STI COLLEGE SOUTHWOODS

Lot 2A Maduya, Carmona, Cavite

COLLEGE OF HEALTH CARE

T/C Typhoid Fever; Post VP

Shunt 2 Hydrocephalus and
2 Meningocele 2008

Presented By:
Capistrano, Reggie
Foroneas, Karen
Nono, Ma. Franine Alyssa
Sobrevega, Reysie
BSN 3rd year Level-Group 3

Presented To:
Herald Clarence Ambayec, R.N

March 18, 2010

Division of Labor

Part of the Case Study_

A. Introduction

Person to Discuss

Marcus Dale Belisario

B.

Biographical Data

Marcus Dale Belisario

C.

Nursing History

Marcus Dale Belisario

D.

Current Health Status

Reggie Capistrano

E.

Psychological Development

Reysie Sobrevega

F.Physical Examination

Ma. Franine Alyssa Nono

G.

Laboratory Examination

Karen Foroneas

H.

Medical Plan of Care

I.

Anatomy and Physiology

Reggie Capistrano

J.

Pathophysiology

Marcus Dale Belisario

K.

Ma. Franine Alyssa Nono

Drug Study

Karen Foroneas

L.

Nursing Care Plan

Karen Foroneas

M.

Discharge Plan of Care

Reysie Sobrevega

N. Health Teaching Plan =

Sobrevega/
Reggie Capistrano
O.

Summary of Clients Status as of Last Day Contact

Reysie Sobrevega

Reysie

INTRODUCTION:
Typhoid fever, also known as enteric fever, bilious fever, Yellow Jack or commonly just
typhoid, is an illness caused by the bacterium Salmonella enterica serovar Typhi. Common
worldwide, it is transmitted by the ingestion of food or water contaminated with feces from an
infected person. The bacteria then perforate through the intestinal wall and are phagocytes by
macrophages. Salmonella Typhi then alters its structure to resist destruction and allow them
to exist within the macrophage. This renders them resistant to damage by PMN's,
complement and the immune response. The organism is then spread via the lymphatic while
inside the macrophages. This gives them access to the Reticulo-Endothelial System and then
to the different organs throughout the body. The organism is a Gram-negative short bacillus
that is motile due to its peritrichous flagella. The bacterium grows best at 37 C/99 F
human body temperature.
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.
Typhoid fever is characterized by a sustained fever as high as 40 C (104 F), profuse
sweating, gastroenteritis, and non-bloody diarrhea. Less commonly a rash of flat, rosecolored spots may appear.
Classically, the course of untreated typhoid fever is divided into four individual stages, each
lasting approximately one week. In the first week, there is a slowly rising temperature with
relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a
quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the
number of circulating white blood cells, with eosinopenia and relative lymphocytosis, a
positive diazo reaction and blood cultures are positive for Salmonella Typhi or Paratyphi. The
classic Widal test is negative in the first week.
In the second week of the infection, the patient lies prostrated with high fever in plateau
around 40 C (104 F) and bradycardia (Sphygmo-thermic dissociation), classically with a
dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This
delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower
chest and abdomen in around 1/3 patients. There are rhonchi in lung bases. The abdomen is

distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea
can occur in this stage: six to eight stools in a day, green with a characteristic smell,
comparable to pea-soup. However, constipation is also frequent. The spleen and liver are
enlarged (hepatospleenomegaly) and tender and there is elevation of liver transaminases.
Blood cultures are sometimes still positive at this stage.
In the third week of typhoid fever a number of complications can occur:

Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very
serious but is usually non-fatal.

Intestinal perforation in distal ileum: this is a very serious complication and is

frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse
peritonitis sets in.

Encephalitis

Metastatic abscesses, cholecystitis, endocarditis and osteitis

The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the
patient is delirious (typhoid state). By the end of third week defervescence commences that
prolongs itself in the fourth week.
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.
Typhoid can only spread in environments where human feces or urine are able to come into
contact with food or drinking water. Careful food preparation and washing of hands are
therefore crucial to preventing typhoid.

STI COLLEGE SOUTHWOODS

Lot 2A Maduya, Carmona, Cavite
COLLEGE OF HEALTH CARE
PATIENTS HISTORY
A. Biographical Data
Name: Baby Pops
Age: 2 years old and 5 months

Gender: Male

Status: Pedia

Address: San Pablo City, Laguna

Dialect/Language Spoken: Tagalog and English
Chief Complaint: On and off fever x 6 days with poor oral intake
Admitting Diagnosis: T/C Typhoid Fever; Post VP Shunt 2 Hydrocephalus, 2 Meningocele

B. NURSING HISTORY
1. History of Present Illnesses
Last January 16, 2010 Baby Pops experience a fever with 39C consistent of 6
days and self medicated by his mother and given Paracetamol syrup p.o without
any consultation to the doctor. Then 6 days of fever the mother decided to go to
the hospital and having consultation, when they arrived to the hospital and
consulted by the doctor, the mother advised to admit Baby Pops.
2. Family History
Male:

Female:

-No
abnormality

Patient:
-Hirshprung
disease
-Diabetes

-Hydrocephalus
-Lumbuscral
Myelomeningocele

3. Childhood Illnesses
According to the mother, Baby Pops had only a cough and colds and fever.

4. Hospitalization History
First Admission
When Baby pops was 9 months old and diagnosed Pneumonia at PPL San Pablo,
Laguna
Second Admission
When Baby Pops was 1 year old and 4months and admitted at the PGH Manila
December 11, 2008 Lumbuscral Myelomeningocele
December 24, 2008 Inserting VP Shunt
C. CURRENT HEALTH STATUS
A. Activity
Frequency and regularity of exercise: Baby Pops always wants to bend, to crawl
and to play basketball with his dad.
Duration and Length of Exercise: Malimit o Mayat maya is how his mother
describes the duration of his exercise. While if his playing
basketball, he plays at least 2 hours
Limitation of Activity: Baby Pops mother limited him to walk and to play with
relatives especially his cousins, causing him to be tease.
Any Complaints and Discomfort: Baby Pops doesnt have any discomfort or
complaints related to the activity.
B. Rest
Usual no. of hours of sleep and rest at night/at day time: At night, Baby Pops
usually sleeps 10 hours and while in day time, he usually
sleeps at around 10:30am-1:30pm but sometimes, kit
depends on the environment.
No. of hours of sleep and rest to feel rested: Usually, Baby Pops sleeps 4 hours to
feel rested.
Change in sleep/rest pattern: Baby Pops doesnt have any changes in sleeping, but
sometimes it depends on the situation.
Discomfort or difficulty going to sleep: He doesnt have any discomfort going to
sleep but sometimes he get easily destructed when stranger
hold his IV line or touch him, because his mother and his
grandmother can only touch him.

Remedy done with the comfort: The only remedy done with this discomfort was
yapos lang ng nanay ang gusto niya, said by the mother.
No. pillows use when sleep: He had 4 pillows when sleeping; 1 for the head, 1 on
each side and a hotdog pillow to embrace.
C. Nutritional Metabolic Pattern
Food Preference: Baby Pops loves to eat rice and bulanglang a kind of mixed
vegetables, that popular in Bisaya.
Volume and type of fluid taken per day: He drinks 18oz of milk twice a day, with
sabaw ng buko and mais
Source of drinking water: The mother gets water for Baby Pops on a Wilkins
mineral water
Medication used (if any): At home, the mother gives multivitamins like Growee and
Propan TLC, for protection and for rapid growth.
D. Elimination Pattern
i. Bladder
Frequency and amount of urination per day: Baby Pops usually uses 2
(XL) diapers a day.
Color and odor of urine: He had light yellow color urine and with
aromatic odor which indicates of the normal findings.
Any discomfort of urination: The child also doesnt have any complaints
in urination.
ii. Bowel
Frequency of bowel movement: Baby Pops usually defecate 1 or 2 times
a day.
Consistency and color of stools: Baby Pops had a soft stool and scanty
odor and slightly brownish color as alleged.
Changes in bowel elimination: After surgery, he had experienced bowel
movement difficulty.
E. Fluids and Electrolytes
Skin turgor: Baby Pops was found to have a normal skin turgor when pinched,
within 1-2 seconds skin returns to normal prior to the
assessment.
Condition of mucous membrane: Baby Pops mucous membrane was good with
some mild pinkish mucous membrane.
Edema: There were no evident edemas observed on the pt. face and on the lower
and upper extremities.

K, Ca, Na, and supplementation: The present fluid supplement upon assessment
was D5IMB solution.

F. Senses
There are no disturbances or difficulty aside from touch, he just got easily
destructed and disturbed when somebody holds or touch him.
G. Skin Integrity
Pigmentation: Baby Pops had fair skin pigmentation.
Temperature: He was cold to touch due to expose and direct air thru window.
Smooth (+)

Rough (-)

Soft (+)

Dry (-)

H. Neurologic Function
Level of Consciousness: Baby Pops was conscious and coherent.
Orientation: Baby Pops easily becomes irritable when he sees stranger going close
to him.
Gait: Baby Pops had disturbances due to his plantar flexion of foot.
Posture: He had a plantar flexion of foot.
Changes in facial: He also had a downward deviation of the eye (sun setting).
Role Function Mode
Type of family structure: Their family structure was extended.
How many members in the family: They were composed of 5 family members.
Who is the bread winner: The present breadwinner in their family was the father and
the grandmother.
Who is the decision maker: Also, when it comes to decision making it was the father
and the grandmother, who decides in their family.
How does the family feel about the illness: The family feels sad but very supportive,
when it comes to Baby Pops hospitalization.

D. PSYCHOLOGICAL DEVELOPMENT
PSYCHOSEXUAL

PSYCHOSOCIAL

COGNITIVE

(Freud)

(Erickson)

(Piaget)

INTERPERSON
AL

MORAL

SPIRITUAL

(Kohlberg)

(Fowlers)

Anal: 18 mos.-

Autonomy vs.

Pre-

(Sullivan)
Childhood:

3yrs. Old

Shame and

operational:

18 mos.

conventional

Initiative-

Doubt: 18

2-4yrs. Old

6yrs old

Stage 1: Age

Projective

2-3 years old

Faith:

mos.- 3yrs. old

Level1: Pre-

Stage 1:

Toddler/
Pre-pleasure is

-Impulsitivity,

school

through

determination

-no cause and

-learn to delay

-punishment

elimination or

and compulsion

effect

need

or obedience

-No

retention of

-curious to

reasoning,

gratification

(heteronymou

spiritual

feces

everything that

egocentrism;

s morality)

concept

-behaviors:

their body

use of

Baby Pops

-a child does

but

control of

secretes

symbols;

doesnt have

the right

involves

holding on and

- significant

magical

control in his

things because

parents on

letting go.

relation: Parents

thinking

defecation,

a parent tells

religion

would have a

him or her to

and

-develop
concepts of

Baby Pops is a 2

Baby Pops was

hard time

avoid

spiritual

power,

years old, he

able to imitate

developing his

punishment.

beliefs.

punishment,

already have the

different

so called

ambivalence,

authority to

activities

sense of

Baby Pops

Baby Pops

concern with

command what

demonstrated

power as he

knows how to

already

cleanliness or

he wants to do

to him such as

attempts to

be an obedient

knows how

being dirty.

even it is

throwing the

control

child to his

to pray

dangerous. And

ball, asking

himself and

mother. But

and always

Baby Pops was

he also wants to

him to run

his

sometimes,

go to

a 2years and 5

be beside of his

after you,

environment.

the child

church

months old

mother.

hides and

This sense of

learns not to

every

child, he still

seeks an

power can

follow the task

Sunday

uses diaper, he

example of

also be used

that given to

with his

can already

mental

to please the

him. And a

parents

control his feces

representation

mother. He

punishment

but he

even his in the

also learns to

will be given

doesnt

hospital. The

interact with

to him.

know very

resolution of

the other child

well about

the patient was

to play and

the

Shame and

build to have

concept of

Doubt, due to

friends.

religion

anxiety with

and

strangers.

spiritual
beliefs that
his parents
taught to
him.

E. PHYSICAL EXAMINATION
Date performed: January 22, 2010
1.

2.

Vital signs :
a.

Temperature:

36.4C

b.

Pulse Rate:

103bpm

c.

Respiratory Rate:

25cpm

Regional Examination:

Regions of the body

a. Hair

No. of hospital Days: 2 days

Methods of Assessment
(IPAP)
Inspection

b. Head

Results
Short, slightly oily hair
Oblong shape, open anterior
fontanel at the frontal area,

Inspection

(+) VP Shunt tube located at

Palpation

the right temporal, (-) mass,

(+) scar at least 1 inch at
the right occipital area.
Symmetrical,
with
slight

c. Face

d. Eyes

Inspection

bulging at the top of head,

Inspection

downward deviation of eyes.

Sunsetting eye, watery
color of the eye is black,
constricted,

(eyes

do

not

follow in response to head

movement)

can

focus

on

objects 7-8 inches away, can

follow up to midline,

Eyelids-fully cover eye when

close

and

when

open

partially

raise

(blink

reflex

present), placement in eye

e. Nose

Inspection

f. Mouth and pharynx

socket-normally placed.
Flat
nose,
smooth,

(-)

distress, (-) nasal flaring

Lip color-normally pinkish,
open evenly when cry, soft
and

Inspection

hard

palate

intact,

tongue slightly heart shape,

freely movable and does not
protrude, milk teeth present,
but upper teeth in front are
decayed.
Symmetric,

g. Neck

flexible

movement
Inspection

equally

of

to

and

the

head

both

sides,

supported by pillows when

h.

Chest

eating, (+) lymph nodes

Symmetric,
clavicles

wall

( Anterior)

straight, (-) fractures, heart

Inspection
Auscultation

rate

heard

clavicular

at

the

space

at

mid
fourth

intercostal space (103bpm),

(-)murmur
(-) fracture, spine is aligned,

i. Chest wall (Posterior)

Inspection
Auscultation

lumbar area (+) scar 1

inch long due to lumboscral
myelomeningocele
Nipple are prominent, well

j. Breast and Axilla

Inspection

formed

and

symmetrical

place
103bpm, apical pulse and

k. Heart
Auscultation
l. Abdomen

(-) murmur. At the midline of

Inspection
Auscultation

respiratory

rate

normal rhythm
(-)kidney
and
enlargement,

identified,
spleen
(+)

burborgymi sounds (18p/m),

globular, , (-) masses

m. Skin and nails

Skin- (-)dry, (+) smooth

Inspection

Nails- short nails with some

dirt at the singit inside
nails
(+)patent anus, (-)rashes,

n. Anus and Rectum

Inspection

(-)hemorrhoids

o. Extremities (lower)

BM- 1x
Rating: 5 normal, there is an

*include

active resistance with simple

ROM

and

muscle strength

Inspection
Palpation

motion
-equal in length, five
fingers on each feet, but the
both foot is in plantar flexion
(equinus)
Rating: 5 normal, there is an

p. Extremities (upper)
*include

ROM

muscle strength

and

Inspection

active resistance with simple

Palpation

motion, complete fingers on

both hands
Color- light yellow

q. Urinary

Transparency- turbid
Specific Gravity- 1.005
Reaction- acid
Albumin- ++
Sugar- negative
Inspection

Pus Cell- TNTC

RBC- 2-4hpf
Bacteria- +
Epithelial Cell- few
Crystals- Amorphous
Urates(+)

r. Genitals
s. Musculoskeletal

Inspection
Inspection

Void- 2 diapers per day

(-) hernia
- (-) weakness, equal size on
both

side

smooth

of

and

the

body,

coordinated

movements
-

(+)

equinus

(plantar

flexion of foot)
- no tenderness, swelling of

joints
- (+) gait problems
Refer to Lab results

t. Hematology

Based on laboratory
If applicable please include Neuromuscular Vital signs / assessment

F. LABORATORY EXAMINATION
Purpose of
Date and
Type of

Nursing

the
examinatio

Normal

n to the

Values

Examination

patients

responsibiliti

Results of
the

es

Interpretation

(before,

examination

during ,

case
1-22-10
Urinalysis

-to

detect

after)
Color:

normal

yellow-

versus

straw/amber

Color: light
yellow

All of the results

in the urinalysis
that

abnormal

are

significant is the

urine

Transparen

Transparenc

presence of pus

component

cy: clear

y: turbid

cells

glycosuria

Specific

Specific

The urine of the

-to aid in the

Gravity:

Gravity:

patient

diagnosis of

1.010-1.020

1.005

diluted

-to

detect

renal

was
due

less

failure

to

specific

gravity
Reaction:

Reaction:

4.5-8.0

acidic

Albumin:

Albumin:

CSF

Negative

++

composed
protein

Sugar:

Sugar:

Negative

Negative

Pus Cell:

Pus Cell:

3-4

too numerous
to count

RBC: 1-2

RBC: 2-4

was
of

Before:
Check the
chart of the
pt. And
carried out
doctors
order
During:
Explain the
procedure to
the pt. And
its
importance.
Assist client
with the
urine
collection as
needed
Obtain
history of
excess
amount of
certain foods
such as
carrots,
rhubarb
After:
Provide
Comfort to
the pt. After
the
procedure.
Wait for the

result

Bacteria:

Bacteria:

Due the VP shunt

Negative

Positive

the patient have

Epithelial

Epithelial

Cells:

Cells: few

Negative
Crystals:

Crystals:

Due

to

Negative

amorphous

hydrocephalus
and

Urates:

his

the

VP

Shunt

Negative
Hematology -

to

check

HGB- (110-

HGB- (94.6

the

blood

165 g/L)

g/L)

Before:
Check for

component
for

any

abnormality
-

to

HCT- (0.35-

HCT- (0.26

0.50 g/L)

g/L)

check

CBC order
Due

to

the

decrease

the volume

Platelet

Platelet

pressure

of RBCs in

count-

count- (226

VP Shunt

the blood

(150-450 x

x 10 g/L)

Doctors
in

his

Order
During
Explain

10 g/L)

the
WBC- (12.0

WBC- (5.0-

Carry Out

x 10 g/L)

procedure
An

increase

10.0 x 10

WBC

g/L)

signifies

in

which
a

current infection

to the pt.
and
is

what
to

withdrawn

Differential

Differential

from

count-

count-

blood.

Segmenter

Segmenters

s- (43.0-

- (60.7%)

76%)

be
the

Assess
client

signs/symp
toms

Lymphocyt

Lymphocyte

allergies

es- (17-

s- (32.7%)

such

48%)

for

tearing,

of
as

runny nose
Leukocytes

Leukocytes-

- (4.0-

(6.6%)

and rashes
After
Wait

10.0%)

for

the result
TYPHIDOT

To

IgM:

determine

Negative

IgM: Positive
Implication

for

the presence of

the
presence of

IgG:

IgG:

IgM

antibodies

Salmonella

Negative

Negative

includes previous

typhi which

infection

is

relapsed

the

or

re-

infection,

causative
agent

or

of

therefore;

Before:
Check for
CBC order
Carry Out
Doctors
Order
During

it

is

that

Explain

typhoid

important

fever

interpretation be

procedure

made

to the pt.

together

the

with the clinical

and

symptoms

is

to

what
to

be

diagnosed if the

withdrawn

patient

from

is

currently having
typhoid fever.

the

blood.
After
Wait

for

the result

G. MEDICAL PLAN OF CARE

Date of the

Doctors order

order
1-21-10

pls. admit to Pedia ward

(Misc) under Dr. Mamasig
Secure Consent

Responsibility of the

Purpose of the

nurse with the order

given order
- for admission

- Ask if the Doctor had

already inform her and
had signed the consent

- for legal purposes

TPR q shift and recorded

Soft diet

Labs:

CBC with platelet

1-22-10

8:00 am
1-23-10

1-24-10

1-25-10

U/A

Typhi dot

Executes
as
per
Doctors order
Refer
to
Medical
Technologists

Tx
D5 0.3 NaCl 500ml x
55ugtts/min
Chloramphenicol 300mg
TIV
(-) ANST every 6 hours
Paracetamol
125/5ml
every 4 hours p.o
TSB inform PROD of the
admission
Pls. re-insert IV
Pls. give chloramphenicol
IV drip for 15 units
Refer
IVF TF #2 D5IMB 500ml x
8 hours

Continue meds
TF #3 D5IMB 500ml x 8
hours

Continue meds
Pls. re-insert IV now
Warm compress on
sites

IVF TF #4 D5IMB 500 x 8

hours
Continue meds
Refer

1-26-10

- Monitor V/S every 4

hours
- Inform the mother
the proper diet for the
patient

Executes
as
Doctors order
Carried out

Carried out

Carried out

Carried out
IV

IVF TF #5 D5IMB 500 x 8

hours
Continue meds
Refer

Carried out

Carried out

per

-as baseline data

To know the proper
nutrition for the
patient
To further know the
other complications
to the disease
- To assess for any
abnormalities within
the urinary system
as well as for
systemic problems
that may manifest
symptoms through
the urinary tract.
-To detect Typhoid
fever and any other
salmonella
infection.

1-27-10

1-28-10

IVF TF #6 D5IMB 500 x 8

hours
Continue meds

Carried out
- executes as
Doctors order

per

IVF TF #7 D5IMB 500 x 8

hours
To
consume
IV
chloramphenicol; shift to
cefixime 20mg/ml 2x a
day
Refer

Carried out
- executes as
Doctors order

per

H. ANATOMY AND PHYSIOLOGY

The Digestive Process:

The start of the process - the mouth:

The digestive process begins in the mouth. Food is partly broken down by the process
of chewing and by the chemical action of salivary enzymes (these enzymes are produced
by the salivary glands and break down starches into smaller molecules).
On the way to the stomach: the esophagus
After being chewed and swallowed, the food enters the esophagus. The esophagus is a
long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle
movements (called peristalsis) to force food from the throat into the stomach. This muscle
movement gives us the ability to eat or drink even when we're upside-down.
In the stomach
The stomach is a large, sack-like organ that churns the food and bathes it in a very
strong acid (gastric acid). Food in the stomach that is partly digested and mixed with
stomach acids is called chyme.
In the small intestine
After being in the stomach, food enters the duodenum, the first part of the small
intestine. It then enters the jejunum and then the ileum (the final part of the small
intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder),

pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small
intestine help in the breakdown of food.
In the large intestine
After passing through the small intestine, food passes into the large intestine. In the
large intestine, some of the water

and

electrolytes

(chemicals

removed from the food. Many microbes (bacteria like

like

sodium)

are

Bacteroides, Lactobacillus

acidophilus, Escherichia coli, and Klebsiella) in the large intestine help in the digestion
process. The first part of the large intestine is called the cecum (the appendix is connected
to the cecum). Food then travels upward in the ascending colon. The food travels across
the abdomen in the transverse colon, goes back down the other side of the body in the
descending colon, and then through the sigmoid colon.
The end of the process
Solid waste is then stored in the rectum until it is excreted via the anus.
Digestive System Glossary:
Anus - the opening at the end of the digestive system from which feces (waste) exits
the body.
Appendix a small sac located on the cecum.
Ascending colon - the part of the large intestine that run upwards; it is located after
the cecum.
Bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and
secreted into the small intestine.
Cecum - the first part of the large intestine; the appendix is connected to the cecum.
Chyme - food in the stomach that is partly digested and mixed with stomach acids.
Chyme goes on to the small intestine for further digestion.
Descending colon - the part of the large intestine that run downwards after the
transverse colon and before the sigmoid colon.
Duodenum - the first part of the small intestine; it is C-shaped and runs from the
stomach to the jejunum.
Epiglottis - the flap at the back of the tongue that keeps chewed food from going
down the windpipe to the lungs. When you swallow, the epiglottis automatically closes.
When you breathe, the epiglottis opens so that air can go in and out of the windpipe.
Esophagus - the long tube between the mouth and the stomach. It uses rhythmic
muscle movements (called peristalsis) to force food from the throat into the stomach.
Gallbladder - a small, sac-like organ located by the duodenum. It stores and releases
bile (a digestive chemical which is produced in the liver) into the small intestine.
Ileum - the last part of the small intestine before the large intestine begins.
Jejunum - the long, coiled mid-section of the small intestine; it is between the
duodenum and the ileum.

Liver - a large organ located above and in front of the stomach. It filters toxins from
the blood, and makes bile (which breaks down fats) and some blood proteins.
Mouth - the first part of the digestive system, where food enters the body. Chewing
and salivary enzymes in the mouth are the beginning of the digestive process
(breaking down the food).
Pancreas - an enzyme-producing gland located below the stomach and above the
intestines. Enzymes from the pancreas help in the digestion of carbohydrates, fats and
proteins in the small intestine.
Peristalsis - rhythmic muscle movements that force food in the esophagus from the
throat into the stomach. Peristalsis is involuntary - you cannot control it. It is also what
allows you to eat and drink while upside-down.
Rectum - the lower part of the large intestine, where feces are stored before they are
excreted.
Salivary glands - glands located in the mouth that produce saliva. Saliva contains
enzymes that break down carbohydrates (starch) into smaller molecules.
Sigmoid colon - the part of the large intestine between the descending colon and the
rectum.
Stomach - a sack-like, muscular organ that is attached to the esophagus. Both
chemical and mechanical digestion takes place in the stomach. When food enters the
stomach, it is churned in a bath of acids and enzymes.
Transverse colon - the part of the large intestine that runs horizontally across the
abdomen.

I. PATHOPHYSIOLOGY
A. Diagram

Precipitating Factors:
Environment
Street Foods
(contaminated)
Unboiled water

Predisposing Factor:
Age: 2years and 5 months old
Sex: Male
Genes

Salmonella Typhi

Enter the G.I tract

(jejunum, ileum,
colon)

Enters bloodstream
via lymphatics
(peyers patch)

Penetrate cell with

little lysis

Multiply in lamina
propia

Systemic
spread

Local
Infection

Release of endogenous pyrogens (prostaglandin

E1) from neutrophils and macrophages
(specialized form of leukocytes)

Resetting the thermostatic set

point (prostaglandin E2)

The hypothalamus initiates heat

production behaviors (shivering and
vasoconstriction)
B. Tabular

FEVER

Definition of the
diseases

Signs and
Symptoms found in
the book

Typhoid Fever
A general infection
Signs and
caused by
Symptoms in book:
Salmonella typhi, a Fever
gram negative
Anorexia
motile and
Diaphoresis
nonspore- forming Weakness
bacillus. It is a
Myalgia
general infection
Malaise
that primarily
Moist crackles
involves the Peyers
Second week:
patches of the small
104F, evening chills
intestines
Delirium
Increasing abdominal
pain
Diarrhea or
constipation
Maculopapular rash
cough

Signs and
Symptoms

Evaluation or

manifested by the

comparison

patient
Signs and
Symptoms in
patient:
fever (6 days)
anorexia
constipation
cough

These means that the

signs and symptoms in
the book about typhoid
fever are seen to the
patient.

J. DRUG STUDY
Name of Drug,
Classification,
Route, Frequency

Drug Indication

and Dosage
Chloramphenicol Haemophillus
(anti-infective)

influenzae

Nursing Responsibility

Drug Action

Inhibits
protein

(before, during , after)

bacterial Use cautiously in patient

synthesis

with impaired hepatic or

R: TIV

Meningitis

by binding to the

renal

F: q6 hours

Acute Salmonella

50 sub-unit of the

intermittent

ribosome;

and G6PD deficiency; also

bacteriostatic

use cautiously with other

D: 300mg

typhi infection
Bacteremia
Other severe

drugs

function,

that

phorphyria

cause

infections caused by

marrow

sensitive Salmonella

blood disorders

species

Obtain

acute

bone

suppression
specimen

or
for

culture and sensitivity test

before giving first dose.
Therapy

may

pending results.

begin

 Obtain

plasma

levels

maintain levels at 5-20

mcg/ml
Monitor
iron

CBC,

and

platelets,

reticulocytes

before and every 2 days

during this therapy. Stop
immediately

if

anemia

occurred.
Name of Drug,
Classification,
Route, Frequency
and Dosage
Paracetamol

Drug Indication

Mild pain or fever

Drug Action

Nursing Responsibility
(before, during , after)

Thought to produce Use liquid form for

(analgesics)

analgesia by

children and patients

(antipyretics)

blocking pain

who have difficulty

R: p.o

impulses by

swallowing.

F: q4 hours PRN

inhibiting synthesis In children, dont exceed

D: 4ml

of prostaglandin in

five doses in 24 hours.

the CNS or of other Tell parents to consult

substances that

prescriber before giving

sensitize pain

drug to children younger

receptors to

than age 2.

stimulation. The

Advise parents that drug

drug may relieve

is only for short-term

fever through

use; urge them to

central action in the

consult prescriber if

hypothalamic heat-

giving to children for

regulating center.

longer than 5 days or

adults for longer than 5
days or adults for longer
than 10 days.

Name of Drug,
Classification,

Drug Indication

Drug Action

Uncomplicated UTI

Cefixime binds to

Route, Frequency
and Dosage
Cefixime

Nursing Responsibility
(before, during , after)
Check if the patient is

(anti-infective)
R: p.o

caused by E. coli

one or more of the

and proteus mirabilis

penicillin-binding

F: BID

Otitis media caused

D: 2ml

allergy to cephalosporins
Use cautiously in patient

proteins (PBPs)

with impaired hepatic or

by Haemophillus

which inhibits the

renal

influenzae

final

intermittent

phorphyria

transpeptidation

and

deficiency;

step of

also use cautiously with

peptidoglycan

other drugs that cause

synthesis in bacterial

bone

cell wall, thus

suppression

inhibiting

disorders

biosynthesis and

function,
G6PD

Obtain

acute

marrow
or

blood

specimen

for

arresting cell wall

culture

assembly resulting

test before giving first

in bacterial cell

dose. Therapy may begin

death.

pending results.
Obtain

and

sensitivity

plasma

levels

maintain levels at 5-20

mcg/ml
Monitor CBC, platelets,
iron and reticulocytes
before and every 2 days
during this therapy. Stop
immediately if anemia
occurred.

Nursing Prioritization and Competencies

NO.
1

Nursing Diagnosis
Ineffective Gastrointestinal Tissue

Nursing Competencies
Communication

Date
Identified
Jan.22,201

Perfusion r/t normactive bowel

Health Teaching

sounds as manifested by burborgymi

Safe and Quality Nursing

sounds (18p/m)

Care
Ethico-Moral Responsibility
Communication

Impaired physical mobility r/t loss of

2

Health Teaching

integrity of bone structure as

Safe and Quality Nursing

manifested by plantar flexion of foot.

Jan.22,201
0

Care

Knowledge Deficient r/t typhoid fever

Ethico-Moral Responsibility
Communication

as evidenced by unfamiliarity to the

Health Teaching

Jan.22,201

Safe and Quality Nursing

causative factor of the disease

Care
Communication
4

Health Teaching

Severe anxiety r/t unfamiliar person

Safe and Quality Nursing

as evidenced by crying

Care
Ethico-Moral Responsibility
Communication

Risk for infection r/t open anterior

5

Jan.22,201

Health Teaching

fontanel as manifested by scratching

Safe and Quality Nursing

of the head

Jan.22,201

Care

Ethico-Moral Responsibility

K. NURSING CARE PLAN

Cues
(subjective/objectiv
e)

Nursing
Diagnosis

Nursing
Objectives

Intervention

Evaluation

and Rationale

S:

Ineffective

After 4 hours

- V/S monitored

Goal is met.

Malimit siya maging

Gastrointestina

of

and checked for

After 4 hours

tampulan ng tukso ng

intervention

baseline data

of nursing

Tissue

nursing

mga

pinsa niya

verbalized

by

as
the

Perfusion

the

patient

- Determine

intervention

normactive

will be able to

whether

the patient

bowel

decreased

condition is

will be able to

burborgymi

permanent or

decreased

by burborgymi

sounds

temporary to

burborgymi

(+) burborgymi

sounds

18p/m to

enhance

sounds from

sounds

(18p/m)

acceptance

18p/m to

patients mother

as
O:
-

r/t

sounds

manifested

from

(18p/m)

- Establish a

Body malaise

patient-nurse

Brownish color

relationship to

of stool

convey an
attitude of
caring and
develop sense
of trust
- Auscultate
bowel sounds
to determine
problems in
abdomen
Encourage rest
after meals to
enhance
digestion

Cues

Nursing

(subjective/objecti

Nursing Diagnosis

Objectives

ve)
Impaired

Malaro siya kaso

hindi

pinapayagan

Evaluation

and Rationale

S:
talaga

Intervention

siya
na

After

mobility r/t loss of

hours

of

integrity

nursing

recorded for

of

intervention

baseline

intervention

structure

physical
of

bone
as

V/S
taken

Goal is met.
and

After 5 hours
nursing

makipaglaro

manifested

by

the

madali siya mainis at

plantar

of

will able to

sumungin

foot.

verbalized

dahil
as
by

the

patients mother
O:

flexion

patient

limited ROM

difficulty

Provided

was

to

security

participation

the safety of

in

in

the child

command

Encouraged

his mother or

participation

relatives.

activities
-

mother

or relatives.

demonstrate,

for

participation

is self care;
to encourage

side

self
plantar

concept

and sense of

flexion of foot

independenc

Difficulty

move

able

and

turning side to
(+)

patient

safety

his
of

the

demonstrate

command by
-

data.

to
-

Encouraged
adequate
intake

of

fluids

and

nutritious
food;

to

promote
well-being
and
maximize
energy
production
-

Instructed
proper
hygiene

for

cleanliness
of

the

patient

to

avoid spread
of infection
-

Provide quiet
and

calm

environment
to

promote

activities,
by

relaxation
Cues
(subjective/objecti

Deficient

kung

typhoid

nilagnat

ng

siya

Intervention

Evaluation

and Rationale

Knowledge

Hindi namin alam

paano

Objectives

Diagnosis

ve)
S:

Nursing

Nursing

After 2 hours
r/t

fever

nursing

V/S
taken

Goal
and

is

partially met.

intervention

recorded

After 2 hours

the patient will

for baseline

of

data.

intervention

mataas

as

as verbalized by the

by

be

patients mother

unfamiliarity to

understand the

the

related factors

the relative

will be able to

about

of

understand

O:

evidenced

of

causative

factor
-

Unfamiliarity to
the

of

the

disease

able

to
-

the

present illness

causative

factor

of

the

disease

Explain

to

patient

nursing

the

patient

the

the

condition of

factors

the patient

the

Discuss

illness

Restlessness

related

irritability

factors
about

related
about
present

the

present
disease
-

Encourage
them
read

to
some

books
about

the

disease and
causative
agent
Cues
(subjective/objectiv
e)
S:
Madali
sa

siya
mga

Nursing

Nursing

Objectives

Diagnosis

Intervention

Evaluation

and Rationale

Severe anxiety r/t

After

4 hours -

matakot

unfamiliar person

of

taong

as evidenced by

intervention

nursing

V/S

Goal

is

met.

monitored

After 4 hours

and recorded

of

nursing

ngayonlang
nakita

as

niya

crying

verbalized

by the patients mother

the patient will

as

be

data

able

develop

to

sense -

of trust.

baseline

the
Provide

adequate

O:
crying

(+)

stranger

With

will be able to

to

of trust.

promote
relaxation

anxiety
-

patient

develop sense

rest
-

intervention

poor

eye

Build

trusting

contact

relationship

With extraneous

with

movement

patient

(+)

facial

the
to

promote

grimace

rapport.
-

Encoura
ge patient to
play

to

promote
therapeutic
empathy

to

the patient
-

Provide
physical
contact
the
as

to

patient
well

as

being truthful
to

soothe

fears.
Cues
(subjective/objectiv
e)
S:

Nursing

Nursing

Objectives

Diagnosis

Intervention

Evaluation

and Rationale

Risk for infection

After 4 hours -

monitor

V/S

Goal

is

met.

r/t open anterior

of

every 4 hours

After

hours

kamutin yung nasa ulo

fontanel

as

intervention

as

of

niya as verbalized by

manifested

by

the pt will able

data

Lagi

niya

gusto

nursing

baseline

nursing

intervention

the

patients

grandmother
O:

scratching of the

to know what -

soft

head

are

instructed

the

prevent

restraining

intervention to

and easily to

prevent

swallow

risk of infection

monitored

is.

irritability

infection.

restlessness

(+)

the
of
-

open

IVF

anterior

and

IV

rates

fontanel

to know what
the

risk

on

to

avoid

afebrile

Scar

the pt was able

intervention to
-

diet

the

kept back dry

to

prevent

right side of the

occurrence of

head

other disease

Scratching

of

the head

kept
environment
well
ventilated

emphasized
hygiene

provide safety
and

security

such as
dont

leave

the

child
unattende
d
put

pillows
each side
of the bed
-

monitor I/O
to

prevent

reoccurrence
of
disease
-

Health
teaching

other

the

instructed
such as;

Hygiene
measures

Safety
measures
(

tell

patient
not

to

scratch
site of VP
shunt)

to

prevent
risk

of

infection

Diet
instructed

L. DISCHARGE PLAN OF CARE

Key Area
1. Nutrition

Plan of Care
Continue advice of soft diet as prescribed by the physician,
encourage patient to eat nutritious food, and avoid street foods
to avoid possible of having typhoid fever.
Encourage patient or instruct mother of daily exercise, avoid

2. Activity

sleeping late hours, prevents activity that causes trauma or

3. Self Care / knowledge on

injury
Instructed hygienic measures (e.g. proper hand washing, before

treatments

and after eating and urinate and defecate, as well as proper

4. Medication
5. Follow up check ups

grooming)
Advise to continue medication as prescribed by the doctor.
To comeback as prescribed by the doctor. Have a daily
consultation to neuro and physical therapist for the VP Shunt
and for plantar flexion of foot.

M. HEALTH TEACHING PLAN

Topic

Objective

1. Choosing Right After 30 mins of

Foods

discussion the

Methods of
Teaching
Discussion
Explanation

Visual aids
-

Evaluation

Sample

After 30 mins of

Procedures

discussion the

2. Importance

mother of the pt.

mother of the pt.

will be able to

was able to know

know the

the importance

importance and

and

understanding,

understanding,

choosing foods

choosing foods

to eat

to eat

After 30 mins of

Picture of

After 30 mins of

of clean and

discussion the

Discussion

nutritious

discussion the

safe foods

mother of the pt.

Explanation

foods

mother of the pt.

for the

will able to know

List of right

will able to know

family

the importance

and affordable

the importance

of clean and safe

foods

of clean and safe

3. Proper Boiling
of Water

foods for the

foods for the

family

family

After 30 mins of

Notes of

discussion the

Discussion

importance of

After 30 mins of

relative of the

Explanation

clean and safe

discussion the

foods

relative of the pt.

pt. will be able

to know the

was able to know

proper boiling of

the proper

water to kill the

boiling of water

microorganism

to kill the

in the water.

microorganism in
the water.

4. Safety and

After 1 hour of

Security of

nursing care and

Child

Demonstration

needed for

After 1 hour of

health teaching

demonstration

nursing care and

the mother of

such as pillows,

health teaching

the pt. will able

things that

the mother of

to know the

could harm your

the pt. was able

safety measures

child (e.g. knife,

to know the

needed by the

holder and pins)

safety measures

child

Explanation

- pictures

needed by the
child

N. SUMMARY OF CLIENTS STATUS OR CONDITION AS OF LAST DAY OF CONTACT

Date: January 23, 2010
The condition of the Baby Pops on the last day of duty in the Pedia ward had no signs of
distress, afebrile and cooperative. He still afraid of strangers especially when touching
him. Baby Pops was still under observation and possible for MGH the next day.