BROAD OBJECTIVEBy the end of this presentation, learners should acquire knowledge on how to manage a patient with shigellosis.
SPECIFIC OBJECTIVESO Definition of shigellosisO Causes of shigellosisO TypesO How it is spreadO PathophysiologyO Clinical manifestationsO Medical managementO Nursing managementO Complications
DefinitionO This is an acute bacterial infection of the lining of the intestines (especially large intestines)CausesShigellosis is caused by a group of bacteria called shigella (gram- negative organism)
Types1. Shigella sonei – also called group D. it is responsible for most of the cases2. Shigella flexineri Also called group B3. Shigella dysenteriae Can lead to outbreaks in developing countries
SPREADO Shigellosis is spread through fecal-oral routeO People with shigellosis release it through the stoolsO It spreads from one infected person to contaminate water or food or directly to another person.O Outbreaks are associated with poor sanitation, contaminated food or water and crowded living conditionsO Common among travelers in developing countries and workers or residents of refuge camps
CLINICAL MANIFESTATIONSO Usually develop about 1-7 days (average 3 days) after you come into contact with the bacteria O Acute (sudden) abdominal pain or cramping O Acute (sudden) fever O Blood, mucus or pus in stools O Crampy rectal pain O Nausea and vomiting
O Watery diarrhoeaO Abdominal tendernessO Dehydration with fast heart rate and low BpO Loss of appetite
Diagnostic testsO Stool cultureO White blood cells in stoolsO Elevated blood cell count (FBC)
PATHOPHYSIOLOGYO Once ingested, the bacteria survives the gastric environment of the stomach and progresses to large intestinesO There, they attach to and penetrate the epithelial cells of the intestinal mucosa.O After invasion, they multiply intracellulary and spread to neighboring epithelial cells, resulting in tissue destruction.O It produces toxins that can attack the lining of the large intestines, causing swelling, ulcers on the intestinal wall and bloody diarrhoea.
Pathophysiology cont….O Severity of diarrhoea sets apart shigellosis from regular diarrhoea and it is usually associated with bloody or pus stained diarrhoea.
MEDICAL MANAGEMENTO The goal is to replace fluids and electrolytesO Advise patient on dietO Self measure to avoid dehydration like drinking electrolyte solution to replace fluids e.g. ORSO Antibiotics only in severe cases e.g. ampicillin and ciprofloxacin 250mg BD IV-they shorten the length of illnessO Antidiarrhoea agents e.g. Loperamide 2mg BDO I.V fluids 2-3 litres/24hrs e.g. R/LO Stop taking diuretics
NURSING MGTO ASSESSMENT - History of stool pattern and associated symptoms O Frequency O Duration O Character O Consistency of stoolsO history of medication use of other drugs known to cause diarrhoea e.g. laxativesO Social history
NURSING MGT CONT……O Family historyO Recent travel, stress, health and family history of illnessO Eating habits, appetite, food intolerance especially milk and other dairy products
Physical examinationO Vital signs and weight measurementO Patients’ skin is inspected for signs of dehydrationO Poor turgor and dryness and area of breakdown of the skinO Abdomen • Distension • Bowel sounds • Palpate for tenderness
Nursing diagnosisO Diarrhoea r/t acute infectious process evidenced by frequent loose and liquid stoolsO Fluid and electrolyte imbalance r/t diarrhoea and vomitingO Nutritional imbalance; less than body requirements r/t loss of appetite, nausea, vomiting evidenced by weight lossO Altered thermoregulation hyperthermia r/t to the infection as evidenced by rise of temperature to 38 degrees celsius
O Altered comfort (abdominal pain) r/t increased peristalsis evidenced by patient’s verbalization and facial expressionO Risk for anemia related to blood in stoolsO Risk for altered skin integrity related to dehydrationO Risk for Hypovolemic shock r/t loss of fluids due to diarrhoea
InterventionsO Commence IV fluids as ordered e.g. R/L – to replace lost fluids and correct electrolyte balanceO Catheterize – to monitor input and output and balance fluidsO Enforce strict IP measures to avoid cross infectionO Provide small and frequent food to normalize nutritional status and reduce peristalsis movementO Administer prescribed antipyretics e.g. panadol 1g tds po. This will act on the prostagrandin of the hypotharamus hence it will reduce fever.
O Administer analgesics e.g. panadol 1g po tds to reduce pain .
ReferencesO Lewis S.M., Heitkemper M.M and Dirksen S.R. (2010). Medical surgical nursing assessment and management of clinical problems.(7thed) St Louis:C.V.MosbyO Smeltzer S.C., Bare B.G and Hinke J.L (2010). Brunner & suddarth’s textbook of medical surgical nursing.(12th ed). Philadelphia:J.B LippincottO www.mayoclinic.com