Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella typhi.

The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within one month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.

S typhi has been a major human pathogen for thousands of years, thriving in conditions of poor sanitation, crowding, and social chaos. It may have responsible for the Great Plague of Athens at the end of the Peloponnesian War. The name S typhi is derived from the ancient Greek typhos, an ethereal smoke or cloud that was believed to cause disease and madness. In the advanced stages of typhoid fever, the patient's level of consciousness is truly clouded. Although antibiotics have markedly reduced the frequency of typhoid fever in the developed world, it remains endemic in developing countries.

To be able to determine the epidemiology of the disease and the appropriate care management to be applied for Typhoid fever.

 18 years old male patient from Camiling Tarlac PRESENT COMPLAINT 2 days PTA, the client experienced high fever accompanied by loose bowel movements, vomiting and loss of appetite. PRESENT ILLNESS Typhoid Fever

Physical development Inspection Behavior Inspection

chronological age Cooperative attitude and behavior Normal

Mild anxiety or tenseness Normal Dressed appropriately

Mood
Inspection Normal Erect posture, coordinated, smooth and steady gait Normal

Dress Inspection Gait

Inspection
Body build Inspection Joints and muscles

Bilateral, firm, developed muscles Normal Joints appear normal(no edema), muscles appear to be relaxed Posture is upright, attentive, and without excessive changes in position and posture Client smiles with appropriate facial expressions and maintains adequate eye contact. No inconsistency, wounds or bruising Ranges from 36.5 37.5 C

Normal

Posture

Inspection

Normal

Facial expression

Inspection

Normal

Observe skin for scars, lesions, rashes, changes or discoloration Temperature

Inspection

Normal

Inspection

Ranges from 60 100

38.8 C (febrile)

The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral cavity, where food enters the mouth, continuing through the pharynx, esophagus, stomach and intestines to the rectum and anus, where food is expelled. There are various accessory organs that assist the tract by secreting enzymes to help break down food into its component nutrients. Thus the salivary glands, liver, pancreas and gall bladder have important functions in the digestive system. Food is propelled along the length of the GIT by peristaltic movements of the muscular walls.

The primary purpose of the gastrointestinal tract is to break food down into nutrients, which can be absorbed into the body to provide energy. First food must be ingested into the mouth to be mechanically processed and moistened. Secondly, digestion occurs mainly in the stomach and small intestine where proteins, fats and carbohydrates are chemically broken down into their basic building blocks. Smaller molecules are then absorbed across the epithelium of the small intestine and subsequently enter the circulation. The large intestine plays a key role in reabsorbing excess water.

Finally, undigested material and secreted waste products are excreted from the body via defecation (passing of feces). In the case of gastrointestinal disease or disorders, these functions of the gastrointestinal tract are not achieved successfully. Patients may develop symptoms of nausea, vomiting, diarrhea, malabsorption, constipation or obstruction. Gastrointestinal problems are very common and most people will have experienced some of the above symptoms several times throughout their lives.

All pathogenic Salmonella species are engulfed by phagocytic cells, which then pass them through the mucosa and present them to the macrophages in the lamina propria. Nontyphoidal salmonellae are phagocytized throughout the distal ilium and colon. With toll-like receptor (TLR)5 and TLR-4/MD2/CD-14 complex, macrophages recognize pathogen-associated molecular patterns (PAMPs) such as flagella and lipopolysaccharides. Macrophages and intestinal epithelial cells then attract T cells and neutrophils with interleukin 8 (IL-8), causing inflammation and suppressing the infection.

In contrast to the nontyphoidal salmonellae, S typhi enters the host's system primarily through the distal ilium. S typhi has specialized fimbriae that adhere to the epithelium over clusters of lymphoid tissue in the ilium (Peyer patches), the main relay point for macrophages traveling from the gut into the lymphatic system. S typhi has a Vi capsular antigen that masks PAMPs, avoiding neutrophil-based inflammation. The bacteria then induce their host macrophages to attract more macrophages.

It co-opts the macrophages' cellular machinery for their own reproduction as it is carried through the mesenteric lymph nodes to the thoracic duct and the lymphatics and then through to the reticuloendothelial tissues of the liver, spleen, bone marrow, and lymph nodes. Once there, the S typhi bacteria pause and continue to multiply until some critical density is reached. Afterward, the bacteria induce macrophage apoptosis, breaking out into the bloodstream to invade the rest of the body.

The gallbladder is then infected via either bacteremia or direct extension of S typhi infected bile. The result is that the organism re-enters the gastrointestinal tract in the bile and reinfects Peyer patches. Bacteria that do not reinfect the host are typically shed in the stool and are then available to infect other hosts.

TYPHIDOT
Result: IgM: IgG: +

RAPID DENGUE TEST

Result: IgM:IgG:-

FECALYSIS
Method: direct fecal smear/iodine mount Color: green Consistency: watery

MICROSCOPIC EXAMINATION
Starch Granules: few Fat Globules: few

CHEMICAL EXAMINATION
Parasites: no ova/parasite seen

URINALYSIS
Physical characteristics Quantity: 20cc Specific Gravity: 1.005 Color: yellow Ph: 6.5 Transparency: slightly turbid

QUALI CHEM TEST

Albumin: trace Sugar: negative

MICROSCOPIC
Rbc: 3-5/hpf Wbc: 0-1/hpf Epithelial cells: rare Bacteria: few

GENERIC NAME

BRAND NAME

DOSAGE 1g IVP q8(ANST)

CLASSIFICATION Anti- infectives Cephalosporins

ACTION Inhibits cellwall synthesis, promoting osmotic instability; usually bactericidal

INDICATION Intra abdominal infection

CONTRAINDICA TIONS -contraindicated in patients hypersensitive to drug or other cephalosporins -use cautiously in patients hypersensitive to penicillins because of possibility of cross-sensitivity with other betaLactam antibiotics

SIDE EFFECTS CNS: fever, headache, dizziness GI: diarrhea Other: hypersensitivit y reactions

CEFTRIAXO ROCEPHI NE SODIUM N

NURSING CONSIDERATIONS -tell patient to report adverse reactions promptly - instruct patient to report discomfort at I.V insertion site -tell patient to notify prescriber about loose stools or diarrhea -monitor patient for signs and symptoms of superinfections

ENERIC AME

BRAND NAME REGLAN

DOSAGE 1amp IVP q8 1x 3doses

CLASSIFICATION Gastrointestinal tract drugs Antiemetics

ACTION Stimulates motility of upper GI tract, increase lower esophageal sphincter tone and blocks dopamine receptors at the chemorecepto rs trigger zone

INDICATION To prevent or reduced nausea and vomiting

CONTRAINDICATIONS -contraindicated in patients hypersensitive to drug -contraindicated in patients for whom stimulation of GI motility might be dangerous -use cautiously in patients with history of hypertension

SIDE EFFECTS GI: bowel disorders GU: urinary frequency Skin: rash, urticaria

METOCLOPR MIDE YDROCHLO IDE

URSING CONSIDERATIONS

monitor bowel sounds ell patient to avoid activities that require alertness for 2 hours after doses

GENERIC NAME ACETAMINOP HEN (paracetamol)

BRAND NAME TYLENOL

DOSAGE 1amp IV q4/PRN

CLASSIFICATION Nonopioid analgesics and antipyretics

ACTION Thought to produce analgesia by inhibiting prostaglandi n and other substance that sensitive pain receptors. Drug may relieve fever through central action in the hypothalamic heat regulating center

INDICATION Fever

CONTRAINDICATIONS -contraindicated in patients hypersensitive to drug -use cautiously in patients with long term alcohol use because therapeutic doses cause hepatoxicity in these patients

SIDE EFFECTS Hematologic: hemolytic anemia Hepatic: jaundice Metabolic: hypoglycemia Skin: rash, urticaria

NURSING CONSIDERATIONS -alert: many OTC and prescription products contain acetaminophen; be aware of this when calculating total daily dose -in children, dont exceed five doses in 24 hours -tell parents to consult prescriber before giving drug to children younger than 2 years -assess patients temperature

GENERIC NAME

BRAND NAME

DOSAGE 500mg q6/po

CLASSIFICATION Miscellaneous antiinfectives

ACTION Inhibits bacterial protein synthesis by binding to the 50s subunit of the ribosome; bacteriost atic

INDICATION Acute salmonella typhi infections

CONTRAIN DICATIONS contraindicat ed in patients hypersensitiv e to drugs or any of its components -use cautiously in patients with impaired or renal or hepatic function. Dosage adjustment may be needed

SIDE EFFECTS CNS: headache EENT: decreased visual acquity GI: diarrhea, enterocolitis, glossitis, nausea, vomiting, stomatitis Hepatic: jaundice

CHLORAMPHENI PENTAMYCET COL SODIUM IN SUCCINATE

NURSING CONSIDERATIONS =alert: use for serious infections only -monitor patients for signs and symptoms of superinfections -instruct patient to notify prescriber if adverse reactions occur, especially nausea, vomiting, diarrhea, fever, confusion, sore throat, or mouth sores

ASSESSMENT Subjective: masakit ulo ko. As verbalized by the patient Objective: -weak in appearance -skin warm to touch Vital signs: t- 38.9 febrile pr- 90 bpm rr- 34 cpm bp- 130/80 urine- 6x stool- 2x

NURSING DIAGNOSIS Hyperthermia related to infectious process

SCIENTIFIC EXPLANATION Elevation of temperature above normal caused by a bacterial infection. Protein called pyrogens are released when the white blood cells fight the microorganisms that are responsible for the infection. Pyrogens act on the temperature controlling center in the brain, causing it to raise the body temperature in an attempt to destroy the invading microorganisms.

PLANNING within 8 hours of nursing interventions, the pain felt by the client will lessen and the patients temperature will decrease and maintain to its normal range

NURSING INTERVENTION - Monitor vital signs

RATIONALE

EVALUATION

- note absence of sweating

- use blanket and wrap extremities with bath towels -do TSB

- to obtain baseline data and to After 8 hours of determine if there is any changes nursing in clients condition interventions, the pain felt by the - environmental factors client has lessened decreases evaporation. Factors and patients such as humidity and high temperature is ambient temperature decreased and maintained to its - to minimize shivering normal range.

-to promote heat loss by evaporation and conduction - To treat underlying cause and to relieve pain

- administer medications as indicated

-maintain bed rest

- to reduce metabolic demands/ oxygen consumption

To determine any changes in clients condition

-monitor laboratory results

ASSESSMENT

NURSING DIAGNOSIS Subjective: Diarrhea nagtatae ako. related to As verbalized by infectious the patient process Objective: -weak in appearance -watery bowel movement -afebrile Vital Signs: t- 36.4 pr- 82 rr- 23 bp- 120/80 urine- 6x stool- 6x

SCIENTIFIC EXPLANATION Diarrhea is an increased in fluidity, frequency on volume of bowel movements. It is usually a result of consuming foods and water contaminated with certain bacteria or viruses.

PLANNING

NURSING INTERVENTION Within 8 hours - monitor vital signs of nursing interventions, - determine recent exposure the client will to different foreign maintain environments, changes in normal drinking water/ food intake pattern of bowel - auscultate abdomen movements and functions

RATIONALE

EVALUATION

- to obtain baseline data After 8 hours of nursing - help identify causative interventions, the environmental factors client maintained normal pattern of bowel movements and functions. - for presence, location and characteristics of bowel sounds

- review medications noting side effects

- often cause changes in bowel habits

- monitor/record all source - potentiates fluid and of fluid loss such as urine, electrolyte losses vomiting and diarrhea - administer/give medications as indicated/ ordered - review causative factors and appropriate interventions - review food preparations - to treat infectious process and to decrease gastro intestinal motility - to prevent recurrence

- to prevent bacterial growth/ contamination

THANK YOU!!!

-Tasha Ferrandiz -Claribel Lagman -Charisse Bautista -Rose ann Jose -Manilyn Guting