Remegio cagampan

29 yrs old

Diagnosis: typhoid fever

Nursing diagnosis:
Acute pain r/t injuring agents aeb observe pain with pain scale of 8 as scale of 0-10

Sign and symptoms:

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.

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 not fatal.
• Intestinal perforation in the 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 the
fever has started reducing (defervescence). This carries on into the fourth and final
week.

Pathophysiology:
The pathophysiology of typhoid fever is complex and occurs through several stages.
Once, the bacteria (Salmonella typhi), survives the acidity of the stomach, it
reaches the intestine
and invades the Peyer`s patches of the intestinal wall. Peyer`s patches are the
clusters of cell
primarily composed of Macrophages are specialized cells that are essential to kill
any bacteria.
But, Salmonella Typhi is unaffected by these macrophages but, start survive within
the
macrophage itself. Salmonella Typhi alters its structure to resist destruction and
allow them to
exist within the macrophage. This renders them resistant to damage by
Polymorphonuclear
leukocytes (PMN or PML) and the immune response.
So, during this asymptomatic incubation period of 7-14 days, the bacteria spread
via the
lymphatics while inside the macrophages. This gives them access to the
reticuloendothelial system
and then to the different organs throughout the body such as the liver, spleen,
gallbladder, and
bone marrow. 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.
The first week of symptomatic period is characterized by progressive elevation of
temperature.
In the second week, the victim may experience abdominal pain, spleen enlargement
and notice
Rose spots on his skin.
The third week is more intense as the bacteria start causing necrosis of the Peyer`s
patches of the
intestine which leads to perforation and bleeding. This is the terminal stage, if, left
untreated, death is immenent.

Nursing intervention:

A. Prevention
• Choose foods processed for safety
• Prepare food carefully
• Foods prepared by others (avoid if possible)
• Keep food contact surfaces clean
• Eat cooked food as soon as possible
• Maintain clean hands
• Steam or boil shellfish at least 10 minutes
• All milk and dairy products should be pasteurized
• Control fly populations
B. Antibiotics
For uncomplicated cases, use Conventional Therapy:
1 . Chloramphenicol 3-4 gm per day PO in 4 divided doses x 14 days (50-100 mg/kg
BW)
except it with low WBC.
or 2. Co-trimoxazole forte or double-strength tab BID PO x 14 days
or 3 . Amoxicillin 4-6 gm per day PO in 3 divided doses x 14 days
For cases with complications, presence of severe symptoms, or clinical deterioration
despite
conventional therapy, use Empiric Therapy for Suspected Resistant Typhoid Fever:
1 . Ceftriaxone (Rocephin) 3 gm IV infusion OD x 5-7 days
Ceftriaxone may be used for pregnant women and children.
or 2. Fluoroquinolones:
Ciprofloxacin (Ciprobay) 500 mg tab PO BID x 7-10 days
or Ofloxacin (Inoflox) 400 mg tab PO BID x 7-10 days
Treatment for typhoid fever usually includes:

The rediscovery of oral rehydration therapy in the 1960s provided a simple way to
prevent many of the deaths of diarrheal diseases in general.
Where resistance is uncommon, the treatment of choice is a fluoroquinolone such
as ciprofloxacin otherwise, a third-generation cephalosporin such as ceftriaxone or
cefotaxime is the first choice. Cefixime is a suitable oral alternative.

Typhoid fever in most cases is not fatal. Antibiotics, such as ampicillin, chloramphenicol,
trimethoprim-sulfamethoxazole, Amoxicillin and ciprofloxacin, have been commonly used to
treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics
reduces the case-fatality rate to approximately 1%. The common treatment of Typhoid is
Mucomelt-Forte which is the combination of Cefixime with Acetylcysteine.