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NURSING CLIENT WITH ENDOCRINE AND GENITOURINARY DISORDER AND COMMUNICABLE

DISEASE

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Typhoid fever is a systemic infection caused by Salmonella enterica serotype Typhi (S. typhi). The disease remains an important public health problem in developing countries.

About 16 million cases of typhoid fever and 600,000 deaths occur yearly worldwide and that more than 90% of this morbidity and mortality occurred in Asia

INTRODUCTION

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What?

An acute illness with fever caused by infection with the Salmonella typhi

bacteria contracted from contaminated water and food. Also called enteric fever,

bilious fever and yellow jack .

TYPHOID FEVERDEFINITION

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•Virulent bacterium that cause illness called Salmonella typhi.1.Bacteria

• spread through contaminated food or water and occasionally through direct contact with someone who is infected.

2.Fecal-oral route

• These people, called chronic carriers, shed the bacteria in their faeces and are capable of infecting others.

3.Typhoid carriers

ETIOLOGY

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work in or travel to areas where typhoid fever is endemic

Work as a clinical microbiologist handling Salmonella typhi bacteriaHave close contact with someone who is infected or has recently been infected with typhoid fever

Have an immune system weakened by medications such as corticosteroids or diseases such as HIV/AIDS

Drink water contaminated by sewage that contains S. typhi

RISK FACTOR

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Fever, often as high as (39.4 or 40 C)

Poor appetite

Weakness and fatigue

Headache

Abdominal pain

Rash

Diarrhea or constipation

CLINICAL MANIFESTATION 1st WEEK

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CLINICAL MANIFESTATION con’t…

Continuing high fever

Extremely distended abdomen

Diarrhea or severe constipation

weight loss

2nd WEEK

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CLINICAL MANIFESTATION con’t…

Intestinal bleedingLie motionless and

exhausted

3rd WEEK

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PATHOPHYSIOLOGySalmonella typhi contracted from contaminated water and food

Ingested by human.The S.typhi survives the acidity of the stomach

It will invades the payer’s patches of the intestinal wall

The bacteria is within the macrophages and survives

Bacteria spreads via the lymphatics while inside the macrophages

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Access to reticuloendothelial system,liver,spleen,gallbladder and bone marrow.

1st week: elevation of the body temperature

2nd week: abdominal pain, spleen enlargement and rose spot

3rd week: necrosis of the payer’s patches

Leads to perforation, bleeding .And if left untreated, death is imminent

PATHOPHYSIOLOGy con’t…

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Blood culture (C&S)A blood culture during the first week of the fever can show S. typhi bacteria

Complete blood count (CBC)A complete blood count (CBC) will show a high number of white blood cells.

DIAGNOSTIC TEST

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.

Stool C&Sstool culture may be positive for S.typhi several days after ingestion of the bacteria

Widal test

Test whereby bacteria causing typhoid fever are mixed with serum containing specific antibodies obtained from an infected individual

DIAGNOSTIC TEST CON’T…

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TREATMENT

Brand name :Ci

pro (Ciproflox

acin)

Class of drugs :qui

nolone antibiotics

.

USES: This medication is used to treat a variety of bacterial

infections.

Routes : per oralDosage :Adult :500 mg orally

every 12 hours for 10 days

Side effect :nausea, vomiting,dizziness ,blurred vision,feeling nervous,sleep problems

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TREATMENT CON’T…

Brand name :Ro

cephin (Ceftriaxo

ne)

group of drugs :

cephalosporin

antibiotics

Uses :It works by fighting bacteria in body

Route : intravenousDosage:Pediatric :75 to 80 mg/kg IV once a day for 5 to 14 daysAdult:2 g IV every 24 hours

Side effect : Mild

diarrhea, mild pain, swelling, nausea,vo

miting

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COMPLICATION OF TYPHOID

Gastrointestinal Perforation

Myocarditis

Gastrointestinal Bleeding

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GASTROINTESTINAL BLEEDING

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COMPLICATION OF TYPHOID

Gastrointestinal Bleeding

Myocarditis

Gastrointestinal Perforation

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GASTROINTESTINAL PERFORATION

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COMPLICATION OF TYPHOID

Gastrointestinal Bleeding

Gastrointestinal Perforation

Myocarditis

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MYOCARDITIS

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• Nursing Diagnosis :Hyperthermia related to increased metabolic rate, illness.

• Goal : Client can maintain the normal body temperature without complication

NURSING CARE PLAN 1

Nursing Intervention Rationale

Monitor patient temperature degree and patterns Fever pattern may aids in diagnosing underlying disease.

Observe for shaking chills and profuse diaphoresis Chills often precede during high temperatureand in presence of generalized infection.

Wash hands with anti-bacterial soap before and after each care of activity and encourage proper hygiene.

Reduces cross contamination and preventsthe spread of infection.

Provide tepid sponge baths and avoid the use of ice water and alcohol.

May help reduce fever .Use of ice water andalcohol may cause chills and can elevatetemperature.

Monitor for signs of deterioration of condition or failure to improve with therapy.

May reflect inappropriate antibiotic therapy.

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NURSING CARE PLAN 2

• Nursing Diagnosis : Risk for imbalance nutrition related to disease process. • Goal : Patient will be maintain the nutrition balance and body weight status

Nursing Intervention Rationale

Monitor the Input & Ouput Chart To maintain nutrient status of patient

Assess client’s nutritional patterns Offer client their favorite food to ensure patient taken the diet

Recommend bed rest / activity restrictions during the acute phase, balanced body weight each day

To minimize the pain and to maintain patient weight

Record or report such things as nausea, vomiting, stomach pain and distension.

To do further management to reduce the symptom

Collaboration with a nutritionist for dietary administration

To maintain patient taken diet well

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NURSING CARE PLAN 3

• Nursing Diagnosis : Increase frequency of bowel movement related to disease process.

• Goal : Client will maintain the hydration of body from over diarrhea

Nursing Intervention Rationale

Monitor the vital sign such as pulse and respiration To monitor patient from over dehydration

Monitor the Input & Output chart. To maintain the fluid balance in patient body

Encourage the patient to eat more nutritious food such as fruit & vegetable. To prevent patient from get constipation

Encourage pt to drink plenty of water at least 2.5 liters / 24 hours. To maintain hydration status of patient

Observe the drip infusion & administer the medication as ordered by doctor.

To prevent infection and maintain fluid balance

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Wash hand before and after handling something

Avoid drinking untreated water

Avoid raw food and vegetables

Choose well-cooked food

HEALTH EDUCATION

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HEALTH EDUCATION con’t…Avoid popsicles and flavored ices that may have been made with contaminated water.

Avoid eat the foods and beverages from the street vendor

Remember taking antibiotics injection as doctor orders

Getting vaccinated before travelling to another country where common gets the typhoid.

Follow up with the doctor

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Salmonella Typhi causes a protracted bacteremic illness referred to as typhoid fever. Since humans are the only reservoir for S. Typhi, infection is most often acquired through ingestion of food or water contaminated by feces and urine of infected persons and chronic carriers.

Typhoid fever is characterized by the gradual onset of fever, headache, malaise, anorexia, abdominal pain, hepatosplenomegaly, rose spots, and changes in mental status. Laboratory diagnosis can be made by culture of stool, blood and widal test.

SUMMARY

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Antimicrobial therapy is indicated for patients with typhoid fever. Typhoid fever cases should be excluded from food handling, and from direct care of infants, elderly,immunocompromised, and hospitalized or institutionalized patients. An individual may return to normal duties after 3 consecutive negative stool culture taken at least one month apart, and at least 48 hours after completion of antibiotic therapy. If without prompt treatment, it can cause serious complications and can be fatal.

SUMMARY con’t…

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• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002308/• http://en.wikipedia.org/wiki/Typhoid_fever• http://www.nhsdirect.wales.nhs.uk/encyclopaedia/t/article/typhoidfever/• http://www.nhs.uk/Conditions/Typhoid-fever/Pages/Introduction.aspx• http://www.answers.com/topic/typhoid-fever#Signs_and_symptoms• http://en.wikipedia.org/wiki/File:Typhoid_inoculation2.jpg• http://www.nlm.nih.gov/medlineplus/ency/article/001332.htm• http://www.livestrong.com/article/133749-an-introduction-typhoid-fever/• http://en.wikipedia.org/wiki/File:ForskeligeVeje_ad_hvilkenBroen_kan_inf

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REFERENCES

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