FATHER SATURNINO URIOSUNIVERSITYNURSING PROGRAM
Butuan CityAn Individual Case StudyOn
TYPHOIDFEVER
Bondoc , James Aurelle S. Student NurseMs. Edgracia Airrane A. Vega, RNSupervising Clinical Instructor
Introduction
Typhoidfever
Salmonella typhi
bacteria.
S. typhosa
is a short, plump, gram negative rodthat is flagellated and actively motile. Contaminated food or water is the common medium of contagion.The disease follows four stages. The first stage is known as incubation period, usually 10-14 days in occurrence. In this stage generalization of the infection occurs. In the second stage,aggregation of the macrophages and edema in focal areas indicates bacterial localization(embolization) and resultant toxic injury which disappear after few days. The third stage of disease is dominated by effects of local bacterial injury especially in the intestinal tract,mesenteric lymph nodes, spleen, and liver. The fourth stage, or the stage of lysis, is the stagewherein the infectious process is gradually overcome. Symptoms slowly disappear and thetemperature gradually returns to normal.The symptoms of typhoid fever include high fever, chills, cough, muscle pain, weakness,stomach pain, headache and a rash made up of flat, rose-colored spots. Diarrhea is a lesscommon symptom of a typhoid fever, although it is a gastrointestinal disease. Sometimes thereare mental changes, know as ‘
typhoid psychosis’
. A characteristic feature of typhoid psychosisis plucking at the bedclothes if patient is confined to bed.Risk factors for acquiring typhoid fever likely include improper food handling, eatingfood from outside sources like carinderia, drinking contaminated water, poor sanitation and even poor hygiene practices. War and natural disasters as well as weak, non existent of health careinfrastructure may also contribute. Both genders do have equal chances on acquiring suchdisease. Asian, African and Americans are at greatest risks of acquiring the disease sincegeographical locations play a part.Complications of typhoid fever are secondary conditions, symptoms, or other disordersthat are caused by typhoid fever. Complications include overwhelming infection, pneumonia,intestinal bleeding, and intestinal perforation may eventually lead to death.Typhoid fever is one of the most protean of all bacterial diseases thus laboratory procedures are usually depended on to confirm or disprove suspicion of such disease. The placeof blood culture, serologic studies and bacteriologic examination feces and urine are useful inestablishing the diagnosis. Agglutination (Widal) for typhoid fever is done to determine antibodyresponse against different antigenic fractions of organisms.Typhoid fever is treated with antibiotics which kill the
Salmonella
bacteria. Severalantibiotics are effective for the treatment of typhoid fever. The choice of antibiotics needs to beguided by identifying the geographic region where the organism was acquired and the results of cultures once available. Two new vaccines are currently licensed and widely used worldwide, asubunit (Vi PS) vaccine administered by the intramuscular route and a live attenuated S typhistrain (Ty21a) for oral immunization.In most cases, typhoid fever is managed at home with antibiotics and bed
rest. For hospitalized patients, effective antibiotics, good
nursing care, adequate nutrition, careful attentionto fluid
and electrolyte balance, and prompt recognition and treatment
of complications arestrategies to avert the possibility of death.I choose this topic since it catches my interest from the time being I was able to handle patient having typhoid fever. It gives me the motivation to look for the things that governs suchdisease. Typhoid fever as my case study allows me to find for ways to contribute something for the alleviation of the condition of its victims may it be in my own little ways perhaps. May thiscase study of mine serves as advent to understand more fully the existence of such disease andthe proper interventions needed to be rendered upon to address such condition looking to a new perspective of life.
Nursing health history is the first part and one of the most significant aspects in casestudies. It is a systematic collection of subjective and objective data, ordering and step-by-step process inculcating detailed information in determining client’s history, health status,and functional status and coping pattern. These vital informations provide a conceptual baseline data utilized in developing nursing diagnosis, subsequent plans for individualizedcare and for the nursing process application as a whole. It is needed for solving anddetermining a client’s problem and for the nurse to know what interventions to be appliedand rendered upon and what may be the cause of the illness. It aims to determine the biographic data of the client, chief complaint history of present illness, social data psychological data, lifestyle patterns and se of health care systems among othersIt was the 19
th
day of April, 2010 when our group was first exposed to the world of pediatric nursing. Under the supervision of Ms. Edgracia Airrane A. Vega, RN, all of us practiced our skills by applying the concepts we learned from school. Then we were told byour C.I to make an individual case study regarding on the cases of the children we were ableto care with. I was able to care patient with typhoid fever last April 20, 2010. So I chose towork on the case of typhoid fever after obtaining the permission of the patient as well to her significant othersFor the purpose of confidentiality and respect to the identity of my patient, I decided towithhold her real identity and decided to address her as Patient R. We will also address her mother as Mother A, grandmother as Grandmother B and aunt as Aunt C.Patient R is a native of Agusan and true Filipino in blood. She first saw the light lastOctober 11, 1995. She is fourteen years old at present and an Iglesia ni Cristo in faith.
Prenatal History
The pregnancy of Patient R was expected by the couple. “Wala man ko nasakit adtongnagbuntis ko niya” as verbalized by Mother A when asked about any history illnesses during pregnancy. According to her, she took iron supplements such as Ferrous Sulfate during thecourse of pregnancy as prescribed to her. She also had her regular check up to the barangayhealth center and vaccinated with tetanus toxoids respectively.Mother A gave birth to 7 lbs baby girl on the 11
th
day of October, 1995 through Normal Spontaneous Vaginal Delivery at Agusan del Norte Provincial Hospital, Libertad,Butuan City. According to Mother A, the labor took for three days and the length of hospitalization was also three days. She was then breastfed hours after birth. Breastfeedingcontinued up to 6 months of life of Patient R.“Kumpleto jud na siya ug bakuna” as verbalized by Mother A when asked aboutimmunization status of the patient.
Developmental Milestones
Between the 1
st
and 2
nd
months, client M can already flex her elbows.She was about 3 months old when the first smile was noted by Mother A.On the 4
th
month of life, she can lift upper part of he body while in prone position.She was about 5 to 6 months old when client M can already rest weight on her forearmwhen in prone position. She can also turn from front to back. “Sige man to siya ug hilak bastamagligid- ligid siya” as verbalized by Mother A. Her first tooth erupted at the age of 6 months.It was between the 7
th
and 8th month when Patient R can already crawl as what beingmentioned by Mother A.Between the 9
th
to 11
th
months, client M can sit momentarily but with support from her mother. “Mohilak gale siya kung kugoson sa uban” as verbalized by Mother A. when asked boutthe client’s reaction if held by others.
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