Académique Documents
Professionnel Documents
Culture Documents
Presented By:
Capistrano, Reggie
Foroneas, Karen
Nono, Ma. Franine Alyssa
Sobrevega, Reysie
Presented To:
Herald Clarence Ambayec, R.N
= Reysie Sobrevega/
Reggie Capistrano
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.
Classically, the course of untreated typhoid fever is divided into four individual stages, each
lasting approximately one week. In the first week, there is a slowly rising temperature with
relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a
quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the
number of circulating white blood cells, with eosinopenia and relative lymphocytosis, a
positive diazo reaction and blood cultures are positive for Salmonella Typhi or Paratyphi. The
classic Widal test is negative in the first week.
In the second week of the infection, the patient lies prostrated with high fever in plateau
around 40 °C (104 °F) and bradycardia (Sphygmo-thermic dissociation), classically with a
dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This
delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower
chest and abdomen in around 1/3 patients. There are rhonchi in lung bases. The abdomen is
distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea
can occur in this stage: six to eight stools in a day, green with a characteristic smell,
comparable to pea-soup. However, constipation is also frequent. The spleen and liver are
enlarged (hepatospleenomegaly) and tender and there is elevation of liver transaminases.
Blood cultures are sometimes still positive at this stage.
• Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very
serious but is usually non-fatal.
• Encephalitis
The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the
patient is delirious (typhoid state). By the end of third week defervescence commences that
prolongs itself in the fourth week.
Sanitation and hygiene are the critical measures that can be taken to prevent typhoid.
Typhoid does not affect animals and therefore transmission is only from human to human.
Typhoid can only spread in environments where human feces or urine are able to come into
contact with food or drinking water. Careful food preparation and washing of hands are
therefore crucial to preventing typhoid.
B. NURSING HISTORY
1. History of Present Illnesses
Last January 16, 2010 Baby Pops experience a fever with 39C consistent of 6
days and self medicated by his mother and given Paracetamol syrup p.o
without any consultation to the doctor. Then 6 days of fever the mother decided
to go to the hospital and having consultation, when they arrived to the hospital
and consulted by the doctor, the mother advised to admit Baby Pops.
2. Family History
-Hirshprung
-No disease
abnormality -Diabetes
-Hydrocephalus
-Lumbuscral
Myelomeningocele
3. Childhood Illnesses
According to the mother, Baby Pops had only a cough and colds and fever.
4. Hospitalization History
First Admission
When Baby pops was 9 months old and diagnosed Pneumonia at PPL San Pablo,
Laguna
Second Admission
When Baby Pops was 1 year old and 4months and admitted at the PGH Manila
December 11, 2008 Lumbuscral Myelomeningocele
December 24, 2008 Inserting VP Shunt
B. Rest
Usual no. of hours of sleep and rest at night/at day time: At night, Baby Pops
usually sleeps 10 hours and while in day time, he usually
sleeps at around 10:30am-1:30pm but sometimes, kit
depends on the environment.
No. of hours of sleep and rest to feel rested: Usually, Baby Pops sleeps 4 hours to
feel rested.
Change in sleep/rest pattern: Baby Pops doesn’t have any changes in sleeping, but
sometimes it depends on the situation.
Discomfort or difficulty going to sleep: He doesn’t have any discomfort going to
sleep but sometimes he get easily destructed when stranger
hold his IV line or touch him, because his mother and his
grandmother can only touch him.
Remedy done with the comfort: The only remedy done with this discomfort was
“yapos lang ng nanay ang gusto niya”, said by the mother.
No. pillows use when sleep: He had 4 pillows when sleeping; 1 for the head, 1 on
each side and a hotdog pillow to embrace.
C. Nutritional Metabolic Pattern
Food Preference: Baby Pops loves to eat rice and “bulanglang” a kind of mixed
vegetables, that popular in Bisaya.
Volume and type of fluid taken per day: He drinks 18oz of milk twice a day, with
“sabaw ng buko and mais”
Source of drinking water: The mother gets water for Baby Pops on a Wilkins
mineral water
Medication used (if any): At home, the mother gives multivitamins like Growee and
Propan TLC, for protection and for rapid growth.
D. Elimination Pattern
i. Bladder
Frequency and amount of urination per day: Baby Pops usually uses 2
(XL) diapers a day.
Color and odor of urine: He had light yellow color urine and with
aromatic odor which indicates of the normal findings.
Any discomfort of urination: The child also doesn’t have any complaints
in urination.
ii.Bowel
Frequency of bowel movement: Baby Pops usually defecate 1 or 2 times
a day.
Consistency and color of stools: Baby Pops had a soft stool and scanty
odor and slightly brownish color as alleged.
Changes in bowel elimination: After surgery, he had experienced bowel
movement difficulty.
F. Senses
There are no disturbances or difficulty aside from touch, he just got easily
destructed and disturbed when somebody holds or touch him.
G. Skin Integrity
Pigmentation: Baby Pops had fair skin pigmentation.
Temperature: He was cold to touch due to expose and direct air thru window.
Smooth (+) Rough (-) Soft (+) Dry (-)
H. Neurologic Function
Level of Consciousness: Baby Pops was conscious and coherent.
Orientation: Baby Pops easily becomes irritable when he sees stranger going close
to him.
Gait: Baby Pops had disturbances due to his plantar flexion of foot.
Posture: He had a plantar flexion of foot.
Changes in facial: He also had a downward deviation of the eye (sun setting).
B. PSYCHOLOGICAL DEVELOPMENT
INTERPERSON
PSYCHOSEXUAL PSYCHOSOCIAL COGNITIVE MORAL SPIRITUAL
AL
(Freud) (Erickson) (Piaget) (Kohlberg) (Fowler’s)
(Sullivan)
Anal: 18 mos.- Autonomy vs. Pre- Childhood: Level1: Pre- Stage 1:
3yrs. Old Shame and operational: 18 mos. – conventional Initiative-
Doubt: 18 2-4yrs. Old 6yrs old Stage 1: Age Projective
mos.- 3yrs. old 2-3 years old Faith:
Toddler/
Pre-
-pleasure is -Impulsitivity, school
through determination -no cause and -learn to delay -punishment
elimination or and compulsion effect need or obedience -No
retention of -curious to reasoning, gratification (heteronymous spiritual
feces everything that egocentrism; morality) concept
-behaviors: their body use of Baby Pops -a child does but
control of secretes symbols; doesn’t have the right involves
holding on and - significant magical control in his things because parents on
letting go. relation: Parents thinking defecation, a parent tells religion
-develop would have a him or her to and
concepts of Baby Pops is a 2 Baby Pops was hard time avoid spiritual
power, years old, he able to imitate developing his punishment. beliefs.
punishment, already have the different so called
ambivalence, authority to activities sense of Baby Pops Baby Pops
concern with command what demonstrated power as he knows how to already
cleanliness or he wants to do to him such as attempts to be an obedient knows how
being dirty. even it is throwing the control child to his to pray
dangerous. And ball, asking himself and mother. But and always
Baby Pops was he also wants to him to run his sometimes, go to
a 2years and 5 be beside of his after you, environment. the child church
months old mother. hides and This sense of learns not to every
child, he still seeks an power can follow the task Sunday
uses diaper, he example of also be used that given to with his
can already mental to please the him. And a parents
control his feces representation mother. He punishment but he
even his in the . also learns to will be given doesn’t
hospital. The interact with to him. know very
resolution of the the other child well about
patient was to play and the
Shame and build to have concept of
Doubt, due to friends. religion
anxiety with and
strangers. spiritual
beliefs that
his parents
taught to
him.
C. PHYSICAL EXAMINATION
Date performed: January 22, 2010 No. of hospital Days: 2 days
1. Vital signs :
a. Temperature: 36.4°C
2. Regional Examination:
Methods of Assessment
Regions of the body Results
(IPAP)
a. Hair Inspection Short, slightly oily hair
b. Head Oblong shape, open anterior
fontanel at the frontal area,
Inspection (+) VP Shunt tube located at
Palpation the right temporal, (-) mass,
(+) scar at least 1 inch at
the right occipital area.
c. Face Symmetrical, with slight
Inspection bulging at the top of head,
downward deviation of eyes.
d. Eyes Inspection “Sunsetting” eye, watery
color of the eye is black,
constricted, (eyes do not
follow in response to head
movement) can focus on
objects 7-8 inches away, can
follow up to midline,
Eyelids-fully cover eye when
close and partially raise
when open (blink reflex
present), placement in eye
socket-normally placed.
e. Nose Flat nose, smooth, (-)
Inspection
distress, (-) nasal flaring
f. Mouth and pharynx Lip color-normally pinkish,
open evenly when cry, soft
and hard palate intact,
tongue slightly heart shape,
Inspection
freely movable and does not
protrude, milk teeth present,
but upper teeth in front are
decayed.
g. Neck Symmetric, flexible and
movement of the head
Inspection equally to both sides,
supported by pillows when
eating, (+) lymph nodes
h. Chest wall Symmetric, clavicles
( Anterior) straight, (-) fractures, heart
Inspection rate heard at the mid
Auscultation clavicular space at fourth
intercostal space (103bpm),
(-)murmur
i. Chest wall (Posterior) (-) fracture, spine is aligned,
(-) murmur. At the midline
Inspection
of lumbar area (+) scar 1 ½
Auscultation
inch long due to lumboscral
myelomeningocele
j. Breast and Axilla Nipple are prominent, well
Inspection formed and symmetrical
place
k. Heart 103bpm, apical pulse and
Auscultation respiratory rate identified,
normal rhythm
l. Abdomen (-)kidney and spleen
Inspection enlargement, (+)
Auscultation burborgymi sounds (18p/m),
globular, , (-) masses
m. Skin and nails Inspection Skin- (-)dry, (+) smooth
Nails- short nails with some
dirt at the “singit” inside
nails
n. Anus and Rectum (+)patent anus, (-)rashes,
Inspection (-)hemorrhoids
BM- 1x
o. Extremities (lower) Rating: 5 normal, there is an
*include ROM and active resistance with simple
muscle strength motion
Inspection
-equal in length, five
Palpation
fingers on each feet, but the
both foot is in plantar flexion
(equinus)
p. Extremities (upper) Rating: 5 normal, there is an
*include ROM and Inspection active resistance with simple
muscle strength Palpation motion, complete fingers on
both hands
q. Urinary Color- light yellow
Transparency- turbid
Specific Gravity- 1.005
Reaction- acid
Albumin- ++
Sugar- negative
Inspection Pus Cell- TNTC
RBC- 2-4hpf
Bacteria- +
Epithelial Cell- few
Crystals- Amorphous
Urates(+)
Void- 2 diapers per day
r. Genitals Inspection (-) hernia
s. Musculoskeletal - (-) weakness, equal size on
both side of the body,
smooth and coordinated
movements
Inspection - (+) equinus (plantar
flexion of foot)
- no tenderness, swelling of
joints
- (+) gait problems
t. Hematology Based on laboratory Refer to Lab results
If applicable please include Neuromuscular Vital signs / assessment
A. LABORATORY EXAMINATION
Purpose of Nursing
the responsibiliti
Date and Results of
examinatio Normal es
Type of the Interpretation
n to the Values (before,
Examination examination
patient’s during ,
case after)
1-22-10 -to detect Color: Color: light All of the results Before:
• Check
Urinalysis normal yellow- yellow in the urinalysis
the
versus straw/amber that are chart of
the pt.
abnormal significant is the
And
urine Transparen Transparenc presence of pus carried
out
component cy: clear y: turbid cells
doctor’s
-to detect order
During:
glycosuria Specific Specific The urine of the
• Explain
-to aid in the Gravity: Gravity: patient was the
procedu
diagnosis of 1.010-1.020 1.005 diluted due to
re to
a renal less specific the pt.
And its
failure gravity
importa
Reaction: Reaction: nce.
• Assist
4.5-8.0 acidic
client
with the
urine
Albumin: Albumin: CSF was
collectio
Negative ++ composed of n as
needed
protein
• Obtain
Sugar: Sugar: history
of
Negative Negative
excess
amount
of
Pus Cell: Pus Cell:
certain
3-4 too numerous foods
such as
to count
carrots,
rhubarb
After:
RBC: 1-2 RBC: 2-4
• Provide
Comfort
to the
Bacteria: Bacteria: Due the VP shunt
pt. After
Negative Positive the patient have the
procedu
re.
• Wait for
Epithelial Epithelial
the
Cells: Cells: few
result
Negative
– Pls. re-insert IV
– Pls. give chloramphenicol
8:00 am IV drip for 15 units – Carried out
– Refer
– IVF TF #2 D5IMB 500ml x
1-23-10 8 hours
– Continue meds
– TF #3 D5IMB 500ml x 8
1-24-10 hours – Carried
out
– Continue meds
– Pls. re-insert IV now
– Warm compress on IV
1-25-10 sites – Carried
out
– IVF TF #4 D5IMB 500 x 8
hours
– Continue meds
1-26-10 – Refer
– Carried
– IVF TF #5 D5IMB 500 x 8 out
hours
– Continue meds
1-27-10 – Refer
Precipitating Factors:
Predisposing Factor: •Environment
•Age: 2years and 5 months old •Street Foods
(contaminated)
•Sex: Male
•Unboiled water
•Genes
Salmonella Typhi
Enters bloodstream
via lymphatics
(peyer’s patch)
Multiply in lamina
propia
Systemic Local
spread Infection
B. Tabular FEVER
Signs and
Signs and
Definition of the Symptoms Evaluation or
Symptoms found in
diseases manifested by the comparison
the book
patient
Typhoid Fever
A general infection Signs and Signs and These means that the
caused by Symptoms in book: Symptoms in signs and symptoms in
Salmonella typhi, a ✔ Fever patient: the book about typhoid
gram negative ✔ Anorexi ✔ fever (6 fever are seen to the
motile and a days) patient.
nonspore- forming ✔ Diaphor ✔ anorexia
bacillus. It is a esis ✔ constipati
general infection ✔ Weakne on
that primarily ss ✔ cough
involves the Peyer’s ✔ Myalgia
patches of the small ✔ Malaise
intestines ✔ Moist
crackles
Second week:
✔ 104F,
evening chills
✔ Delirium
✔ Increasin
g abdominal
pain
✔ Diarrhea
or constipation
✔ Maculopa
pular rash
✔ cough
A. DRUG STUDY
Name of Drug,
Classification, Nursing Responsibility
Drug Indication Drug Action
Route, Frequency (before, during , after)
and Dosage
Chloramphenicol ✔ Haemophil Inhibits bacterial ✔ Use cautiously
(anti-infective) lus influenzae protein synthesis in patient with
R: TIV ✔ Meningitis by binding to the impaired hepatic or
F: q6 hours ✔ Acute 50 sub-unit of the renal function,
D: 300mg Salmonella ribosome; acute intermittent
typhi infection bacteriostatic phorphyria and
✔ Bacteremi G6PD deficiency;
a also use cautiously
✔ Other with other drugs
severe that cause bone
infections marrow suppression
caused by or blood disorders
sensitive ✔ Obtain specimen
Salmonella for culture and
species sensitivity test
before giving first
dose. Therapy may
begin pending
results.
✔ Obtain plasma
levels maintain
levels at 5-20
mcg/ml
✔ Monitor CBC,
platelets, iron and
reticulocytes before
and every 2 days
during this therapy.
Stop immediately if
anemia occurred.
Name of Drug,
Classification, Nursing Responsibility
Drug Indication Drug Action
Route, Frequency (before, during , after)
and Dosage
Paracetamol ✔ Mild Thought to produce ✔ Use liquid
(analgesics) pain or fever analgesia by form for children
(antipyretics) blocking pain and patients who
R: p.o impulses by have difficulty
F: q4 hours PRN inhibiting synthesis swallowing.
D: 4ml of prostaglandin in ✔ In children,
the CNS or of other don’t exceed five
substances that doses in 24 hours.
sensitize pain ✔ Tell parents
receptors to to consult
stimulation. The prescriber before
drug may relieve giving drug to
fever through children younger
central action in the than age 2.
hypothalamic heat- ✔ Advise
regulating center. parents that drug
is only for short-
term use; urge
them to consult
prescriber if giving
to children for
longer than 5 days
or adults for longer
than 5 days or
adults for longer
than 10 days.
Name of Drug,
Classification, Nursing Responsibility
Drug Indication Drug Action
Route, Frequency (before, during , after)
and Dosage
Cefixime ✔ Uncomplicated Cefixime binds to ✔ Check if the
(anti-infective) UTI caused by one or more of the patient is allergy
R: p.o E. coli and penicillin-binding to cephalosporins
F: BID proteus proteins (PBPs) ✔ Use cautiously
D: 2ml mirabilis which inhibits the in patient with
✔ Otitis media final impaired hepatic
caused by transpeptidation or renal function,
Haemophillus step of acute intermittent
influenzae peptidoglycan phorphyria and
synthesis in bacterial G6PD deficiency;
cell wall, thus also use cautiously
inhibiting with other drugs
biosynthesis and that cause bone
arresting cell wall marrow
assembly resulting suppression or
in bacterial cell blood disorders
death. ✔ Obtain
specimen for
culture and
sensitivity test
before giving first
dose. Therapy may
begin pending
results.
✔ Obtain plasma
levels maintain
levels at 5-20
mcg/ml
✔ Monitor CBC,
platelets, iron and
reticulocytes
before and every 2
days during this
therapy. Stop
immediately if
anemia occurred.
Date
NO. Nursing Diagnosis Nursing Competencies
Identified
Cues Nursing
(subjective/objecti Nursing Diagnosis Objectives Intervention Evaluation
ve) and Rationale
– Instructe
d proper
hygiene
for
cleanlines
s of the
patient to
avoid
spread of
infection
– Provide
quiet and
calm
environm
ent to
promote
relaxatio
n
Cues Nursing
Nursing
(subjective/objectiv Objectives Intervention Evaluation
Diagnosis
e) and Rationale
– Restlessness the
– irritability conditio
n of the
patient
– Discuss
related
factors
about
the
present
disease
– Encoura
ge them
to read
some
books
about
the
disease
and
causativ
e agent
Cues Nursing
Nursing
(subjective/objectiv Objectives Intervention Evaluation
Diagnosis
e) and Rationale
– Provide
physical
contact
to the
patient
as well
as being
truthful
to
soothe
fears.
Cues Nursing
Nursing
(subjective/objectiv Objectives Intervention Evaluation
Diagnosis
e) and Rationale
–
N
ot
es
of
i
m
p
or
ta
nc
e
of
cl
ea
n
a
n
d
sa
fe
fo
o
ds
- pictures
needed for
demonstration
such as pillows,
things that
could harm your
child (e.g. knife,
holder and pins)
A. SUMMARY OF CLIENTS STATUS OR CONDITION AS OF LAST DAY OF CONTACT
Date: January 23, 2010
The condition of the Baby Pops on the last day of duty in the Pedia ward had no signs of
distress, afebrile and cooperative. He still afraid of strangers especially when touching
him. Baby Pops was still under observation and possible for MGH the next day.