Lecture : Mr.

Nasrum
Mata Kuliah : Bhs. Inggris
Semester : IV (Four)

DIABETES MELLITUS

BY:

BESSE WALINONO (153010011)

PROGRAM STUDI S1 KEPERAWATAN FAKULTAS

KESEHATAN UNIVERSITAS PATRIA ARTHA

TAHUN 2017
Content

Author......................................................................................................................................2
CHAPTER I................................................................................................................................4
PRELIMINARY...........................................................................................................................4
1. BACKGROUND..................................................................................................................4
2 .FORMULATION OF PROBLEMS.........................................................................................5
3. PURPOSE..........................................................................................................................5
CHAPTER II...............................................................................................................................7
THEORETICAL BASIS.................................................................................................................7
1.UNDERSTANDING..............................................................................................................7
2. Disturbance on the digestive Tract.................................................................................9
3. Disturbance of consciousess.............................................................................................9
3 ETIOLOGY..........................................................................................................................9
4 . MANIFESTASION TRANSMISSION..................................................................................10
5. EXAMNATION.................................................................................................................11
6. HOW TO DEAL WITH TYPHOID FEVER..........................................................................14
7. HOW TO REVENT TYPHOID FEVER........................................................................14
CHAPTER III............................................................................................................................17
COVER....................................................................................................................................17
A.CONCLUSION.......................................................................................................................17
B.SUGGESION........................................................................................................................17
BIBLIOGRAPHY.......................................................................................................................19
 FOREWORT

All praise and thanksgiving is only to Allah SWT, because of the ease and
strength of money given by Him so that we can finish the paper about this TIFOID
FEVER, many obstacles and difficulties encountered, both in terms of reference
needed and in making this paper and Alhamdulillah all have Passed.

Along with the completion of this TIFOID Fever Papers, we as the authors
thank the lecturers who have given us the title of this TIFOID Fever paper and all
those who have assisted with the completion of this paper which can not be
mentioned one by one.

We realize that this paper is not entirely perfect, therefore with all humility we
as the authors expect constructive criticism and suggestions for the perfection of this
paper in the future. Finally, we hope this paper can be a reference for colleagues who
Will and are following this lecture.

Padang, March 2015

Author
 CHAPTER I

PRELIMINARY

1. BACKGROUND

A healthy environment is an environment where bacterial and viral growth will

be less to breed.Likewise with the bacteria salmonella typhi causes of fever tifod
will be more widely available in a dirty environment and a healthy level of
hygienic behavior is very less so that germs will be widely available there.Lack of
maintaining the cleanliness of the environment and low public awareness in a
clean healthy life will backfire for the community itself, especially their
environment will be more susceptible to disease.

Typhoid fever is a health problem, which generally occurs in developing

countries because of poverty, crime and lack of potable water.Typhoid fever is a
systemic infectious disease caused by Salmonella thypi which is still widely found
in various developing countries, especially located in the tropics and
subtropics.The disease is also an important public health problem as its
distribution is closely linked to urbanization, population density, environmental
health, poor water and sanitation sources and low standards of food processing
hygiene

Based on the report of the Directorate General of Medical Services

MOHRI, in 2008, typhoid fever was the second of the 10 most inpatient diseases
in hospitals in Indonesia with the number of cases 81,116 with the proportion of
3.15%, the first sequence was occupied by diarrhea with the number of cases
 193.856 with Proportion of 7.52%, third place was occupied by DBD with number
of 77,539 cases with the proportion of 3.01% (MOH RI, 2009).

If the typhoid fever is not detected and treated promptly and precisely it can
cause death-threatening complications, such as intestinal bleeding, intestinal
leakage, intestinal infections, bronchopnonia (pulmonary inflammation), and
brain abnormalities.Therefore, to prevent the occurrence of typhoid fever and
reduce the incidence, should pay attention to environmental sanitation, healthy
eating patterns and diligent hand washing, especially before and after meals.

2 .FORMULATION OF PROBLEMS

1. What is the definition of typhoid fever?

2. What is the etiology of typhoid fever?

3. What is the pathophysiology of typhoid fever?

4. How do symptoms and signs of typhoid fever?

5. What are the clinical manifestations of typhoid fever?

6. How is the treatment or prevention of typhoid fever?

3. PURPOSE

1. To know the definition of typhoid fever.

2. To determine the etiology of typhoid fever.

3. To determine the pathophysiology of typhoid fever.

4. To know the symptoms and signs of typhoid fever.

5. To know the clinical manifestations of typhoid fever.

6. To know how to handle or prevent typhoid fever.

 CHAPTER II

THEORETICAL BASIS

1.UNDERSTANDING

Thypoid is an acute systemic infection caused by Thypi salmonella

infection.These organisms enter through foods and beverages that have been
contaminated by feces and urine from people infected with salmonella germs.
(Bruner and Sudart, 1994).

Typhoid is an acute infection of the small intestine caused by Thypi

salmonella germs (AriefMaeyer, 1999).

Typhoid is an acute infection of the small intestine caused by salmonella thypi

and salmonella the thypi A, B, C.Synonyms of this disease are Typhoid and
abdominal parathyphoid, (SyaifullahNoer, 1996).

Typhoid is an infectious disease of the small intestine, typhoid called

paratyphoid fever, enteric fever, typhoid and abdominal typhus (.Seoparman,
1996).

Typhoid is a disease of the intestine that causes systemic symptoms caused by

salmonella typhosa, salmonella type ABC transmission occurs pecal, orally
through contaminated food and drink (MansoerOrief.M. 1999).

From some notions of diatasis can be summarized as follows, Typhoid is an

infectious bowel disease caused by salmonella type A, B and C that can be
transmitted through oral, foods and beverages contaminated by feces.
 Clinical Manifestations

7-14 (average 3 - 30) days of shoots during incubation prodromal symptoms

(early symptoms of unusual symptoms / symptoms):
Feeling unwell
Lethargic
Headache
Dizzy
Diarrhea
Anorexia
Cough
Muscle pain (Mansjoer, Arif 1999).

Following other clinical symptoms:

1. Fever Fever lasts 3 weeks

Week I:fever remittances, usually decreases in the morning and rising in the
afternoon and evening headache, dizziness, muscle pain, anorexia, nausea,
vomiting, obstipation or diarrhea, feeling uneasy stomach, cough and epistaxis, on
physical examination not only Obtained an increase in body temperature

Sunday II:Fever continues, fever, typhoid tongue relative Bradikardikardi

(dirty in the middle, and the red edge tremor), Hepatomegali, Plenomegali,
meteorismus, disorders of consciousness as samnolen Sunday III:Fever began to
drop gradually - gradually.
2. Disturbance on the digestive Tract

Tongue dirty brown membrane that is covered with dirty, reddish tips and
edges, often accompanied by tremors enlarged liver and spleen are pain in the
palpabilityThere is constipation, diarrhea.

3. Disturbance of consciousess

Awareness is apathetic - somnole.Other symptoms "roseola" (reddish spots due to

emboli result in skin capillaries) (RahmadJuwono, 1996).

3 ETIOLOGY

Typhus disease is caused by Salmonella Typhosabacteria infection, gram-

negative bacillus, berflagel (moves with shaking feathers), anaerobes, and does not
produce spores.The bacteria enter the human body through the digestive tract and
humans are the main source of infection that secretes disease-causing
microorganisms during illness or recovery.These germs can live very well in the
human body as well as at slightly lower temperatures, but die at 70 C or by
antiseptic.Typhoid fever is an infectious disease caused by Salmonella typhi or
Salmonella paratyphi (Soedarto, 1996).There are hundreds of types of salmonella
bacteria, but only 4 types that can cause typhoid are:

a. Salmonella thyposa, a gram-negative bacillus that moves with vibrating hair,

does not have at least three different antigens: antigen (somatic, consisting
darizatkomplekliopolisakarida): is a polysaccharide that are specific to
Salmonella group and is located on the surface of the organism and also the
somatic antigens that do not spread antigen V1 (a capsule that covers the body
of germs and protects against phagocytosis O antigen) and hyaline membrane
proteins.
 b. B.Salmonella parathypi A

c. C.Salmonella parathypi B

d. D.Salmonella antigen H: found in flagella and and are thermolabile

e. parathypi CFaces and Urine of thypus patients (RahmadJuwono, 1996).

f. The Carier is a person who recovers from typhoid fever and still continues to
secrete salmonella typhi in stool and urine for more than 1 year.

4 . MANIFESTASION TRANSMISSION

Transmission of salmonella thypi can be transmitted through a variety of ways,

known as 5 F: Food, Fingers, Fomitus, Fly (flies), and through Feses.

Feces and vomiting in people with typhoid can transmit salmonella thypi
germs to others.These germs can be transmitted through the middleman of flies,
where flies will perch on the food that will be consumed by healthy people.If the
person is not paying attention to his hygiene such as washing hands and food
contaminated with salmonella thypi bacteria into the body of a healthy person
through the mouth.Then the bacteria enter the stomach, some germs will be
destroyed by stomach acid and partly into the distal intestine and reach the limpoid
tissue.In this lymphoid tissue the bacteria multiply, then enter the bloodstream and
reach the reticuloendothelial cells.

At the end of the incubation period (5-9 days) the bacteria returns to the blood
(secondary bacteria) and spreads throughout the body especially into the lymphoid
glands of the small intestine, giving an oval-shaped ulcer above the Peyer
Plaque.Tukak can cause intestinal bleeding and perforation.In this bactericidal
 period, the bacteria secrete endotoxins that have a role to assist local inflammatory
processes in which these germs develop.At first suspected fever and symptoms of
toxemia in typhoid caused by endotoxemia.But based on experimental research
concluded that endotoxemia is not the main cause of fever in typhoid.Endotoxemia
plays a role in the pathogenesis of typhoid, because it helps local inflammatory
processes in the small intestine.Fever is caused by salmonella thypi and its
endotoxin stimulates synthetic and pyrogenous release by leukocytes in inflamed
tissues.

5. EXAMNATION

Investigation of clients with typhoid is a laboratory examination, consisting of:

a. A.Examination of leukocytes

b. In some literature it is stated that typhoid fever is leukopenia and relative

limposistosis but in fact leukopenia is not common.In most cases of typhoid
fever, the number of leukocytes in the peripheral blood supply is at normal
limits and sometimes there are leukocytes although there are no complications
or secondary infections.Therefore examination of leukocyte count is not
useful for the diagnosis of typhoid fever.

c. B.Checking SGOT and SGPT

d. SGOT and SGPT in typhoid fever are often increased but may return to
normal after typhoid recovery.

e. C.Blood cultures
 When a positive blood culture it indicates typhoid fever, but if negative
blood culture does not close the possibility will occur typhoid fever.This is
because the result of blood culture depends on several factors:

Laboratory inspection techniques The results of one laboratory

examination are different from other laboratories, this is due to the
different techniques and culture media used.A good blood collection time
is at a high fever at the time of bacteremia.

During the examination during the course of the illness.

Blood cultures against salmonella thypi are especially positive in the first
week and decrease in the following weeks.At the time of relapse the blood
culture can be positive again.

Vaccination in the past Vaccination against typhoid fever in the past can
cause antibodies in the client's blood, these antibodies can suppress
bacteremia and blood cultures are negative.

Treatment with anti-microbial drugs. If the client before the blood culture
has received antimicrobial drugs the growth of bacteria in the culture
medium is inhibited and the culture result may be negative.

d. Widal Test

The widal test is an agglutination reaction between the antigen and the
antibody (aglutinin).Aglutinin specific to salmonella thypi is present in serum
clients with typhoid also present in people who have been vaccinated.The
antigens used in the widal test are salmonella suspensions that have been
turned off and processed in the laboratory.The purpose of this widal test is to
 determine the presence of aglutinin in the serum of clients suspected of
typhoid fever.Due to infection by salmonella thypi, the client makes
antibodies or aglutinin namely:

1. Aglutinin O, which is made due to O antigen stimulation (derived from

the ).

2. Aglutinin H, which is made due to stimulation of H antigen (derived from

germ flagellum).

3. Aglutinin Vi, which is made due to Vi antigen stimulation (derived from

germicide)

Of the three agglutinins only agglutinins O and H are determined titernya for
diagnosis, the higher the titer the greater the client suffering from typhoid.

Factors that influence the widal test:

A.Client-related factors:

1. General conditions: poor nutrition can inhibit the formation of

antibodies.

2. 2).During examination during the course of the disease: aglutinin is

found only in the blood after the client is ill 1 week and reaches its peak
at the 5th or 6th week.

3. Certain diseases: there are some diseases that can accompany typhoid
fever that can not cause antibodies such as agamaglobulinemia, leukemia
and advanced carcinoma.
 4. Early treatment with antibiotics: early treatment with anti-microbial
drugs may inhibit the formation of antibodies.

5. .Immunosuppressive drugs or corticosteroids: they can inhibit the

formation of antibodies due to suppression of the reticuloendothelial
system.

6. Vaccination with kotipa or tipa: a person vaccinated with either kotipa or

tipa, the titers of the agglutinin O and H may increase.Aglutinin O
usually disappears after 6 months to 1 year, whereas titer of agglutinin H
decreases slowly for 1 or 2 years.Therefore, the agglutinin titer H in
people who have been vaccinated has less diagnostic value.

7. Clinical / subclinical client infections by previous salmonella: this

condition may support a positive widal test result, albeit with a low titer
yield.

8. Anamnesal reactions: a condition in which an increase in titer of

aglutinin to salmonella thypi is due to an infectious disease with a non-
typhoid fever in someone who has contracted salmonella in the past.

6. HOW TO DEAL WITH TYPHOID FEVER

The disease is not too severe, but it can interfere with our activities.What is needed
is a total rest for several weeks or even months.For someone who is very active,
this is very miserable.You can not feel anything.

To note after exposed to Tipes is the right diet.For example should be soft, so
apply soft food to the limit that has been determined by the doctor, then foods that
are oily, spicy, sour, spicy avoid.Reduce activities that are too draining.
 Treatment of this patient includes bed rest, low-fiber diet - high in calories
andprotein, antibiotics drugs (described in the next paragraph), and treatment of
possible complications.

The medicine for Types disease is Chloramphenikol, Thiamphenikol,

Ciprofloxacin etc antibiotic which is given for 7 - 10 days.The duration of this
antibiotic should be sufficient according to the prescription that the doctor gave.Do
not stop when the symptoms of fever or other has subsided for 3-4 days taking the
drug.Drugs should be taken up (7 - 10 days).If not, then the bacteria Tipes in the
patient's body has not died all and will recur again

7. HOW TO REVENT TYPHOID FEVER

The main prevention in the spread of this disease is by improving the hygiene
of food and environmental sanitation such as getting used to wash hands cleanly
after bowel and before eating.

Vaccination by using TAB vaccine (containing thypoid bacilli and parathypoid

A and B are switched off) given subcutaneous 2 or 3 times of administration with
10-day intervals is a practical measure to prevent transmission of thypoid
fever.The number of cases of the disease in Indonesia is quite high, which is about
358-810 cases per 100,000 population per year.Injection of thypoid immunization
may be done every two years when an oral vaccine is taken every five
years.However, vaccination does not guarantee 100 per cent of protection.

Drink water that has been cooked.Cook water at least five minutes (if water is
ripe, leave it for five minutes).Create rock water using cooked water.If you are on
the way, use bottled water or carbonated beverage without ais.You should be more
careful with peanut aids or mixed-water water that uses water destroyed, especially
in the present circumstances.Eat freshly cooked food.If forced to eat at the stall,
make sure the food ordered is typical and is in a state of `smoke 'because newly
lifted from the kitchen.Hood all foods and beverages to avoid fly flies.Put food in
high place.

Use a brace, spoon, or clean fork to pick up food.Fruits should be peeled and
rinsed before being eaten.Wash your hands with soap and clean water before
providing or eating food, dumping garbage, holding raw materials or after
removing the water.You will find thypoid incidents reduced by this practice which
should be a daily obligation and not just a season of wabak.Choose a clean place
and food controller.In the present circumstances, it is good if the crowd is evasive
rather than buying food or drink of street vendors especially selling cold
drinks.Clean the breeding spots - flies.Use the perfect place.Immediately check to
the doctor if you experience signs of thypoid plagued.The US Disease Research
Center provides two methods to protect yourself from thypoid fever:

A. Boil, cook, peel Avoid risky foods and beverages (street snacks).This may
surprise you but seeing what you eat and drink especially while on the go is
important for your health. Avoiding risky foods can also protect you from
diseases like cholera / taun, minister and hepatitis A.

B. Get the S.Thypi Vaccine

If you are settled or on your way to the country that is commonly attacked by
a fever outbreak, you should consider administering a fever vaccine.See your
doctor if you would like to know more about your vaccine options.

In men more exposed to S. typhi germs than women for more outdoors
activities.All age groups can contract thypoid disease, but many are adult age
groups.The incidence of thypoid fever is not seasonally affected, but in areas
where endemic thypoid fever occurs, the incidence rate increases in certain
months.In Indonesia, the incidence of thypoid fever increases during the long
dry season or the beginning of the rainy season.

This is largely attributed to the increasing population of flies in the season

and the provision of clean water that is less than satisfactory. The thypoid
dengue is still a major problem in Indonesia.The disease in Indonesia is
sporadic and endemic throughout the year.Thypoid fever cases in Indonesia,
still quite high ranged between 354-810 / 100.000 population per year.In
Palembang from retrospective studies over a 5 year period (1990-1994), there
were 83 cases (21.5%) of patients with thypoid fever with positive salmonella
blood cultures from patients treated with clinical thypoid fever.Thypoid fever
is a common disease in Indonesia.
 CHAPTER III

COVER

A. CONCLUSION

Typhoid is an infectious bowel disease caused by salmonella type A, B and C

that can be transmitted through oral, fecal, contaminated food and drink.The
etiology of thypoid fever is salmonella thypi.The symptoms are varied.Disease can
be generated from various factors, and can endanger health and even death.For that
keep the cleanliness felt necessary for the sake of maintaining health and the
environment, in order to avoid the disease that endanger our health.

HCL (gastric acid) in the stomach acts as an inhibitor of entry of

Smonmonellaspp and other intestinal bacteria.If Salmonella spp enters samacairan,
HCL dilution occurs which reduces the inhibitory power of the microorganisms
that cause the incoming disease.This HCL inhibition will decrease at the time of
emptying, so that Salmonella spp can enter into the patient more happily.

In this paper it can be concluded that thypoid fever disease is one of the most
common diseases in society and until now still can not be handled and
stopped.Taking care of yourself and each environment is the best way to prevent
this disease from coming.

B. SUGGESION

Thypoid fever spread all over the world is not dependent on climate.Poor
individual hygiene is the source of the disease although the general environment
is good.With the case of thypoid fever, hopefully it can be a reference
understanding of the parts associated with typoid fever, and can know the correct
way of prevention.
As health workers, we should provide counseling to the community, especially in
children to maintain cleanliness, good environmental hygiene, food, drinking
water, and personal hygiene.
 BIBLIOGRAPHY

Marylin, E Doengoes.1999.Nursing Care PlansIssue 3.EGC: Jakarta.

Barbara, Engram.1998.Medical Surgical Nursing.EGC: Jakarta.

Marjory Gordon, et al.2001. Nursing Diagnoses: Definition & Classification 2001-

2002.NANDA

Kuncara, HY, et al.2002. Textbook of Medical-Surgical Nursing Brunner

&Suddart.EGC: Jakarta.