Typhoid Fever NURSING MANAGEMENT IDEALPossible Nursing Diagnoses Deficient fluid volume Imbalanced nutrition: Less than body requirements Diarrhea Acute pain Risk for infection Hyperthermia Activity intoleranceKey OutcomesThe patient will: Regain and maintain fluid and electrolyte balance. Experience no further weight loss. Maintain normal elimination pattern. Report adequate pain relief with analgesia or other measures. Experience no further signs or symptoms of infection. Remain afebrile. Demonstrate skill in conserving energy while carrying out daily activities to tolerance level.Nursing Interventions Follow contact precautions. Wash your hands thoroughly before and after any contact with the patient. Wear gloves and a gown when disposing of stool or fecally contaminated objects. Continue contact precautions until three consecutive stool cultures are negative: o The first one 48 hours after antibiotic treatment ends, followed by two more at 24-hour intervals. Observe the patient closely for signs of bowel perforation: o sudden pain in the lower right abdomen and rebound tenderness o one or more rectal bleeding episodes o sudden decreasing temperature or blood pressure 1
o orthostatic hypotension o increasing pulse rate During acute infection, promote rest, take safety precautions (because the patient may become delirious), and assign him a room close to the nurses station so that you can check on him often. Use a room deodorizer to minimize odor from diarrhea. Record intake and output. Maintain adequate I.V. fluid and electrolyte therapy as ordered. When the patient can tolerate oral feedings, encourage high-calorie fluids, such as milk shakes. Watch for constipation. Provide good skin and mouth care. Turn the patient frequently and perform mild passive exercises, as indicated. Apply mild heat to relieve abdominal cramps. Dont administer antipyretics, which mask fever and may lead to hypothermia. Instead, promote heat loss by applying tepid, wet towels (dont use alcohol or ice) to the patients groin and axillae or by wiping wet towels down his arms and legs. Report salmonella cases to public health officials.Patient Teaching Explain the causes of salmonella infection. Show the patient how to wash his hands by: o wetting them under running water o lathering with soap and scrubbing o rinsing under running water with his fingers pointing down o and drying with a clean towel or paper towel. Tell the patient to wash his hands after using the bathroom and before eating. Tell him to cook foods thoroughly (especially eggs and chicken) and to refrigerate them at once. Teach him how to avoid cross-contaminating foods by o cleaning preparation surfaces with hot, soapy water and drying them thoroughly after use; o cleaning surfaces between foods when preparing more than one food; o and washing his hands before and after handling each food. Tell the patient with a positive stool culture to avoid handling food and to use a separate bathroom or clean the bathroom after each use. Tell the patient to report dehydration, bleeding, or recurrence of signs of salmonella infection. Advise the patients close contacts to obtain a medical examination and treatment if cultures are positive. Urge those at high risk for contracting typhoid fever (laboratory workers and travelers) to be vaccinated.Prevention and Control:(DOH) Boil water for drinking. (Upon reaching boiling point, extend boiling for two or more minutes) Do water chlorination Cook food well and always use food cover to prevent flies and other insects from contaminating them.
Wash thoroughly all vegetables and fruits especially those that are eaten raw. Avoid eating street vended foods. Wash hands with soap and water after using the toilet and before eating. Keep surrounding clean to prevent breeding of flies.Nursing Considerations Relapses occur in 5% to 10% of untreated cases and may be more common after antibiotic therapy. Educate public o control flies o avoid raw shellfish o thoroughly rinse raw fruits and vegetables Typhoid is communicable as long as the infective organism is in the feces or urine, which may persist for months or, in 2%-5% of cases, permanently.References:Department of Health. Philippine Health Advisories. National Disease Prevention and Control and National Center for Health Promotion. p. 57. Manila, Philippines, 2005. thNettina, S.M., Mills, E.J., Lippincott Manual of Nursing Practice, 8 Ed. United States of America: Lippincott, Williams & Wilkins, 2006. thMcCann, J.A., et al. Diseases: A Nursing Process Approach to Excellent Care, 4 Ed. United States of America: Lippincott Williams and Wilkins, 2006. thSmeltzer, C.S., Bare, B.G., Hinkle, J.L., Cheever, K.H., Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 11 Ed. United States of America: Lippincott Williams and Wilkins, 2008. rdSommers, M.S., Johnson, S., Beery, T., Diseases and Disorders: A Nursing Therapeutics Manual 3 Ed. Philadelphia: F.A. Davis Company, 2007.
MEDICAL MANAGEMENT IDEALDiagnostic Tests Culture of urine or stool - positive for S. typhi during second week Culture of blood - positive for S. typhi during first week Bone marrow culture The presence of S. typhi in stools 1 or more years after treatment indicates that the patient is a carrier (about 3% of patients). Widals test, an agglutination reaction against somatic and flagellar antigens, may suggest typhoid fever with a fourfold increase in titer. o Drug use or liver disease also can increase these titers and invalidate test results. Other supportive laboratory values may include: o transient leukocytosis during the first week of typhoidal salmonellosis o leukopenia during the third week o leukocytosis in local infection.Treatment I.V. fluids and electrolytes. Bed rest. Avoid antispasmodics, laxatives, and salicylates.Drug Therapy The type of antimicrobial agent chosen to treat typhoid fever depends on organism sensitivity. Antimicrobial Agents o Ampicillin o Amoxicillin o Cefotaxime o Ceftriaxone o Chloramphenicol o Ciprofloxacin o Co-trimoxazole o Fluoroquinolone Camphorated opium tincture, kaolin and pectin mixtures, diphenoxylate, codeine, or small doses of morphine can relieve diarrhea and control cramps for patients who remain active.
Prevention Immunization is advised for travelers to areas of high endemicity.References: thNettina, S.M., Mills, E.J., Lippincott Manual of Nursing Practice, 8 Ed. United States of America: Lippincott, Williams & Wilkins, 2006. thMcCann, J.A., et al. Diseases: A Nursing Process Approach to Excellent Care, 4 Ed. United States of America: Lippincott Williams and Wilkins, 2006.Smeltzer, C.S., Bare, B.G., Hinkle, J.L., Cheever, K.H., Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 11th Ed. United States of America: Lippincott Williams and Wilkins, 2008. SURGICAL MANAGEMENT IDEAL Surgical Drainage o may be required for localized abscesses