79200544 Typhoid Fever
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BACKGROUND OF THE STUDY
INTRODUCTIONTyphoid fever, otherwise known as enteric fever, is an acute illness associated with fever caused by theSalmonella typhibacteria.Salmonella typhosais a short, plump, gram negative rod that is flagellated and actively motile. Contaminated food or water is the common medium of contagion.The disease follows four stages. The first stage is known as incubation period, usually 10-14 days in occurrence. In this stage generalization of the infection occurs. In the second stage, aggregation of the macrophages and edema in focal areas indicates bacterial localization (embolization) and resultant toxic injury which disappear after few days. The third stage of disease is dominated by effects of local bacterial injury especially in the intestinal tract, mesenteric lymph nodes, spleen, and liver. The fourth stage, or the stage of lysis, is the stage wherein the infectious process is gradually overcome. Symptoms slowly disappear and the temperature gradually returns to normal.The symptoms of typhoid fever include high fever, chills, cough, muscle pain, weakness, stomach pain, headache and a rash made up of flat, rose-colored spots. Diarrhea is a less common symptom of a typhoid fever, although it is a gastrointestinal disease. Sometimes there are mental changes, known as typhoid psychosis. A characteristic feature of typhoid psychosis plucking at the bedclothes if patient is confined to bed.Risk factors for acquiring typhoid fever likely include improper food handling, eating food from outside sources like carinderia, drinking contaminated water, poor sanitation and even poor hygiene practices. War and natural disasters as well as weak, non-existent of health care infrastructure may also contribute. Both genders do have equal chances on acquiring such disease. Asian, African and Americans are at greatest risks of acquiring the disease since geographical locations play a part.Complications of typhoid fever are secondary conditions, symptoms, or other disorders that are caused by typhoid fever. Complications include overwhelming infection, pneumonia, intestinal bleeding, and intestinal perforation may eventually lead to death.Typhoid fever is one of the most protean of all bacterial diseases thus laboratory procedures are usually depended on to confirm or disprove suspicion of such disease. The place of blood culture, serologic studies and bacteriologic examination feces and urine are useful in establishing the diagnosis. Agglutination (Widal) for typhoid fever is done to determine antibody response against different antigenic fractions of organisms.Typhoid fever is treated with antibiotics which kill the Salmonellabacteria. Several antibiotics are effective for the treatment of typhoid fever. The choice of antibiotics needs to be guided by identifying the geographic region where the organism was acquired and the results of cultures once available. Two new vaccines are currently licensed and widely used worldwide, Asubunit (Vi PS) vaccine administered by the intramuscular route and a live attenuated S. Typhistrain (Ty21a) for oral immunization.In most cases, typhoid fever is managed at home with antibiotics and bed rest. For hospitalized patients, effective antibiotics, good nursing care, adequate nutrition, careful attention to fluid and electrolyte balance, and prompt recognition and treatment of complications are strategies to avert the possibility of death.We choose this topic since it catches our interest from the time being we were able to handle patient having typhoid fever. It gives us the motivation to look for the things that governs such disease. Typhoid fever as our case study allows us to find for ways to contribute something for the alleviation of the condition of its victims may it be in our own little ways perhaps. May this case study serves as advent to understand more fully the existence of such disease and the proper interventions needed to be rendered upon to address such condition looking to a new perspective of life.
OBJECTIVESGeneralThis 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 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 problem 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.
NURSING HEALTH HISTORY
BIOGRAPHIC DATACase #xxx-xx-xx
Patients name:AJVAge:13 years old
Sex:MaleBirthday:April 21, 1996
Address:Muzon, City of San Jose del Monte, Bulacan
Chief Complaint:Abdominal Pain, difficulty in urinating and fever
Admitting Diagnosis:t/c Typhoid Fever
Date of Admission:December 14, 2010 @1:00 pm
Date of Discharge:December 20, 2010 @ 2:00 pm
Admitting Physician:Dr. Lim
Final Diagnosis:Typhoid Fever
HISTORY OF PRESENT ILLNESSFive days prior to admission persistent to consult at OPD. The patient had an intermittent fever associated with abdominal pain and weakness. A few hours to admission still the above signs and symptoms remain but already have (+) rose spots and was diagnosed with Typhoid Fever.
PAST MEDICAL HISTORYAccording to the patient he has no experienced of being hospitalized, only when one time he experience fever and his mom gave paracetamol tablet.FAMILY MEDICAL HISTORYAccording to the patients mother the only disease that the family has genetically is the Hypertension on the fathers side and no similar incident of typhoid fever noted.
SOCIAL ECONOMIC HISTORYRecent Stress:Back and Neck Pain
Support System:Mother, Father and four Siblings
Economic condition:Class C
Eating habits:Eats chicken, process foods, vegetables, fruits and seldom eats salty, oily, and sweet foods.
Food preferences:Meat, Fish, process food, vegetables, and fruits
Area population:Populated area
Environmental Sanitation:Poor Sanitation
Housing:Made of scrap woods and cements
GORDONS FUNCTIONAL HEALTH PATTERNS
PATTERNS OF FUNCTIONINGBEFORE HOSPITALIZATIONDURING HOSPITALIZATIONANALYSIS
Health Perception Health Management Patient AJV does not want any consultations or even go for checkups because he thinks that he is healthy and there is nothing wrong with him. He maintains a healthy body by playing with his friends and helping in household chores. He easily gets bored when he is not doing anything. he has started playing basketball and since he was 10 years old up to present. He is not allergic to any food or drug. His family has a history of hypertension.
Patient AJV considered himself a not healthy person due to present condition. He is expecting to recover from his present condition with the help of the health care providers attending to his needs. All of the medications prescribed to patient AJV are available
Patient AJV cannot function normally like before because of his confinement and his hospital condition. His body image changed due to his condition.
Nutritional Metabolic Management Patient AJVs life before his pre confinement stage was normal, he can eat whatever he wants. He eats fruits like mango and bananas, fish and meats. But most of the time. He always eats meat.
During hospitalization, the patient in on Strict Aspiration Precaution (SAP) diet. He said he loses his appetite due to uncomfortable feeling. Patient AJVs nutritional and metabolic status has been changed due to his confinement and her medical health condition. His pre confinement status is totally affected.
Elimination Pattern Bowel
Patient AJV defecates two times a day without experiencing discomforts, usually morning and afternoon. Stool is brown in color and is well-formed.
Patient AJV voids usually 6-8 times a day. Urine is yellow in color. No pain when voiding.
Patient defecates once a day but not every day. Stool is soft, is minimal in amount, and is brown in color
Patient voids 10-12 times a day with pain and discomfort. Bowel
There was a change in the frequency, consistency and amount of stool.
There was a change in the frequency, and amount.
Activity, Leisure and Recreation Pattern In the morning, Patient AJVs daily activities include collection of water for the days use. In the afternoon after launch, Patient AJV go out and play basketball or swimming on the so called carabao beach Patient AJVs activity in the hospital is eating and sleeping. During Patient AJVs confinement in the hospital, there is limitation in his activities of daily living and a disruption in his leisure and recreation pattern.
Sleep and Rest Pattern Patient AJV puts himself to sleep by watching primetime television programs. He does not have usual time of sleep. He sleeps for long period of time. He feels rested when sleeping and he thinks that his energy is sufficient for his activities. Patient AJV has a difficulty in sleeping. He don't feel rested and comfortable even though he had a long period of sleep, he still feels weak.
Patient AJV sleeps and rest pattern was changed when he was admitted due to his condition. His usual routine of watching television programs to put himself to sleep changed because he doesnt need to do anything to fall asleep.