What is typhoid fever?

Typhoid fever is a bacterial infection of the intestinal tract and occasionally the
bloodstream. It is an uncommon disease with only 30-50 cases occurring in New
York each year. Most of the cases are acquired during foreign travel to
underdeveloped countries. The germ that causes typhoid is a unique human
strain of Salmonella called Salmonella typhi.

What are the signs and symptoms of typhoid fever?

The incubation period is usually 1-2 weeks and the duration of the illness is about
4-6 weeks. The patient experiences:
• poor appetite
• headaches,
• generalized aches and pains,
• fever, and
• lethargy
• Body malaise

Persons with typhoid fever usually have a sustained fever as high as 103 to 104
degrees Fahrenheit (39 to 40 degrees Centigrade).

Chest congestion develops in many patients and abdominal pain and discomfort
are common. The fever becomes constant. Improvement occurs in the third and
fourth week in those without complications. About 10% of patients have recurrent
symptoms (relapse) after feeling better for one to two weeks. Relapses are
actually more common in individuals treated with antibiotics.

How is typhoid fever spread?

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the
bacteria in their bloodstream and intestinal tract. In addition, a small number of
persons, called carriers , recover from typhoid fever but continue to carry the
bacteria. Both ill persons and carriers shed S. Typhi in their feces (stool).

You can get typhoid fever if you eat food or drink beverages that have been
handled by a person who is shedding S. Typhi or if sewage contaminated with S.
Typhi bacteria gets into the water you use for drinking or washing food.
Therefore, typhoid fever is more common in areas of the world where
handwashing is less frequent and water is likely to be contaminated with sewage.

Once S. Typhi bacteria are eaten or drunk, they multiply and spread into the
bloodstream. The body reacts with fever and other signs and symptoms.
Patients Profile

Name: Shiela Acero

Age: 29 years old

Sex: Female

Status: MArried

Religion: Roman Catholic

Home address: House Redeemer, Butuan City

History of Illness

Two days prior to admission patient had been experiencing fever associated with

body malaise and frontoparietal headache. She just took Paracetamol.

One day prior to admission patient had notice a rashes on her back and along to

the extremities and so she decided to be admitted and have a proper

management of her condition.

Reason for admission

Patient was admitted at November 4,2007,Sunday a7 9:15am and was

accompanied by family members, she was ambulatory. With chief complaints of

fever, headache and body malaise. She was seen and examined by Dr. Daisy

Galbo and advised to have a laboratory test and examinations to properly

confirm the cause of her illness.

Patients Condition Upon Receiving

11/6/07 > receive patient lying on bed wake.

4:00pm > with IVF #5 d5IMB 1Liter at 30gtts/nin infusing well at right cephalic
vein at the level of 900cc.
> initial vital signs taken and recorded; a febrile
T - 5.7’C P – 70bpm R – 21cpm BP – 100/80
> she was responsive upon interaction.
> patient was in good grooming.

IVF Classification
D5 IMB ( dextrose in 5% multiple balance maintenance)
• Hypertonic solution
• Indicated to replace fluid and electrolytes and provide glucose.
Diagnostic test:

 Blood Count

Result Normal level (female) Readings

WBC 2,600 5,000 - 10,000/uL Increased

Hemoglobin 12.8 11.00 – 16.0 g/dL Normal

Hematocrit 38.8 38 – 47% normal

 Tubex Test
Tubex test for Salmonella typhi was (+)

 Urinalysis

Color Yellow

Transparency Slightly Hazy

Ph 6.0

Specific Gravity 1.010

Medications

Generic Name Acetaminophen

Brand Name Paracetamol
Classification Nonopioid Analgesic and Antipyretics
Action Drug may relive fever through action of the central action in
the hypothalamic heat regulatory center
Indication Mild Pain and Fever
Adverse Effects Hypoglycemia, rash
Teaching Tell patient to take drugs as prescribed by doctor

Generic Name Cetirizine hydrochloride

Brand Name Zyrtec
Classification Antihistamines
Action Long acting non-sedating antihistamines
Indication Chronic urticaria
Adverse Effects Fatigue, dizziness, headache
Teaching  Tell patient to drink coffee or tea to reduce drowsiness if
not contraindicated.
 Ice chips may relieve dry mouth

Generic Name Ceftriaxone sodium

Brand Name Rocephin
Classification Cephalosporins
Action Inhibits cell wall synthesis, usually bactericidal
Indication Infections
Adverse Effects Fever, headache, rash
Teaching Tell patient to report discomfort on IV insertion

Health Teachings

 Advised patient to wash hands always before and after eating or going to the
bath
 Encourage to cut or shorten fingernails to prevent lodging of bacteria.
 Encourage patient to frequently changed bed linens at least every two days
and dispose it properly
 Advised patient to eat fruits rich in vitamin C like oranges important for her
health.
 Advised patient to loosen blankets or wear only comfortable and thin dress if
fever is noted to help cool of body temp.
 Advised her to properly cooked the food and wash it properly before cooking
it.
 Advised her not to eat foods that are unattended or had been contaminated
by flies.
Nursing Care Plan for Typhoid Fever

Problem: Knowledge Deficient regarding on the disease transmission.

Diagnosis: Knowledge Deficient related to lack of information to the disease secondary to statement of misconception.

Diagnosis Goal Intervention Implementation Evaluation

Subjective: 1. After initial Independent Actions: Goal Met:

Patient verbalized of “ I
don’t know where I get
the disease, basta dili
man pud ko hilig mag
kaon sa gawas”
Objective: 2. She will be
She was avoiding to
ask question upon
Interaction or
unknowledgeable when
ask about her condition.
interaction
patient will be 1. She will be encourage
able to know to say something or talk
the disease about what she knew of
process of her her condition.
condition. • Important to assess her
level of understanding.
2. She will be explained
able to and discussed all the
verbalize necessary information
understanding on how she could have
of her possibly get the
condition, after disease.
initial • Important to clarify her
interaction. mind and be more
informed about its
mode of transmission.
3. Discuss and
demonstrate to her the
proper preventative
• She will be guided Patient was able to
by asking verbalized
questions on the understanding of her
history of her condition and the
condition PTA. disease process itself
and its proper
preventative measures.
• Pictures regarding
Typhoid Fever will
be used to make it
more informative
and easy to
understand.
• She will be
encouraged to
 measures of the have a return
disease like correct demonstration and
hand washing and a discussion to
proper handling of properly assess
foods. her learning on
• Necessary so that she proper hand
will be able to have a washing and
base knowledge of the handling of food.
proper prevention and
self management.
4. Significant others will
be informed about the • Significant others
disease and its proper will also be allowed
prevention. to have a
• Important to prevent demonstration
possible re-occurrence regarding on the
of the disease and correct hand
provide a safe and washing and
proper care to their preparation of
affected family food.
members.

Dependent Actions:

She will be advised to take

medications as prescribed
by the physician.