
complex + iron Minerals the body for the epigastric pain, be alarmed for black
½ tsp BID manufacture of vomiting, stools
carnitine, which is constipation, black > Instruct patient to
an amino acid used stools, anorexia. notify prescriber if
for the proper signs and symptoms
metabolism of fats. occur.
Lysine has also been
found to stimulate
the synthesis of
cholesterol in the
liver.
Vit, B complex:
Vitamins mainly
function as catalysts
for reactions within
the body. They
contain no useful
energy, but as
catalysts, they serve
as essential links and
regulators in
metabolic reactions
that release energy
from food
 Iron: iron is the
central atom of the
heme group, a metal
complex that binds
molecular oxygen in
the lungs and carries
it to all of the other
cells in the body that
need oxygen to
perform their
activities

B. IV Fluids

Why is it to be given
Date Discontinued/ Purpose why is it given
Name of IV Solution Date Started for 12 or 8 hours IV Classification
Consumed to the patient
duration
It contains 5 grams It should be given in a
D5LRs 1L x 12o April 22, 2010 April 22, 2010 dextrose( 170 calories/L) specific hour because it Hypertonic
and 28 mEq Sodium can cause fluid and/or
Lactate (provides 9 solute overloading
calories/L) which gives resulting in dilution of
the patient the right level serum electrolyte
of hydration the patient’s concentrations, over
body needed. hydration, congested
states, or pulmonary
edema. Excess
administration may
result in metabolic
alkalosis.
 The solution is It should be given in a
o
D5NM 1L x 12 April 22, 2010 April 23, 2010 administered by specific hour because it Hypetonic
intravenous infusion for can cause fluid and/or
parenteral maintenance solute overloading
of routine daily fluid and resulting in dilution of
electrolyte requirements serum electrolyte
with minimal concentrations, over
carbohydrate calories. hydration, congested
states, or pulmonary
edema. Excess
administration may
result in metabolic
alkalosis.
For fluid and electrolyte It should be given in a
o
PLRS 1L x 8 April 23, 2010 April 23, 2010 replenishment and specific hour because it Isotonic
caloric supply in a single can cause fluid and/or
dose container for solute overloading
intravenous resulting in dilution of
administration. It serum electrolyte
contains electrolytes concentrations, over
such as potassium, hydration, congested
calcium, sodium and states, or pulmonary
chloride. edema. Excess
administration may
result in metabolic
alkalosis.
XII. Nursing Diagnosis
 ASSESSMENT EXPLANATION OF GOALS AND INTERVENTIONS RATIONALE EVALUATION
THE PROBLEM OBJECTIVES

S> “Mainit ang

pakiramdam ko at
masakit ang ulo ko” Ingestion of foods or STO: Dx: The temperature of the
fluids contaminated • Fever pattern may patient decreases from
with Salmonella typhi After 2 hours of • Monitored vital signs aids in diagnosing 39.9 to 38.
bacteria nursing intervention, the especially temperature. underlying diseases.
O> Temperature- temperature of the
39.9 patient will decrease
• Chills often precede
from 39.9 to 38. • Observe for chills and
 Flushed skin Bacteria enter the during high temperature
diaphoresis
stomach and survive a and is presence of
 Warm to touch
pH as low as 1.5 generalized infection.
 Irritable at
times
 Initial V/S Bacteria invades the
taken as Payer’s patches of the • May reflect
follows: intestinal wall in the • Monitor for signs of inappropriate antibiotic
T: 39.9 small intestines where deterioration of condition or therapy.
it attach (incubation failure to improve with
PR:90 therapy.
period is first 7-14
RR:24 days after ingestion)
Tx:
Bacteria will then
A> Hyperthermia • Provided TSB • May help reduce
injects toxins known
related to infectious intermittently and avoid the fever. Use of ice water
as the effector
process secondary to use of ice water and alcohol and alcohol may cause
proteins into the
Typhoid fever chills and can elevate
intestinal cells and
temperature.
interrupts with the • Changed clothing • To provide comfort
cellular proteins &
lipids & manipulate
their function • To prevent
resulting in dehydration and
phagocytization of the • Offered fluids to drink.
epithelial cell
membrane until it is • Used to reduce fever
engulf down into the and to control the
inferior part of the • Facilitated in giving spread of infection.
host cells where PRN medications as ordered
macrophages is like
present

Edx: • To prevent fluid loss

 ASSESSMENT EXPLANATION OF THE
PROBLEM
O The patient has elevated
 Dry skin body temperature where
the body cannot maintain
 Weak in appearance
stability within this range
 Slightly poor skin
by balancing the heat
turgor
produced by the
 Dry mucous
membrane metabolism with the heat
lost to the environment
 Poor capillary refill
which in turn activates
which goes back for
different physical
about 2-3 seconds
responses designed to cool
 Febrile: 39.9C
or warm the body,
depending on the
A> Fluid volume deficit
circumstances. These
related to increase
responses include:
metabolic rate secondary
decreasing or increasing
to typhoid fever
the flow of blood from the
body's core, where it is
warmed, to the surface,
where it is cooled; slowing
down or speeding up the
rate at which the body
turns food into energy
(metabolic rate); inducing
shivering, which generates
heat through muscle
contraction; and inducing
sweating, which cools the
body through evaporation
which can lead to Fluid
volume deficit related to
increase metabolic rate
secondary to typhoid fever
GOALS AND INTERVENTIONS RATIONALE EVALUATION
OBJECTIVES
STO: Dx> Monitor temperature  Febrile states STO:
decrease body fluids
After 3-4 hour of nursing through perspiration Patient was able to have
intervention, the patient and increased balance intake and output
will be able to have respiration over 24 hours
balance intake and output
over 24 hours
 Observe for excessively
dry skin and mucous  Indicates excessive
membranes, decrease fluid loss or resultant
skin turgor, slowed dehydration
capillary refill  May indicate signs of
 Assess skin turgor and dehydration
mucous membranes
Tx> Maintain IV flow
 To facilitate correct
administration of
fluid
 To prevent fluid
 Administer medications under load and over
as ordered (paracetamol load
for fever)  To lower the fever to
be able to lessen fluid
loose
Edx> Encourage to drink
prescribed fluid amount
 Encouraging the
patient to increase
fluid intake will help
the patient and
 Explain the importance prevent from severe
of maintaining proper dehydration
nutrition and hydration
 EXPLANATION OF THE EVALUATION
PROBLEM GOALS/
ASSESSMENT INTERVENTION RATIONALE
OBJECTIVES

STO Dx STO:
S > Assess patient’s level of > this aids defining what Goal met. After 2-3 hours of
mobility. patient is capable of, nursing interventions the patient
>” nanghihina siya After 2-3 hours of which is necessary before is able to do ADL as tolerated
kaya hindi siya nursing interventions setting realistic goals
masyadong the patient will be
nakakagalaw”, as able to do ADL as
verbalized by the tolerated
>Assessed ability to stand and >To determine current
mother
move about and the degree of status and needs
assistance necessary associated with
participation in needs or
O desired activities
>alert and awake
> febrile ( )
>fatigability noted >Assess potential for physical
> weakness noted > Injury may be related to
injury with activity
when positioning falls or overexertion
>needs assistance in
doing ADL
>restlessness noted > Assess emotional response to
>Depression over inability
change in physical status
to perform required
A> Activity activities can further
Intolerance aggravate the activity
related to intolerance
generalized
weakness > Assessed and monitored V/S >To provide comparative
baseline data
Tx
> Rest between activities
> Provided adequate rest periods, provides time energy
especially before meals, other conservation and
ADLs, and ambulation recovery.
> Assisted with ADLs

> assisting the patient

with ADL allows for
conservation of energy.
Caregivers should balance
providing assistance with
ASSESSMENT EXPLANATION OF GOALS AND INTERVENTIONS RATIONALE EXPECTED
THE PROBLEM OBJECTIVES OUTCOME
O STO: Dx:
>with sleep After 1-2 hours  Documented actual weight  T o obtain baseline STO: Goal met, if the
disturbances Typhoid fever is an of nursing data such as loosing client is able to
>weak in infection caused by interventions the or gaining weight of verbalize understanding
appearance Salmonella enterica client will be able patient on the importance of a
>fatigue noted subtype typhi, a to:  Obtained nutritional  Patient’s perception proper diet and can
>increased food bacteria that grows a. Verbalize history including family, of actual intake may enumerate foods that
intake only in the digestive understanding on the significant others differ should be included in
>good dentition systems and importance of proper diet. his diet
bloodstreams of b. Enumerate  Determine etiological  Proper assessment
humans. foods to be factors for reduced guide intervention. LTO: Goal met, if the
A>Risk for included in nutritional intake client is able to
Imbalanced People infected with his diet demonstrate changes
nutrition less S. typhi usually have Tx:  Determination of and maintain proper
than body a fever (thus the term  Consulted dietician for type, amount and diet.
requirement typhoid fever) -- LTO: further assessment and pattern if food or fluid
related to sometimes up to After 2 to 3 days of recommendations intake is facilitated
decrease oral 103-104 degrees F. Nursing interventions, the regarding food
intake as Often they have client will be able preferences and nutritional
evidenced by abdominal pains, To demonstrate changes support for the client  Maintaining proper
lack of interest loss of appetite, and maintain proper diet  Assisted in feeding nutrition
in food headaches, malaise Edx:
secondary to (feeling lousy) and
 Encouraged patients  It serves as a baseline
Typhoid fever may feel weak as
participation in data and awareness of
well which may lead
recording daily food patient’s own
to risk for
intake condition
imbalanced nutrition
 Discussed possible
less than body
need for enteral or  To promote
requirement.
parenteral nutritional nutritional balance
feeding
 Assessment Explanation of the Objectives Nursing Interventions Rationale Evaluation
Problem

O> Febrile: T- 38.3 C Salmonella Typhi is STO: 1-2 hours of Dx> Monitored & > to get baseline data STO: Patient verbalizes
transmitted on either nursing intervention Recorded V/S an understanding of
> Weak in appearrance water or food, possibly patient is able to Salmonella Typhi
through inadequate verbalize understanding > Assess skin integrity because they were
> (+) Salmonella Typhi > to determine
hygiene. Transmission factors of being a carrier susceptibility to infection adequately informed and
by direct contact, oral of Salmonella Typhi educated
route. The organism >Assess knowledge level > to determine the
A> Risk for to learn and identify awareness of
enters the body via the
Contamination R/T barriers to prevent spread spread/prevention of
GI tract and gains access LTO: 2-3 days of LTO: Patient
ingestion infected food of infection. communicable disease
to the bloodstream via nursing intervention demonstrates the proper
and water 2o Typhoid
the lymphatic. patient is able to
Fever. Tx>Performed proper > to prevent infection and techniques to prevent
Ulceration, hemorrhage, demonstrate necessary spread of bacteria
hand hygiene and use cross contamination
and intestinal perforation actions to prevent spread because he does proper
appropriate Personal
may occur in severe of bacteria to family hand hygiene and covers
Protection Equipment at
cases. Incubation period members and mouth when coughing
all times
is usually with fever, community. and sneezing.
headache, and >Clean all reusable > to prevent spread of
abdominal pain. equipment after each use contamination
Untreated prolonged and properly dispose of
fever is often single use
accompanied by relative
bradycardia and >Monitor visitors > to prevent exposure of
prostration. Late in the client
disease an acute > to reduce risk of cross-
abdomen and > Provide for isolation as contamination
leukocytosis. indicated
> to maximum antibiotic
> Due Med given effectiveness

> Informed patient they > to help them understan

are a Salmonella Typhi how to prevent cross-
carrier and provide contamination
instruction
> to determine further
teaching

> Evaluated response to > to prevent spread of

instruction infection

EDx>Demonstrated > to prevent infection and

proper hand hygiene cross contamination
washing

> Advised patient to

cover mouth when > to prevent drug
coughing or sneezing. resistent

>Advised patient to take

Meds as ordered even
when feeling better
 XIII. Discharge Plan

Diet Medications Health Teachings Activities

> Liquid diet >Tylenol > Encouraged patient > Rest is helpful to the
should be given to (Acetaminophen) to go for his follow patient (complete bed
the patient (milk, Dosage: 366mg To up check up after rest)
38.5oc and 1 tab
barley and fruit hospitalization
every 2 hours for To
juices but orange 38.5
juice would be > Mobility should be
more beneficial to > Emphasized on the maintained
the client with >Pentamycetin
importance of good
typhoid fever) (cholaramphenicol
personal hygiene
sodium succinate)
> Daily medications
Dosage: 500mg 1cap
> The exclusive 3 x a day for 14 days > Encouraged on
diet of orange juice complete bed rest to > Log rolling (if
diluted with warm regain energy patient cannot move)
water can be taken
>Cefizox (ceftriaxone
for first few days
sodium)
of the treatment
> Encouraged to take > TSB (tepid sponge
with highly Dosage: 1gm IV
in liquids that are rich bath) should be
beneficial results. every 12 hours
in Vitamin C (orange administered when
juice, lime juice, fever is 37.5 °C and
> Lysine + Vit. B calamansi juice) above
> Avoid raw complex + iron
vegetables and
fruits that cannot ½ tsp 2x a day
> Encouraged
be peeled.
Significant others on
Vegetables like
cleaning their
lettuce are easily
surroundings to
contaminated and
prevent recurrence of
are very hard to
the illness
wash well.

> Encouraged
Significant others to
prepare a well
prepared foods

> Emphasized on the

importance of
avoiding street foods
that it may also cause
 the recurrence of the
illness

> Emphasized on the

importance of
changing his
sedentary lifestyle to
a healthy one

> Encouraged to boil

water for drinking (if
it came from the
faucet)

> Provided
information on the
causes of typhoid
fever

> Provided
information on the
bacteria that lies in
the body that may
result to typhoid
fever

>Provided preventive
measures like provide
adequate fluid and
dietary intake, and
appropriate clothing

> Provided
Community
resources, consultants
as needed

XIV. Conclusion and Recommendation

 Typhoid fever is a common worldwide, acute illness most commonly caused by
Salmonella typhi. It is contracted by the ingestion of the bacteria in contaminated food or water.
Patients with acute illness can contaminate the surrounding water supply through stool, which
contains a high concentration of the bacteria.

As we can see, the spread of the disease is mainly brought about by poor environmental
sanitation which concerns food handling, improper waste disposal, drainage system, as well as hand
hygiene; all of which are manageable and possible to avoid as threat to people’s health. As we dig in
to the pathophysiology of the disease, we recognized that although the disease is not fatal, it could
damage the body systems and may in fact lead to complications detrimental to well being. Therefore,
given the chance to study this disease and gain knowledge from it is a privilege that we should share
not only to our co – students but most importantly, to the patients who needs to be enlightened.

In this case, we would like to give the following recommendations which in turn will be
of great help in alleviating the cases of Typhoid fever.

• Carriers of typhoid must not be allowed to work as food handlers – to stop the spread
then we should stop the root cause.

• Avoiding risky foods and beverages (especially when traveling in the developing
world) is another good typhoid fever prevention strategy - Avoid foods and beverages
from street vendors. It is difficult for food to be kept clean on the street, if you drink
water, buy it bottled or bring it to a rolling boil for one minute before you drink it, eat
foods that have been thoroughly cooked and that are still hot and steaming, When you eat
raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with
soap first.)

• Adequate water treatment, waste disposal, and protection of food supply from
contamination are important public health measures – managing these areas will help
lessen the risk of incurring the disease.

• Strict hand hygiene – the universal precaution never fails to break the chain of any
infectious disease.

• The typhoid vaccine. There are two types of vaccines. One vaccine contains killed
Salmonella typhi bacteria. This vaccine is administered by a shot. The other vaccine
contains a live but weakened strain of the Salmonella bacteria that causes typhoid fever.
This typhoid vaccine is taken by mouth.
 University of the Cordilleras
College of Nursing
Governor Pack Road, Baguio City Philippines 2600

A Case Report:
Typhoid Fever

A Case Presentation Presented to the Faculty

of the University of the Cordilleras
College of Nursing

In Partial Fulfillment
of the Requirements in
Bachelor of Science in Nursing

By:

Antonio, Joseph Christopher

Cino, Christine
De Vera, Mawee
Escala, Monica
Hagada, Kim
Inagapad, Mhel Florence
Masadao, Daphne Yvonne
Natividad, Earl John
Ngolab, Kirk Lee Wayne
Padawil, Pearly Jhane
Porto, May Rhezalie

BSN 3-6B

May 19, 2010