Introduction

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella

Typhi. In the United States about 400 cases occur each year, and 75% of these

are acquired while traveling internationally. Typhoid fever is still common in the

developing world, where it affects about 21.5 million persons each year.

Typhoid fever can be prevented and can usually be treated with antibiotics. If you

are planning to travel outside the United States, you should know about typhoid

fever and what steps you can take to protect yourself.

Patients Profile

Name: Shiela Acero

Age: 29 years old

Sex: Female

Status: MArried

Religion: Roman Catholic

Home address: House Redeemer, Butuan City

History of Illness

Two days prior to admission patient had been experiencing fever associated with

body malaise and frontoparietal headache. She just took Paracetamol.

One day prior to admission patient had notice a rashes on her back and along to

the extremities and so she decided to be admitted and have a proper

management of her condition.

Reason for admission

Patient was admitted at November 4,2007,Sunday a7 9:15am and was

accompanied by family members, she was ambulatory. With chief complaints of

fever, headache and body malaise. She was seen and examined by Dra. Daisy

Galbo and advised to have a laboratory test and examinations to properly

confirm the cause of her illness.

What is typhoid fever?
Typhoid fever is a bacterial infection of the intestinal tract and occasionally the bloodstream. It is
an uncommon disease with only 30-50 cases occurring in New York each year. Most of the cases
are acquired during foreign travel to underdeveloped countries. The germ that causes typhoid is a
unique human strain of Salmonella called Salmonella typhi. Outbreaks are rare.

What are the signs and symptoms of typhoid fever?

The incubation period is usually 1-2 weeks and the duration of the illness is about 4-6 weeks. The
patient experiences:
• poor appetite,
• headaches,
• generalized aches and pains,
• fever, and
• lethargy.
Persons with typhoid fever usually have a sustained fever as high as 103 to 104 degrees
Fahrenheit (39 to 40 degrees Centigrade).
Chest congestion develops in many patients and abdominal pain and discomfort are common.
The fever becomes constant. Improvement occurs in the third and fourth week in those without
complications. About 10% of patients have recurrent symptoms (relapse) after feeling better for
one to two weeks. Relapses are actually more common in individuals treated with antibiotics.

How is typhoid fever spread?

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their
bloodstream and intestinal tract. In addition, a small number of persons, called carriers , recover
from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in
their feces (stool).

You can get typhoid fever if you eat food or drink beverages that have been handled by a person
who is shedding S. Typhi or if sewage contaminated with S. Typhi bacteria gets into the water you
use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world
where handwashing is less frequent and water is likely to be contaminated with sewage.

Once S. Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The
body reacts with fever and other signs and symptoms.

How is Typhoid Fever treated and what is the prognosis?

Typhoid Fever is treated with antibiotics which kill the Salmonella bacteria. Prior to the use of
antibiotics, the fatality rate was 10%. Death occurred from overwhelming infection, pneumonia,
intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality has
been reduced to 1-2%.
Several antibiotics are effective for the treatment of typhoid fever. Chloramphenicol was the
original drug of choice for many years. Because of rare serious side effects, chloramphenicol has
been replaced by other effective antibiotics. If relapses occur, patients are retreated with
antibiotics.
The carrier state, which occurs in 3-5% of those infected, can be treated with prolonged
antibiotics. Often, removal of the gallbladder, the site of chronic infection, will cure the carrier
state.
For those traveling to high risk areas, vaccines are now available.
How can you avoid typhoid fever?

Two basic actions can protect you from typhoid fever:

1. Avoid risky foods and drinks.

2. Get vaccinated against typhoid fever.
It may surprise you, but watching what you eat and drink when you travel is as important as being
vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will
also help protect you from other illnesses, including travelers' diarrhea, cholera, dysentery, and
hepatitis A.

"Boil it, cook it, peel it, or forget it"

 If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled
carbonated water is safer than uncarbonated water.
 Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles
and flavored ices that may have been made with contaminated water.
 Eat foods that have been thoroughly cooked and that are still hot and steaming.
 Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily
contaminated and are very hard to wash well.
 When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands
with soap first.) Do not eat the peelings.
 Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the
street, and many travelers get sick from food bought from street vendors.
Diagnostic test:

 Blood Count

Blood Count Result Normal level (female) Readings

Wbc 2,600 5,000 - 10,000/uL Increased

Hemoglobin 12.8 11.00 – 16.0 g/dL Normal

Hematocrit 38.8 38 – 47% normal

 Tubex Test
Tubex test for Salmonella typhi was (+)

 Urinalysis

Color Yellow

Transparency Slightly Hazy

Ph 6.0

Specific Gravity 1.010

Medications

Generic Name Acetaminophen

Brand Name Paracetamol
Classification Nonopioid Analgesic and Antipyretics
Action Drug may relive fever through action of the central action in the
hypothalamic heat regulatory center
Indication Mild Pain and Fever
Adverse Effects Hypoglycemia, rash
Teaching Tell patient to take drugs as prescribed by doctor

Generic Name Cetirizine hydrochloride

Brand Name Zyrtec
Classification Antihistamines
Action Long acting non-sedating antihistamines
Indication Chronic urticaria
Adverse Effects Fatigue, dizziness, headache
Teaching  Tell patient to drink coffee or tea to reduce drowsiness if not
contraindicated.
 Ice chips may relieve dry mouth

Generic Name Ceftriaxone sodium

Brand Name Rocephin
Classification Cephalosporins
Action Inhibits cell wall synthesis, usually bactericidal
Indication Infections
Adverse Effects Fever, headache, rash
Teaching Tell patient toreport discomfort on IV insertion
Nursing Care Plan: Typhoid Fever

Problem: Knowledge Deficient on regarding to the mode of transmission.

Diagnosis: Knowledge Deficient related to lack of information to the disease secondary to statement of misconception.

Diagnosis Goal Intervention Implementation Evaluation

Subjective: 1. After initial Independent Actions: Goal Met:

Patient verbalized of “ I
don’t know where I get
the disease, basta dili
man pud ko hilig mag
kaon sa gawas”
Objective: 2. She will be
She was avoiding to
ask question upon
Interaction or
unknowledgeable when
ask about her condition.
interaction
patient will be 1. She will be encourage • She will be guided Patient was able to
able to know to say something or talk by asking verbalized understanding
the disease about what she knew of questions on the of her condition and the
process of her her condition. history of her disease process itself and
condition. • Important to assess condition PTA. its proper preventative
her level of measures.
understanding.
able to 2. She will be explained • Pictures regarding
verbalize and discussed all she Typhoid Fever will
understanding needed to know of her be used to make it
of her condition and how did more informative
condition, after she possibly acquire it. and easy to
initial • Important to clarify understand.
interaction. her mind and be
more informed
about its mode of
transmission.
3. Discuss and • She will be
demonstrate to her the encourage to have
proper preventative a return
demonstration and
 measures of the a discussion to
disease like correct properly assess
hand washing and her learning on
handling of foods. proper hand
• Necessary so that washing and
she will be able to handling of food.
have a base
knowledge of the
proper prevention
and self • Significant others
management. will also be allowed
4. Significant others will to have a
be informed about the demonstration
disease and its proper regarding on the
prevention. correct hand
• Important to prevent washing and
possible re- preparation of
occurrence of the food.
disease and provide
a safe and proper
care to their
affected family
members.

Dependent Actions:

She will be advised to

take medications as
prescribed by the
physician.