A CASE STUDY ON A PATIENT

WITH TYPHOID FEVER

INTRODUCTIION
{Poor health is not caused by something we
dont have ; its caused by disturbing something
that you already have. Healthy is not something
that you to get, its something you have already
if you disturb it.
~Dean Ornish

Health is an essential part of a

person, it is the fuel which gives every
individual the physical drive needed to
conquer a day. Without it no man can
survive, a deficiency in health impairs the
normal functioning of a person, it becomes
a hindrance. Health pertains to the
persons body systems as a whole, it is not
achieved if even only one body system is
impaired, a good heart with weak lung still
does not signal health, there should be
harmony and balance between the system
to achieve ultimate health.

TYPHOID FEVER
Typhoid fever, also known as a typhoid, is a common
worldwide illness, transmitted by the ingestion of
food or water contaminated with the feces of an
infected person, which contain the bacterium
salmonella typhi. The bacteria then perforate
through the intestinal wall and are phagocytosed by
macrophages. The organism is gram-negative short
bacillus that is motile due to its peritrichous flagella.
The bacterium grows best at 37`C/99`F human body
temperature. Typhoid fever remains a serious
disease especially difficult to treat in developing
countries. Salmonella typhi, the bacteria causing
typhoid fever, have become resistant to several
antibiotics increasing the difficulty of treating the
disease.
(http://knowledge-storage.com/medicine/37-medicine/109-typhoid-fever
)

In order to provide an updated assesment of the burden of

typhoid fever in Asia, the world health organization
conducted a population-based surveillance in 5 Asian
countries namely: china, India, Indonesia, Pakistan and
Vietnam. The age groups under surveillance were selected as
those judge by local officials to the most appropriate targets
for typhoid vaccination: 5-60year olds in Chinese site; and
school-aged children and adolescents(5-18years) in the
Vietnamese site. The statistics revealed the following:
A total of 441 435 persons in the targeted age groups were
under surveillance for one year, during which 21 874 fever
episodes lasting 3days were detected and 475 persons had
blood cultured-confirmed S.typhi. The over all incidence of
fever lasting 3days for the five sites combined was 49.6 per
1000 persons-years, ranging from 12.4 to 184.9 for the sites
in china and Pakistan, respectively. The incidence of typhoid
range from 15.3 cases per 1000 person-years among those
age 5-60 years in china to 451.7 cases per 100 000 personyears among 2 to 15 years olds in Pakistan. Overall, the
S.typhi isolation rate(prevalence)was23.1 per 1000 cultured
febrile episodes and ranged from 5.0(vietnamese site) to

The statistics reveal that a significant

amount of people who have typhoid fever
are children. Specifically children who are
at their pre-school age as well as school
age. This highlights the importance of
primary prevention such as better
sanitation, improved water systems and
vaccines.

In a latest study, NIH scientists

developed a vaccine called Vi, made of
a polysaccharide from the surface of
salmonella typhi, the bacteria that
cause typhoid fever. It is effective adults
but not in young children. Clinical trials
have shown that chemically binding the
Vi to a protein to form a conjugate
vaccine has improved its efficacy to
children. Now NIH scientists have
developed another vaccine for typhoid
fever- using polysaccharide from fruit,
known as pectin.

ANATOMY AND
PHYSIOLOGY
GASTROINTESTINAL TRACT
-is a muscular tube lined by a special layer of
cells, called epithelium. The contents of the
tube are considered external to the body and
are in continuity with the outside world at the
mouth an d the anus.
The walls is divided into four layers as follows:
MUCOSA- the innermost layer of the digestive
tract has specialized epithelial cells supported
by an underlying tissue called the lamina
propia.

ANATOMY AND PHYSIOLOGY

SUBMUCOSA
-surrounds the muscularis mucosa and
consists of fat, fibrous connective
tissue and larger vessels and nerves.
MUSCULARIS EXTERNA
-The smooth muscle layer has inner
circular and outer longitudinal layers of
muscle fibers separated by the
myenteric plexus or Auerbach plexus.

ANATOMY AND PHYSIOLOGY

SEROSA/ MESENTERY
-The outer layer of the GIT is formed by
fat and another layer of epithelial cells
called mesothelium.

INDIVIDUAL COMPONENTS
OF THE GI TRACT
ORAL CAVITY
-is responsible for the intake of food. It is
lined by a stratified squamous oral
mucosa with keratin covering those
areas subject to significant abrasion,
such as tongue , hard palate

INDIVIDUAL COMPONENTS
OF THE GI TRACT
SALIVARY GLANDS
-Three pairs of salivary glands
communicate with the oral cavity. Each
is a complex gland with numerous acini
lined by secretory epithelium.

INDIVIDUAL COMPONENTS
OF THE GI TRACT
PAROTIDS
-are large, irregular shaped glands
located under the skin on the side of
the face. They secrete 25% of saliva.
They are situated below the zygomatic
arch and cover part of the mandible.

INDIVIDUAL COMPONENTS
OF THE GI TRACT
SUBMANDIBULAR
-secrete 70% of the saliva in the mouth.
They are found in the floor of the
mouth, in a groove along the inner
surface of the mandible.
SUBLINGUAL
-are the smallest salivary glands, covered
by a thin layer of tissue at the floor of
the mouth. They produce 5% of saliva.

INDIVIDUAL COMPONENTS
OF THE GI TRACT
ESOPHAGUS
-is a muscular tube of approximately
25cm in length and 2cm in diameter. It
extends to the pharynx to the stomach
after passing an opening in the
diaphragm.
STOMACH
-is a J shaped expanded bag, located just
left of the midline between the
esophagus and small intestine.

INDIVIDUAL COMPONENTS
OF THE GI TRACT
SMALL INTESTINE
-is composed of duodenum, jejunum and
ilium. It averages approximately 6m in
length, extending from the pyloric
sphincter of the stomach to the ileocecal valve separating the ileum from
the cecum

INDIVIDUAL COMPONENTS
OF THE GI TRACT
LARGE INTESTINE
-is a horse-shoe shaped and extends around the
small intestine like a frame. It contains the
appendix, cecum, ascending and sigmoid
colon.
LIVER
-is a large, reddish-brown organ situated in the
upper quadrant of the abdomen. It surrounded
by a strong capsule and divided into four lobes
namely, left, audate and quadrate lobes.

INDIVIDUAL COMPONENTS
OF THE GI TRACT
GALL BLADDER
-is a hollow, pear sheped organ that sits in a
depression on the posterior surface of the
livers right lobe. It consist of a fundus,
body and neck.
PANCREAS
-is a lobular, pinkish-grey organ that lies
behind the stomach. Its head
communicates with the duodenum and its
tail extends to the spleen.

NURSING ADMISSION AND

HEALTH ASSESSMENT
GENERAL ADMISSION INFORMATION:
NAME: R. C.
ADDRESS: ZONE IV, PANTALAN, BRGY.
FABRICA, SAGY CITY
BIRTHDAY: JUNE 1,2006
AGE: 6 YEARS OLD
SEX: FEMALE
RELIGION: ROMAN CATHOLIC

NURSING ADMISSION AND

HEALTH ASSESSMENT

CHIEF COMPLAINTS: FEVER 2X

WEEKS
DATE OF ADMISSION: OCTOBER 11,
2012
ATTENDING PHYSICIAN: DR. P.
ADMITTING IMPRESSION: WARM TO
TOUCH, DRY SKIN AND MOUTH
WORKING DX: T/C TYPHOID FEVER

NURSING ADMISSION AND

HEALTH ASSESSMENT

VITAL SIGNS:
TEMPERATURE: 40.3C
PULSE RATE: 86 bpm
RESPIRATION: 23cpm

NURSING ADMISSION AND HEALTH

ASSESSMENT

FAMILY HISTORY
PATERNAL SIDE

MATERNAL SIDE

NURSING ADMISSION AND

HEALTH ASSESSMENT
B. GENERALIZED DATA AND PATIENT
PROFILE
By October 11, 2012, R. C.s parents decided
to bring her in the hospital because of high
fever, sudden abdominal pain, headache and
body weakness. She was diagnosed with
typhoid fever. In her stay in the hospital, R.C.
had experienced diarrhea. According to her
mother, she defecates 5-7 times with 2-3 cups
of soft-watery stool per episode. During her
stay also, she manifested cough and colds.

NURSING ADMISSION AND

HEALTH ASSESSMENT
C. PAST MEDICAL HISTORY
A. CHILDHOOD HOSPITALIZATION: None

B.

CHILDHOOD IMMUNIZATION: The

patient was fully immunized.

C.

ALLERGIES: The patient has no

unknown allergies on food drugs.

NURSING ADMISSION AND

HEALTH ASSESSMENT
PHYSICAL ASSESSMENT
HEAD
skull is round in shape and has
normal contour with no palpated
depressions
Hair has fine strands, scalp is oily
but no masses palpated
Facial features are symmetrical
with no noted abnormalities
Hair evenly distributed and skin is

NURSING ADMISSION AND

HEALTH ASSESSMENT

With straight, long and black hair

No dandruff was observed or any abnormal
skin growth

EYES
Pupils are equally round and reactive to light
Eyebrows are symmetrically aligned
Eyelashes are short evenly distributed and
curled slightly outward

NURSING ADMISSION AND

HEALTH ASSESSMENT

No discharges present
Cornea is transparent, smooth and
shiny
Details of the iris are visible, dark
brown in color
Sclera appears white
Skin around the eye is intact

NURSING ADMISSION AND

HEALTH ASSESSMENT
EARS
Ears are symmetrical and aligned with
the outer canthus of the eye with no
lesions noted
Color is same as facial skin
Absence of difficulty in hearing
No cerumen was noted in both ears

NURSING ADMISSION AND

HEALTH ASSESSMENT
NOSE
Nose has no discharge, no lesions, not occluded and
patent airway
Nose not tender, without masses or any
displacement of bone and cartilage noted upon
palpation
Color is same as facial skin
Normal size for the face
Absence of difficulty in no flaring on both nostrils was
observed
Able to breath clearly and identify mild aromas
present

NURSING ADMISSION AND

HEALTH ASSESSMENT
THROAT AND MOUTH
Throat and mouth have no sores and
swelling or inflammation
Teeth are complete in number,
yellowish and slightly shiny
Dental carries were observed over her
front teeths enamel and whitish
plaque were noted over the molars
Buccal mucosa- moist, smooth and
light pink in color

NURSING ADMISSION AND

HEALTH ASSESSMENT

Lips are slightly dry, pink in color

No lesions in his lips and mouth, was
able to purse his lips, protrude and
move tongue from side to side, up and
down
Gag reflex was elicited
Palate appears pale; soft palate is
smooth and light pink, hard palate is
lighter pink with more irregular texture
Uvula- positioned at the midline of the

NURSING ADMISSION AND

HEALTH ASSESSMENT
Tonsils- pink in color, not inflamed or
swollen
Pale gums
NECK
Neck is centered and aligned with the
head
Able to move the neck without much
effort from side to side, up and down
and even in rotation
No palpable lymph nodes

NURSING ADMISSION AND

HEALTH ASSESSMENT
Thyroid gland not visible upon
inspection and ascends while
swallowing
Arteries and veins not distended
CHEST
Symmetrical breasts
No lesions
No abnormal swelling or presence of
masses

NURSING ADMISSION AND

HEALTH ASSESSMENT
CARDIOVASCULAR
Absence of chest pain and murmurs
Normal heart rhythm and regular rate
Veins are not visibly distended
No presence of sound/bruit upon auscultation
RESPIRATORY
Chest is symmetric: anteroposterior to
transverse diameter ratio is one is 1:2
Chest expansions are symmetrical

NURSING ADMISSION AND

HEALTH ASSESSMENT

Spine vertically aligned

Spinal column is straight; left and right
shoulders and hips are the same height
Regular respiratory rhythm and normal
respiratory rate: 23cpm
Productive cough, unable to
expectorate

NURSING ADMISSION AND

HEALTH ASSESSMENT
SKIN
Skin is dry and has good skin turgor
Exhibits a fair complexion
No masses were observed and
palpated all over his body
(-) edema
(-)jaundice, (-) cyanosis
Some blemishes on her lower
extremities

NURSING ADMISSION AND

HEALTH ASSESSMENT
NAIL
Capillary refill is less than 2 sec.
Untrimmed and dirty fingernails
GASTROINTESTINAL
Skin is fair
Abdomen is soft and flat
Non tender abdomen

NURSING ADMISSION AND

HEALTH ASSESSMENT
EXTREMITIES
Some blemishes were noted over the
patients leg
No edema noted on both upper and
lower extremities, without numbness
and tingling sensation
Grossly normal
(-) edema, (-) cyanosis
GENITOURINARY

NURSING ADMISSION AND

HEALTH ASSESSMENT
NEUROLOGICAL
BEHAVIORAL- the patient is silent but
not conscious and coherent upon
interaction
MOTOR FUNCTIONING- slowed
movement of extremities.
REFLEXES- Reflexes were present such
as the blinking reflex.

PATHOPHYSIOLOGY

LABORATORY STUDY
ACTUAL
RESULTS

LABORATOR NORMAL
Y
RESULTS
STUDIES
TYPHIDOT

HEMOGLOBIN

RBC

IgM: negative
IgG:
negative

11-16 g/dl

IgM:
positive
IgG:
positive

10.1 g/dl

4.0-4.5x1012/L

4.5x1012/L

INDICATIONS

Positive IgM
and IgG
indicates
presence of
typhoid

NURSING
CONSIDERATIONS

Encourage the
mother of the patient
to give the
medications as
prescribed by the
physician.
Decreased
Encourage the
level may
mother to prepare
account for
Iron rich food for the
anemia, acute child. (E.g. milk,
blood loss or green leafy
hemodilutation vegetable) and take
Iron supplement as
prescribed.
Within normal Encourage the
range
mother to maintain
healthy diet for the
child.

Neutrophils

0.55-0.65

0.78

High count
indicates
infection

Lymphocytes 0.25-0.40

0.10

Within
normal
range

Eosinophils

0.01-0.06

0.03

Within
normal
range

Monocytes

0.02-0.08

0.08

Within
normal
range

Encourage
the mother
to prepare
vit. C rich
foods for the
child.
Encourage
the mother
to maintain
healthy diet
for the child.
Encourage
the mother
to maintain
healthy diet
for the child.
Encourage
the mother
to maintain
healthy diet

PROBLEM LISTING
CUES

PROBLE
M

RAN
K

PHYSIOLOGICAL
ACTUAL
POTENTIAL

SUBJECTIVE:

MGA DUHA
NA KA
SEMANA
GABALIKBALIK IYA
HILANAT DAW
KATAAS
DASUN
GINAUBO PA
GUID SITA.
AS
VERBALIZED
BY THE
MOTHER.

FEVER

INEFFECTIVE
FOR
THERMOREGULATION
R/T INVASION
(S. TYPHI) IN
THE BODYGI TRACT
AS EVID. BY
ELEVATED
TEMP. 40.3C

BEHAVIORAL
ACTUAL

RISK

POTENTIAL