STI COLLEGE SOUTHWOODS

Lot 2A Maduya, Carmona, Cavite

COLLEGE OF HEALTH CARE

T/C Typhoid Fever; Post VP

Shunt 2 Hydrocephalus and
2° Meningocele 2008

Presented By:
Capistrano, Reggie
Foroneas, Karen
Nono, Ma. Franine Alyssa
Sobrevega, Reysie

BSN 3rd year Level-Group 3

Presented To:
Herald Clarence Ambayec, R.N

March 18, 2010

Division of Labor
 Part of the Case Study_ Person to Discuss

A.Introduction = Marcus Dale Belisario

B.Biographical Data = Marcus Dale Belisario

C.Nursing History = Marcus Dale Belisario

D.Current Health Status = Reggie Capistrano

E.Psychological Development = Reysie Sobrevega

F.Physical Examination = Ma. Franine Alyssa Nono

G.Laboratory Examination = Karen Foroneas

H.Medical Plan of Care = Karen Foroneas

I. Anatomy and Physiology = Reggie Capistrano

J. Pathophysiology = Marcus Dale Belisario

K.Drug Study = Ma. Franine Alyssa Nono

L.Nursing Care Plan = Karen Foroneas

M.Discharge Plan of Care = Reysie Sobrevega

= Reysie Sobrevega/
Reggie Capistrano

O.Summary of Clients Status as of Last Day Contact = Reysie Sobrevega

INTRODUCTION:
Typhoid fever, also known as enteric fever, bilious fever, Yellow Jack or commonly just
typhoid, is an illness caused by the bacterium Salmonella enterica serovar Typhi. Common
worldwide, it is transmitted by the ingestion of food or water contaminated with feces from an
infected person. The bacteria then perforate through the intestinal wall and are phagocytes by
macrophages. Salmonella Typhi then alters its structure to resist destruction and allow them
to exist within the macrophage. This renders them resistant to damage by PMN's,
complement and the immune response. The organism is then spread via the lymphatic while
inside the macrophages. This gives them access to the Reticulo-Endothelial System and then
to the different organs throughout the body. The organism is a Gram-negative short bacillus
that is motile due to its peritrichous flagella. The bacterium grows best at 37 °C/99 °F –
human body temperature.

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.

Typhoid fever is characterized by a sustained fever as high as 40 °C (104 °F), profuse

sweating, gastroenteritis, and non-bloody diarrhea. Less commonly a rash of flat, rose-
colored spots may appear.

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.

In the third week of typhoid fever a number of complications can occur:

• Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very
serious but is usually non-fatal.

• Intestinal perforation in distal ileum: this is a very serious complication and is

frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse
peritonitis sets in.

• Encephalitis

• Metastatic abscesses, cholecystitis, endocarditis and osteitis

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.

STI COLLEGE SOUTHWOODS

Lot 2A Maduya, Carmona, Cavite

COLLEGE OF HEALTH CARE

PATIENT’S HISTORY
A. Biographical Data
Name: Baby Pops
Age: 2 years old and 5 months Gender: Male Status:
Pedia
Address: San Pablo City, Laguna
Dialect/Language Spoken: Tagalog and English
Chief Complaint: On and off fever x 6 days with poor oral intake
Admitting Diagnosis: T/C Typhoid Fever; Post VP Shunt 2 Hydrocephalus, 2
Meningocele

B. NURSING HISTORY
1. History of Present Illnesses
Last January 16, 2010 Baby Pops experience a fever with 39C 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

Male: Female: Patient:

-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

A. CURRENT HEALTH STATUS

A. Activity
Frequency and regularity of exercise: Baby Pops always wants to bend, to crawl
and to play basketball with his dad.
Duration and Length of Exercise: “Malimit” o “Maya’t maya” is how his mother
describes the duration of his exercise. While if his playing
basketball, he plays at least 2 hours
Limitation of Activity: Baby Pops mother limited him to walk and to play with
relatives especially his cousins, causing him to be tease.
Any Complaints and Discomfort: Baby Pops doesn’t have any discomfort or
complaints related to the activity.

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.

E. Fluids and Electrolytes

Skin turgor: Baby Pops was found to have a normal skin turgor when pinched,
within 1-2 seconds skin returns to normal prior to the
assessment.
Condition of mucous membrane: Baby Pops mucous membrane was good with
some mild pinkish mucous membrane.
Edema: There were no evident edemas observed on the pt. face and on the lower
and upper extremities.
K, Ca, Na, and supplementation: The present fluid supplement upon assessment
was D5IMB solution.

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).

Role Function Mode

Type of family structure: Their family structure was extended.
How many members in the family: They were composed of 5 family members.
Who is the bread winner: The present breadwinner in their family was the father and
the grandmother.
Who is the decision maker: Also, when it comes to decision making it was the father
and the grandmother, who decides in their family.
How does the family feel about the illness: The family feels sad but very supportive,
when it comes to Baby Pops’ hospitalization.

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

b. Pulse Rate: 103bpm

c. Respiratory Rate: 25cpm

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

Crystals: Crystals: Due to his

Negative amorphous hydrocephalus
and the VP Shunt
Urates:
Negative

Hematology – t HGB- (110- HGB- (94.6

o 165 g/L) g/L)
check
the HCT- (0.35- HCT- (0.26 Due to the
blood 0.50 g/L) g/L) decrease
comp pressure in his
onent Platelet Platelet VP Shunt
for count- count- (226
any (150-450 x x 10 g/L)
abnor 10 g/L)
Before:
malit WBC- (12.0 An increase in
•Check for
y WBC- (5.0- x 10 g/L) WBC which
CBC order
– t 10.0 x 10 signifies a
•Carry Out
o g/L) current infection
Doctors
chec
Order
k the Differential Differential
During
volu count- count-
•Explain the
me Segmenter Segmenters
procedure
of s- (43.0- - (60.7%)
to the pt.
RBC’ 76%)
and what
s in
is to be
the Lymphocyt Lymphocyte
withdrawn
bloo es- (17- s- (32.7%)
from the
d 48%)
blood.
•Assess
Leukocytes Leukocytes-
client for
- (4.0- (6.6%)
 10.0%) signs/symp
toms of
allergies
TYPHIDOT IgM: IgM: Positive Implication for such as
Negative the presence of tearing,
IgM antibodies runny nose
IgG: IgG: includes previous and rashes
Negative Negative infection or After
relapsed or re- •Wait for
infection, the result
therefore; it is
important that
interpretation be Before:
made together •Check for
with the clinical CBC order
symptoms to •Carry Out
diagnosed if the Doctors
patient is Order
To currently having During
determine typhoid fever. •Explain the
the procedure
presence of to the pt.
Salmonella and what
typhi which is to be
is the withdrawn
causative from the
agent of blood.
typhoid After
fever •Wait for
the result
 A. MEDICAL PLAN OF CARE
Date of the Responsibility of the Purpose of the
Doctor’s order
order nurse with the order given order

1-21-10 – pls. admit to Pedia ward - for admission

(Misc) under Dr. Mamasig
– Secure Consent - Ask if the Doctor had - for legal purposes
already inform her and
had signed the consent
– TPR q shift and recorded - Monitor V/S every 4 -as baseline data
hours
– Soft diet - Inform the mother the – To
proper diet for the know the
patient proper
– Labs: nutrition for
•CBC with platelet – Executes the patient
as per Doctor’s – To
•U/A order further know
– Refer to the other
Medical complication
Technologists s to the
disease
- To assess for any
abnormalities within
the urinary system
•Typhi dot as well as for
systemic problems
that may manifest
– Tx symptoms through
•D5 0.3 NaCl the urinary tract.
500ml x 55ugtts/min – Executes -To detect Typhoid
•Chloramphenicol as per Doctor’s fever and any other
300mg TIV order salmonella
•(-) ANST every 6 – Carried infection.
hours out
•Paracetamol
125/5ml every 4
hours p.o
– TSB inform PROD of the
1-22-10 admission

– 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

– IVF TF #6 D5IMB 500 x 8 – Carried

hours out
1-28-10 – Continue meds

– IVF TF #7 D5IMB 500 x 8

hours
– To consume IV – Carried
chloramphenicol; shift to out
cefixime 20mg/ml 2x a - executes as per
day Doctor’s order
– Refer
– Carried
out
- executes as per
Doctor’s order
A. ANATOMY AND PHYSIOLOGY

The Digestive Process:

The start of the process - the mouth:
The digestive process begins in the mouth. Food is partly broken down by the process
of chewing and by the chemical action of salivary enzymes (these enzymes are produced
by the salivary glands and break down starches into smaller molecules).
On the way to the stomach: the esophagus
After being chewed and swallowed, the food enters the esophagus. The esophagus is a
long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle
movements (called peristalsis) to force food from the throat into the stomach. This muscle
movement gives us the ability to eat or drink even when we're upside-down.
In the stomach
The stomach is a large, sack-like organ that churns the food and bathes it in a very
strong acid (gastric acid). Food in the stomach that is partly digested and mixed with
stomach acids is called chyme.
In the small intestine
After being in the stomach, food enters the duodenum, the first part of the small
intestine. It then enters the jejunum and then the ileum (the final part of the small
intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder),
pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small
intestine help in the breakdown of food.
In the large intestine
After passing through the small intestine, food passes into the large intestine. In
the large intestine, some of the water and electrolytes (chemicals like sodium) are
removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus
acidophilus, Escherichia coli, and Klebsiella) in the large intestine help in the digestion
process. The first part of the large intestine is called the cecum (the appendix is connected
to the cecum). Food then travels upward in the ascending colon. The food travels across
the abdomen in the transverse colon, goes back down the other side of the body in the
descending colon, and then through the sigmoid colon.
The end of the process
Solid waste is then stored in the rectum until it is excreted via the anus.
Digestive System Glossary:
Anus - the opening at the end of the digestive system from which feces (waste) exits
the body.
Appendix – a small sac located on the cecum.
Ascending colon - the part of the large intestine that run upwards; it is located after
the cecum.
Bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and
secreted into the small intestine.
Cecum - the first part of the large intestine; the appendix is connected to the cecum.
Chyme - food in the stomach that is partly digested and mixed with stomach acids.
Chyme goes on to the small intestine for further digestion.
Descending colon - the part of the large intestine that run downwards after the
transverse colon and before the sigmoid colon.
Duodenum - the first part of the small intestine; it is C-shaped and runs from the
stomach to the jejunum.
Epiglottis - the flap at the back of the tongue that keeps chewed food from going
down the windpipe to the lungs. When you swallow, the epiglottis automatically closes.
When you breathe, the epiglottis opens so that air can go in and out of the windpipe.
Esophagus - the long tube between the mouth and the stomach. It uses rhythmic
muscle movements (called peristalsis) to force food from the throat into the stomach.
Gallbladder - a small, sac-like organ located by the duodenum. It stores and releases
bile (a digestive chemical which is produced in the liver) into the small intestine.
Ileum - the last part of the small intestine before the large intestine begins.
Jejunum - the long, coiled mid-section of the small intestine; it is between the
duodenum and the ileum.
Liver - a large organ located above and in front of the stomach. It filters toxins from
the blood, and makes bile (which breaks down fats) and some blood proteins.
Mouth - the first part of the digestive system, where food enters the body. Chewing
and salivary enzymes in the mouth are the beginning of the digestive process
(breaking down the food).
Pancreas - an enzyme-producing gland located below the stomach and above the
intestines. Enzymes from the pancreas help in the digestion of carbohydrates, fats and
proteins in the small intestine.
Peristalsis - rhythmic muscle movements that force food in the esophagus from the
throat into the stomach. Peristalsis is involuntary - you cannot control it. It is also
what allows you to eat and drink while upside-down.
Rectum - the lower part of the large intestine, where feces are stored before they are
excreted.
Salivary glands - glands located in the mouth that produce saliva. Saliva contains
enzymes that break down carbohydrates (starch) into smaller molecules.
Sigmoid colon - the part of the large intestine between the descending colon and the
rectum.
Stomach - a sack-like, muscular organ that is attached to the esophagus. Both
chemical and mechanical digestion takes place in the stomach. When food enters the
stomach, it is churned in a bath of acids and enzymes.
Transverse colon - the part of the large intestine that runs horizontally across the
abdomen.
B. PATHOPHYSIOLOGY
A. Diagram

Precipitating Factors:
Predisposing Factor: •Environment
•Age: 2years and 5 months old •Street Foods
(contaminated)
•Sex: Male
•Unboiled water
•Genes

Salmonella Typhi

Enter the G.I tract

(jejunum, ileum,
colon)

Enters bloodstream
via lymphatics
(peyer’s patch)

Penetrate cell with

little lysis

Multiply in lamina
propia

Systemic Local
spread Infection

Release of endogenous pyrogens (prostaglandin

E1) from neutrophils and macrophages
(specialized form of leukocytes)
 Resetting the thermostatic set
point (prostaglandin E2)

The hypothalamus initiates heat

production behaviors (shivering and
vasoconstriction)

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:
✔ 104F,
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
the CNS or of other
substances that
sensitize pain
receptors to
stimulation. The
drug may relieve
fever through
central action in the
hypothalamic heat-
regulating center.
✔ In children,
don’t exceed five
doses in 24 hours.
✔ Tell parents
to consult
prescriber before
giving drug to
children younger
than age 2.
✔ Advise
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.

Nursing Prioritization and Competencies

Date
NO. Nursing Diagnosis Nursing Competencies
Identified

1 Ineffective Gastrointestinal Tissue Communication Jan.22,201

Perfusion r/t normactive bowel Health Teaching 0
 sounds as manifested by burborgymi Safe and Quality Nursing
sounds (18p/m) Care
Ethico-Moral Responsibility
Communication
Impaired physical mobility r/t loss of Health Teaching
Jan.22,201
2 integrity of bone structure as Safe and Quality Nursing
0
manifested by plantar flexion of foot. Care
Ethico-Moral Responsibility
Knowledge Deficient r/t typhoid fever Communication
as evidenced by unfamiliarity to the Health Teaching Jan.22,201
3
causative factor of the disease Safe and Quality Nursing 0
Care
Communication
Health Teaching
Severe anxiety r/t unfamiliar person Jan.22,201
4 Safe and Quality Nursing
as evidenced by crying 0
Care
Ethico-Moral Responsibility
Communication
Risk for infection r/t open anterior
Health Teaching
fontanel as manifested by scratching Jan.22,201
5 Safe and Quality Nursing
of the head 0
Care
Ethico-Moral Responsibility

A. NURSING CARE PLAN

Cues Nursing
Nursing
(subjective/objectiv Objectives Intervention Evaluation
Diagnosis
e) and Rationale

S: Ineffective After 4 hours - V/S monitored Goal is met.

“Malimit siya maging Gastrointestinal of nursing and checked for After 4 hours
tampulan ng tukso ng Tissue intervention baseline data of nursing
mga pinsa niya” as Perfusion r/t the patient - Determine intervention
verbalized by the normactive will be able to whether the patient
patient’s mother bowel sounds decreased condition is will be able to
as manifested burborgymi permanent or decreased
O: by burborgymi sounds from temporary to burborgymi
– (+) burborgymi sounds 18p/m to enhance sounds from
sounds (18p/m) acceptance 18p/m to
(18p/m) - Establish a
– Body malaise patient-nurse
– Brownish color relationship to
of stool convey an
attitude of
caring and
develop sense
of trust
- Auscultate
bowel sounds to
determine
problems in
abdomen
Encourage rest
after meals to
enhance
digestion

Cues Nursing
(subjective/objecti Nursing Diagnosis Objectives Intervention Evaluation
ve) and Rationale

S: Impaired physical After 5 – V/S Goal is met.

“ Malaro siya kaso mobility r/t loss of hours of taken After 5 hours
hindi talaga siya integrity of bone nursing and of nursing
pinapayagan na structure as intervention recorded intervention
makipaglaro dahil manifested by the patient for the patient
madali siya mainis at plantar flexion of will able to baseline was able to
sumungin” as foot. demonstrate data. demonstrate,
verbalized by the , – Provided participation
patient’s mother participation safety in activities,
in activities and command by
O: command by security his mother or
– limited ROM his mother for the relatives.
– difficulty of or relatives. safety of
turning side to the child
side – Encourag
– (+) plantar ed
flexion of foot participat
– Difficulty to ion is self
move care; to
encourag
e self
concept
and
sense of
independ
ence
– Encourag
ed
adequate
intake of
fluids and
nutritious
food; to
promote
well-
being and
maximize
energy
productio
n

– 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

S: – Knowledge After 2 hours – V/S Goal is

“ Hindi namin alam Deficient r/t of nursing taken partially met.
kung paano siya typhoid intervention and After 2 hours
nilagnat ng mataas” fever as the patient will recorde of nursing
as verbalized by the evidenced be able to d for intervention
patient’s mother by understand the baseline the patient

unfamiliarit related factors data. will be able to

O: y to the about the – Explain understand

– Unfamiliarity to causative present illness to the the related

the causative factor of relative factors about

factor of the the disease of the present

disease patient illness

– 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

S: Severe anxiety r/t After 4 hours – V/S Goal is met.

“Madali siya matakot unfamiliar person of nursing monitor After 4 hours
sa mga taong as evidenced by intervention ed and of nursing
ngayonlang niya crying the patient will recorde intervention
nakita” as verbalized be able to d as the patient
by the patient’s mother develop sense baseline will be able to
of trust. data develop sense
O: – Provide of trust.
– crying adequat
– (+) stranger e rest to
anxiety promote
– With poor eye relaxati
contact on
– With extraneous – Build a
movement trusting
– (+) facial relation
grimace ship
 with the
patient
to
promote
rapport.
– Encoura
ge
patient
to play
to
promote
therape
utic
empath
y to the
patient

– 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

S: Risk for infection After 4 hours – monitor Goal is met.

“ Lagi niya gusto r/t open anterior of nursing V/S After 4 hours
kamutin yung nasa ulo fontanel as intervention every 4 of nursing
niya’ as verbalized by manifested by the pt will able hours as intervention
the patient’s scratching of the to know what baseline the pt was able
grandmother head are the data to know what
 intervention to – soft diet the
O: prevent the instruct intervention to
– afebrile risk of ed to prevent the
– irritability infection. avoid risk of infection
– restlessness restraini is.
– (+) open ng and
anterior easily to
fontanel swallow
– Scar on the – monitor
right side of the ed IVF
head and IV
– Scratching of rates
the head – kept
back
dry to
prevent
occurre
nce of
other
disease
– kept
environ
ment
well
ventilat
ed
– emphasi
zed
hygiene
– provide
safety
and
security
such as
 don’t
leave
the child
unatten
 ded
 put
pillows
each
side of
the bed
– monitor
I/O to
prevent
reoccurr
ence of
other
disease
– Health
teaching
instruct
ed such
as;
 Hygiene
measur
es
 Safety
measur
es ( tell
patient
not to
scratch
site of
VP
shunt)
to
prevent
risk of
infection
 Diet
instruct
ed
 A. DISCHARGE PLAN OF CARE
Key Area Plan of Care
1. Nutrition Continue advice of soft diet as prescribed by the physician,
encourage patient to eat nutritious food, and avoid street foods
to avoid possible of having typhoid fever.
2. Activity Encourage patient or instruct mother of daily exercise, avoid
sleeping late hours, prevents activity that causes trauma or
injury
3. Self Care / knowledge on Instructed hygienic measures (e.g. proper hand washing, before
treatments and after eating and urinate and defecate, as well as proper
grooming)
4. Medication Advise to continue medication as prescribed by the doctor.
5. Follow up check ups To comeback as prescribed by the doctor. Have a daily
consultation to neuro and physical therapist for the VP Shunt
and for plantar flexion of foot.

B. HEALTH TEACHING PLAN

Methods of
Topic Objective Visual aids Evaluation
Teaching
1. Choosing Right After 30 mins of Discussion – After 30 mins of
Foods discussion the Explanation S discussion the
mother of the pt. a mother of the pt.
will be able to m was able to know
know the pl the importance
importance and e and
understanding, Pr understanding,
choosing foods oc choosing foods
to eat e to eat
d
2. Importance After 30 mins of ur After 30 mins of
of clean and discussion the Discussion es discussion the
safe foods mother of the pt. Explanation mother of the pt.
for the will able to know will able to know
family the importance the importance
of clean and safe of clean and safe
foods for the foods for the
family family
3. Proper Boiling After 30 mins of –
of Water discussion the Discussion P After 30 mins of
relative of the Explanation ict discussion the
pt. will be able ur relative of the pt.
to know the e was able to know
proper boiling of of the proper
water to kill the n boiling of water
microorganism ut to kill the
in the water. rit microorganism in
io the water.
4. Safety and After 1 hour of Demonstration us
Security of nursing care and Explanation fo After 1 hour of
Child health teaching o nursing care and
the mother of ds health teaching
the pt. will able – the mother of
to know the L the pt. was able
safety measures ist to know the
needed by the of safety measures
child ri needed by the
g child
ht
a
n
d
af
fo
rd
a
bl
e
fo
o
ds

–
 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.