Mr. Marlou W. Miao, a 3-year old male from Leyte, was admitted to the hospital for typhoid fever. He had a 7-day history of intermittent fever, cough, and abdominal pain. Diagnostic tests confirmed Salmonella typhi in his blood. As a toddler experiencing illness and hospitalization, he exhibited signs of separation anxiety from his aunt, fear of medical professionals due to previous painful procedures, and loss of control from changes to his routine. The student nurse assessed his developmental stage and needs to develop an appropriate nursing care plan.

1. A Case Study On
Typhoid Fever
_____________________________________________
In partial Fulfillment of the Course
Requirement in Nursing Care Management
______________________________________________
Presented to the Faculty of
San Lorenzo Ruiz College of Nursing
Ormoc City
______________________________________________
Submitted by:
Busa, Ana Marie
Echo Class 2010

2. Introduction
Typhoid fever, also known as “Tipos” (in laymen’s term), is one of the most
common worldwide illness most specifically in third world country such as ours, this is a
question of sanitation since this disease is transmitted through ingestion of food or water which
is improperly prepared and contaminated with the feces of an infected person, that contains the
bacterium Salmonella enterica, serovar Typhi. The said bacteria perforates through the intestinal
wall and grows best at 37 °C/99 °F – human body temperature.
Typhoid fever is characterized by:
 a slowly progressive fever as high as 40 °C (104 °F)
 profuse sweating, gastroenteritis
 nonbloody diarrhea.
 less commonly, a rash of flat, rose-colored spots may appear.
Common causes of transmission are flying insects most specifically flies feeding
on feces that may occasionally transfer the bacteria through poor hygiene habits and public
sanitation conditions. A person may become an asymptomatic carrier of typhoid fever, suffering
no symptoms, but capable of infecting others. Diagnosis is made by any blood, bone marrow or
stool cultures and the Widal test. Sanitation and hygiene are the critical measures that can be
taken to prevent typhoid. Typhoid does not affect animals and therefore transmission is only
from human to human. 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.
The student nurse personally chose this case study because as one of the persons
living in a developing country, where handwashing and proper sanitation are not well practiced
by some people, are at risk of acquiring typhoid fever. Moreover, the student felt that this study
is important to her because this usually inflicts children particularly toddlers in which his son is.
This study will help the nursing profession by providing information about the
proper management and care for patients with Typhoid fever. It will also educate the people,
especially those with Typhoid Fever and vulnerable individuals to seek medical care in order to

3. prevent the illness. It will increase awareness about the importance of having a healthy lifestyle
and clean environment. This study will elaborate the inter relatedness of environment, life style
habits and acquiring Typhoid Fever.
Through this, the student nurse would be able to formulate a plan of care for the
patient and formulate a health teaching plan to lay a foundation and minimize difficulties in the
future. This study is not limited to the patients with Typhoid Fever only, but it is for all people
who are interested in Typhoid Fever.
The student nurse expects a lot from this case study, even if she couldn’t really
tackle the deepest part of the illness, she expect to gain more knowledge about the disease. The
student nurse also expects to raise concern and awareness to everyone that typhoid fever is a
communicable disease in which everyone is at risk of acquiring. However, it is greatly
preventable with enough knowledge and understanding about the disease and with proper
practicing handwashing and sanitation in our respective homes. The treatments and the different
psychotherapy are important factors that she also wants to know as part of her job as a student
nurse. From this study, she expect to have a better understanding about typhoid fever, learn
skills especially with the care of these patients as well as nursing responsibilities that are
involved in this care.

4. Objectives
GENERAL OBJECTIVES:
After 3 days of giving holistic nursing care to the patient, the student nurse will be
able to acquire knowledge, attitude and skills about the care for pediatric patients with typhoid
fever.
SPECIFIC OBJECTIVES:
After 8 hours of giving holistic nursing care to the patient, the student-nurse will
be able to:
1. make thorough nursing assessment of the patient to be able to come up with an
apposite plan of care.
2. explain the pathophysiology of Typhoid fever
3. identify the causes of Typhoid fever.
4. recognize the possible symptoms of Typhoid fever as manifested by the patient.
5. develop an individualized plan considering client characteristics or the situation and
setting a specific, measurable, attainable, realistic and time bounded plan that reflect
the onset, date of problem identified.
6. list ways on preventing Typhoid fever.
7. site the importance of preventions, medication compliance and positive attitude to
early healing.
8. render appropriate nursing care to the patient to promote wellness and optimum level
of functioning.
9. medicate properly and accurately the prescribed medications and to be able to identify
its action and drug information.
10. endorse proper health behaviors in relevance to her care and age through play therapy

5. GENERAL OBJECTIVES:
After 3 days of giving holistic nursing care or student nurse-patient-significant
others interaction, the patient as well as the significant others will be able to acquire knowledge,
attitude, and skills in the proper management with typhoid fever.
SPECIFIC OBJECTIVES:
After 8 hours of giving holistic nursing care, the patient and the significant others
will be able to:
1. understand awareness of the disease.
2. identify the risk factors of typhoid fever
3. explain the causes of typhoid fever
4. recognize own symptoms of typhoid fever.
5. learn and understand why laboratory examinations are being done.
6. know and understand the treatments of typhoid fever.
7. demonstrate proper management with the signs and symptoms manifested.
8. enumerate drugs or medications necessary with the care through understanding of drug
information and precautions regarding its use.
9. show proper diet and exercise and stress its importance in promoting health and
preventing further complications.
10. display proper hygiene techniques and stress its importance in promoting health and
preventing further complications.

6. Nursing Assessment
Personal History
Patient’s Profile
Name: Mr. Marlou W. Miao
Age: 3 years old
Civil Status: Single
Religion: Roman Catholic
Date of Admission: July 17, 2010
Room Number: P2
Complaints: Fever, Cough
Impression/Diagnosis: Typhoid fever
Physician: Dr. Neda Labtic
Family/Individual Information, Social and Health History
Mr. Miao, Marlou W. is a Filipino and was born on April 26, 2007. He is the
youngest child of Ms. Melinda Miao, his mother died right after delivery due to some
complications. He lives at Lomboy, Sherwood Albuera, Leyte together with his grandparents and
aunty who looks after him, his other brother lives at another house with his father. He usually
plays outside their house together with his brother and neighbor. He sometimes forgets to wash
her hands prior to eating.
7 days prior to admission, Mr. Miao had an intermittent fever (38-39°C), with no
abdominal pain and no nausea and vomiting, condition was tolerated. The next day, patient still
has fever accompanied by productive cough, yellow phlegm, difficult to expectorate and with
abdominal pain. Patient was then brought by her mother to a private medical doctor and was
prescribed by some medications. Fever was then decreased but still with persistent cough. Patient
was told to come back after 5 days. After 5 days, patient still has fever and the private doctor
requested a Salmonella test, after the test went positive, the doctor made a request for admission
at Ormoc Sugarcane Planters Association-Farmers Medical Center.
A case of Mr. Marlou W. Miao, 3 years old male was admitted at OSPA-FMC on
July 17, 2010 for fever of about 7 days already. On admission, his Salmonella test revealed
positive for salmonella typhi anti-09 antibodies.

7. Level of Growth and Development
Normal Development at particular stage
A. Physical
Two year old children lose the baby look. Toddlers are usually chubby, with
relatively short legs and a large head. The face appears small when compared to the skull; but as
the toddlers grows, the face seems to grow from under the skull and appears better proportioned.
Toddlers have a pronounced lumbar lordosis and a protruding abdomen. The abdominal muscles
develop gradually with growth, and the abdomen flattens.
Weight: two years old can be expected to weight approximately four times their
birth weight. The weight gain is about 2 kg (5 lbs) between 1 year and 2 years and about 1-2 kg
(2-5 lbs) between 2 and 3 years. The 3 year old weighs about 13.6 kg (30 lbs).
Height: between ages 1 and 2 years, the average growth in height is 10-12 cm (4-
5 in), and between ages 2 and 3 years, it slows to 6 to 8 cm (2 ½ to 3 ½ in).
Head Circumference: The head circumference of the toddler increases on an
average about 2.5 cm (1 in), and by 24 months the head is four-fifths of the average adult size.
The brain is 70% of its adult size by the time the infant is 2 years old.
Sensory Abilities: visual acuity is fairly well established at 1 year; average
estimates of acuity for the toddler are 20/70 at 18 months and 20/40 at 2 years of age.
Accommodation to near and far objects is fairly well developed by 18 months and continues to
mature with age. At 3 years of age the toddler can look away from a toy prior to reaching out and
picking it up. This ability requires the integration of visual and neuromuscular mechanisms. The
senses of hearing, taste, smell, and touch become increasingly developed and associated with
each other. Hearing in the 3 year old is at adult levels. The taste buds of the toddler are sensitive
to natural flavors of food, and the 3-year old prefers familiar odors and tastes. Touch is a very
important sense and a distressed toddler is often soothed by tactile sensations.
Motor abilities: fine muscle coordination and gross motor skills improve during
toddlerhood. At 2 years, toddlers can hold a spoon and put it into the mouth correctly. They are
able to run; their gait is steady; and they can balance on one foot; by 3 years, most children are

8. toilet trained, although they still may have the occasional accident when playing or during the
night. (Source: Kozier, 2004)
B. Cognitive
According to Piaget, the toddler completes the 5th
and 6th
stages of the
sensorimotor phase and starts the preconceptual phase at about 2 years of age. In the 5th
stage, the
toddler solves problems by a trial-and-error process. By stage 6, toddlers can solve problems
mentally. (Source: Kozier, 2004)
During Piaget’s preconceptual phase, toddlers develop considerable cognitive and
intellectual skills. They learn about the sequence of time. They have some symbolic thought.
Concepts start to form in late toddlerhood. A concept develops when child learns words the
represent classes of objects or thoughts. (Source: Kozier, 2004)
C. Moral
According to Kohlberg, the first level of moral development is the
preconventional when children respond to labels of “good” or “bad”. During the second year of
life, children begin to know that some activities elicit affection and approval. They also
recognize that certain rituals, such as repeating phrases from prayers, also elicit approval. This
provides children with feelings of security. By 2 years of age, toddlers are learning what attitudes
their parents hold about moral matters. (Source: Kozier, 2004)
D. Psychosexual (Freud)
Anal: anus and rectum are the center of pleasure. This stage occurs during toilet
training. Fixation at the anal stage can result in obsessive compulsive personality traits, such as
obstinacy, stinginess, cruelty and temper tantrums. (Source: Kozier, 2004)
E. Psychosocial (Erikson)
Erikson sees the period from 18 months to 3 years as the time when the central
developmental task is autonomy versus shame and doubt. Toddlers begin to develop their sense
of autonomy by asserting themselves with the frequent use of the word “no.” They are often
frustrated by restraints to their behavior and between ages 1 and 3 may have temper tantrums.

9. Children learn to develop sense of self through their immediate social
environment, in which their parents play a significant role. If children’s social interactions with
their parents are negative, the children may begin to see themselves as bad.
Although children like to explore the environment, they always need to have a
significant person nearby. Parents need to know that young children experience acute separation
anxiety, the fear and frustration that comes with parental absences. Abandonment is their greatest
fear. (Source: Kozier, 2004)
F. Spiritual Development
According to Fowler, the toddler’s stage of spiritual development is
undifferentiated. Toddlers may be aware of some religious practices, but they are primarily
involved in learning knowledge and emotional reactions rather than establishing spiritual beliefs.
A toddler may repeat short prayers at bedtime, conforming to a ritual, because praise and
affection result. This parental response enhances a toddler a sense of security. (Source: Kozier,
2004)
1.3.2 The Ill Person at Particular Stage of Patient
Separation Anxiety
Children react aggressively to the separation from the parent. They cry and
scream for their parents, refuse the attention or anyone else, and are inconsolable in their grief.
Children in the toddler stage demonstrate more goal-directed behaviors. For example, they may
plead with their parents to stay and physically try to keep the parents with them or try to find
parents who have left. They may demonstrate displeasure on the parent’s return or departure by
having temper tantrums; refusing to comply with the usual routine of mealtime, bedtime, or
toileting; or regressing to more primitive level of development.
Loss of Control
When their egocentric pleasures meet with obstacles, toddlers react with
negativism, especially temper tantrums. Any restriction or limitation of movement, such as the
simple act of making toddlers lie down, can cause forceful resistance and noncompliance. Loss

10. of control also results from altered routines and rituals. Toddlers rely on consistency and
familiarity of daily rituals to provide a measure of stability and control in their complex world of
growing and developing. The experience of hospitalization or illness severely limits their sense
of expectation and predictability, since practically every detail of the hospital environment
differs from that of the home. The principal reaction to such change is regression.
Bodily Injury and Pain
Toddlers’ reactions to pain are similar to those seen during infancy, except that
the number of variables influencing the individual response is highly complex and varied. In
general, children in this age-group continue to react with intense emotional upset and physical
resistance to any actual or perceived painful experience. Behaviors indicating pain include
grimacing, clenching their teeth or lips, opening their eyes wide, rocking, rubbing, and acting
aggressively, such as biting, kicking, hitting or running away. (Source: Kozier, 2004)
The ill person at the particular stage of patient:
The patient, Mr. Miao is quite cooperative and responds to my questions.
Although he is afraid of other health care members that would come near him thinking that they
would hurt him through some injections. He manifests this kind of attitude because of his
experience during his admission at the emergency room where he was started with an IV line
several times due to difficulty in locating his veins and also during extractions of blood for some
tests. After that, he makes a face and sometimes cry every time he sees any of the health care
members. He would also cling to his aunt most of the time because he is afraid that she might
leave him.

11. SAN LORENZO RUIZ COLLEGE OF ORMOC
COLLEGE OF NURSING
ORMOC CITY
Name: Mr. Marlou W. Miao Room Number: P2
Impression/Diagnosis: Typhoid fever Physician: Dr. Labtic
Date of Admission: July 17, 2010
Diagnostic results
Diagnostic Test Normal Value Patient’s Result Significance
HEMATOLOGIC
EXAM:
Date: July 17, 2010
Hemoglobin
MCH
MCHC
Hematocrit
WBC
Granulocytes
Lymphocytes
Mid
Eosinophils
Basophils
Monocytes
Granulocytes
Lymphocytes
Mid
11.5 - 16.5 g/dl
27 - 32 pg
32 - 36 g/dl
41.5 - 50.4 %
5 - 10 x 10^9/uL
35 - 80 %
20 - 40 %
2 - 15 %
1.2 - 8 x 10^9/uL
0.5 – 5 x 10^9/uL
.10 - 1.5 x 10^9/uL
10.70 g/dl
27.90 pq
34.80 g/dl
30.7%
10.60x10^9/uL
90.6 %
34.3 %
5.1 %
2 %
1 %
3 %
6.40 x 10^9/uL
3.60 x 10^9/uL
.60 x 10^9/uL
Decreased, Infection
Normal
Normal
Decreased, Infection
Increased, Infection
Increased, Infection
Normal
Normal
Normal
Normal
Normal

12. RBC
MCV
RDWR
RDWA
Platelet count
MPV
PDW
PCT
LPCR
MICROBIOLOGY
SECTION:
SALMONELLA TEST:
Date: July 17, 2010
URINALYSIS:
Date: July 17, 2010
I. Macroscopic
Color
Albumin
Sugar
Transparency
pH
Specific Gravity
II. Microscopic
4.8-5 x 10^12/L
80 – 100 fl
11-16 %
30 – 160 fl
150 - 450 x 10^12/L
8 – 11 fl
.10 – 9.99 fl
.09 – 9.99 fl
.10 – 9.99 %
Light straw or yellow
Negative
Negative
Clear
4.0-8.0
1.007-1.030
3.83 x 10^12/L
80.10 fl
12.60 %
51.90 fl
337.10 x 10^12/L
6.40 fl
8.40 fl
.21 fl
9.10 %
Igm Positive
-acute Typhoid
Fever
Yellow
Negative
Negative
Slightly Turbid
6.0
1.080
Decreased, Infection
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
positive typhoid fever
Normal
Normal
Normal
Normal
Normal
Increased, Infection

13. Pus Cells
RBC
Squamous Cells
Bacteria
Mucus Threads
Crystals
Amorphous nitrites
STOOL EXAM:
Date: July 17, 2010
Color
Consistency
Mucus
Yellow
Formed
negative
1-2
0-1
few
few
few
few
Yellow brown
Watery
Slightly mucoid
Typhoid fever
diarrhea
intestinal infection;
typhoid fever
1. Present Profile of Functional Health Patterns
Health Perception/ Health Management Pattern
Before admission, Mr. Miao is a healthy active toddler who tries everything under
his nose. He is not conscious about health practices such as washing hands before eating. His
aunt verbalizes that he is healthy that is without any major illnesses. Upon Marlou’s admission,
he became very attached to his aunty and grandmother. He also becomes very sensitive because
of his present condition. Every time a health personnel gets inside his room, he immediately
clings to his aunty and cry. He is afraid that the health personnel might inject and hurt him.
Marlou has fever and his body temperature ranges from 38-39°C. To manage such condition, his
aunt performs tepid sponge bath and he has an antipyretic PRN for temperature greater than
38°C.

14. Nutritional-Metabolic Pattern
Marlou has a big appetite before admission, he usually eats lots of sweets such as
candies in between meals and during mealtime he eats vegetables and rice and sometimes dried
fish. During his admission here in OSPA-FMC Marlou is on diet as tolerated. His aunty gives
him rice, fish, vegetables and some fruits. She also gives him milk. But, Marlou only eats a little
because he has decreased in appetite due to his condition. He only eats a maximum of 4
tablespoons per meal. However, he drinks a lot of water. He experiences abdominal pain.
Elimination Pattern
Marlou defecates once a day and have not encountered problems in urinary
elimination prior to admission. He cannot really control hid elimination pattern well that is why
he is still wearing diapers and he urinates more often. He can consume 4-5 diapers in one shift.
Sometimes, he is constipated because he cannot defecate within 2 days.
Activity/ Exercise Pattern
Before admission, Marlou is a very active toddler who spends most of the time
outside the house playing on the grounds. Now the patient’s movements seemed weak. He keeps
on lying down. Sometimes, he sits up on his bed or asks his aunty to cuddle him. He moves
slowly every time he eats or does something. He is assisted by his aunty every time he attempts
to sit up. His past time inside his room is just watching other patients since there is no television.
Cognitive / Perceptual Pattern
Prior and during admission, Marlou still functions and thinks his age. He still
enjoys watching cartoon movies and playing. But only during hospitalization that he becomes
more attached to his aunty just clinging onto her and expresses tantrums.
Rest / Sleep Pattern
During admission, sometimes the patient’s sleep is disturbed due to abdominal
pain and feeling of cold whenever he would have fever again. He also wakes up and cries every
time a health personnel comes into his room. His sleep and rest are interrupted because he feels
anxious whenever someone that she does not know comes near her. Prior to admission, he never
had problems with sleep because according to his aunt he enjoys an afternoon nap.

15. Self perception pattern
Before admission the patient thinks he is loved and cared by his aunt and feels
secure whenever she is near that is why her aunt stopped schooling just to take care of him.
During admission the patient thinks that he really needs more attention from his aunty because
he is not feeling very well. He knows that he has an illness and thus he must not be left by his
aunty thinking that he would be worse if he is left by her.
Role Relationship Pattern
Prior and during admission the patient is very close to his aunty and grandmother.
He seems very dependent to his aunty and asks his auntie’s permission every time he wants to do
something. He usually doesn’t responds to people he doesn’t know. You need to gain his trust
before he would communicate with you.
Coping – Stress Tolerance Pattern
Before and during admission, his coping mechanism is to cry every time he
doesn’t feel well, he asks his aunty to cuddle him and puts him to sleep. And when there are
things done to him that he doesn’t like, he uses crying as a way of coping.
Value – Belief Pattern
The Patient’s values and beliefs is basically the same before and during
admission. He does not pay much attention on praying, though she knows about God. She can
recite the Prayer before meals and Prayer before sleep. He goes to mass with his aunty and
grandmother every Sundays, but there are times that they can’t attend mass due to some
uncontrolled circumstances. He doesn’t blame God with his hospitalization and he prays with his
aunty before he goes to sleep at night.

16. Pathophysiology and Rationale
Normal Anatomy and Physiology of Affected organ
The Digestive System
The organs of the digestive system together perform a vital function of preparing
food for absorption and use by the million of body cells. Most foods when eaten is in a form that
cannot reach the cells (because it cannot pass through the intestinal mucosal into the
bloodstream) nor could it be used by the cells even if it could reach them. It must, therefore, be
modified as both to chemical and physical composition of food so that it can be absorbed and
utilized by the cells is known as digestion and is the function of the digestive system.
Mouth (Buccal Cavity)
The following structures form the buccal cavity: the cheeks (side walls), the
tongue and its muscle (floor), and the hard and soft palates (roof). Of these, only the palates and
the tongue are important. The palate consists of portions of four bones: two maxillae and two
palatines. The soft palate which forms the portion between the mouth and the nasopharynx and is
named fauces. Suspended from the midpoint of the posterior of the arch is small cone-shaped
process the uvula.
Teeth
Twenty deciduous teeth, the so called baby teeth, appear early in life and are later
replaced by 32 permanent teeth. The name and the numbers of teeth present in both sets are:
Name of tooth deciduous teeth Permanent teeth
Central incisors 2 2
Lateral Incisors 2 2
Cuspids (Canines) 2 2
Premolars (Bicuspid) 0 4
First Molars (Tricuspid) 2 2
Second Molars 2 2
Third Molars 0 2
Total per set 20 32

17. The first deciduous tooth erupts usually at the age of 6 months. The rest follow at
the rate of 1 or more a month until all 20 have appeared. There is, however, great individual
variation in the age at which teeth erupts. Deciduous teeth are shed generally between the ages of
6 and 13 years. The third molars (wisdom teeth) are the last to appear, erupting usually
sometimes at the age of 17 years old.
Pharynx
Food passes from the mouth to esophagus by way of the pharynx
Esophagus
The esophagus, a collapsible tube about 25cm (10 inches) long, extends from the
pharynx to the stomach piercing tho the diaphragm in this descent from the thoracic to the
abdominal cavity. It also lies posterior to the trachea and the heart.
Stomach
Just below the diaphragm, the digestive tube dilates on elongated pouch-like
structure, the stomach, the size of which varies according to several factors, notably the gender
and amount of distention. In general, the female stomach is usually more slender and smaller
than the male stomach. For sometime after a meal, the stomach enlarges because of distention of
walls, but as food leaves, the walls partially collapsed, leaving the organ about the size of a large
sausage. Sphincter muscle consist of circular fibers so arrange that there is an opening they are
contracted. The cardiac sphincter guards the opening of the esophagus into the stomach into the
first part of the small intestine (duodenum).
Gallbladder
The gallbladder is an active storage shed, which absorbs mineral salts and water
received from the liver and converts it into a thick, mucus substance called "bile," to be released
when food is present in the stomach. The gallbladder is a small, pear-shaped sac which is
situated just below the liver and is attached to it by tissues. It stores bile and then releases it when
food passes from the stomach to the duodenum (the first part of the small intestine) to help in the
process of digestion.
Small intestine

18. Chemical digestion of foods begins in the small intestine. The small intestine is
able to process only a small amount of food at one time. The pyloric sphincter controls food
movement into the small intestine from the stomach and prevents the small intestine from being
overwhelmed. Enzymes, produced by the intestinal cells and more importantly by the pancreas
and ducted into the duodenum through the pancreatic duct, complete the chemical breakdown of
foods in the small intestine.
Large intestine
The large intestine is about 5 feet long extends from the ileocecal valve to the anus. Its
major function is to dry out the indigestible food residue by absorbing water and to eliminate this
residue from the body as feces. It frames the small intestine on three sides and has the following
subdivisions: cecum, appendix, colon, rectum, and anal canal. .(Source: Elaine Marieb, Human
Anatomy and Physiology 2006)

19. PATHOPHYSIOLOGY OF TYPHOID FEVER
Signs
Non bloody Diarrhea
Slow progressive Fever
Decreased Appetite
Transient skin rash (rose spots)
Profuse sweating
Leukopenia
Positive Widal test
Predisposing Factors:
Age
Gender
Medical History
Geographical area
Precipitating Factors:
contaminated foods
unsanitary food
preparation
unsanitary
environment
Ingestion of food or fluids contaminated by S.typhi
Bacteria invades the Payer’s patches of the intestinal wall in
the small intestines where it attach (incubation period is first 7-
14 days after ingestion)
Bacteria will then injects toxins known as the effector proteins
into the intestinal cells and interrupts with the cellular proteins
& lipids & manipulate their function resulting in
phagocytization of the epithelial cell membrane until it is
engulf down into the inferior part of the host cells where
macrophages is present.
The bacteria induced macrophage apoptosis, breaking out
into the bloodstream and cause systemic infection. The
bacteria induced macrophage apoptosis, breaking out into the
bloodstream and cause systemic infection
TYPHOID FEVER
Symptoms
Body Malaise
Abdominal Pain
Headache
Cough
Weakness

20. Medical Management:
 Administration of Analgesics
 Admonistration of Antipyretics
 Administration of Antibiotics
(Ceftriaxone)
Nursing Management:
 Perform tepid sponge bath


21. Disease Process of Typhoid Fever
Typhoid fever is a bacteremia in which the organism gains access to the blood
stream through the bowel, principally through the infected peyers patches of lymphoid tissue in
the lower portion of the ileum. The first week these patches are swollen: the second week they
form sloughs, which are often bile colored; the third week the sloughs separates and leaves an
ulcerative surface, which then starts to heal by granulation.
Since the organism reaches all parts of the body through the bloodstream, almost
all organs at time may show pathologic changes being those due to toxemia and high fever.
Commonly, however, the heart, liver, spleen, muscle, and mesenteric lymph glands may be
either red or swollen, or else broken down into messy masses. The muscles are flabby granular.
The urine may be milky in appearance with the peculiar opalescence, which is due to the
presence in it of millions of typhoid bacilli.
The causative organism invades the bloodstream by way of lymphatic tissues and
is carried to all parts of the body. Early symptoms may vary, may be vague with headaches,
anorexia and malaise. As the disease progresses, there are joint pains, abdominal discomfort,
vomiting and usually constipation although they may be diarrhea. Cough and bronchitis occur in
about 50% of the cases. During the first week, the body temperature rise in step ladder pattern
until it reaches about 104. Wherein remains until near the end of the 3rd
week, after which it falls
by lysis. The temperature is irregular, with 2 remissions in the morning. (Source: Smeltzer and
Bare,2004)

22. Classical and Clinical Signs and Symptoms of Typhoid fever
Classical Symptoms Clinical Symptoms Rationale
 Body Malaise
 Decreased Appetite /
Anorexia
 Fever (intermittent)
 Abdominal Pain
 Manifested: patient keeps
of lying in bed and
seldom moves around.
He needs his aunty’s
assistance whenever she
wants to sit up from his
bed.
 Manifested: patient only
eats three spoons to five
spoons of food per meal.
 Manifested: patient’s
temperature fluctuates
from 38-39°C to 36°C
 Manifested: Abdominal
pain of 5/10 pain scale,
guarding behavior,
 Illness can deplete a
person’s energy to such
degree that it becomes
difficult for the person
to deal with day-to day
life. (Source: Lemone &
Burke, Medical surgical
Nursing, Chapter 24,
page 639)
 Loss of appetite occurs
as a result of the
decreased metabolic rate
and the increased
catabolism that company
immobility (Source:
Lemone & Burke,
Medical surgical
Nursing, Chapter 24,
page 640)
 The body temperature
alternates at regular
intervals between
periods or subnormal.
(Source: Lemone &
Burke, Medical surgical
Nursing, Chapter 24,
page 639)
 Abdominal spasm is
induced to limit mucosal
injury adding in
stimulation of increased
peristalsis. Perforation

23.  Diarrhea
facial grimace
 Manifested: Consumes 4-
5 diapers per shift due to
watery stools
and destruction of
mucosal lining of the
intestinal wall can lead
to persistent
inflammation (Source:
Monahan, Medical
surgical Nursing,
Chapter 30, page 1708)
 Tissue damage and
inflammation causes
loss of absorption due to
damaged villi causing an
increase in water,
electrolytes, mucus,
blood, and serum to be
pulled into the intestine
from immature crypt
cells (Source: Lemone
& Burke, Medical
surgical Nursing,
Chapter 24, page 639)
Nursing Interventions
Care Guide of Patients with Typhoid Fever
The patient must be isolated until at least 3 negative stool cultures, 24 hours apart and has
been secured. Strict asepsis must be carried out. All stool, urine, and vomitus must be
disinfected unless disposal of in a municipal sewage system. The rectal thermometer
should be taken to conserve the patient’s strength and to avoid chilling the patient.
Antipyretic drug should be administered for fever. The skin must be protected by
frequent turning of the patient and proper positioning, since it is susceptible to skin
infection. Mouth care should be given at regular intervals. The patient should be
encouraged to take adequate fluids by mouth. If fluids are administered parenterally,
caution must be exercised, since overloading the vascular system may lead to
cardiovascular complications. Abdominal distention should be guarded against, since it

24. thins the intestinal walls and may contribute to hemorrhage or perforation of intestinal
ulcers. Small low enemas may be given and glycerine suppositories or mineral oil to
avoid constipation. All stools must be examined for evidenced of blood and any bright
blood must be reported at once. The patient should be examined for bladder distention
and retention of urine. During acute stage, the patient is drowsy and lethargic and
incontinence may occur. The patient should be in a quiet pleasant surroundings and
visitors reduced to a minimum. (Source: Lemone & Burke, 639)

25. SAN LORENZO RUIZ COLLEGE OF ORMOC
COLLEGE OF NURSING
ORMOC CITY
Nursing Assessment
Name: Mr. Marlou W. Miao Room Number: P2
Impression/Diagnosis: Typhoid fever Physician: Dr. Labtic
Date of Admission: July 17, 2010

26. Body
Part
PHYSIOLOGIC
I P P A
Head:
Hair
Scalp
Forehead
Face
Eyebrow
Eyelash
Eyelids
Conjunctiva
Sclera
Pupils
External eyes
Nose
Lips
Ears
Gums
Tongue
Uvula
Teeth
Hard palate
Black, evenly distributed,
shoulder level
White, no dandruff
Smooth, fair skin
No deformities, brown
colored skin, dry, good
skin turgor
Evenly distributed, black
in color, parallel
Slightly curved outward
Intact, able to open and
close
Pale pink color, no
inflammation, moist, no
accumulation of
secretions.
White, small veins are
visible
Round, reactive to light
and accommodation.
Parallel, symmetrical
Smooth, proportional to
the face
Pink, dry, presence of
some cracks and peelings
Symmetrical
Dark pink, no ulceration
Smooth, pinkish, no
ulceration
Located at the midline,
not inflamed
Yellowish in color
Located anteriorly with
ruggae
Absence of nodules
No tenderness,
warm, temporal
pulse: 124bpm
No lumps, no
tenderness
No masses
No lump, no
secretions
Rough
Flexible
No masses
Resistant
Intact to gums
Hard
26
26

27. Actual Patient Care
SAN LORENZO RUIZ COLLEGE OF ORMOC
COLLEGE OF NURSING
ORMOC CITY
Name: Mr. Marlou W. Miao Room Number: P2
Impression/Diagnosis: Typhoid fever Physician: Dr. Labtic
Date of Admission: July 17, 2010
Nursing Care Plans
Needs/
Problems/
Cues
Nursing
Diagnosis
Scientific
Basis
Objectives Nursing
Actions
Rationale
Physiologic
Deficit:
1. Altered
thermoregula
tion
Cues:
- body
temperature
of 38.5 °C
- flushed skin
- skin warm
to touch
- teary eyes
- cracked lips
-Positive
Salmonella
typhi stool
exam result
“gitugnaw
kuno siya.”
As verbalized
by the SO.
Altered
Thermoregul
ation: Fever
related to on
going
infection
Fever is the
most
common
sign of a
systemic
response to
injury and it
is most
likely
caused by
endogenous
pyrogens
released
from
neutrophils
and
macrophage
s, a
specialized
form of
leukocytes.
These
substances
reset the
hypothalami
c thermostat
which
controls
body
temperature
After 8 hours
of nurse-
patient
interaction,
the patient
will be able
to:
1. manifest a
lowered
temperature
as evidenced
by body
temperature
from 38.5 °C
to 36.5 °C
Measures to:
1. decrease
body
temperature
a. provide dry
clothing and
bed linens
b. remove
excessive
clothing and
covers.
c. reduce
physical
activity
d. provide
adequate
foods and
fluids
- to increase
heat loss
through
conduction
- to lower
temperature
- to limit heat
production
- to meet the
increase
metabolic
demands and
27
27

28. and produce
fever.
Source:
Brunner &
Suddarth’s
Medical
Surgical
Nursing
e. provide
tepid sponge
bath
f. provide
oral hygiene
g. provide
additional
cooling
mechanisms
like cooling
mattress, cold
packs
h. administer
Paracetamol
(tempra
syrup) 5ml
q4 hours
i. administer
Ceftriaxone
500g IVTT
q12h
prevent
dehydration
- to increase
heat loss
through
conduction
- to keep the
mucous
membranes
moist. They
become dry and
cracked as a
result of
excessive fluid
loss
- to maintain
patient’s
comfort
- drugs that
reduce the level
of fever
-to treat
underlying
cause
28
28

29. Physiologic
Overload:
2. Acute Pain
Cues:
-Grimace
face
-Guarding at
the
abdominal
area
-Pain started
yesterday
(July 17,
2010)
accompanied
by diarrhea,
located at the
abdominal
area for 8-10
seconds with
a pain scale
of 5,
characterized
by colicky
pain. It is
aggravated
by walking
and is
relieved by
bowel
movement. It
is treated
with
Paracetamol
as pain relief.
“Sakit kuno
iyaha tiyan,
as verbalized
by SO”
Alteration in
comfort:
Acute Pain
related to
inflammation
of gastric
mucosa
secondary to
Typhoid
Fever
Salmomella
Gastroenteri
tis is
characterize
d by initial
symptoms
of nausea
and
vomiting
followed by
abdominal
cramps and
diarrhea
which is
accompanie
d by fever.
The
diarrhea
varies from
loose
watery
stools to
bloody
purulent
cholera like
stools.
Source:
Oxford
Textbook of
Medicine
volume 3
By:David A
Warrell p
661
After 8 hours
of nurse-
patient
interaction,
the patient
will be able
to:
2. experience
increased
comfort
concerning
pain as
evidenced by
lowered pain
intensity
from 5/10 to
2/10.
Measures to:
2. increase
patient’s
comfort:
a. Keep at
rest in Semi-
Fowler’s
Position.
b. Encourage
verbalization
of feelings
about pain.
c. Provide
Additional
Comfort
Measures
such as
touch.
d. Instruct the
patient to use
diversional
activity such
as play
therapy.
e. use
puppets to
demonstrate
procedures.
f. Administer
-to promote
proper lung
expansion.
- To alleviate
pain by
promoting non-
pharmacologica
l pain
management
-To reduce pain
especially when
moving.
- Refocuses
attention,
promotes
relaxation and
may enhance
coping abilities
-to enhance
understanding
and reduce
anxiety or fear
level.
-Relief of pain
29
29

30. Paracetamol
(tempra
syrup) 5ml
q4 hours
facilitates
cooperation
with other
therapeutic
interventions.
30
30

31. Physiologic
deficit
3. Diarrhea
Cues:
-Consumed
3-4 diapers
due to watery
stools at
100cc per
defecation
-Stool exam
results on
p.11
-dry lips
-hyperactive
bowel sounds
“Magsige
man siya ug
kalibang, as
verbalized by
the SO”
Fluid Volume
Deficit
related to
diarrhea
secondary to
Typhoid
Fever
Salmomella
Gastroenteri
tis is
characterize
d by initial
symptoms
of nausea
and
vomiting
followed by
abdominal
cramps and
diarrhea
which is
accompanie
d by fever.
The
diarrhea
varies from
loose
watery
stools to
bloody
purulent
cholera like
stools.
Source:
Oxford
Textbook of
Medicine
volume 3
By:David A
Warrell p
661
After 8 hours
of nurse-
patient
interaction,
the patient
will be able
to:
3. maintain
hydration
balance.
3. maintain
fluid balance:
a. Assess for
the signs of
dehydration
including
skin turgor,
oral mucosa,
etc.
b. Encourage
the client to
increase the
fluid intake.
c. Monitor I
& O and IV
fluids q4h
d. Keep a
quiet
environment
and calm
activities.
e. Provide
health
teachings on
avoidance of
dehydration.
conducive for
sleeping
- This will
provide a data
that could be
used to evaluate
the proper
intervention that
the client needs.
-To reduce the
dryness of the
oral mucosa
-To determine if
IV fluid and
electrolyte
replacement are
needed
-To reduce
stress and
anxiety
-To promote
awareness on
related factors
31
31

32. SAN LORENZO RUIZ COLLEGE OF ORMOC
COLLEGE OF NURSING
ORMOC CITY
Name: Mr. Marlou W. Miao Room Number: P2
Impression/Diagnosis: Typhoid fever Physician: Dr. Labtic
Date of Admission: July 17, 2010
Drug Therapeutic Record
Drug/ Dose/
Frequency/
Route
Classifications
/ Mechanism
of Action
Indications/
contraindications/
side effects
Principles
of
Care
Treatment Evaluation
Ceftriaxone
500g IVTT
q12h
Classification:
Antibiotics
Mechanism of
Action:
- binds to 50 S
ribosomal sub
unit, which
interferes with
or inhibits
protein
synthesis
promoting
osmotic
instability
usually
bactericidal.
Indications:
 Uncomplicated
gonoccocal
vaginitis
 UTI
 Lower
Respiratory Tract
Infection
 Septicemia
 Meningitis
 Peri-operative
prevention
 Acute bacterial
otitis media
 Neurologic
complication
Contraindications:
 Hypersensitivity
to cephalosporins
 severe renal
disease
 severe hepatic
disease
 minor
infections.
Side Effects:
Hema:
thrombocytopenia,
leucopenia.
 Inject
deep into
large
muscle
for IM
such as
gluteus
maximus.
 Obtain
culture
may
before
giving
first dose
 Before
giving
drug, ask
patient if
he is
allergic to
penicillin
s/cephalo
sphorins.
 Use
cautiousl
y in
breastfee
ding
women
 Not to
 Monitor
Vital
Signs
 Tell
patient/S
O to
report any
signs of
adverse
reactions.
 Perform
tepid
sponge
bath for
fever.
 Increase
fluids
 Give drug
with food
Medications
taken at
ordered
dose,date
and time.
Desired
effects
obtained.
32
32

33. GI: Nausea,
vomiting, diarrhea,
abdominal pain,
colitis, glossitis
CNS: headache,
depression,
dizziness, fever
CV: phlebitis
Skin: pain,
induration,
tenderness at
injection site, rash,
pruritus
exceed
with
recomme
nded
dose.
Paracetamol
(tempra
syrup) 5ml
q4 hours
PRN for T =
38˚C
Classification:
Antipyretics
Analgesics
Mechanism of
Action:
- antipyretic
action results
from inhibition
of
prostaglandin
in the Central
Nervous
System; may
block pain
impulses
peripherally
that occur in
response to
inhibition of
prostaglandin
synthesis.
Indications:
 Fever
 mild pain
Contraindication:
 Hypersensitivity
 Anemia
 Hepatic or
severe renal disease
Side Effects:
Hema: leucopenia,
neutropenia,
hemolytic anemia
CNS: drowsiness
GI: nausea,
vomiting,
abdominal pain,
hepatotoxicity,
INTEG: rash
urticaria
 Not to
exceed
with
recomme
nded
dose;
acute
poisoning
with liver
damage
may
result
 Use
liquid
form for
children
& pts
with
difficulty
in
swallowi
ng.
 In
children,
don’t
exceed 5
doses in
 Give with
full glass
of water
 With food
or milk to
decrease
gastric
symptom
s.
 Increase
fluids
 Monitor
V/S
 Avoid
usage of
multiple
preparatio
ns
containin
g
acetamen
ophen.
 Perform
Tepid
Medications
taken at
ordered
dose,date
and time.
Desired
effects
obtained.
33
33

34. 24 hours.
 Carefully
check
over-the-
counter
products
 Give drug
with food
Sponge
Bath
34
34

35. SAN LORENZO RUIZ COLLEGE OF ORMOC
COLLEGE OF NURSING
ORMOC CITY
Name: Mr. Marlou W. Miao Room Number: P2
Impression/Diagnosis: Typhoid fever Physician: Dr. Labtic
Date of Admission: July 17, 2010
SOAPIE #1
“gitugnaw kuno siya.” As verbalized by the grandmother.
Received patient lying in bed, with an of IVF of #2 D5IMB @ 18cc/hr at
the right dorsum of his hand, conscious, and responsive. The patient looks
tired and skin is warm to touch. Patient has flushed skin, teary eyes,
cracked lips and is shivering. Patient’s vital signs are: Pulse rate: 120bpm,
temp: 38.5 °C, RR:28cpm
Altered themoregulation: fever related to on going infection
To report body temperature is lowered from 38.5 °C to 36.5 °C
35
35

36. Monitored vital signs qshift; assisted his needs; rendered tepid sponge
bath; loosened clothing of patient; encouraged increase fluid intake;
administered tempra (antipyretic) as ordered by the physician
Patient’s temperature lowered from 38.5 °C to 37.5 °C
36
36

37. SAN LORENZO RUIZ COLLEGE OF ORMOC
COLLEGE OF NURSING
ORMOC CITY
Name: Mr. Marlou W. Miao Room Number: P2
Impression/Diagnosis: Typhoid fever Physician: Dr. Labtic
Date of Admission: July 17, 2010
SOAPIE #2
“wala siya’y gana mokaon.” As verbalized by the grandmother.
Received patient lying on bed, with an IVF of #2 D5IMB @ 18cc/hr on his
right hand, conscious and responsive. The patient looks tired and ate only
5 tablespoons of her breakfast. Patients vital signs were: temperature: 37
°C, pulse rate: 118 beats per minute, respiration rate of 22 cpm
Altered Nutrition: less than body requirements related to decreased
appetite
To promote optimal nutritional status as evidenced by eating up her entire
meal
37
37

38. Monitored vital signs; attended patients needs; provided small frequent
feedings; limited activities of patient; offered healthy fruit juices;
organized nursing activities
The patient was eating his fruits and drinking his juices. He was able to
finish eating more half of his lunch.
SAN LORENZO RUIZ COLLEGE OF ORMOC
COLLEGE OF NURSING
ORMOC CITY
Name: Mr. Marlou W. Miao Room Number: P2
Impression/Diagnosis: Typhoid fever Physician: Dr. Labtic
Date of Admission: July 17, 2010
PLAY THERAPY
Developmental
task
Type of Play Objective of Play Framework of Play
Toddler
(1-3 Years old)
- leaves and
independent
behaviors
regarding
toileting, bathing,
feeding, dressing,
exert self
awareness
exercise device
Source:
(Pediatric Nursing
by Pot)
PARALLEL
PLAY
The toddler
demonstrate little
attention to the
feelings of play
pattern and
frequently grabs
desired toys or
hates others to
keep favorite toy.
After 45 minutes
of conduction play
therapy, the patient
will be able to:
1. develop
necessary source
of touch
a. provide necessary materials or
toys that have different textures
(smooth, rough, soft and hard)
b. let the child touch the different
materials provided
c. use different sizes of boxes to
use for put in and take out toy
d. ask mother to had her cuddle
the toddler in her lap
38
38

39. 2. interact with the
environment by
responding to
various stimuli
3. develop fine
motor skills
through playing
a. talk to the child in a soft and
exciting manner
b. allow child to listen to her
heartbeat through the stethoscope
a. prepare variety of objects to
handle such as rings, blocks,
squeeze toy etc. that the child
could lift with one hand
b. walk with the child in the
hallway
c. allow child to run but assist her
properly
39
39

40. Evaluation and Recommendation
The prognosis of the patient is good because he is responding to the treatment and
nursing interventions positively. Improvements have been noticed in the patient, such as increase
food intake, afebrile for 2 days now, increased activity tolerance and compliance of medication
intake. The patient was advised not to eat foods or drinks from unsanitary area or container.
Thus, the student nurse recommends having a continuous care of the client. The
family should support the patient in all aspects since this is the time when the client needs his
family so much. The client should take vitamins and eat lots of fruits and vegetables. Prevention
of any other disease depends on the client himself.
40
40

41. Evaluation and Implication
Nursing Practice:
Nursing action should be based on standard nursing practice developed through
the basic foundation of biological and psychological sciences. This case study will provide more
emphasis on the treatment of typhoid fever. It is designed to improve and assist individuals to the
performance of nursing care to patient with typhoid fever. The student nurse should have an
attitude of caring characterized by a free and easy environment. This may mean rendering
holistic nursing care effectively and efficiently. It is important to emphasize the good of the
positive aspects in what the patient is capable of doing.
Nursing Education:
This case study will enhance and broaden the knowledge, expertise and ideas
about typhoid fever through the information gathered. It will also contribute to the important
facts when we talk of communicable nursing and will provide a concrete example in the other
related studies during discussion. One can also compare and actual situation with basic
information and may come to appreciate man’s unique being.
Nursing Research:
This case study will enhance research regarding initiating a holistic nursing care
to a patient with typhoid fever. There has always been a need to know more about nursing
measures to be rendered. Through this case study, more works will be instilled towards the
patient with typhoid fever. Researchers may be inspired to continue to research, more
comprehensions and extensive study especially with complications and their response to the care
given.
41
41

42. Bibliography
Books:
Billings, Diane McGovern. Medical- Surgical Nursing. The C.V. Mosby Company. 11830
Westline Industrial Drive, TS. Louis, Missouri. 1987.
Black, Joyce M. Luckmann and Sorensen’s Medical-Surgical Nursing. 4th
edition. W.B.
Saunders Company. 1993
Bullock, Barbara L. Pathophysiology. 4th
edition. Lippincott Williams and Wilkins Company.
Philadelphia, Pennsylvania. 2001
Holloway, Nancy M. Medical-Surgical Care Planning. 3rd
edition. Springhouse Corporation.
Springhouse, Pennsylvania. 1999
Kozier, Barbara, et al. Fundamentals of Nursing. 5th
edition. Addison Longman Inc. Singapore.
1998
Merch, et al. The Merck Manual. 16th
edition. Merck Research Laboratories. New Jersey.1992
Hockenberry, Marilyn J. Wong’s Essentials of Pediatric Nursing. 7th
edition. Mosby, Elsevier
Inc., Philippines. 2005
Marieb, Essentials of Human Anatomy and Physiology 7th
Edition, Pearson Education Inc., San
Francisco, 2003
Doenges, Moorhouse and Geissler-Murr, Nurrse’s Pocket Guide Diagnoses, Interventions
and Rationale 9th
Ed, Taber’s Publisher, Philadelphia, Pennsylvania, 2004
Internet:
Microsoft® Encarta® Encyclopedia 2002. © 1993-2001 Microsoft Corporation. All rights
reserved.
www.innerbody.com
http://en.wikipedia.org/wiki/Typhoid_fever
Math homework help
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42

43. https://www.homeworkping.com/
Math homework help
https://www.homeworkping.com/
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