ANGELES UNIVERSITY FOUNDATION Angeles City COLLEGE OF NURSING

In Partial Fulfillment of the requirements in Related Learning Experience III

CASE STUDY:

TYPHOID FEVER

Submitted by: DEANG, KATHLEEN DIANNE A. DEL ROSARIO, EDWIN RYAN S. HAMPAL, SARABJIT IBAY, KRISTINE CAROL BSN III 10 GROUP 40

Submitted to: MARY ANNE YALUNG, R.N.

TABLE OF CONTENTS

I. INTRODUCTION II. NURSING ASSESSMENT A. Personal Data B. Pertinent Family History C. Personal History

3 4 5 6 9

D. History of Past Illness E. History of Present Illness

F. Physical Examination 10 G. Diagnostic and Laboratory Procedures III. ANATOMY AND PHYSIOLOGY IV. THE PATIENT ILLNESS Synthesis of the Disease V. THE PATIENT AND HIS CARE A. Medical Management IVFs Drugs Diet ... 39 ... 48 ... 53 37 14

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Activity/Exercise Nursing Care Plan SOAPIE

B. Nursing Management ... 54 ... 67 69

VI. CLIENTS DAILY PROGRESS IN THE HOSPITAL Clients Daily Progress Chart Discharge Planning

74 75

VII. CONCLUSION AND RECOMMENDATION

VIII. BIBLIOGRAPHY

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I. INTRODUCTION

Throughout history, nursing has been redefined countless times and has evolved into the profession it stands today. Over 100 years ago, Florence Nightingale defined nursing as the act of utilizing the environment of the patient to assist him in his recovery. Decades later, in the 1980s, it was redefined by the American Nurses Association (ANA) as the diagnosis and treatment of human responses to actual or potential health problem (Kozier et al, 2004) Typhoid fever is a life-threatening illness caused by the bacterium Salmonella typhi. In the United States about 400 cases occur each year, and 75% of these are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year (Coordinating Center for Infectious Diseases, 2005). New research carried out by researchers in Nepal has shown that a new and affordable drug, Gatifloxacin, may be more effective at treating typhoid fever than the drug currently recommended by the World Health Organization. The study, funded by the Wellcome Trust, has implications for the treatment of typhoid particularly in areas where drug resistance is a major problem. Enteric fever, of which typhoid fever is the most common form, is a major disease affecting the developing world, where sanitary conditions remain poor. The best global estimates are of at least 22 million cases of typhoid fever each year with 200,000 deaths. Drug resistance is becoming a major problem and treatment is becoming increasingly difficult, leading to patients taking longer to recover, suffering more complications and continuing to spread the disease to their family and to their community. Clinical investigators based at Patan Hospital Lalitpur in Kathmandu, Nepal, and the Oxford University Clinical Research Unit in Vietnam have completed a study to see if they can improve the treatment for patients with typhoid fever. Kathmandu has been

termed the typhoid fever capital of the world as a result of this disease remaining so common. The results of the study show that a cost-effective new fluoroquinolone drug, Gatifloxacin, may be a better treatment for enteric fever than Cefixime, which is currently recommended by the World Health Organization. In addition, Salmonella enterica typhi and Salmonella enterica serovar Paratyhpi A, the two most common bacteria to cause enteric fever, do not show resistance to Gatifloxacin, unlike for other fluoroquinolones. The group decided to choose this case for the study due to very common and accounts for a high percentage of hospital admissions in the Philippines, especially in young children under the age of 5 and below. Such a problem will continue to exist as long as poor environmental sanitation and living conditions are not improved. Proper nursing care management of this condition is important in order to alleviate suffering and hasten recovery of patients suffering from typhoid fever. Through the conducting of this case study, the student nurses aim to gain more knowledge regarding the nature of typhoid fever, its etiology, signs and symptoms, nursing interventions for proper management, and preventive measures which they may be able to share with their patients and SOs in order to minimize the occurrence of this disease. The patients names as well as his familys names were changed in order to ensure anonymity and confidentiality. II. NURSING ASSESSMENT 1. PERSONAL DATA Girlalu is a 25 year old female diagnosed with suppurative acute

tonsillopharygitis born on June 7, 1986. She was baptized as a Roman Catholic. She is a natural born pure-blooded Filipino who was born in Tarlac City. She and her parents

currently reside in Villa Aglipay, San Jose Tarlac. She was admitted on December 31, 2011 and discharged on January 2, 2012. Girlalu is a call center agent. She works five times a week from 11pm to 8am. She is a smoker and consumes not less than 10 sticks of cigarette per day and drinks beer occasionally.

4. HISTORY OF PAST ILLNESS Baby TF had a history of primary complex during her first year of life. Mommy Typho failed to recall what medications were given and the exact diagnosis given by the physician to her daughter. Nonetheless, she was able to recover. She seldom experience flu, cough and cold. 5. HISTORY OF PRESENT ILLNESS Few hours prior to admission, Baby TF had positive high grade fever (intermittent type), cold, cough, chills, hyperactive bowel sounds and negative rash. Due to persistence of above symptoms Mommy and Daddy Typho together with Baby Typho prompted to seek consultation, hence admitted.

6. PHYSICAL EXAMINATION (IPPA Cephalocaudal-Approach) July 23, 2007 (MONDAY): Vital Signs

Temperature: 36.1C Pulse Rate: 95 Respiration Rate: 21 Integumentary Has good skin turgor, light brown complexion, with good capillary refill time of less than 3 seconds. Hair Has long black hair, evenly distributed. Head Proportional to body size, no depressions noted. Eyes Round in shape, dark brown pupil, equally reactive to light and accommodation. Nose No discharges noted. Mouth Lips are pink, smooth in texture, moist, can purse lips. Without lesions in the mouth and halitosis. Gums are pink.

Neck Exhibit coordinated movements with no discomforts. Can flex, hyperextend, rotate the neck. Lymph nodes not palpable. Heart

No heaves nor murmurs. Chest Symmetric chest, skin and chest wall intact with no tenderness and masses. Has full and symmetric chest expansion. Breathing pattern is quiet, rhythmic and effortless respiration. Abdomen Contour is rounded, with symmetric movement. Extremities No nodules are present and as well as edema on both extremities. With scars on upper and lower extremities. July 24, 2007 (TUESDAY): Vital Signs Temperature: 37C Pulse Rate: 100 Respiration Rate: 29 Integumentary Has good skin turgor, light brown complexion, with good capillary refill time of less than 3 seconds.

Hair Has long black hair, evenly distributed. Head Proportional to body size, no depressions noted.

Eyes Round in shape, dark brown pupil, equally reactive to light and accommodation. Nose No discharges noted. Mouth Lips are pink, smooth in texture, moist, can purse lips. Without lesions in the mouth and halitosis. Gums are pink. Neck Exhibit coordinated movements with no discomforts. Can flex, hyperextend, rotate the neck. Lymph nodes not palpable. Heart No heaves nor murmurs. Chest Symmetric chest, skin and chest wall intact with no tenderness and masses. Has full and symmetric chest expansion. Breathing pattern is quiet, rhythmic and effortless respiration. Abdomen Contour is rounded, with symmetric movement. Extremities No nodules are present and as well as edema on both extremities. With scars on upper and lower extremities.

7. DIAGNOSTIC AND LABORATOTY PROCEDURES DIAGNOSTIC/ LABORATORY PROCEDURES *DATE ORDERED **DATE RESULT(S) IN HEMATOLOGY INDICATION(S) OR PURPOSE(S) RESULTS NORMAL VALUES (UNITS IN THE HOSPITAL) ANALYSIS AND INTERPRETATION OR RESULTS

> Hemoglobin (Hgb)

*July 22, 2007 **July 23, 2007

To measure O2 carrying capacity of the blood. To evaluate the effectiveness of blood transfusion. To monitor the Hgb level.

13.6 gms%

12-16 gms%

Normal There is no sign of anemia.

> Hematocrit (Hct)

*July 22, 2007 **July 23, 2007

To measure formed elements against plasma. To evaluate the 10

40%

36-46%

Normal There is no sign of anemia.

effectiveness of blood transfusion. To monitor the hematocrit. > WBC count *July 22, 2007 **July 23, 2007 To detect infection, neoplasm, allergy or immunosuppression. To evaluate effectiveness of antibiotics prescribed. > Lymphocytes *July 22, 2007 **July 23, 2007 To detect if there is viral infection. To monitor lymphocyte level. > Platelet Count *July 22, 2007 **July 23, 2007 To determine the amount of cells responsible for clotting. 260,000 cumm 150-400,000 cumm There is no thrombocytosis. There is viral infection. Normal 40% 25-35% Increased WBC is increased indicates presence of infection 10,900/cumm 5-10,000/cumm Increased

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To monitor platelet count.

Nursing Responsibilities: Before: After: Apply pressure to the puncture site. DATE ORDERED DATE RESULT(S) IN INDICATION(S) OR PURPOSE(S) RESULTS NORMAL VALUES (UNITS IN THE HOSPITAL) URINALYSIS *July 22, 2007 **July 23, 2007 This was done to the patient as a screening for 12 Transparency: slight turbid Transparency: transparent Slight turbidity is the result of the presence of ANALYSIS AND INTERPRETATION OR RESULTS Explain the procedure to the patient. Tell the patient that no fasting is required. Collect approximately 5 to 7 ml of venous blood in a lavender-top tube. Avoid hemolysis. List on the laboratory slip any drugs that may affect test results.

During:

DIAGNOSTIC/ LABORATORY PROCEDURES

abnormalities within the urinary system as well as for system problems that may manifest through the urinary tract. Sp. Gravity: 1.015 Specific gravity: 1.010-1.030 Color: yellow Color: colorless dark yellow

bacteria. Normal in color. Suggests no signs of dilution or concentration of urine. Specific gravity is within borderline limit. pH: 7.5 (-)protein and sugar RBC: 1-2/hpf Pus cells 2-3/hpf Epithelial cells: 2+ Mucus threads: 1+ Phosphates/PO4: pH: 4.6 8.0 (-)glucose, proteins, ketones, leukocytes, Hgb, bilirubin, RBC, nitrites Suggest a disruption of gastric mucosa. pH level is at borderline limit. Normal findings. Client is not hypoglycemic.

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few Nursing Responsibilities: Before: Explain the procedure to the SO. Provide the patient with a sterile specimen container. Instruct SO to clean genitals of patient before voiding because the specimen should be free from any contamination. Instruct the SO to obtain urine sample at 3 to 4 ounces. Inform the SO that mid-catch first voided urine is preferred to collect the correct urine that is free from contamination. During: After: Record data. The specimen should be sent to the laboratory within 1 hour after collection or if the specimen cannot be processed immediately, refrigerate it. If a 24 hour urine collection is requested the specimen should be refrigerated or preserved within formalin during the collection time.

DIAGNOSTIC/

DATE ORDERED

INDICATION(S)

RESULTS

NORMAL

ANALYSIS AND

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LABORATORY PROCEDURES

DATE RESULT(S) IN

OR PURPOSE(S)

VALUES (UNITS IN THE HOSPITAL)

INTERPRETATION OR RESULTS

FECALYSIS

*July 22, 2007 **July 23, 2007

To evaluate the digestive efficiency and the integrity of stomach and intestines. To evaluate therapeutic regimen prescribed.

Consistency: soft

Consistency: Soft and well-formed consistency

Consistency and color of the stool are normal but there is an ascaris lumbricoids found in the result.

Color: brown

Color: brown

Ascaris Lumbricoids: 35/lpf

No Ascaris Lumbriocoids

Nursing Responsibilities: Before: After: 15 Explain the procedure to the SO. Provide the patient with a sterile specimen container. Assist patient during the procedure. Provide privacy. Instruct SO to obtain moderate amount of fecal matter.

During:

The specimen should be sent to the laboratory immediately within 1 hour. Record results DATE ORDERED DATE RESULT(S) IN INDICATION(S) OR PURPOSE(S) RESULTS NORMAL VALUES (UNITS IN THE HOSPITAL) ANALYSIS AND INTERPRETATION OR RESULTS

DIAGNOSTIC/ LABORATORY PROCEDURES

PROTHROMBIN TIME (PRO-TIME)

*July 22, 2007 **July 23, 2007

It is used to determine the clotting tendency of blood, in the measure of warfarin dosage, liver damage and vitamin K status.

14 sec. Control: 13 sec. %Activity: 92.8% Patient ratio: 1.07 INR: 1.2

11-14 sec

The time of blood clotting or prothrombin time is within the normal range.

Nursing Responsibilities: Before: Explain the procedure in language the patient understands, use concrete terms and avoid using medical terms. Make sure the patient understands the exact body part to be involved and that the procedure will be limited to that area.

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 After:

Stress the benefits of the procedure and anything that the patient may find pleasurable afterwards, such as feeling better or going home. Wrap an elastic band around the upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein. Clean the needle site with alcohol. Put the needle into the vein. More than one needle stick may be needed. Attach a tube to the needle to fill it with blood. Remove the band from the arm when enough blood is collected. Put a gauze pad or cotton ball over the needle site as the needle is removed. Put pressure to the site and then a bandage. Record the result. DATE ORDERED DATE RESULT(S) IN Th PTT *July 22, 2007 **July 23, 2007 e doctor may order this test if you have 39 sec. Control: 38 sec. 28 45 sec. The result of the test is normal; it takes 39 seconds INDICATION(S) OR PURPOSE(S) RESULTS NORMAL VALUES (UNITS IN THE HOSPITAL) ANALYSIS AND INTERPRETATION OR RESULTS

During:

DIAGNOSTIC/ LABORATORY PROCEDURES

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problems with bleeding or blood clotting. The test may also be used to monitor patients who are taking heparin, a blood thinner. A PTT test is usually done with other tests, such as the prothrombin test. Nursing Responsibilities: Before: Explain the procedure to the client and the SO.

for the blood to clot. Baby TF does not have any bleeding any clothing problem.

The health care provider may tell you to stop taking certain drugs before the test. Drugs that can affect the results of a PTT test include antihistamines, vitamin C (ascorbic acid), aspirin, and chlorpromazine (Thorazine). Tell the client that they will use needle to collect blood from one the veins of client.

During: The blood collects into an air-tight container.

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After: The client shall be given bandage to stop any bleeding. DATE ORDERED DATE RESULT(S) IN INDICATION(S) OR PURPOSE(S) RESULTS NORMAL VALUES (UNITS IN THE HOSPITAL) WIDAL TEST *July 22, 2007 **July 23, 2007 The Widal test is a serological test for Salmonella typhi. It is a demonstration of salmonella antibodies against antigens Osomatic and Hflagellar in the blood. It is used to ascertain the presence of typhoid fever. However, it is not 19 Typhoid O.: 1:160 Typhoid H.: 1:40 Paratyphoid A.: 1:40 Paratyphoid B.: 1:40 < / = 1:40 Baby TF is positive of having Salmonella typhi. ANALYSIS AND INTERPRETATION OR RESULTS

DIAGNOSTIC/ LABORATORY PROCEDURES

a very accurate method, since patients are often exposed to other bacteria (e.g. Salmonella enteritidis, Salmonella typhimurium) in this species that induce crossreactivity; many people have antibodies against these enteric. Nursing Responsibilities: Before: Explain the procedure to the SO. A single Widal test in an endemic area is of no diagnostic value. It should not be used as a screening test in asymptomatic individuals.

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A "negative" Widal test rule out the diagnosis of typhoid fever in patients with signs and symptoms of the disease since a "negative" Widal test may be seen early in the course of illness.

During: After: The specimen should be sent to the laboratory immediately within 1 hour. The Widal test should not also be used as the basis for deciding the duration of antimicrobial therapy. Record results. A "negative" Widal test rule out the diagnosis of typhoid fever in patients with signs and symptoms of the disease since a "negative" Widal test may be seen early in the course of illness. The Widal test should not also be used as the basis for deciding the duration of antimicrobial therapy. Record results. DATE ORDERED DATE RESULT(S) IN INDICATION(S) OR PURPOSE(S) RESULTS NORMAL VALUES (UNITS IN THE HOSPITAL) TYPHIDOT *July 22, 2007 **July 23, 2007 To determine the presence of typhoid fever through the IgG IgG: (+) IgM: (-) IgG: (-) IgM: (-) Baby TF had a relapsed or reinfection of previous infection. ANALYSIS AND INTERPRETATION OR RESULTS Assist patient during the procedure. Provide privacy.

DIAGNOSTIC/ LABORATORY PROCEDURES

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and IgM antibodies. IgM positive: Acute typhoid fever IgM & IgG positive: Acute typhoid fever (in the middle stage of infection) IgG positive: Implications for the presence of IgG antibodies include relapse or reinfection or previous infection (in which

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case current fever may not be due to typhoid). Nursing Responsibilities: Before: After: Explain and tell the client about the result of the test. Check the doctors order. Explain the procedure to the client and the SO. Tell the client that they will use needle to collect specimen. Provide client with a clean culture for the specimen. Provide client with comfort measures after the collection of specimen.

During:

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III. ANATOMY AND PHYSIOLOGY

Introduction Digestion is the process by which food is broken down into smaller pieces so that the body can use them to build and nourish cells and to provide energy. Digestion involves the mixing of food, its movement through the digestive tract (also known as the alimentary canal), and the chemical breakdown of larger molecules into smaller molecules. Every piece of food we eat has to be broken down into smaller nutrients that the body can absorb, which is why it takes hours to fully digest food. 24

The digestive system is made up of the digestive tract. This consists of a long tube of organs that runs from the mouth to the anus and includes the esophagus, stomach, small intestine, and large intestine, together with the liver, gall bladder, and pancreas, which produce important secretions for digestion that drain into the small intestine. The digestive tract in an adult is about 30 feet long. Mouth and Salivary Glands Digestion begins in the mouth, where chemical and mechanical digestion occurs. Saliva or spit, produced by the salivary glands (located under the tongue and near the lower jaw), is released into the mouth. Saliva begins to break down the food, moistening it and making it easier to swallow. A digestive enzyme (called amylase) in the saliva begins to break down the carbohydrates (starches and sugars). One of the most important functions of the mouth is chewing. Chewing allows food to be mashed into a soft mass that is easier to swallow and digest later. Movements by the tongue and the mouth push the food to the back of the throat for it to be swallowed. A flexible flap called the epiglottis closes over the trachea (windpipe) to ensure that food enters the esophagus and not the windpipe to prevent choking. Esophagus Once food is swallowed, it enters the esophagus, a muscular tube that is about 10 inches long. The esophagus is located between the throat and the stomach. Muscular wavelike contractions known as peristalsis push the food down through the esophagus to the stomach. A muscular ring (called the cardiac sphincter) at the end of the esophagus allows food to enter the stomach, and, then, it squeezes shut to prevent food and fluid from going back up the esophagus.

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Stomach The stomach is a J-shaped organ that lies between the esophagus and the small intestine in the upper abdomen. The stomach has 3 main functions: to store the swallowed food and liquid; to mix up the food, liquid, and digestive juices produced by the stomach; and to slowly empty its contents into the small intestine. Only a few substances, such as water and alcohol, can be absorbed directly from the stomach. Any other food substances must undergo the digestive processes of the stomach. The stomachs strong muscular walls mix and churn the food with acids and enzymes (gastric juice), breaking it into smaller pieces. About 3 quarts of the gastric juice is produced by glands in the stomach every day. The food is processed into a semi-liquid form called chyme. About 4 hours or so after eating a meal, the chyme is slowly released a little at a time through the pyloric sphincter, a thickened muscular ring between the stomach and the first part of the small intestine called the duodenum. Small Intestine Most digestion and absorption of food occurs in the small intestine. The small intestine is a narrow, twisting tube that occupies most of the lower abdomen between the stomach and the beginning of the large intestine. It extends about 20 feet in length. The small intestine consists of 3 parts: the duodenum (the C-shaped part), the jejunum (the coiled midsection), and the ileum (the last section). The small intestine has 2 important functions. First, the digestive process is completed here by enzymes and other substances made by intestinal cells, the pancreas, and the liver. Glands in the intestine walls secrete enzymes that breakdown starches and sugars. The pancreas secretes enzymes into the small intestine that help breakdown carbohydrates, fats, and proteins. The liver produces bile, which is stored in the gallbladder. Bile helps to make fat molecules (which otherwise are not soluble in water) soluble, so they can be absorbed by the body. Second, the small intestine

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absorbs the nutrients from the digestive process. The inner wall of the small intestine is covered by millions of tiny fingerlike projections called villi. The villi are covered with even tinier projections called microvilli. The combination of villi and microvilli increase the surface area of the small intestine greatly, allowing absorption of nutrients to occur. Undigested material travels next to the large intestine. Large Intestine The large intestine forms an upside down U over the coiled small intestine. It begins at the lower right-hand side of the body and ends on the lower left-hand side. The large intestine is about 5-6 feet long. It has 3 parts: the cecum, the colon, and the rectum. The cecum is a pouch at the beginning of the large intestine. This area allows food to pass from the small intestine to the large intestine. The colon is where fluids and salts are absorbed and extends from the cecum to the rectum. The last part of the large intestine is the rectum, which is where feces (waste material) is stored before leaving the body through the anus. The main job of the large intestine is to remove water and salts (electrolytes) from the undigested material and to form solid waste that can be excreted. Bacteria in the large intestine help to break down the undigested materials. The remaining contents of the large intestine are moved toward the rectum, where feces are stored until they leave the body through the anus as a bowel movement. Liver The center of metabolic activity in the body - its major role in the digestive process is to provide bile salts to the small intestine, which are critical for digestion and absorption of fats.

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Pancreas Important roles as both an endocrine and exocrine organ - provides a potent

mixture of digestive enzymes to the small intestine which are critical for digestion of fats, carbohydrates and protein.

IV. THE PATIENT ILLNESS SYNTHESIS OF THE DISEASE: 1. DEFINITION OF THE DISEASE Typhoid fever is a severe infection caused by a bacterium, Salmonella typhi. S. typhi is in the same family of bacteria as the type spread by chicken and eggs, commonly known as "salmonella poisoning," or food poisoning. S. typhi bacteria do not have vomiting and diarrhea as the most prominent symptoms of their presence in humans. Instead, persistently high fever is the hallmark of S. typhi infection. S. typhi bacteria are passed into the stool and urine of infected patients. They may continue to be present in the stool of asymptomatic carriers, who are persons who have recovered from the symptoms of the disease but continue to carry the bacteria. This carrier state occurs in about 3% of all individuals recovered from typhoid fever. Typhoid fever is passed from person to person through poor hygiene, such as incomplete or no hand washing after using the toilet. Persons who are carriers of the disease and who handle food can be the source of epidemic spread of typhoid.

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Pathophysiology (Client Centered) Non- Modifiable (Predisposing Factor) Age (children) Modifiable (Precipitating Factor) Poor Environmental Sanitation Contaminated Food/water

SALMONELLA TYPHOSA/TYPHI Contaminated food/water, feces, fingers, fomites and flies Increase motility of intestines Microorganisms attach and enter mature enterocytes at the tips of small intestinal villi serotonin release

hyperactive bowel sounds

Structural changes to the small bowel mucosa and inflammation of the lamina propria Bacteria invades blood stream across lamina propria Bacteria releases endotoxin INCREASE WBC (July 23, 2007)

Diarrhea (July 22, 2007)

Releases pyrogens that stimulates hypothalamus FEVER and CHILLS (July 22, 2007) Inhibition of Na & water reabsorption DIARRHEA (July 22, 2007)

Increase amount of diarrheal Fluid Active Secretion of Chloride & Bicarbonate Ions

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2. PREDISPOSING/PRECIPITATING FACTORS Poor Environmental Sanitation the conduciveness of the environment could trigger the growth of the bacteria. Even cross-contamination may occur if food handling is done unhygenicaly, for this may be a breeding ground for the causative agent. (DOH) Age children are more prone to this disease particularly toddlers, because they dont have knowledge in acquiring diseases. In addition, they have a less developed immunity for as they are still in their growing years. (DOH) 3. SIGNS AND SYMPTOMS a. Headache sustained muscle contractions directly deform pain receptors. b. Fever an abnormal rise in the body temperature. It rises because of the invasion of infectious organisms, which include the bloods disease-fighting white cells to release pyrogen. c. Chills is a sensation of cold accompanied by shivering. d. Diarrhea symptom of an underlying disorder which may been caused by stress, dietary indiscretion, flu, or food poisoning. e. Fatigue is the temporary loss of power to respond induced in a sensory receptor or motor end organ by continued stimulation. f. Weakness is an indefinite feeling of debility or lack of health often indicative of or accompanying the onset of an illness. g. Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly. INCLUDEPICTURE MERGEFORMATINET "http://www.healthline.com/images/clear.gif" \*

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4. HEALTH PROMOTION AND PREVENTIVE ASPECTS OF THE DISEASE Educate the public regarding the importance of hand washing. Provide suitable hand washing facilities; this is particularly important for food handlers and attendants involved in the care of patients and children. Disposal of human feces in a sanitary manner and maintain fly proof latrines. Stress use of sufficient toilet paper to minimize finger contamination. Under field conditions, dispose of feces by burial at a site distant and downstream from the source of drinking water. Protect, purify and chlorinate public water supplies, provide safe private supplies, and avoid possible back flow connections between water and sewer systems. For individual and small group protection, and while traveling or in the field, treat water chemically or by boiling. Control flies by screening, spraying with insecticides and use of insecticidal baits and traps. Control fly breeding by frequent collection and disposal of garbage, and fly control measures in latrine construction and maintenance. Use scrupulous cleanliness in food preparation and handling; refrigerate as appropriate. Particular attention should be directed to the proper storage of salads and other foods served cold. These provisions apply equally to home and public eating places. If uncertain about sanitary practices, select foods that are cooked and served hot, and fruits peeled by the consumer. Pasteurize or boil all milk and dairy products. Supervise the sanitary aspects of commercial milk production, storage and delivery. Enforce suitable quality-control procedures in industries that prepare food and drink for human consumption. Use chlorinated water for cooling during canned food processing. Limit the collection and marketing of shellfish to supplies from approved sources. Boil or steam (for at least 10 minutes) before serving.

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Instruct patients, convalescents and carriers in personal hygiene. Emphasize handwashing as a routine practice after defecation and before preparing and serving food.

Encourage breast feeding throughout infancy; boil all milk and water used for infant feeding. Exclude typhoid carriers from handling food and from providing patient care. Identify and supervise typhoid carriers; culture of sewage may help in locating carriers. Chronic carriers should not be released from supervision and restriction of occupation until local or state regulations are met, often not until 3 consecutive negative cultures are obtained from authenticated fecal (and urine in schistosomiasis endemic areas) specimens taken at least 1 month apart and at least 48 hours after antimicrobial therapy has stopped. Fresh stool specimens are preferred to rectal swabs; at least 1 of the 3 consecutive negative stool specimens should be obtained by purging.

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V. THE PATIENT AND HIS CARE A. MEDICAL MANAGEMENT: a. IVFs MEDICAL MANAGEMENT/ TREATMENT *DATE ORDERED **DATE PERFORMED ***DATE CHANGED/ D/C D5 0.3NaCl 500cc x 60 ugtts/min. *July 22, 2007 **July 22 - 26, 2007 A hypertonic solution owing to the higher than normal amount of Na and Cl ions. Normal saline less 154 mEq of both Na and Cl without other plasma electrolytes. The 5% dextrose spares body protein and 0.3 NaCl promotes diuresis, corrects moderate fliud loss, prevents alkalosis provides calorie and NaCl. Baby TF felt pain upon insertion of the needle, but she was able to tolerate it. The medication worked as intended. There was no undesirable effect. GENERAL DESCRIPTION INDICATION(S)/ PURPOSE(S) CLIENTS RESPONSE TO THE TREATMENT

Nursing Responsibilities:

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Before: After: Check the IV infusion for infiltration, pain or phlebitis and other complications of IV therapy. In administering and starting the IV line of the patient always starts with identifying the patient and explaining the procedure to the SO to gain their trust. Prepare the equipment. Cleanse the fluid to be given, make sure it is the same with the prescribed fluid. Drip the tubing before connecting it in the needle once being infused. Adjust the fluid as ordered by the physician. If there is any question with the flow rate ordered, check with the physician who gave the order. During:

b. DRUGS

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NAME OF DRUG

*DATE ORDERED **DATE GIVEN ***DATE CHANGED/ D/C

ROUTE OF ADMIN./ DOSAGEAND FREQUENCY OF ADMINISTRATION

GENERAL ACTION/ FUNCTIONAL CLASSIFICATION / MECHANISM OF ACTION

INDICATION(S)/ PURPOSE(S)

CLIENTS RESPONSE TO THE MEDICATION WITH ACTUAL SIDE EFFECTS

Chloramphenicol

*July 22, 2007 **July 22 - 26, 2007

475mg IV q 6hrs. ANST ( - )

ANTIBIOTIC Treatment or prevention of bacterial infection.

It is used in the treatment of infections caused by bacteria. It works by killing bacteria or preventing their growth.

The bacterial growth was prevented and killed. Baby TFs condition had improved.

Nursing Responsibilities: Before: After: Instruct S.O to report changes in the patients condition. 35 Explain the purpose of the medication. Administer recommended doses to prevent gray baby syndrome (infants), hypotension and cyanosis. During:

Properly discard the drug if it is no longer needed or expired. Encourage the S.O for regular blood tests of the patient to check levels of the blood components. *DATE ORDERED **DATE GIVEN ***DATE CHANGED/ D/C ROUTE OF ADMIN./ DOSAGEAND FREQUENCY OF ADMINISTRATION GENERAL ACTION/ FUNCTIONAL CLASSIFICATION/ MECHANISM OF ACTION INDICATION(S)/ PURPOSE(S) CLIENTS RESPONSE TO THE MEDICATION WITH ACTUAL SIDE EFFECTS It provides temporary ANTIPYRETIC Symptomatic relief of pain and fever. analgesia for mild to moderate pain. In addition, acetaminophen lowers body temperature in individuals with fever. Baby TFs temperature decreased from 39 C to 36.1 C

NAME OF DRUG

Paracetamol

*July 22, 2007 **July 22 - 26, 2007

200mg IV q 4hrs. RTC

ANALGESIC

Nursing Responsibilities: Before:

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 After:

Identify indications for therapy and expected outcomes Document presence for fever Do not administer Paracetamol more than 10 days for adults it increases anti coagulant activity. Document date and time.

During:

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NAME OF DRUG

*DATE ORDERED **DATE GIVEN ***DATE CHANGED/ D/C

ROUTE OF ADMIN./ DOSAGEAND FREQUENCY OF ADMINISTRATION

GENERAL ACTION/ FUNCTIONAL CLASSIFICATION / MECHANISM OF ACTION

INDICATION(S)/ PURPOSE(S)

CLIENTS RESPONSE TO THE MEDICATION WITH ACTUAL SIDE EFFECTS

Ranitidine

*July 22, 2007 **July 22 - 26, 2007

20mg IV q 8hrs

ANTI-ULCER AGENT Inhibits the action of histamine at H2 receptor site located primarily in the gastric parietal cells, resulting in inhibition of gastric acid secretion

Short term of active duodenal ulcer and benign gastric ulcers. Prophylaxis of duodenal ulcers (at lower doses). Treatment and prevention of heartburn, acid indigestion and sour stomach.

The abdominal pain has decreased and development of ulcers was prevented.

Nursing Responsibilities:

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Before: After: May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known. Inform patient that increased fluid and fiber intake and exercise may minimize constipation. Advise to report onset of black, tarry stool; fever, sore throat, diarrhea, dizziness, rash, confusion or hallucination. Document date and time. Assess for epigastric of abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. May cause false-positive results for urine protein; test with sulfosalicyclic acid. Prepare the medication.

During:

NAME OF DRUG

*DATE ORDERED **DATE GIVEN

ROUTE OF ADMIN./ DOSAGEAND

GENERAL ACTION/ FUNCTIONAL

INDICATION(S)/ PURPOSE(S)

CLIENTS RESPONSE TO THE

39

***DATE CHANGED/ D/C Diphenhydramin e HCl Syrup *July 24, 2007 **July 24 - 26, 2007

FREQUENCY OF ADMINISTRATION

CLASSIFICATION / MECHANISM OF ACTION

MEDICATION WITH ACTUAL SIDE EFFECTS Relief of allergic symptoms caused by histamine release including: Anaphylaxis, Seasonal and perennial allergic rhinitis, Allergic dermatoses. Parkinsons disease and dystonic reactions from medications. Mild nighttime sedation. Prevention of Diphenhydramine worked as intended. There was no other undesirable effect.

7ml TID x 3days

Decreased symptoms of histamine excess (sneezing, rhinorrhea, nasal and ocular pruritus, ocular tearing and redness, urticaria). Relief of acute dystonic reactions. Prevention of motion sickness. Suppression of cough.

40

motion sickness. Antitussive (syrup only).

Nursing Responsibilities: Before: Determine why the medication was ordered and assess symptoms that apply to the individual patient. Prevention and Treatment of Anaphylaxis: Assess for urticaria and for patency of airway. Allergic Rhinitis: Assess degree of nasal stuffiness, rhinorrhea, and sneezing. Parkinsonism and Extrapyramidal Reactions: Assess movement disorder before and after administration. Insomnia: Assess sleep patterns. Motion Sickness: Assess nausea, vomiting, bowel sounds, and abdominal pain. Pruritis: Asses degree of itching, skin rash, and inflammation. Do not confuse Benadryl (diphenhydramine) with Benylin (dextromethorphan). When used for insomnia, administer 20 min before bedtime and schedule activities to minimize interruption of sleep. When used for prophylaxis of motion sickness, administer at least 30 min and preferably 1-2 hr. before exposure to conditions that may precipitate motion sickness. 41

During:

Instruct patient to take medication as directed; do not exceed recommended amount. Caution patient not to use oral OTC diphenhyramine products with any other product containing diphenhydramine, including products used topically.

After:

Can cause excitation in children. Caution parents/caregiver about proper dose of calculation; overdosage, esp. in infants and children, can cause hallucinations, seizures and death. Inform patient that this drug may cause dry mouth. Frequent oral rinses, good oral hygiene, and sugarless gum or candy may minimize the effect Parkinsonism and Extrapyramidal Reactions: Assess movement disorder before and after administration. Cough Suppressant: Assess frequency and nature of cough, lung sounds, and amount and type of sputum produced. Unless contraindicated, maintain fluid intake of 1500-2000 ml daily to decrease viscosity of bronchial secretions.

Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions. Caution patient to avoid use of alcohol and other CNS depressants concurrently with this medication.

42

NAME OF DRUG

*DATE ORDERED **DATE GIVEN ***DATE CHANGED/ D/C

ROUTE OF ADMIN./ DOSAGEAND FREQUENCY OF ADMINISTRATION

GENERAL ACTION/ FUNCTIONAL CLASSIFICATION / MECHANISM OF ACTION

INDICATION(S)/ PURPOSE(S)

CLIENTS RESPONSE TO THE MEDICATION WITH ACTUAL SIDE EFFECTS

Gelminthic Syrup

*July 24, 2007 **after 3 days of Diphenhydramine

10ml HS x 3 doses

ANTI HELMINTHICS

Single or mixed infestation by threadworm, pinworm, roundworm & hookworm.

** Unknown

Nursing Responsibilities: Before: After: Instruct patient to take medication exactly as directed and to continue medication for full course of therapy. May cause dizziness. Caution patient to avoid driving or activities requiring alertness until response to medication is known. 43 Check the drug before giving. Prepare the medication. During:

Advise patient to consult health care professional if no improvement is seen within a few days. Document date and time.

c. DIET TYPES OF DIET *DATE ORDERED **DATE STARTED ***DATE CHANGED GENERAL DESCRIPTION INDICATION(S)/ PURPOSE(S) SPECIFIC CLIENTS OR REACTION TO DIET NPO *July 22, 2007 **July 22, 2007 ***July 23, 2007 A patient care instruction by advising that the patient is prohibited from ingesting food, beverage or medicine. To empty stomach prior to diagnostic procedure or those who unable to tolerate food and fluids by mouth. None No untoward digestive effect occurred. FOODS TAKEN RESPONSE AND/

Nursing responsibilities: Check physicians order.

44

Instruct the SO not to give anything to the patient by mouth either liquid or solid. Tell the patient what is the purpose of not letting him or her to eat. *DATE ORDERED **DATE STARTED ***DATE CHANGED GENERAL DESCRIPTION INDICATION(S)/ PURPOSE(S) SPECIFIC CLIENTS OR REACTION TO DIET

TYPES OF DIET

FOODS TAKEN RESPONSE AND/

General Liquid Diet

*July 23, 2007 **July 23, 2007 ***July 23, 2007

A more liberal diet than clear liquid, the full liquid diet allows only foods in liquid form or those which readily become liquid at body temperature the diet, if planned carefully, may supply a good amount of essential nutrients.

It is indicated for Baby TF to reduce the workload of the digestive system.

Milk, Juice, Water

No untoward digestive effect occurred.

45

Nursing Responsibilities: Before: After: Allow client to wash his hands and face if needed. Evaluate whether the client had an appetite for the diet. Document how well the client tolerated the diet. Note any eating difficulties client exhibited. Assess the appropriateness of the ordered diet for clients needs Assess the clients needs for specialized utensils. Assess the clients ability to swallow. Plan and choose liquids that are good sources of protein, carbohydrates, fats, vitamins and minerals. Read labs of commercially prepared liquid foods. Use bended straw for convenience. Administer this diet in small frequent feedings. Avoid coffee, tea, alcoholic beverages and soda drinks. Wash your hands. Help the client wash his hands. Remove or move any unpleasant visual stimuli such as commodes, bedpans and urinals. Have the client sit on the side of the bed or in a chair.

** Teach the patient to:

During:

46

TYPES OF DIET

*DATE ORDERED **DATE STARTED ***DATE CHANGED

GENERAL DESCRIPTION

INDICATION(S)/ PURPOSE(S)

SPECIFIC

CLIENTS OR REACTION TO DIET

FOODS TAKEN RESPONSE AND/

Soft Diet

*July 23, 2007 **July 23, 2007

A diet that allows fruits and vegetables with low-cellulose content as well as fish and meat with no very little connective tissues. Proper food selection will provide both the persons nutrient needs together with the rest of the digestive systems needs.

It is indicated for Baby TF to reduce the workload of the digestive system and to provide more energy.

Lugaw, fruits (orange), bread

No untoward digestive effect occurred.

47

Nursing Responsibilities: Before: Assess the appropriateness of the ordered diet for clients needs Assess the clients needs for specialized utensils. Assess the clients ability to chew and swallow. Choose fruits low in cellulose content like banana and apple. Choose vegetables low in cellulose content like chayote, carrots, green papaya, upo, and squash preferably without skin and seeds. Choose fish and meat no tough connective tissues. Choose polished rice and white breath rather than whole grain cereals. Avoid foods that have caffeine, alcohol, and pepper. Avoid spicy foods like instant noodles, chips, spicy nuts, sauces, and fatty foods. They can cause discomfort and irritation. During: Wash your hands. Help the client wash his hands and face in preparation for eating. Remove or move any unpleasant visual stimuli such as commodes, bedpans and urinals. Have the client sit on the side of the bed or in a chair. Check to be sure that the food presented is in fact this clients food and corresponds to what the client ordered. Start the meal with a sip of cool beverage to lubricate the inside of the mouth.

Teach the patient to:

48

After: Encourage the client to keep his head up or continue to sit up for at least 15 minutes following the meal. Allow client to wash his hands and face if needed. Evaluate whether the client had an appetite for the meal. Document how well the client tolerated the meal. Note any eating difficulties client exhibited.

d. ACTIVITY/EXERCISE ** There was no prescribed activity or exercise for the patient.

B. NURSING MANAGEMENT 1. NURSING CARE PLAN Problem #1: Acute Pain

49

ASSESSMENT

NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION >Wh en typhi

OBJECTIVE

NURSING INTERVENTION > Establish

RATIONALE

EXPECTED OUTCOME

S> O> Grimace

> Acute pain

Salmonella Short Term: nursing

> To build trust and gain cooperation > To obtain baseline data and useful in evaluating verbal comments and effectiveness of interventions > Helpful in assessing need for intervention: may indicate developing

Short Term: After 4 hours of the shall been pain relieved. Long Term: After hours nursing intervention, the shall relax patient have and 24 of nursing patient have report is intervention,

is After 4 hours rapport infect intervention, the report pain is record vital sign, note non verbal cues (restlessness) Long Term: After 24 hours nursing intervention, the patient will > Investigate appear and relax report of pain. to able

ingested, it may of directly through

the gallbladder the patient will > Monitor and hepatic duct or relieved. spread to other areas body the bloodstream abdominal pain. of the through

that can lead to of

sleep and rest.

been appear able to sleep

50

complications > Provide a quiet environment and reduce stressful stimuli. > Place in position of comfort. > May decrease associated discomfort > Assist with/provide diversional activities, relaxation technique. Problem #2: Hyperthermia ASSESSMENT NURSING DIAGNOSIS SCIENTIFIC EXPLANATION OBJECTIVE NURSING INTERVENTION RATIONALE > Helps with pain management by redirecting attention. > Promotes rest

and rest.

EXPECTED OUTCOME

51

S> O> Elevated temperature of 39 oC

>Hyperthermia

> A fever occurs when the thermostat resets at a higher temperature, primarily in response to an infection. To reach the higher temperature, the body moves blood to the warmer interior, increases the metabolic rate, and induces shivering. The "chills" that often accompany a

Short nursing

Term: > Establish

> To build trust and gain cooperation > To obtain baseline data

Short nursing

Term:

After 4 hrs. of rapport intervention, the body will 37 oC. patients > Monitor and temp. record vital reduce signs
o

After 4 hrs. of intervention, the body shall patients temp. have

from 39 C to > Assess condition Long of the body will maintain within normal range 36.5C of > Assess vital to signs > Vital signs provide more Term: > Identification and management of underlying causes are essential to recovery nursing precipitating factor patients temp. be > To determine patients present status

been reduced from 39 oC to normal 37 oC. Long of the body shall Term: nursing patients temp. have

After 24 hours > Determine intervention,

After 24 hours intervention,

been maintain within normal range 36.5C of to

52

fever are caused by the movement of blood to the body's core, leaving the surface and extremities cold. Once the higher temperature is achieved, the shivering and chills stop. When the infection has been overcome or drugs such as aspirin or acetaminophen (Tylenol) have been taken, the

37.5C.

accurate identification of core temperature > Remove excess clothing > This decreases warmth and temperature > Perform TSB > To decrease temp. by means of nonpharmacologica l measure > Provide adequate rest > To conserve energy and avoid fatigue > Increase OFI > To replace liquid losses

37.5C.

53

thermostat resets to normal and the body's cooling mechanisms switch on: the blood moves to the surface and sweating occurs. > Administer anti-pyretic as ordered

and decreasing body temp. > To decrease temp. by means of pharmacologica l measure

Problem #3: Diarrhea ASSESSMENT NURSING DIAGNOSIS S> > Diarrhea r/t enteric O> Hyperactive infection. bowel sounds. SCIENTIFIC EXPLANATION > It may result Short Term: factors, including of nursing OBJECTIVE NURSING INTERVENTION > Establish > To build trust and gain cooperation RATIONALE EXPECTED OUTCOME Short Term: After 4 hours of nursing intervention,

from a variety of After 4 hours rapport intervention,

54

intestinal absorption disorders, increased secretion fluid by intestinal mucosa the and

the patient will > Monitor and verbalize understanding of the given. health > Obtain a fecal analysis of teachings record vital signs

> To obtain baseline data

the shall

patient have

been verbalize understanding > To identify the causative organism of given. Long Term: After 24 hours of the nursing patient have intervention, shall health teachings

hypermotility of Long Term: Diarrhea infectious as parasites. may of nursing

> Assess

> To prevent dehydration and electrolyte imbalance

intestines. After 24 hours hydration status

also result form intervention, the patient will > Encourage of increase OFI > Teach patients SO the importance of perianal hygiene after each bowel movement processes such decrease frequency defecation.

> To replace fluid loss > Hygiene controls perianal skin excoriation and minimizes risk of spread of

been decrease the frequency of defecation.

55

infectious diarrhea > Auscultate abdomen > To note presence, location, and characteristics of bowel sounds > Restrict solid food intake as indicated > To allow for bowel rest/ reduced intestinal workload > Provide for changes in dietary > To avoid foods/ substances that precipitate diarrhea

56

> Promote the use of relaxation technique > Give medications as ordered

> To decrease stress/ anxiety

> To treat infectious process, decrease gastric motility, and/ or absorb water

> Review causative factors and appropriate interventions > Review food preparation, emphasizing adequate

> To prevent recurrence

> To prevent bacterial growth/ contamination

57

cooking time and proper refrigeration/ storage Problem #4: Readiness for enhanced fluid balance ASSESSMENT NURSING DIAGNOSIS S> Umiinom na siya ngaun as verbalized by the SO. O> > Readiness for enhanced fluid balance. SCIENTIFIC EXPLANATION > The S.O is Short Term: willing to interventions at the of nursing S.O will > Monitor and record vital to signs fluid > To ensure accurate picture of fluid status Long Term: After 2 days of appropriately, being aware of insensible loses and hidden After 2 days of sources of OBJECTIVE NURSING INTERVENTION > Establish > To build trust and gain cooperation > To obtain baseline data RATIONALE EXPECTED OUTCOME Short Term: After 4 hours of nursing intervention, the S.O shall have behaviors monitor patient. been to fluid demonstrate

put After 4 hours rapport

into action and intervention, same the time, the patient demonstrate demonstrated willingness readiness balance evidenced intake. behaviors or monitor

for balance of the > Monitor I/O as as by

enhanced fluid patient.

balance of the

increasing fluid Long Term:

58

nursing intervention,

intake > To maximize intake and maintain fluid balance > Recommend restrictions of caffeine > Prevents untoward diuretic effect and possible dehydration > Instruct S.O how to measure and record I/O if needed for home management > Provides means of monitoring status and adjusting therapy to meet changing needs

nursing intervention, the shall patient have

the patient will > Encourage maintain volume fluid regular oral at a intake

been maintain fluid volume at a level indicated adequate urinary output. functional as by

functional level as indicated by adequate urinary output.

Problem #5: Self-care Deficit: Hygiene 59

ASSESSMENT

NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION >Salmone lla

OBJECTIVE

NURSING INTERVENTION > Establish

RATIONALE

EXPECTED OUTCOME

S> Hindi siya kamay pag kumakain as verbalized by the SO. O>

> Self-care weakness.

typhi are Short Term: nursing

> To build trust and gain cooperation > To obtain baseline data

Short Term: After 4 hrs of nursing intervention, the shall been self-care patient have perform

naghuhugas ng Deficit r/t to

spread contaminated water. Following ingestion, from

by After 4 hrs of rapport

food, drink, or intervention, the patient will > Monitor and perform self- record vital the care activities signs the own ability. > Promote S.O participation in problem identification and decision > Enhance commitment to plan optimizing outcomes

bacteria spread within level of intestine via the bloodstream to the lymph liver, blood they and this intestinal nodes, Long Term:

activities within level ability. Long Term: After 2 days of nursing of own

and After 2 days of making where intervention, can demonstrate lifestyle changes 60 .> Provide among those who are to involved in > Enhances coordination and continuity of care

spleen via the nursing multiply the patient will communication

intervention, the shall been demonstrate patient have

cause malaise.

meet self-care caring for the needs. client > Assess abilities and level of deficit > Aids in anticipating/ planning for meeting individual needs > Avoid doing that the patient can do for self, providing assistance as necessary > To maintain esteem and promote recovery

lifestyle changes needs. to meet self-care

things for patient pts self-

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2. SOAPIE July 23, 2007 (Monday) S> Nanghihina siya as verbalized by the SO. O> Received patient on bed conscious and coherent with IVF #2 D5 0.3NaCl 500cc x 60 micro gtts/min at 400cc level; vital signs of T: 36.2 C; P: 95 bpm; R: 21 bpm. A> Activity intolerance related to generalized weakness. P> After 4 hours of nursing intervention, the patient will demonstrate a decrease in physiologic signs of intolerance. I> Established rapport. > Monitored and recorded vital signs. > Planned care with rest period between activities. > Provided PM care. > Increased activity level gradually. > Provided comfort measures. > Encouraged strict compliance to treatment regimen. > Due meds given. > Needs attended. > Endorsed E> Goal met AEB increase in activity tolerance. July 24, 2007 (Tuesday) S> Malakas na siyang kumaen ngayon as verbalized the the SO. O> Received patient on bed conscious and coherent with IVF #3 D5 0.3NaCl 500cc x 60 micro gtts/min at ? level; vital signs of T: 36.2 C; P: 95 bpm; R: 21 bpm. A> Readiness for enhanced nutrition P> After 4 hours of nursing intervention, the patient will demonstrate behaviors on how to maintain appropriate weight. I> Established rapport.

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> Monitored and recorded vital signs. > Provided PM care. > Encouraged to increase OFI > Encouraged patients beneficial eating pattern. > Thought the importance of eating nutritious foods. > Enforced soft diet. > Implemented strict compliance to treatment regimen. > Needs attended. > Due meds given. > Endorsed E> Goal met AEB patients regular eating pattern.

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VI. CLIENTS DAILY PROGRESS IN THE HOSPITAL 1. CLIENTS DAILY PROGRESS CHART (From admission to discharge) DAYS NURSING PROBLEMS 1. Acute Pain 2. Hyperthermia 3. Diarrhea 4. Readiness for enhanced fluid balance 5. Self-care Deficit: Hygiene VITAL SIGNS (+) ADMISSION (JULY 22, 2007) TEMPERATURE PULSE RATE 39 oC 113bpm 36.1 oC 91bpm 36.8 oC 98bpm (+) JULY 23, 2007 (+) JULY 24, 2007 DISCHARGED (JULY 26, 2007) 36.1 oC 100bpm (+) (+) (+) (+) (+) (+) (+) ADMISSION (JULY 22, 2007) JULY 23, 2007 JULY 24, 2007 DISCHARGED (JULY 26, 2007)

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RESPIRATORY RATE LABORATORY PROCEDURES HEMATOLOGY Hemoglobin Hematocrit WBC Count Lymphocytes Platelet Count URINALYSIS

26bpm ADMISSION (JULY 22, 2007)

28bpm JULY 23, 2007

28bpm JULY 24, 2007

24bpm DISCHARGED (JULY 26, 2007)

13.6 gms% 40% 4,600/cumm 40% 260,000 cumm Transparency: slight turbid Color: yellow Sp. Gravity: 1.015 pH: 7.5 Protein & Sugar: (-) RBC: 1-2/hpf Pus cells: 2-3/hpf Epithelial cells: 2+ Mucus threads: 1+ Phosphates/PO4: few

65

FECALYSIS

Consistency: soft Color: brown Ascaris Lumbricoids: 3-5/lpf

PRO-TIME

14 sec. Control: 13 sec. %Activity: 92.8% Patient ratio: 1.07 INR: 1.2

PTT

39 sec. Control: 38 sec.

WIDAL TEST

Typhoid O.: 1:160 Typhoid H.: 1:40 Paratyphoid A.: 1:40 Paratyphoid B.: 1:40

TYPHIDOT MEDICAL

IgG: (+) IgM: (-)

66

MANAGEMENT IVF

ADMISSION (JULY 22, 2007)

JULY 23, 2007

JULY 24, 2007

DISCHARGED (JULY 26, 2007)

D5 0.3NaCl 500cc x 60 ugtts/min DRUGS

(+)

(+)

(+)

(+)

ADMISSION (JULY 22, 2007)

JULY 23, 2007

JULY 24, 2007

DISCHARGED (JULY 26, 2007)

CHLORAMPHENICOL PARACETAMOL RANITIDINE DIPHENHYDRAMINE HCI SYRUP GELMINTHIC SYRUP DIET

(+) (+) (+)

(+) (+) (+)

(+) (+) (+) (+)

(+) (+) (+) (+)

** After 3 days of ADMISSION (JULY 22, 2007) JULY 23, 2007 Diphenhydramine JULY 24, 2007 DISCHARGED (JULY 26, 2007)

67

NPO GENERAL LIQUID DIET SOFT DIET ACTIVITY/EXERCISE

(+) (+)

(+) ADMISSION (JULY 22, 2007) JULY 23, 2007

(+) JULY 24, 2007

(+) DISCHARGED (JULY 26, 2007)

** There was no prescribed activity or exercise for the patient.

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2. DISCHARGE PLANNING: a. GENERAL CONDITION OF CLIENT UPON DISCHARGE Prior to discharge of Baby TF, she had good appetite, formed stool and without abdominal pain. Due to the good condition of Baby TF, the physician ordered MGH (May Go Home). b. METHOD M: Home meds prescribed and instructed on right dosage and route. Chloramphenicol 475mg IV q 8 hours for 7 days Gelminthic Syrup 10ml HS x 3 doses after 3 days of Diphenhydramine E: T: H: Instructed to do active range of motion exercise. Continue treatment regimen. Encouraged frequent hand washing. Encouraged to avoid eating street foods. Encouraged to eat nutritious foods. Encouraged strict compliance to treatment regimen. O: D: Advise the patient to come back one week after for follow-up check-up. Enforced soft diet.

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VII. CONCLUSION AND RECOMMENDATION A patient having typhoid fever experiences stomachache and extreme pain in the abdominal region. There are many ways to acquire this condition. Many people actually dont have proper hygienic practices such as hand washing thats why they are prone gastrointestinal disorder and typhoid fever is one of them. It is very important also to eat clean and well prepared foods and also clean water because some diarrheal diseases that also causes typhoid fever starts with contaminated food and water. Many people love to eat street foods and they dont even realize how unclean these foods are. They are exposed to flies and smoke thats why if you eat these foods, you are likely to be infected with typhoid fever. We therefore conclude that typhoid fever is very common if you do not practice proper hygiene. It is very important to wash your hands first before and after eating, boil water before drinking and to teach the public to have proper hygienic practices. Hand washing is a very important and we must always practice it to prevent the occurrence of this disease. Proper disposal of excreta and garbage in a sanitary manner must also practice. By doing these, it will help to control the breeding of flies which can be a carrier of the disease. We recommend this case study not only to our fellow student nurses but also to our patients whom weve handled. It is applicable to the field of community health nursing where there are many cases occur.

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VIII. BIBLIOGRAPHY Books: Kozier et. al, 2004, Fundamentals of Nursing: Concepts, Process, and Practice 7th Edition, Pearson Education South Asia PTE LTD. Readers Digest, Guide to Medical Cures and Treatmentss Lippincot Williams and Wilkins 2005, Nurses Quick Check: Diseases, A Wolters Kluwer Company, USA URL: http://www.answers.com/topic/typhoid-fever?cat=health http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm http://www.sciencedaily.com/releases/2007/06/070626211740.htm http://www2.merriam-webster.com/cgi-bin/mwmednlm http://www.doh.wa.gov/notify/guidelines/typhoid.htm http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp? requestURI=/healthatoz/Atoz/ency/fever.jsp http://www.nlm.nih.gov/medlineplus/ency/article/003653.htm

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