Angeles University Foundation

Angeles City, Philippines College of Nursing

A Case Study on TYPHOID FEVER

Submitted by: Castro, Kimberlee M. Diaz, Raymoncler B. Garcia, Coco Chanel G. Santiago, Antonio Miguel O. Vitug, Shaneen Jenica M. BSN III ² 1, Group 1

Submitted to: Marthia C. Dizon, R.N., M.N. August 23, 2010

A.Y. 2010 ² 2011

I. Introduction

´There are three wicks you know to the lamp of a man's life: brain, blood, and breath. Press the brain a little, its light goes out, followed by both the others. Stop the heart a minute, and out go all three of the wicks. Choke the air out of the lungs, and presently the fluid ceases to supply the other centres of flame, and all is soon stagnation, cold, and darkness.µ

-Oliver Wendell Holmes, Sr.

Health is an essential part of a person, it is the fuel which gives every individual the physical drive needed to conquer a day. Without it no man can survive, a deficiency in health impairs the normal functioning of a person, it becomes a hindrance. Health pertains to the person·s body systems as a whole, it is not achieved if even only one body system is impaired, a good heart with weak lung still does not signal health, there should be harmony and balance between the systems to achieve ultimate health.

Typhoid fever Typhoid fever, also known as typhoid, is a common worldwide illness, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella typhi. The bacteria then perforate through the intestinal wall and are phagocytosed bymacrophages. 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 ² human body temperature. Typhoid fever remains a serious disease especially difficult to treat in developing countries. Salmonella typhi, the bacteria causing typhoid fever,

have become resistant to several antibiotics increasing the difficulty of treating the disease. ( http://knowledge-storage.com/medicine/37-medicine/109-

typhoid-fever)

In order to provide an updated assessment of the burden of typhoid fever in Asia, the World health Organization conducted a population-based surveillance in 5 asian countries namely: China, India, Indonesia, Pakistan and Vietnam. The age groups under surveillance were selected as those judged by local officials to be the most appropriate targets for typhoid vaccination: 5²60 year-olds in the Chinese site; all ages in the Indian and Indonesian sites; 2²15 year-olds in the Pakistani site; and school-aged children and adolescents (5²18 years) in the Vietnamese site. The statistics revealed the following:

A total of 441 435 persons in the targeted age groups were under surveillance for one year, during which 21 874 fever episodes lasting • 3 days were detected and 475 persons had blood culture-confirmed S. typhi. The overall incidence of fever lasting • 3 days for the five sites combined was 49.6 per 1000 person-years, ranging from 12.4 to 184.9 for the sites in China and Pakistan, respectively. The incidence of typhoid ranged from 15.3 cases per 100 000 person-years among those aged 5²60 years in China to 451.7 cases per 100 000 person-years among 2²15 year-olds in Pakistan. Overall, the S. typhi isolation rate (prevalence) was 23.1 per 1000 cultured febrile episodes and ranged from 5.0 (Vietnamese site) to 33.1 per 1000 (Indonesian site)

A total of 42 typhoid cases required hospitalization: 6 (40% of all cases) in China, 2 (2%) in India, 26 (20%) in Indonesia, 3 (2%) in Pakistan, and 5 (28%) in Vietnam

Clinical trials have shown that chemically binding the Vi to a protein to form a "conjugate vaccine" has improved and extended its efficacy to children (conjugate vaccines to other bacteria. 15 hospitalized cases (36% of all hospitalized cases. as was formed for Vi. This highlights the importance of primary prevention such as better sanitation. It has been approved by the World Health Organization and is licensed in 94 countries. made of a polysaccharide (a chain of linked sugars) from the surface of Salmonella typhi. notably meningitis causing bacteria have been used extensively and successfully). 1 in India.using a polysaccharide from fruit. the bacteria that cause typhoid fever. (http://www. Similarly to the Vi conjugate it induces antibodies against Salmonella typhi in laboratory .(P < 0. 7 in Indonesia. The pectin has been chemically treated so that it resembles Vi. exoprotein A. Now NIH scientists have developed another vaccine for typhoid fever .int/bulletin/volumes/86/4/06- 039818/en/) The statistics reveal that a significant amount of people who have typhoid fever are children. Altogether.0001 for overall heterogeneity of these proportions in the five sites). 2 in Pakistan. Specifically children who are at their pre-school age and as well as school age. known as pectin. The treated pectin. (rEPA).who. improved water systems and vaccines. and 3 in Viet Nam. All detected cases recovered and no death due to typhoid was reported. The result is a conjugate. With the exception of the Chinese and Indonesian sites. O-acetyl pectin. the majority of the inpatient cases involved children aged 5²15 years. 5% of all cases from the age group) were in children aged 5²15 years: 2 in the sites in China. NIH scientists developed a vaccine called Vi. It is effective in adults but not in young children. is bound to a protein. In a latest study.

. If the O-acetyl pectin conjugate proves successful. The group understood the seriousness of the matter since children at a very young age have developing immune systems that could be compromised because of typhoid fever and may lead to the deterioration of their health. The group saw this case as an opportunity to gain more knowledge about the disease and with it enhances our abilities to take care of such patients with typhoid fever. toward using it with routine vaccines for infants. The new vaccine is called the exoprotein A. If the evaluation of this vaccine is of success then this vaccine could be used as a routine vaccine for children to prevent typhoid fever.animals.( http://clinicaltrials. it will be evaluated in children ages 5 to 14 years old and in infants. but also to the ways on how this condition can be managed and how people could prevent this condition from occurring. The group chose. the Vi polysaccharide vaccine. not only the pathophysiology.gov/ct/show/NCT) The study states that a another vaccine has been developed which resembles the first vaccine. typhoid fever since it is a very common and serious problem affecting several people especially young children. This case will open our minds to the disease. The new vaccine is said to have a more potent effect on children as compared to that of the Vi vaccine.

comes from a nuclear family composed of seven members the father. Amando Garcia Medical Center.II. the eldest sister of Nella are the primary source of information. 2010 via Caesarean Section at Dr. headache and abdominal pain upon admission and likewise the day before admission to the hospital. the fourth one is 10 years old and last is Nella. Mrs. Her parents Mrs. her four other siblings has likewise no history of Typhoid Fever. the patient would be referred as ´Nellaµ throughout the study. Pertinent Family History Nella a 7 year old girl. Tay have no history of Typhoid Fever. the third one is 12 years old. Fe. Nella is a 7 year old girl and a naturally born Filipino citizen affiliated to the Adventist religion who lives in a barangay in Angeles City along with her parents and four siblings.4ÝC. Fe has five children the first one is Ver who is 22 years old. Personal Data To secure confidentiality. 2010 with a final diagnosis of Typhoid Fever. She delivered the first four through normal spontaneous delivery and the last which is Nella was delivered via Caesarean Section. . 2. difficulty of walking cause of body weakness. She was born last January 7. Fe and Mr. Nella was admitted last August 8. the second one is 17 years old. NURSING ASSESSMENT 1. The admitting diagnosis is T/C Typhoid Fever and was discharged on August 12. mother and five children. the mother of Nella and Ver. She is the youngest among five siblings. 2010 at around 11am at Ospital ning Angeles with complaints of having high fever with a temperature of 39.

electricity ² 500 per month. While her mother. the mother also puts the uneaten food inside the rice cooker for the food to be hot.000 per month with a total of Php 15. Their income suffices the daily needs of the family. At present.000 per month. water ² 300 per month. In terms of insufficiency. According to her eldest sister. Her father. Tay work as an automotive mechanic to sustain the needs of their family. The remaining from the salary is used for other expenses.000 per month. These would all amount to 3. they use some medications like Tempra if one of the children is suffering from fever like what . concerning financial needs. The family of Nella do not rely on cultural practices when it comes to their health. And her eldest sister Ver. Both of them earned money of an estimated amount of Php 6. they put it in their refrigerator for storage. The breakdown of their expenses is as follows: food ² 500 per day. such as medical emergencies and for the four children who were still at school. they live in a singlestoried house or what they call as bungalow. Moreover. Fe work as a housekeeper. The drinking water of the family comes from the faucet supplied by NAWASA. The family is affiliated to the Adventist Community and they serve well to their religion.Nella lives in a barangay which has easy accessibility to the hospital.300 php per month. who is a call center agent earns money of Php 9. Mr. and grocery ² 2. Mrs. However. Her mother describes their community as a peaceful one and her neighbours are hospitable. they would ask help from their relatives.000 per month. mother sometimes buys distilled water for them. They drink unboiled water. However. they do not believe in albularyos they readily consult for medical assistance like going to the health center or hospital. if ever they have extra food. which is made up of cement walls that is thrice as big as the private rooms in the hospital.

she is fond of eating street foods like fish balls especially when she is at school. . Nella has good habits which is conducive to health maintenance like taking a bath everyday. She never sleeps in the afternoon that she rather plays or watched T. Then she will be heading to school picked up by her service. Regarding the Nella·s activities of daily living. she also admitted that she always eats siopao at school which she knows is not that cleaned and student nurses had also observed that she is fond of biting her nails when she was doing nothing and student nurses have observed that Nella is fond of biting her nails when she is doing nothing. By one o·clock in the afternoon she was already in their house and she would be doing all her homework and study.they did to Nella and Solmux if someone·s suffering from cough but admitted that they never used herbal medicines. By seven o·clock in the morning up to twelve o·clock in the noon she was in the school. Morever. brushing teeth at all times and taking supplemental like Multivitamins but also stop two years ago. Regarding Nella·s behaviour. They have a Kapampangan culture which means most of their diet is mostly high in salt and fat since they are known for cooking food increasing the risk in acquiring disease of the heart and kidney problems. than sleeping.V. she usually wakes up at six o·clock in the morning and she would be eating breakfast with her siblings than dress up for school. after doing school stuffs she would be playing in the computer or just watch the television up to six o·clock in the evening then by eight o·clock in the evening she would be sleeping already.

Pertinent Family Health-Illness History Paternal Side Maternal Side Grandfather Heart Attack Ø Grandmother Grandfather DM Ø Grandmother 46 y/o * 65 y/o * 47 y/o * 42 y/o * 40 y/o * 38 y/o * Father 63 y/o HPN Mother 44 y/o 36 y/o * 1 = 22 y/o 2 = 17 y/o 3 = 12 y/o 4 = 10 y/o 5 = NELLA 7 y/o .A.

Except for the diet of the family which most likely contributes to the said condition of Nella. .Family Health-Illness History Legend: Ø= deceased *= did not specify any illness or disease 1= 1st sibling 2=2nd sibling 3=3rd sibling 4=4th sibling 5=5th sibling There are no significant influences of the diseases/ illnesses of Nella·s grandparents and parents to his present condition which is Typhoid Fever.

Not only Nella was fed like that with the five children. According to her. She never fed Nella with formula milk for she knows that breast feeding is much healthier than formula milks. Nella was born via Caesarean section at Dr. Fe she had Gravida 7. Mrs. Abortion 2. She was born without any complications to herself and to her mother. Nella·s eldest sister. All she does is to make her self-healthy for baby to come out very healthy too. she fed them with soft diet like lugaw. Fe have breast fed Nella from the day she was born until she reaches one year old. 3 DPT.3. . Living 5. has no specific habits during her pregnancies to her five children. Amando Garcia Medical Center at exact 9th month. She had also completed her vaccines needed for pregnancy. the first one is when she was diagnosed with ectopic pregnancy. Para 5. Fe makes sure that Nella was vaccinated on schedule and goes to the health center to avoid the preventable diseases. 3 OPV. Fe could not remember the exact dates she was vaccinated. Preterm 0. According to Ver. Her mother. and two months after she undergone again. she undergone DIC twice. but also the other four. Term 5. which is TT1 to TT5. 3 Hepa B and measles at Lourdes Sur East Health Center. Personal History Mrs. After they reach one year old. Mrs. Regarding the obstetric history of Mrs. She attends her prenatal check ² ups with her doctor regularly to make sure her baby is healthy and never misses one. Fe. and Multiple pregnancies 0. But Mrs. Nella is already vaccinated with 1 BCG.

multiplication. children ask.Theories of Growth and Development (Client-centered) Erik Ericson Psychosocial Development Industry VS Inferiority (6 ² 12 years old) During school age. When they are absorbed in a project. their sense of industry grows. in which objects are ordered according to increasing or decreasing measures such as weight. ´Am I doing a good job? Am I doing this right?µ When they are encouraged in their efforts to do practical tasks or make practical things and are praised and rewarded for the finished results. Classifications involve sorting objects according to attributes such as color. in which objects are simultaneously classified and seriated using weight. Jean Piaget Cognitive development Concrete Operational Thought (7 ² 12 years old) Concrete operations include systematic reasoning. sees constancy despite . seriation. Understands conversation. children learn how to do things well. an opposite operation or continuation of reasoning back to a starting point (follows a route through a maze and then reverses steps). Parents who see their children·s efforts at making and doing things as merely ´busy workµ or who don·t show appreciation for their children·s efforts may cause them to develop a sense of inferiority rather than pride and accomplishment. Uses memory to learn broad concepts and subgroups of concepts. Child is aware of reversibility.

social sanctions or to provide a refuge from a situation with which one cannot currently cope. Anna Freud Ego Psychology Defense mechanisms are psychological strategies brought into play by various entities to cope with reality and to maintain self-image. Ego defense mechanism becomes pathological only when its persistent use leads to maladaptive behavior such that the physical and/or mental health of the individual is adversely affected. Good activity for this period: collecting and classifying natural objects such as native plants. a time in which children·s libido appears to be diverted into concrete thinking. Healthy persons normally use different defenses throughout life. child·s personality development appears to be nonactive or dormant. He saw no developments as obvious as those in earlier periods appearing during this time. etc. Sigmund Freud Psychosexual development Latent Stage (6 ² 12 years old) Freud saw the school ² age period as a ´latent phaseµ. The purpose of the Ego Defense Mechanisms is to protect the mind/self/ego from anxiety. They also . 6 ² 12 years old children shows fear of separateness with their parents where they experience anxiety. They should also help the child have positive experiences so his or her self ² esteem continues to grow and the child prepares for the conflicts of adolescence.transformation (mass or quantity remains the same even if it changes shape or position). sea shells. In here.

All they just do is gave her some medicines and then gave her some tepid sponge bath. History of present illness Nella·s fever started at August 5. The time she had been sick was just last year. And according to Nella·s eldest sister.have fear of the loss of an object they loved.04ÝC. 5. Then the next day she still has fever which the temperature increases at 39. Family Health-Illness History History of Past Illness According to Nella·s eldest sister. measles and any other illness or sickness except for what was mentioned above. they haven·t let her go to school and just gave her a bed rest and gave her Tempra to lessen her fever. . After that her fever would be decreasing up to 38ÝC. She never had chicken pox. 2010 Thursday. then she would be complaining of headache then the next morning she has a high fever again. this was the first time Nella was admitted to the hospital. She was brought to a doctor that time and was prescribed with some medications but she can barely recall it all she knows they let Nella drink Tempra for her fever. Nella never had any illness when she was a baby. because of fever cause by cough and colds. and the fear of being punished when they have done something wrong. they thought that she only got wet in the rain and thought that she only had a simple fever. 4.

By August 8, 2010, her parents decided to bring her to the hospital because of high fever, sudden abdominal pain, headache and body weakness. She was diagnosed with Typhoid Fever. In her stay in the hospital, Nella had experienced diarrhea. According to Ver, she defacates 5 ² 7 times at night with 2 ² 3 cups of soft-watery stool per episode. During her stay also, she manifested cough and colds.

6. Physical Examination (IPPA Cephalocaudal Approach)

August 08, 2010 (lifted from the chart)

Vital Signs: T- 38.5°C/axilla PR- 86bpm RR- 21cpm Weight- 21kg.

HEENT: y y Pink Palpebral Conjunctiva Icteric Conjunctiva

Chest and Lungs: y y y Symmetrical chest expansion No rales, no retractions Clear breath sounds

Heart: y y Adynamic precardium No murmur

Abdomen: y Flat, Normal abdominal bowel sounds, nontender, soft

Genitalia: y Not examined

Extremities: y Grossly normal, no edema, no cyanosis

August 09, 2010 (first nursing-patient interaction)

Vital Signs: T- 36.3°C/axilla PR- 108bpm RR- 28cpm Wt- 21kg

General Appearance and Mental Status: Conscious, awake; oriented to time and place and aware of self and environment; responds to external stimuli; attentive, cooperative,

demonstrates continuity of ideas; wears clean clothes (white t-shit and green pajamas)

General Appearance o Attitude is cooperative o Speech is understandable, slow paced, speaks tagalog and

kapampangan and exhibits thought association o Appears weak with slow movement

Head o Skull is round in shape and has normal contour with no palpated depressions o Hair has fine strands, scalp is oily but no masses palpated o Facial features are symmetrical with no noted abnormalities o Hair evenly distributed and skin is intact o With straight, long and black hair o No dandruff was observed or any abnormal skin growth

Eyes o Pupils are equally round and reactive to light, (+) PERRLA o Pink palpebral conjunctiva and icteric sclera

o Eyebrows are symmetrically aligned o Eyelashes are short. smooth and shiny o Details of the iris are visible. dark brown in color o Sclera appears white o Skin around the eyes is intact o Eyes move in consensus Ears o Ears are symmetrical and aligned with the outer canthus of the eye with no lesions noted o Color is same as facial skin o Pinna recoils after being folded o Absence of difficulty in hearing o No cerumen was noted in both ears Nose o Nose has no discharge. not occluded & with patent airway o Nose is not tender. evenly distributed and curled slightly outward o No discharges present o Cornea is transparent. without masses or any displacement of bone and cartilage noted upon palpation o Color is same as facial skin o Normal size for the face o Absence of difficulty in breathing and no nasal flaring on both nostrils was observed o Able to breathe clearly and identify mild aromas presented to her Throat and Mouth o Throat & mouth have no sores and swellings or inflammation . no lesions.

pink in color.pink in color. smooth and light pink in color o Tongue. rough-surfaced. was able to purse his lips.pink in color. smooth. moist.o Teeth complete in number. and aligned at the center of the mouth o Lips are dry.positioned at the midline of the soft palate o Oropharynx. no lesions. not inflamed or swollen o Pale gums Neck o Neck is centered and aligned with the head o Able to move the neck without much effort from side to side. up and down and even in rotation o No palpable lymph nodes o Trachea is movable and aligned at the center o Thyroid gland not visible upon inspection and ascends while swallowing o Arteries and veins not distended Chest symmetrical BREASTS .dry. hard palate is lighter pink with more irregular texture o Uvula. with no discharge o Tonsils. soft palate is smooth and light pink. protrude and move tongue from side to side. and slightly shiny o Dental caries were observed over her front teeth's enamel and whitish plaque were noted over her molars o Buccal Mucosa. yellowish. pink in color o No lesions in his lips and mouth. up and down o Gag reflex was elicited o Palate appears pale.

(-) cyanosis o Some blemishes on her lower extremities -> NAILS . left and right shoulders and hips are the same height o Regular respiratory rhythm & normal respiratory rate: 28cpm Skin o Skin is dry and has good skin turgor o Exhibits a fair complexion o No masses were observed and palpated all over his body o (-) Edema o (-) Jaundice.o No lesions o No abnormal swelling or presence of masses Cardiovascular o Absence of chest pain and murmurs o Normal heart rhythm and regular rate o Veins are not visibly distended o No presence of sound/bruit heard upon auscultation o Adynamic precardium Respiratory o Chest is symmetric. Anteroposterior to transverse diameter ratio is 1:2 o Chest expansions are symmetrical o Absence of rales on both lung fields (clear breath sounds) o Spine vertically aligned o Spinal column is straight.

72bpm RR. (+) bowel movement o (-) Organomegaly o Non tender abdomen Extremities o Some blemishes were noted over the patient's legs o No edema noted on both upper and lower extremities.15cpm Wt.4°C/axilla PR. (-) cyanosis Genitourinary o No tenderness o Not examined August 10.o Pale in color o Capillary refill is less than 3 seconds o (-) Schamroth·s test o Untrimmed and dirty Gastrointestinal o Skin is fair o Abdomen is soft and flat o (+) Bowel sounds 4/min. without numbness and tingling sensation o Grossly nomal o (-) edema.21kg .35. 2010 (second nursing-patient interaction) Vital Signs: T. (+) flatus.

wears clean clothes (blue t-shit and pink pajamas) General Appearance o Attitude is cooperative o Speech is understandable. responds to external stimuli. attentive. long and black hair o No dandruff was observed or any abnormal skin growth Eyes o Pupils are equally round and reactive to light. (+) PERRLA o Pink palpebral conjunctiva and anicteric sclera o Eyebrows are symmetrically aligned o Eyelashes are short. evenly distributed and curled slightly outward o No discharges present o Cornea is transparent. speaks tagalog and kapampangan and exhibits thought association o Appears weak Head o Skull is round in shape and has normal contour with no palpated depressions o Hair has fine strands. scalp is oily but no masses palpated o Facial features are symmetrical with no noted abnormalities o Hair evenly distributed and skin is intact o With straight.General Appearance and Mental Status: Conscious. cooperative. demonstrates continuity of ideas. smooth and shiny . awake. oriented to time and place and aware of self and environment.

smooth and light pink in color .o Details of the iris are visible. no lesions. yellowish. and slightly shiny o Dental caries were observed over her front teeth's enamel and whitish plaque were noted over her molars o Buccal Mucosa. dark brown in color o Sclera appears white o Skin around the eyes is intact o Eyes move in consensus Ears o Ears are symmetrical and aligned with the outer canthus of the eye with no lesions noted o Color is same as facial skin o Pinna recoils after being folded o Absence of difficulty in hearing o No cerumen was noted in both ears Nose o Nose has no discharge.moist. not occluded & with patent airway o Nose is not tender. without masses or any displacement of bone and cartilage noted upon palpation o Color is same as facial skin o Normal size for the face o Absence of difficulty in breathing and no nasal flaring on both nostrils was observed o Able to breathe clearly and identify mild aromas presented to her Throat and Mouth o Throat & mouth have no sores and swellings or inflammation o Teeth complete in number.

rough-surfaced.pink in color. up and down o Gag reflex was elicited o Palate appears pale. moist.pink in color. hard palate is lighter pink with more irregular texture o Uvula. soft palate is smooth and light pink. pink in color o No lesions in his lips and mouth. up and down and even in rotation o No palpable lymph nodes o Trachea is movable and aligned at the center o Thyroid gland not visible upon inspection and ascends while swallowing o Arteries and veins not distended Chest symmetrical BREASTS o No lesions o No abnormal swelling or presence of masses Cardiovascular . and aligned at the center of the mouth o Lips are slightly dry. no lesions.o Tongue. not inflamed or swollen o Pale gums Neck o Neck is centered and aligned with the head o Able to move the neck without much effort from side to side. protrude and move tongue from side to side. with no discharge o Tonsils.positioned at the midline of the soft palate o Oropharynx. smooth.pink in color. was able to purse his lips.

(-) cyanosis o Some blemishes on her lower extremities -> NAILS o Capillary refill is less than 2 seconds o (-) Schamroth·s test o Untrimmed and dirty fingernails . left and right shoulders and hips are the same height o Regular respiratory rhythm & normal respiratory rate: 23cpm o Productive cough.o Absence of chest pain and murmurs o Normal heart rhythm and regular rate o Veins are not visibly distended o No presence of sound/bruit heard upon auscultation Respiratory o Chest is symmetric. unable to expectorate Skin o Skin is dry and has good skin turgor o Exhibits a fair complexion o No masses were observed and palpated all over his body o (-) Edema o (-) Jaundice. Anteroposterior to transverse diameter ratio is 1:2 o Chest expansions are symmetrical o Absence of rales on both lung fields (clear breath sounds) o Spine vertically aligned o Spinal column is straight.

(+) flatus. (-) bowel movement o (-) Organomegaly o Non tender abdomen Extremities o Some blemishes were noted over the patient's legs o No edema noted on both upper and lower extremities. (-) cyanosis Genitourinary o No tenderness o Not examined .Gastrointestinal o Skin is fair o Abdomen is soft and flat o (+) Bowel sounds 4/min. without numbness and tingling sensation o Grossly nomal o (-) edema.

08. DIAGNOSTIC AND LABORATORY PROCEDURES A. TYPHIDOT Diagnostic/Lab Procedure Typhidot Date Ordered Date result(s) in August. IgM: Positive Indication/Purpose Results Normal Values IgM: Negative Analysis and Interpretation Positive ( IgM and IgG) : Indicates presence of typhoid IgG: Positive IgG: Negative . 2010 This procedure is a test for igG &igM detection of typoid .7.

Nursing Responsibilities: BEFORE THE PROCEDURE: o Check the doctor·s order o Determine the prescribed test and other restrictions prior to the test o Get the laboratory requisition slip o Explain to the patient what the procedure to be done is DURING THE PROCEDURE: o Explain to the patient what test should be done. . Evaluate test results in relation to the patient·s symptoms and other test performed. o Prepare all the equipments to be used After: y y Answer any questions or address any concerns voiced by the patient or family.

B. High Results: bacterial infection. It was done to assess anemia.2010 (CBC) A procedure done to count the blood components such as the RBC and WBC. infection. Normal patient has normal concentrations of RBCs in the blood.08. WBC =3.41 0. fluid status and other blood abnormalities.8 WBC count is low thus suggests that the pt. Normal patient has normal hemoglobin level in blood. It also shows the hemoglobin and hematocrit count. Complete Blood Count Diagnostic/ Laboratory Procedure Date Order/ Indications Date Results In Purposes or Normal Values Analysis (Units Used in Interpretation the Hospital) Results 5-10x109/L and of Results Complete Blood Count August. = 131 120-160mg/L Hct = 0.10-0.47 L/L Lymphocytes = 0.40 % .51 0.0. Hgb. has no infection.37.

79 4.RBC=4.49 0. Normal result Segmenters = 0.4 x 1012/L Normal result Platelet Count = 275 150-400X109/L Normal result: the patient still have enough platelets to promote coagulation.2-5.65 % Nursing Responsibilities: BEFORE THE PROCEDURE: o Check the doctor·s order o Determine the prescribed test and other restrictions prior to the test o Get the laboratory requisition slip o Explain to the patient what the procedure to be done is .45-0.

Do not leave the tourniquet for more than one minute because doing so causes hemoconcentration o Encourage the patient to remain calm during the test o Assist the patient if necessary o Ensure a sterile blood sample from the patient . the body·s defense against infection. Instruct the patient that she may eat and drink before collection of the specimen. the number and condition of RBCs in the body.o Explain to the patient that she may feel slight discomfort from the needle puncture and the tourniquet o Inform the patient that this requires a blood sample o Explain that this test evaluates the blood for the presence/absence of infection in the body. to check for possible bleeding tendencies. o Prepare all the equipments to be used o Tell the patient when to insert the needle for her to be prepared o Do not use hand or arm receiving IV fluid this causes hemodilution. the equipment to be used. blood type and the presence/absence of anemia o Inform the patient how the procedure is performed. DURING THE PROCEDURE: o Explain to the patient what test should be done.

apply warm soaks. Send the blood sample to the laboratory immediately .AFTER THE PROCEDURE: o Apply pressure on the puncture site o Ensure that subdermal bleeding has stopped before removing pressure o If a hematoma develops at the venipuncture site.

08. URINALYSIS DIAGNOSTIC DATE ORDERED INDICATION(S) RESULTS OR PURPOSES NORMAL VALUES ANALYSYS INTERPRETATION RESULTS AND OF DATE LABORATORY RESULTS(S) PROCEDURES IN URINALYSIS August.2010 This is a screening COLOR: test for abnormalities yellow within the urinary system that may manifest through the TRANSPARENCY: urinary tract s. clear pH: 6.0 7.C. Turbid Amber Normal result since all the results meets the normal values.35-7.45 . No affectation of the kidney.

GRAVITY: 1.020 1.035 MICROSCOPIC EXAM PUS CELLS/HPF 6-8 negative RBC: 0-1 negative EPITHELIAL CELLS: FEW MUCUS THREADS: FEW .0051.SP.

ALBUMIN: Trace negative SUGAR: Negative negative .

NURSING RESPONSIBILITIES: Before: y Inform the patient that the test is used to assist in the diagnosis of renal diseases and as an indication of inflammatory diseases. y y y y Obtain a history of the patient·s genitourinary. fluid or medication restrictions. surgical procedures and other diagnostic procedures. During: y y y After: Instruct the patient to thoroughly wash his hands. . cleanse the meatus. unless by medical direction. There are no food. void a small Amount in the toilet and void directly into the specimen container. Obtain a list of medication the patient is taking. Review the procedure with the patient. Promptly transport the specimen to the laboratory for processing and analysis.

y y Answer any questions or address any concerns voiced by the patient or family. .y Instruct the patient to report symptoms such as pain related to tissue inflammation. Evaluate test results in relation to the patient·s symptoms and other test performed. pain or irritation during void or alterations in urinary elimination.

Fecalysis Diagnostic Laboratory Procedures Fecalysis Date ordered: Date results in: Date Ordered: August 11. 2010 digestive tract Help find the cause of symptoms affecting the digestive tract y To determine the presence of parasitic worm in the GI tract of No Intestinal parasite seen Color : Brown Consistency: Soft Others: Bacteria many Bacteria: none Results Normal Values Color: brown Consistency: formed Analysis & Interpretation Of Results Color: Normal Consistency: Abnormal presence of indigestion Bacteria: Abnormal No OVA / Amoeba seen: Normal . 2010 y Indication or Purpose Help to diagnose certain conditions affecting the Date results in: y August 11.D.

the patient NURSING RESPONSIBILITIES Before: y y y Check doctors order Explain to the SO the purpose and the procedure of fecalysis Usual aseptic technique .

Look for adult worms of Ascaris lumbricoides or Trichuris trichuria. Record the client·s name. soft or watery. mucus or parasites.y y y y Try to collect the freshest stool possible Take a small piece of stool with the wooden applicator Provide clean specimen cup Refer to the other member of the Health Care team During: y y y Collect the stool in a clean specimen cup Report the consistency of the stool sample: Formed. . semi-formed. After: y y y Immediately label the specimen. Report the visible presence of blood. the test performed and disposition of the specimen collected criteria. Remove gloves and wash hands.

Accessory glands are associated with . Nutrients cross the wall of the digestive tract to enter the circulation. esophagus. The digestive tract consists of the oral cavity. Anatomy and Physiology ANATOMY AND PHYSIOLOGY OF THE DIGESTIVE SYSTEM The digestive tract consists of the digestive tract. The inside of the digestive tract is continuous with the outside environment. a tube extending from the mouth to the anus. pharynx. and anus. small intestine. stomach. The term gastrointestinal tract technically only refers to the stomach and intestine but is often used as a synonym for the digestive tract.III. plus the associated organs. where it opens at the mouth and anus. large intestine. which secrete fluids into the digestive tract.

also innervated by autonomic nerves. a loose connective tissue called the lamina propria. and its underlying connective tissue are referred to histologically as the serosa. and serosa or adventitia.the digestive tract. but nearly all parts consist of four layers or tunics the mucosa. lies between the two muscle layers. sub mucosa. It is a thick layer of loose connective tissue containing nerves. and a thin smooth muscle layer. the digestive tract is . consists of mucous epithelium. The muscularis which in most part of the digestive tube consists of an inner layer of circular smooth muscle and an outer layer of longitudinal smooth muscle. An extensive network of nerve cell processes forms a plexus (network). The fourth. layer of the digestive tract is either a serosa or an adventitia. The plexus is innervated by autonomic nerves. Some regions of the digestive tract are covered by peritoneum and other regions are not. The epithelium in the mouth. blood vessels. muscularis. Digestive Tract Histology The innermost tunic. The sub mucosa lies just outside the mucosa. and epithelium in the stomach and intestine absorbs and secretes. esophagus and anus resists abrasion. Various parts of the digestive tract are specialized for different functions. Together the nerve plexuses of the sub mucosa and muscularis compose the enteric plexus. the muscularis mucosa. Another nerve plexus. the mucosa. This plexus is extremely important in the control of movement and secretion within the tract. The peritoneum. or outermost. The salivary glands empty into the oral cavity and the liver and pancreas are connected to the small intestine. In regions of the digestive tract not covered by peritoneum. and small glands. which is a smooth epithelial layer.

covered by a connective tissue layer called the adventitia. This mesentery is also called the mesentery proper. The greater omentum is unusual in that it is a long. and the mesentery connecting the greater curvature of the stomach to the transverse colon and posterior body wall is the greater omentum. . Many of the organs of the abdominal cavity are held in place by connective tissue sheets called mesenteries. descending colon. kidneys. Specific mesenteries are given names. or serosa. ascending colon. The serous membrane that covers the organs is the visceral peritoneum. The term is also used specifically to refer to the mesentery that attaches the small intestine to the posterior abdominal wall. rectum. pancreas. double fold of mesentery that extends inferiorly from the stomach before looping back to the transverse colon to create a cavity or pocket. The retroperitoneal organs include the duodenum. adrenal glands and urinary bladder. Mesentery is a general term referring to the serous membrane attached to the abdominal organs. and are described as retroperitoneal. Fat accumulates in the greater omentum. The mesentery connecting the lesser curvature of the stomach to the liver and diaphragm is the lesser omentum. have no mesenteries. giving it the appearance of a fat-filled apron that covers the anterior surface of the abdominal viscera. which is continuous with the surrounding connective tissue. Other abdominal organs lie against the abdominal wall. called the omental bursa. The mesenteries consist of two layers of serous membranes with a thin layer of loose connective tissue between them. Peritoneum and Mesenteries The body wall of the abdominal cavity and the abdominal organs are covered with serous membranes. The serous membrane that lines the wall of the abdominal cavity is the parietal peritoneum.

It is bounded by the lips and cheeks and contains the teeth and tongue. The keratinized stratified epithelium of the skin becomes thin at the margin of the lips. The lips are muscular structures. The outer surfaces of the lips are covered by skin. Tongue The tongue is a large. The cheeks form the lateral walls of the oral cavity. The major attachment of the tongue is in the posterior part of the oral cavity. The lips and cheeks are important in the process of mastication. The buccinators muscles are located within the cheeks and flatten the cheeks against teeth. The anterior part of the tongue is relatively free. formed mostly by the orbicularis oris muscle. transparent epithelium. the epithelium is continuous with the moist stratified squamous epithelium of the mucosa in the oral cavity. or chewing. The color from the underlying blood vessels can be seen through the thin. Mastication begins the process of mechanical digestion. or mouth. muscular organ that occupies most of the oral cavity. holds the food in place during mastication. in cooperation with the lips and cheeks. The cheeks also help form words during the speech process. is the first part of the digestive tract. It also plays a major role in the process of swallowing. .Oral Cavity The oral cavity. At the internal margin of the lips. They help manipulate the food within the mouth and hold the food in place while the teeth crush or tear it. in which large food particles are broken down into smaller ones. as well as being one of the major organs of speech. There is an anterior attachment to the floor of the mouth by a thin fold of tissue called the frenulum. The tongue moves food in the mouth and. The tongue is a major sensory organ for taste. giving the lips a reddish-pink appearance.

The alveolar processes are covered by dense fibrous connective tissue and moist stratified squamous epithelium. which is filled with blood vessels. which protects the tooth against abrasion and acids produced by bacteria in the mouth. which helps anchor the tooth in the jaw. referred to as the gingival. bonelike tissue called dentin. nerves and connective tissue. Palate and Tonsils . cellular. or gums. Most of them are replacements of the 2 primary. The teeth can be divided into quadrantsright upper. called pulp. teeth. and left lower. Each tooth consists of a crown with one or more cusps. when the person is old enough to have acquired some degree of wisdom. and third molars. The pulp cavity is surrounded by a living. or deciduous.Teeth There are 32 teeth in the normal adult mouth. one canine. located in the mandible and maxillae. The dentin of the tooth crown is covered by an extremely hard. each quadrant contains one central and one lateral incisor. The surface of the dentin in the root is covered with cementum. The teeth are held in place by periodontal ligaments. teeth. or secondary. The third molars are called wisdom teeth because they usually appear in a persons late teens or early twenties. The center of the tooth is a pulp cavity. right lower. left upper. The teeth are rooted within alveoli along the alveolar processes of the mandible and maxillae. which are connective tissue fibers that extend from the alveolar walls and are embedded into the cementum. a neck and a root. In adults. and first. second. acellular substance called enamel. first and second premolars. The teeth of adults are permanent.

The anterior part contains bone and is called the hard palate. the parotid glands. the smallest of the three paired salivary glands. at the ends of the ducts. The submandibular ducts open into the oral cavity on each side of the frenulum of the tongue. There are three pairs of salivary glands the parotid. produce primarily mucous secretions. are serous glands located just anterior to each ear. They produce saliva. The sublingual glands. The submandibular glands produce more serous than mucous secretions. The largest of the salivary glands. They lie immediately below the mucous membrane in the floor of the oral cavity. and in the posterior surface of the tongue. saliva can squirt out of the mouth from the ducts of these glands. which is a mixture of serous and mucous fluids. The palate separates the oral cavity from the nasal cavity and prevents food from passing into the nasal cavity during chewing and swallowing. The uvula is a posterior extension of the soft palate. consists of two parts. Saliva helps keep the oral cavity moist and contains enzymes that begin the process of chemical digestion. submandibular. resembling grapes.The palate. . Parotid ducts enter the oral cavity adjacent to the second upper molars. and sublingual glands. The salivary glands are compound alveolar glands. if the mouth is opened and the tip of the tongue is elevated. The tonsils are located in the lateral posterior walls of the oral cavity. In certain people. in the nasopharynx. Each sublingual gland has 10-12 small ducts opening onto the floor of the oral cavity. whereas the posterior portion consists of skeletal muscle and connective tissue and is called the soft palate. They have branching ducts with clusters of alveoli. Each gland can be felt as a soft lump along the inferior border of the mandible. or roof of the oral cavity.

which turns to the right. lubricating mucus that coats the inner surface of the esophagus. Stomach The stomach is an enlarged segment of the digestive tract in the left superior part of the abdomen. It passes through the diaphragm and ends at the stomach. and inferior pharyngeal constrictor muscles. which connects the mouth with the esophagus. The largest part of the stomach is the body. and a lesser curvature on the right. middle. Normally only the oropharynx and laryngopharynx transmit food. located at the upper and lower ends of the esophagus. The region of the stomach around the cardiac opening is called the cardiac region. The most superior part of the stomach is the fundus. and laryngopharynx. which is surrounded by a relatively thick ring of . forming a greater curvature on the left. consists of three parts the nasopharynx. Esophagus The esophagus is a muscular tube. The opening from the stomach into the small intestine is the pyloric opening. lined with moist stratified squamous epithelium that extends from the pharynx to the stomach. respectively. The lower esophageal sphincter is sometimes called the cardiac sphincter. Upper and lower esophageal sphincters. The posterior walls of the oropharynx and laryngopharynx are formed by the superior. or throat. It is about 25 centimeters (cm) long and lies anterior to the vertebrae and posterior to the trachea within the mediastenum.Pharynx The pharynx. oropharynx. The opening from the esophagus into the stomach is called the cardiac opening because it is near the heart. regulate the movement of food into and out of the esophagus. Numerous mucous glands produce thick.

The mucosal surface forms numerous. The sub mucosa and mucosa of the stomach are thrown into large folds called rugae when the stomach is empty. which produce pepsinogen. The jejunum is about 2. The muscular layer of the stomach is different from other regions of the digestive tract in that it consists of three layers an outer longitudinal layer. and the folds disappear as the stomach is filled. .5 meter long and makes up two-fifths of the total length of the small intestine. which are the openings for the gastric glands. important in the digestive process.5 meter long and makes up three-fifths of the small intestine. These folds allow the mucosa and sub mucosa to stretch. and chief cells. The ileum is about 3. and an inner oblique layer. a middle circular layer. These muscular layers produce a churning action in the stomach. The epithelial cells of the stomach can be divided into five groups. tube-like gastric pits. and ileum. They are mucous neck cells.smooth muscle called the pyloric sphincter. jejunum. endocrine cells. which produce regulatory hormones. which produce mucous. which produce hydrochloric acids and intrinsic factors. parietal cells. The duodenum is about 25 centimeter (the term duodenum means 12. suggesting that it is 12 inches long). The region of the stomach near the pyloric opening is the pyloric region. Those cells produce mucus which coats and protect the stomach lining. The first group consists of surface mucous cells on the inner surface of the stomach and lining the gastric pits. The stomach is lined with simple columnar epithelium. Small Intestines The small intestine is about 6 meters long and consists of three partsthe duodenum. a precursor of the protein-digesting enzyme pepsin.

Within the loose connective tissue core of each villus is a blood capillary called lacteal. Most of the cells composing the surface of the villi have numerous cytoplasmic extensions. Tiny finger like projections of the mucosa forms numerous villi. which have microvilli. Endocrine cells. in the thickness of the . which open into the base of the intestinal glands. at the base of the villi. The sub mucosa of the duodenum contains mucous glands.5-1. Part of the pancreas lies within this arc. The mucosa of the small intestine is simple columnar epithelium with four major cell types: Absorptive cells. which are 0. Each villus is covered by simple columnar epithelium. (Paneths cells). The epithelial cells are produce within tubular glands of the mucosa. The mucosa and sub mucosa form a series of circular folds that run perpendicular to the long axis of the digestive tract. The blood capillary network and the lacteal are very important in transporting absorbed nutrients. called microvilli.The duodenum nearly completes a nearly an 18degree arc as it curves within the abdominal cavity. villi. called intestinal glands. and microvilli. The small intestine is the major site of digestion and absorption of food. and absorb digested food Goblet cells. which may help protect the intestinal epithelium from bacteria. The duodenum. jejunum. and ileum are similar in structure except that there is a granular decrease in the diameter of the small intestine. produce digestive enzymes. which produce regulatory hormones. which produce a protective mucus Granular cells. called duodenal glands.5 mm long. Granular and endocrine cells are located in the bottom of the glands. The common bile duct from the liver and the pancreatic duct from the pancreas join each other and empty into the duodenum. which are accomplished by the presence of a large surface area. The surface of the small intestine has three modifications that increase surface area about 600foldcircular folds.

These lymphatic tissues in the intestine help protect the intestinal tract from harmful micro organisms. The amino acids and monosaccharides can be absorbed by the intestinal epithelium. and in the number of villi as one progress through the small intestine. Lymph nodules are common along the entire length of the digestive tract. Most of the secretions entering the small intestine are produced by the intestinal mucosa. They also keep the chime in the small intestine in a liquid form to facilitate the digestive process. called Peyers patches. into monosaccharide. which allows material contained in the intestine to move from the ileum to the large intestine. Mucus is produced by duodenal glands and by goblet cells. Hormones released from the intestinal mucosa stimulate liver . Clusters of lymph nodules.intestinal wall. It has a ring of smooth muscle. which are dispersed throughout the epithelial lining of the entire small intestine and within intestinal glands. The epithelial cells in the walls of the small intestine have enzymes bound to their free surfaces that play a significant role in the final steps of digestion. Disaccharidases break down dissacharides. are numerous in the ileum. in the number of circular folds. but not in the opposite direction. the ileocecal sphincter. ions and water. Secretions of the Small Intestines Secretions from the mucosa of the small intestine mainly contain mucus. such as maltose and isomaltose. The junction between the ileum and the large intestine is the ileocecal junction. but the secretions of the liver and the pancreas also enter the small intestine and play important roles in the process of digestion. Intestinal secretions lubricate and protect the intestinal wall from the acidic chime and the action of the digestive enzymes. and an ileocecal valve. Peptidases break the peptide bonds in proteins to form amino acids.

tucked against the inferior surface of the diaphragm. Absorption in the Small Intestines A major function of the small intestine is the absorption of nutrients. . Liver The liver weighs about 1. the falciform ligament. Two smaller lobes. Secretion by duodenal glands is stimulated by the vagus nerve. The ileocecal sphincter at the juncture of the ileum and the large intestine remains mildly contracted most of the time. and chemical or tactile irritation of the duodenal mucosa. but peristaltic contractions reaching the ileocecal sphincter from the small intestine cause the sphincter to relax and allow movement of chime from the small intestine into the cecum. Movement of Small Intestines Mixing and propulsion of chime are the primary mechanical events that occur in the small intestine. but tends to prevent movement from the large intestine back into the ileum. it is divided into two major lobes. The ileocecal valve allows chime to move from the ileum into the large intestine. secretin release. although some absorption also occurs in the ileum. the right and left lobes. separated by a connective tissue septum. the caudate and quadrate. Most absorption occurs in the duodenum and jejunum. The posterior surface of the liver is in contact with the right ribs 5-12.36 kilograms and is located in the right upper quadrant of the abdomen. Segmental contractions are propagated for only short distances and function to mix intestinal contents.and pancreatic secretions. Peristaltic contractions proceed along the length of the intestine for variable distances and cause the chime to move along the small intestine.

The mixed blood flows towards the center of each lobule into a central vein. The hepatic portal vein carries blood that is oxygen-poor but rich in absorbed nutrients and other substances from the digestive tract to the liver. The portal triads contain three structuresthe hepatic artery. which empty into the inferior vena cava. which supplies liver cells with oxygen. the bile canaliculus. are located between the center and the margins of each lobule. Blood from the hepatic portal vein and the hepatic artery flows into the sinusoids and becomes mixed. The hepatic artery brings oxygen-rich blood to the liver. produced by the hepatocytes. A cleft-like lumen. and hepatic duct. ducts and nerves enter or exit the liver. The sinusoid epithelium contains phagocytic cells that help remove foreign particles from the blood. Many delicate connective tissue septa divide the liver into lobules with portal triads at the corners of the lobules. Also seen from the inferior view is the porta. which is the gate through which blood vessels.can be seen from an inferior view. which carry blood out of the liver to the inferior vena cava. flows through the bile canaliculi to the hepatic ducts in the portal triads. formed by platelike groups of cells called hepatocytes. The common hepatic ducts is joined by the cystic duct from the gallbladder is a small sac on the inferior surface of the liver that stores and concentrates bile. The hepatic cords are separated from one another by blood channels called hepatic sinusoids. Blood exits the liver through hepatic veins. The liver receives blood from two sources. The hepatic ducts converge and empty into the right and left hepatic ducts. which transport bile out of the liver. is between the cells of each hepatic cord. Bile. The central veins from all the lobes unite to form the hepatic veins. . hepatic portal vein. The right and left hepatic ducts unite to form a single common hepatic duct. Liver cells process nutrients and detoxify harmful substance from the blood. Hepatic cords.

Cholecystokinin stimulates the gall bladder to contract and release bile into the duodenum. much like the action of detergent in dish-water. store and processes chemicals. The loss of bile salts in the feces is reduced by this recycling process. Parasympathetic stimulation through the vagus nerve also stimulates bile secretion and release. and the blood carries them back to the liver. This storage function is usually short term. The liver performs important digestive and excretory functions. Bile excretion by the liver is stimulated by secretin. Bile also contains excretory products such as bile pigments. breaking the fat globules into smaller droplets. It can also store fat. cholesterol and fats. nutrients. copper and iron. which is released from the duodenum. synthesizes new molecules. Most bile salts are reabsorbed in the ileum. vitamins. The liver secretes about 70mL of bile each day. where they stimulate additional bile salts secretion and are once again secreted into the bile. Bile salts emulsify fats. Bile contains no digestive enzymes. The small droplets are more easily digested by the digestive enzymes. and detoxifies harmful . The liver can remove sugar from the blood and store it in the form of glycogen.The common bile duct joins the pancreatic duct and opens into the duodenum at the duodenal papilia. The opening into the duodenum is regulated by a sphincter. but it plays an important role in digestion by diluting and neutralizing stomach acid and by dramatically increasing the efficiency of fat digestion and absorption. Bilirubin is a bile pigment that results from the breakdown of hemoglobin. Digestive enzyme cannot act efficient on large fat globules.

The liver transforms some nutrients into more readily usable substances. Pancreas Pancreas is a fish-shaped spongy grayish-pink organ about 6 inches (15 cm) long that stretches across the back of the abdomen. the body itself produces many by-products of metabolism that. which carries bile (a fluid that helps digest fat) connects to the small intestine near the stomach. The head of the pancreas is on the right side of the abdomen and is connected to the duodenum (the first section of the small intestine). Beta cells . The liver can also produce its own unique new compounds. As pancreatic juices are made. The pancreatic juices are enzymes that help digest food in the small intestine. Many ingested substances are harmful to the cells of the body. The common bile duct. It is compoundin the sense that it is composed of both exocrine and endocrine tissues. making their excretion easier. The pancreas makes pancreatic juices and hormones. which connects the pancreas to the liver and the gallbladder. called the tail. It detoxifies them by altering their structure. Many of the blood proteins. Insulin controls the amount of sugar in the blood. and clotting factors. extends to the left side of the body. The narrow end of the pancreas. In addition. fibrinogen. The liver is an important line of defense against many of those harmful substances. they flow into the main pancreatic duct. globulins. if accumulated. behind the stomach. are toxic. are synthesized in the liver and released into the circulation. The endocrine function resides in the million or so cellular islands (the islets of Langerhans) embedded between the exocrine units of the pancreas. including insulin. such as albumin. The exocrine function of the pancreas involves the synthesis and secretion of pancreatic juices. This duct joins the common bile duct. The pancreas is thus a compound gland.

or tiny structures providing blood to the colon. which helps control carbohydrate metabolism. and the rectum and anus. and specialized muscles for carrying out the tasks of water absorption and waste removal. and a host of muscle groups and beneficial microorganisms work to maintain the digestive system. and is a muscular tube composed of lymphatic tissue. The tough outer covering of the colon protects the inner layer of the colon with circular muscles for propelling waste out of the body in an action called peristalsis. Their purpose is ridding the body of toxins that have entered the body from food sources. blood vessels. digestive enzymes are released. or toxins produced within the body. In this process. appendix.of the islands secrete insulin. environmental poisons. 2. blood vessels. Large Intestines The colon is made up of 6 parts all working collectively for a single purpose. The colon is approximately 4. The names of these parts are the transverse colon. descending colon. and contains the villi. and connective tissue. The colons role is to transfer nutrients into the bloodstream through the absorbent walls of the large intestine while pushing waste out of the body. The shorter of the two intestinal groups. Alpha cells of the islets secrete glucagon that counters the action of insulin. connective tissue. ascending colon.5 feet long. Transverse Colon . The colon is actually just another name for the large intestine. Under the outer muscular layer is a sub-mucous coat containing the lymphatic tissue. sigmoid colon. the large intestine. The innermost lining is highly moist and sensitive. consists of parts with various responsibilities. water is absorbed by the stool.5 inches wide.

Within these parts of the colon. Rectum and Anus The rectum is about eight inches long and serves. . contractions from smooth muscle groups work food material back and forth to move waste through the colon and eventually.The transverse. and corresponding to the direction food takes as it encounters those sections. basically. the descending colon turns downward and becomes the sigmoid colon. out of the body. When you·re ready. and descending colons are named for their physical locations within the digestive tract. The ascending colon travels up along the right side of the body. the muscular contractions working against gravity are essential to keep the system running smoothly. Due to waste being forced upwards. Ileocecal and Cecum Valves The ileocecal valve is located where the small and large intestines meet. as a warehouse for poop. followed by the rectum and anus. The next section of the colon is termed the transverse colon due to it running across the body horizontally. The cecum follows this valve and is an opening to the large intestine. It hooks up with the sigmoid colon to the north and with the anal canal to the south. This valve is an opening between the small intestine and large intestine allowing contents to be transferred to the colon. The intestinal walls secrete alkaline mucus for lubricating the colon walls to ensure continued movement of the waste. ascending. The rectum has little shelves in it called transverse folds. Then. These folds help keep stool in place until you·re ready to go to the bathroom.

stool enters the lower rectum. The rectum intestinum acts as a temporary storage facility for feces. stretch receptors from the nervous system located in the rectal walls stimulate the desire to defecate. the increase in intrarectal pressure forces the walls of the anal canal apart. moves into the anal canal. . The internal and external sphincter allows the feces to be passed by muscles pulling the anus up over the exiting feces. and then passes through the anus on its way out. allowing the fecal matter to enter the canal. the material in the rectum is often returned to the colon where more water is absorbed. If the urge is not acted upon. The rectum shortens as material is forced into the anal canal and peristaltic waves propel the feces out of the rectum. If defecation is delayed for a prolonged period of time constipation and hardened feces results. When the rectum becomes full. As the rectal walls expand due to the materials filling it from within.

Latin y America.5 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) .) Book-Centered Medical Diagnosis Typhoid fever Definition Typhoid fever . Africa.III.is a life-threatening illness caused by the bacterium Salmonella typhi. The Patient¶s Illness A. PATHOPHYSIOLOGY a. Schematic Diagram Predisposing y Geographical area ± Asia. and Oceania School-aged children and young adults Precipitating Washing of hands inadequately Drinking unpurified water Eating foods from an unknown source Economic status Ingestion of foods or fluids contaminated with Salmonella typhi bacteria Bacteria enter the stomach and survive a pH as low as 1. the Caribbean.

blood.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. breaking out into the bloodstream and cause systemic infection Tissue damage and inflammation causes loss of absorption due to damaged villi causing an increase in water. mucus. and serum to be pulled into the intestine from immature crypt cells . electrolytes. Diagnostic: Hematology: Neutrophils-elevated Macrophages & intestinal epithelial cells then attract T cells & neutrophils with interleukin 8 (IL-8 causing inflammation of the intestinal wall) Perforation and destruction of mucosal lining of the intestinal wall can lead to persistent inflammation Signs/ symptoms: Abdominal pain The bacteria is within the macrophages and survives Ulceration and bleeding in the mucosal lining and leads to necrosis Diagnostic: Fecalysis: brown color RBC: elevated Bacteria spread via the lymphatics while inside the macrophages The bacteria induced macrophage apoptosis.

Signs/ symptoms: Febrile Warmth to touch Headache Body weakness Rash/ Red spots Sore throat Typhoid Fever Abdominal spasm is induced to limit mucosal injury adding in stimulation of increased peristalsis Signs/ symptoms: Abdominal pain.Signs and symptoms . Guarding behavior. or severe constipation Hyperactive bowel sounds Dry skin Decreased body weight .Diagnostic exams . Facial grimace Tachypnea Acute Gastroenteritis Complications: Bile is infected and typically shed in the stool and are then available to infect other hosts Legend: .Pathophsiology Complications: Peritonitis Pancreatitis Hepatic and splenic abscesses Disseminated intravascular coagulation Myocarditis Shock Death Signs/ symptoms: Diarrhea that has the color and consistency of pea soup.Complications .

is a life-threatening illness caused by the bacterium Salmonella typhi.b. Schematic Diagram Predisposing y Geographical area ± tropical islands in the Pacific (Philippines) and Asia y Children aged 5-15 Precipitating y Washing of hands inadequately y Drinking unpurified water y Eating street foods y Nail biting y Economic Status Ingestion of foods or fluids contaminated with Salmonella typhi bacteria Bacteria enter the stomach and survive a pH as low as 1.5 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) .) Client-Centered Medical Diagnosis Typhoid fever Definition Typhoid fever .

4 12 x 10 /L) Bacteria spread via the lymphatics while inside the macrophages The bacteria induced macrophage apoptosis.2-5. mucus.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. electrolytes. and serum to be pulled into the intestine from immature crypt cells Signs/ symptoms: Febrile: T-38. Macrophages & intestinal epithelial cells then attract T cells & neutrophils with interleukin 8 (IL-8 causing inflammation of the intestinal wall) Perforation and destruction of mucosal lining of the intestinal wall can lead to persistent inflammation Signs/ symptoms: Abdominal pain The bacteria is within the macrophages and survives Ulceration and bleeding in the mucosal lining and leads to necrosis Diagnostic: Fecalysis: Color: Brown RBC: RBC=4. body weakness Typhoid Fever .79 (4. breaking out into the bloodstream and cause systemic infection Tissue damage and inflammation causes loss of absorption due to damaged villi causing an increase in water. blood.5C Warmth to touch Headache of 3/10.

Legend: . tachypnea-RR of 38cpm.Diagnostic exams . guarding behavior.Abdominal spasm is induced to limit mucosal injury adding in stimulation of increased peristalsis Signs/ symptoms: RUQ Abdominal pain of 5/10 pain scale. defecates 5-7 times at night.Signs and symptoms . soft watery stool 2-3 cups per episodes. Complications: Bile is infected and typically shed in the stool and are then available to infect other hosts Signs/ symptoms: Diarrhea. facial grimace.Pathophsiology . Dry skin.Complications .

The bacterium multiplies in the gallbladder. Contamination of the water supply can. they multiply in high numbers. DEFINITION OF THE DISEASE (book-based) Typhoid fever is acute. Pathophysiology After the ingestion of contaminated food or water. Here. Patients with acute illness can contaminate the surrounding water supply through stool. generalized infection caused by Salmonella typhi. taint the food supply. The bacteria are carried by white blood cells in the liver. The bacteria can survive for weeks in water or dried sewage. biliary system. or liver and passes into the bowel. The bacteria then multiply in the cells of these organs and reenter the bloodstream. These patients can become long-term carriers of the bacteria. SYNTHESIS OF THE DISEASE 1. when the organism reenters the bloodstream. food handlers who are carriers. bile ducts. About 3%-5% of patients become carriers of the bacteria after the acute illness. Bacteria invade the gallbladder. Typhoid fever is contracted by the ingestion of the bacteria in contaminated food or water. The main sources of infection are contaminated water or milk and. spleen. and the lymphatic tissue of the bowel. which contains a high concentration of the bacteria. especially in urban communities. Some patients suffer a very mild illness that goes unrecognized. and bone marrow. including fever.B. Patients develop symptoms. These chronic carriers may have no symptoms and can be the source of new outbreaks of typhoid fever for many years. in turn. the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria pass into the intestinal tract and can be identified for diagnosis in .

Typhoid fever infects roughly 21. and Oceania. Typhoid fever is endemic in Asia. Laos. Within those countries. Africa. but 80% of cases come from Bangladesh. y y Work in or travel to areas where typhoid fever is endemic Have close contact with someone who is infected or has recently been infected with typhoid fever y Have an immune system weakened by medications such as corticosteroids y y Drink water contaminated by sewage that contains Salmonella typhi Low economic status .6 per 1. PREDISPOSING AND PRECIPITATING FACTORS  Age According to WHO.  Race Typhoid fever occurs worldwide. Indonesia. 2. the Caribbean. typhoid fever is most common in underdeveloped areas. Pakistan. China. most documented typhoid fever cases involve school-aged children and young adults.000 people every year.000 population) and kills an estimated 200. Latin America. or Vietnam. Stool cultures are sensitive in the early and late stages of the disease but often need to be supplemented with blood cultures to make the definite diagnosis.6 million people (incidence of 3. India. primarily in developing nations whose sanitary conditions are poor. Nepal.cultures from the stool tested in the laboratory.

. SIGNS AND SYMPTOMS The symptoms of typhoid appear 10 to 14 days after infection. rose-colored spots on your lower chest or upper abdomen.body has raised its temperature to fight an infection or condition y y y y y y Headache Weakness and fatigue A sore throat Abdominal pain Diarrhea or constipation Rose spots in the abdomen. flat. whereas adults may become severely constipated. the patient may develop a rash of small. In some cases you may not become sick for as long as two months after exposure. usually disappearing in two to five days.pathognomic sign Children are more likely to have diarrhea. During the second week. often as high as 103 or 104 F (39 or 40 C) . The rash is temporary. the patient would likely to experience: y Fever.y Poor hand washing practice 3. . First stage Once signs and symptoms do appear.

he/she may enter a second stage during which you become very ill and experience: y y Continuing high fever Either diarrhea that has the color and consistency of pea soup or severe constipation y y Considerable weight loss Extremely distended abdomen The typhoid state By the third week. HEALTH PROMOTION AND PREVENTIVE ASPECTS OF THE DISEASE . he/she may: y y Become delirious Lie motionless and exhausted with eyes half-closed in what's known as the typhoid state Life-threatening complications often develop at this time.DOC DIET High caloric diet 4. TREATMENT Chloramphenicol is the most effective drug in combating typhoid.Second stage If the patient doesn·t receive treatment for typhoid fever. .

Wash hands Frequent hand washing is the best way to control infection. For that reason. Contaminated drinking water is a particular problem in areas where typhoid is endemic. Use bottled water to brush teeth. Wash hands thoroughly with hot. avoid fruits and vegetables that can't be peeled. Choose hot foods. especially lettuce. especially before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn't available. To be absolutely safe. and try not to swallow water in the shower. .1. Steaming hot foods are best. soapy water. Ask for drinks without ice. Because raw produce may have been washed in unsafe water. it's best to avoid food from street vendors ³ it's more likely to be contaminated. Wipe the outside of all bottles and cans before opening. Avoid drinking untreated water. 4. drink only bottled water or canned or bottled carbonated beverages. wine and beer. Carbonated bottled water is safer than uncarbonated bottled water. Avoid raw fruits and vegetables. Avoid food that's stored or served at room temperature. avoid raw foods entirely. And although there's no guarantee that meals served at the finest restaurants are safe. 3. 2.

According to the approved package insert (PI). The PI further states:  "Based on the available efficacy data. these measures can help keep others safe: . Reimmunization every two years under conditions of repeated or continued exposure to the S. TY21a Primary vaccination with oral Ty21a vaccine consists of a total of four capsules. Vi polysaccharide vaccines Typhim Vi is a sterile solution containing the cell surface Vi polysaccharide extracted from Salmonella typhi Ty2 strain and is for intramuscular use. The vaccine manufacturer recommends that Ty21a not be administered to infants or children younger than 6 years of age.5. one taken every other day. Typhim Vi is indicated for active immunization against typhoid fever for persons two years of age or older. Each capsule should be taken with cool liquid no warmer than 37° Celsius (98."  "An optimal reimmunization schedule has not been established. and all four doses must be taken to achieve maximum efficacy. The vaccine offers between 33 and 78% protection. The vaccine is most commonly used to protect travelers to endemic countries To prevent infecting others If you're recovering from typhoid." 6. The capsules should be kept refrigerated (not frozen).6° Fahrenheit). vaccination with Typhim Vi may not be expected to protect 100% of susceptible individuals. typhi organism is recommended at this time. approximately one hour before a meal.

4. telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths. Set aside towels. If he/she works in the food service industry or a health care facility. This is the single most important thing that can do to keep from spreading the infection to others.  Observe for shaking chills and profuse diaphoresis . especially before eating and after using the toilet. soapy water. he/she won't be allowed to return to work until tests show that he/she is no longer shedding typhoid bacteria. bed linen and utensils for own use and wash them frequently in hot. NURSING INTERVENTION INDEPENDENT:  Monitor patient temperature degree and pattern. 2. Clean toilets. Clean household items daily. Heavily soiled items can be soaked first in disinfectant. Keep personal items separate. Use plenty of hot. 3. Avoid handling food. Avoid preparing food for others until the doctor says it is no longer contagious. soapy water and scrub thoroughly for at least 30 seconds. door handles.1. Wash hands often.

Bacteria invade the gallbladder. Here. they multiply in high numbers. The bacteria pass into the intestinal tract and can be identified for diagnosis in cultures from the stool tested in the laboratory. she is fond of eating street foods especially fish balls and siopao. biliary system. *PATIENT. spleen. the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily.  Monitor for signs of deterioration of condition or failure to improve with therapy . and bone marrow. when the organism reenters the bloodstream. The bacteria are carried by white blood cells in the liver. The patient developed symptoms. The bacteria then multiply in the cells of these organs and reenter the bloodstream.COLLABORATIVE  Administer antipyretics as prescribed. Stool cultures are sensitive in the . including fever. The main sources of infection caused by salmonella typhi are contaminated foods and water.CENTERED According to the patient.-administer antibiotics as prescribed. and the lymphatic tissue of the bowel. Pathophysiology The patient ingested a contaminated food or water.  Provide tepid sponge baths and avoid the use of ice water and alcohol. Wash hands with anti-bacterial soap and after each care of activity and encourage proper hygiene.

body has raised its temperature to fight an infection or condition ( August 8. often as high as 103 or 104 F (39 or 40 C) . . 2010) . 2010 ) y Abdominal pain ( August 8. Predisposing and precipitating factors:  Drinking water (water from the faucet) and eating contaminated food by sewage that contains Salmonella typhi (street foods)  Low economic status  Poor hygiene (biting untrimmed nails as manifested by the patient)  Poor hand washing practice SIGNS AND SYMPTOMS The symptoms of typhoid appear 10 to 14 days after infection. First stage y Fever.early and late stages of the disease but often need to be supplemented with blood cultures to make the definite diagnosis. In some cases you may not become sick for as long as two months after exposure. 2010 ) y Headache due to decreased perfusion in the brain and fever (August 8. 2010 ) y Weakness and fatigue related to decreased absorption of nutrients ( August 8.

2010 ) Rose spots in the abdomen.y y Diarrhea ( August 9.pathognomic sign (did not manifest) Second stage If the patient doesn·t receive treatment for typhoid fever.. he/she may enter a second stage during which you become very ill and experience: y y Continuing high fever ( date manifested) Either diarrhea that has the color and consistency of pea soup or severe ( date manifested) y y Considerable weight loss.did not manifest The typhoid state: y Become delirious.did not manifest Extremely distended abdomen.did not manifest .

It the approximates Date(s) performed: fluid and electrolyte composition of blood and provides August 08. need to replace the fluid volume lost. IVFs Medical management: treatment Date changed/D/C Date ordered Date(s) performed General description Indication(s) Or Purpose(s) Client·s response to the treatment PLRS 1L X 10-12 X 8hours Date ordered: It is an isotonic PLRS was ordered The patient was crystalloid expander volume for the patient to able to meet the that replace fluid loss. 2010 expands circulating blood volume. Medical Management: a. . 2010 9 cal/L.V. August 08. The Patient and her care: A.

Date changed: August 09. allergy to tape Check the status or veins to determine appropriate venipuncture site . 2010 Nursing Responsibilities: Prior to: y y y y y y y y Prepare the equipment Verify doctor·s order Use strict aseptic technique Explain the procedure to the S0 and give formation about the purpose of IVF to be inserted Identify the client Assess vital signs for baseline data Assess skin turgor.

date started. If there is any question with the flow rate ordered. if air is present. Check for patency of the tubing Spike the solution container Cleanse the fluid to be given. y y y y Monitor IV flow and patient·s response Monitor patient for evidence of IV infiltrations Check for presence of air in the tubing.During: y y y y y y y y Use the smallest gauge needle possible. number) Ensure appropriate infusion flow. make sure it is the same with the prescribed fluid. remove immediately Check for the patency of the line always. Partially fill the drip chamber gently with solution. Select a suitable vein for venipuncture Dilate the vein Put on clean gloves and clean the venipuncture site. . Adjust the rate of fluids appropriate to the needs f the patient as ordered. After: y y y Label the IVF (name. check with the physician who gave the order.

y y Regulate and monitor the IV rate of fluid. . Document relevant data.

chloride). to the body. USP is a sterile. nonpyrogenic solution isotonic containing This medication is an intravenous (IV) solution used to supply water and electrolytes (e.Medical management: treatment Date ordered Date(s) performed Date changed/D/C General description Indication(s) Or Purpose(s) Client·s response to the treatment D5LRS 500cc X 16-17 drops/min Date ordered: August 09.. potassium.g. It is also used as a mixing solution (diluent) for other IV medications. and . 2010 Lactated Ringer·s Injection. 2010 intravenous infusion for parenteral of replacement extracellular losses of fluid electrolytes. either with or without calories (dextrose). The patient was able to meet the need to replace the fluid D5LRS 1000cc X 1617 drops/min Date(s) performed: August 09. It is by administered Date changed: August 10. sodium. 2010 volume lost. calcium. concentrations of electrolytes in water for injection.

Partially fill the drip chamber gently with solution. allergy to tape Check the status or veins to determine appropriate venipuncture site During: y y y y y y Use the smallest gauge needle possible. Select a suitable vein for venipuncture .Nursing Responsibilities: Prior to: y y y y y y y y Prepare the equipment Verify doctor·s order Use strict aseptic technique Explain the procedure to the S0 and give formation about the purpose of IVF to be inserted Identify the client Assess vital signs for baseline data Assess skin turgor. make sure it is the same with the prescribed fluid. Check for patency of the tubing Spike the solution container Cleanse the fluid to be given.

date started. Adjust the rate of fluids appropriate to the needs f the patient as ordered. if air is present. Regulate and monitor the IV rate of fluid. After: y y y Label the IVF (name. check with the physician who gave the order. If there is any question with the flow rate ordered. y y y y y y Monitor IV flow and patient·s response Monitor patient for evidence of IV infiltrations Check for presence of air in the tubing.y y Dilate the vein Put on clean gloves and clean the venipuncture site. . Document relevant data. number) Ensure appropriate infusion flow. remove immediately Check for the patency of the line always.

2010 210 4hour mg IV q For patients. 2010 pain and fever. anti. Have no antithe of The patient·s Route administration of Indication(s) purposes Mechanism action of or Classification Client·s response to medication the temperature slightly decreases. Drugs Name of Drugs: Generic Name: Date Ordered Date Given Dosage Date Changed And frequency 1.nonopiod analgesics Inhibits Date Given: August 08. pyretics febrile Antipyrectics. 2010 synthesis prostaglandins that may serve as mediators of Discontinued: August 10.b.PARACETAMOL Date ordered: August 08. significant inflammatory . primarily in the CNS.

2010 maintain effectiveness of bacteria Cefuroxime organisms. dizziness development of similar drug-resistant bacteria penicillin. 2010 caused bacteria. She didn·t experienced any side effects of diarrhea.CEFUROXIME 8hour mg IV q To reduce the chemically to It is Typhi responded well with the medication. Haemophilus and abdominal pain. such suspected to be as Date Given: August 08. 750 2. Streptococcus pneumoniae.properties or GI toxity. and effective against the a wide variety of Date ordered: August 08. Cefuroxime is a semisynthetic cephalosporin antibiotic. by Staphylococcus aureus. . nausea. vomiting. headaches/migr aines.

particularly those caused against specific . used many to infective component gentamicin The signs and of were 8hour anti. gonorrhoeae. E. 2010 influenzae. N. many 35 mg IVP q The Gentamicin is an aminoglycosi de antibiotic.symptoms infections in reduced. treat sulfatetypes prednisolone acetate included provide is to action of bacterial infe ctions. coli.Discontinued: August 10. and others.

Escherichia coli. Streptococcus pyones. Discontinued: August 10. Haemophilus . N eisseria meningitidis orLe gionella following microorganisms: Staphylococcus aureus. Enterobacter aerogenes. Date Given: August 10. 2010 pneumophila. is used organisms susceptible to it. Gentamicin sulfate active in vitro against susceptible strains of the is gentamicin not for Neisseria Date ordered: August 10.3. 2010 gonorrhoeae.GENTAMYCIN by Gramnegative bacteri a. However. 2010 Streptococcus pneumoniae.

influenzae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Pseudomonas aeruginosa, and Serratia marcescens .

NURSING RESPONSIBILITIES FOR MEDICATIONS: Prior to: y Check the written medication order for completeness. frequency, and duration of the therapy. y Check to see if there are any special circumstances surrounding administration of the dose to the patient. y Be certain that you know the expected action, safe dosage range, special instructions for administration and adverse effects associated with drug orders. y y Prepare the necessary equipment like the medication tray, medication card, and water. Wash your hands. It should include the drug name, dosage,

y y y

Prepare the dosage as ordered. Check the label on the medications three times before administering any drug. Never prepare a dosage of medication, which is discolored, has precipitated, is contaminated or outdated.

During: y y y y Identify the right patient. Elevate the head of the bed to aid the patient in swallowing the medication. Stay with the patient as he swallows the medication. Provide necessary assistance. Use a dropper o give infants or very small children liquid meds while holding them in a sitting or semisitting position. Position or place the medication between the gums and cheeks to prevent aspiration. y y Do not tilt the head backward when the patient has difficulty in swallowing liquid medications. Give medication between meals.

After: y If the patient vomits with in 20-30 minutes of taking the medication, the physician must be promptly notified. Also note the details on the patient·s chart.

y

Following administration, be certain that the patient is comfortable, then immediately record the procedure. This should include the name of the drug, dosage, time of administration, and your name or initials.

y y

Monitor hemoglobin level, hematocrit, and reticulocyte count. Advise patient or SO to report constipation and change in stool color or consistency.

NURSING RESPONSIBILITIES FOR DRUGS Paracetamol Observe the 10R·s of medication administration Assess overall health status and alcohol usage before administering acetaminophen. Patients who are malnourished or chronically abuse alcohol are at risk of developing hepatotoxity with chronic use of usual doses of this drug. Assess amount, frequency, and type of drugs take in patients self-medicating, especially with OTC drugs. Prolonged use of acetaminophen increases the risk of adverse effects. For the short-term use, combined doses of acetaminophen and salicytes should not exceed the recommended dose of either drug given alone. Pain: assess type, location, and intensity prior to 30-60 min following administration.

y y

y

y

Wash your hands. and is contaminated or outdated. Obtain specimen for culture and sensitivity tests before giving the first dose. special instructions for administration and adverse effects associated with drug orders. y Be certain that you know the expected action. y Cefuroxime Observe the 10R·s of medication administration Check the written medication order for completeness. Prepare the dosage as ordered. note presence of associated signs (diaphoresis. tachycardia. y Check to see if there are any special circumstances surrounding administration of the dose to the patient. safe dosage range. frequency. Check the label on the medications three times before administering any drug. and malaise) Toxicity and overdose: if overdose occurs. which is discolored.y Fever: assess fever. and duration of the therapy. Decrease dosage in patients with impaired renal function. has precipitated. Never prepare a dosage of medication. y y . ask patient about allergic reactions too cefuroxime or cephalosporin. acetylcysteine (acedote) is the antidote. y y y y y y Prepare the necessary equipment. It should include the drug name. dosage. y y Before giving drug.

and duration of the therapy. y y y y Prepare the necessary equipment. be certain that the patient is comfortable. Wash your hands. vomiting. y Following administration. nausea. Prepare the dosage as ordered. fever. y Inform patient or SO to notify prescriber if rash. then immediately record the procedure. Ampicillin Observe the 10R·s of medication administration Check the written medication order for completeness. safe dosage range. or chills develop. dosage. headaches/migraines. y Check to see if there are any special circumstances surrounding administration of the dose to the patient. It should include the drug name. y Patient may experience this side effects diarrhea. drug label and dosage on the container. frequency. y Be certain that you know the expected action. dizziness and abdominal pain. Decrease dosage in patients with impaired renal function. y y . special instructions for administration and adverse effects associated with drug orders.y Identify the patient expresses any doubt about the medication. always recheck the order.

such as erythematous maculopapular rash. if prescribed and the infection is severe or if patient can·t take oral drug. y y Monitor sodium level because each gram of ampicillin contains 2. or I. y y y y Give drug I. has precipitated.9 mEq of sodium. y Inform patient or SO to notify prescriber if rash. Watch for signs and symptoms of hypersensitivity. give drug with gentamicin. always recheck the order. y y Obtain specimen for culture and sensitivity tests before giving the first dose. then immediately record the procedure. and anaphylaxys. be certain that the patient is comfortable.V. and is contaminated or outdated. y Before giving drug. Following administration. or chills develop. these substances promote rapid breakdown of ampicillin. y Don·t mix with solutions containing dextrose or fructose.y y Check the label on the medications three times before administering any drug. fever. drug label and dosage on the container. Never prepare a dosage of medication. A negative history of penicillin allergy is no guarantee against a future allergic reaction. To prevent bacterial endocarditis. Identify the patient expresses any doubt about the medication. which is discolored. Give drug 1 to 2 hours before or 2 to 3 hours after meals. ask patient about allergic reactions too penicillin. urticaria. .M.

the regimen. 2010 can eat Performed: tolerate with to the of Gatorade. Patient·s SO with diet No foods and drinks nutritional that the patient requirements August 08. Discontinued General Description Indication or Purpose Specific foods taken Client·s response and/or reaction to diet DAT Diet Tolerated as Ordered: These are the For normal body Bread. Fruits complied and vegetables. Fish.Type of Diet DATES: Ordered. August 08. 2010 Discontinued: August 10. 2010 . allergic reaction. consideration proper nutrition that is needed by the body. Rice. Performed.

c. Assess the client·s ability to chew and swallow. Diet NURSING RESPONSIBILITIES: Prior: y y y Assess the appropriateness of the ordered diet for client·s needs Assess the client·s needs for specialized utensils. Help the client wash his hands and face in preparation for eating. Have the client sit on the side of the bed or in a chair. bedpans and urinals. Check to be sure that the food presented is in fact this client·s food and corresponds to what the client ordered. y Start the meal with a sip of cool beverage to lubricate the inside of the mouth. After: . During: y y y y y Wash your hands. Remove or move any unpleasant visual stimuli such as commodes.

Document how well the client tolerated the meal. d. Note any eating difficulties client exhibited.y y y y y Encourage the client to keep his head up or continue to sit up for at least 15 minutes following the meal. Evaluate whether the client had an appetite for the meal. Exercise ² not indicated . Allow client to wash his hands and face if needed.

Conclusion. although its effectiveness does not include children. so that children would have early protection from typhoid fever . brain. with permanent injury or death. The development of such vaccines greatly helps people to maintain good health despite of threats of the occurrence of such conditions such as typhoid fever. Typhoid fever is a very serious condition that affects several people especially children. Recommendation and Learning Derived A. . The Vi vaccine has been approved by the World Health Organization in 94 countries. and intestines. in order to widen the people·s knowledge and simple sanitation of food and water goes a long way in order to minimize cases of typhoid fever. Nowadays new trends in the treatment of typhoid fever have been created such as the Vi polysaccharide vaccine and exoprotein A vaccine. Conclusion Typhoid Fever is a condition that is brought about by salmonella typhi . That is why in these types of cases primary prevention such as information dissemination. In children. a bacteria that can be transmitted by contaminated food or water. typhoid fever is evident since they are the ones who are more susceptible to eat or drink unsanitary food or water especially when they do not have parental supervision. This bacteria then attacks the Gastrointestinal system. In our world today. people who are affected especially children may be at risk of having serious complications effecting bones. In typhoid fever the transmission of salmonella typhi is fast and easily acquired. no one can afford to have their health compromised since we live in a world that is continuously functioning and because most people are nowadays financially challenged. That is why the exoprotein A vaccine is the one that is more likely to be included in the routine vaccine of children if its evaluation proves to be successful.VII.

In order for the HCPs or students to be able to function in the hospital setting more efficiently and well informed with the said condition. Providing simple health teachings to people such as sanitation of food and water could greatly help them to prevent themselves from acquiring such condition especially for . These types of disease condition such as typhoid fever should not be a hindrance in our goal of achieving optimal health for everyone. Health is in the hands of the people and is the responsibility of every person to maintain and improve their health so as to lead to a better society. as well as students who are in line with the medical field who may encounter such condition so that their knowledge about the condition may be broadened and may help them in managing their patients with typhoid fever. Recommendation The group recommends this case study to health care professionals. As well as teach them the proper places to eat and get their food so that children are aware of what food and drinks are healthy and safe to eat from those that are not. B. Although this should not discourage people since by preventive measures alone and healthy sanitary ways this condition can be stopped from spreading and affecting dozens of lives.The prevalence of typhoid fever is high. especially in asian countries as proven by the world health organization. The group also recommends this case study for the parents of young children so that they may teach them proper hygiene so as to prevent contamination of what they eat or drink. spreads and how it can be prevented. The group also recommends that there may be information dissemination to the people so as to increase the knowledge of the people on how the condition occurs.

This case has helped us to be more competent and has given us better knowledge. There are a lot of things you could do as to minimize or prevent the occurrence of such illness.children who at their young age are not aware of the dangers of eating or drinking unsanitary food or water. must be well-versed in knowing many things on the said condition. Learning is a continuing process and patients should be given with the most basic facts regarding typhoid fever. I learned that it is not just enough to gather and record information that we·ve seen. As student nurses. doing what is right and loving our profession and chosen career somehow may help to do our tasks. Castro. Knowledge deficit also plays a role in the lives of people living below the poverty line. I realized that finishing such good project like this case study is a fulfillment within us. That·s why. Kimberlee M. but despite of this I·ve learned that knowing what we want. as members of the health care team. and that we need to do thorough assessment. Doing a case study is difficult. they are prone in acquiring different kinds of diseases due to ignorance. prevention and treatment. Learning Derived With the case we have had handled. proper management. With the information we·ve gathered. C. skills and attitude necessary to serve our patients in the best way we can. we have been and could be able to give health teachings. it is very important that we. I was able to learn and acquire awareness of the disease condition Typhoid Fever. studies and analysis. Somehow. As student nurses. it is recommended . One of which is proper nutrition and good lifestyle.

student nurses. thus. In the process of completing this requirement. Health teaching should be given in order for the patient/significant other to realize the effects of the disease condition. It served as a way for us to be able to scrutinize the root of the problem. treatment and medication on the said disease. This case study proves to us. establishing critical analysis on our part. Let us not deprive them of the care. to be knowledgeable of the different kinds of diseases.to encourage patients to continuously read and learn about their disorder and to keep abreast of new developments in the field but in our patient·s condition it should be his mother or other care taker because she is still young to do and know those things. we were able to achieve the fruits of hard work. it does not only enrich us intellectually but as well emotionally and socially. As for us student nurses. Also. As student nurses we should check and correct the lifestyle of the patient to lessen the occurrence of such disease. respect and compassion that they all deserve Proper nursing management must be administered to help the patient cope with her condition. Diaz. like knowledge and experience which would greatly help us in our future profession. typhoid fever. case studies enable us. We also become familiarized with the different diagnostic procedures. Raymoncler B. that proper knowledge on the part of the nurses and any of the health care team is very critical in promoting proper health management. student nurses. we are tasked to learn the different interventions that should be given in a client who has typhoid fever in order for us to provide our clients with the necessary care that they need. like in our case. Through this case study. .

Our health teachings are of great need by the people. As student-nurses. The practices mentioned above plays a vital role in the occurrence of typhoid fever as its cause is contaminated food and water. a bacteria that can be transmitted through contamination of food or water. there is a reported increasing incidence of typhoid fever in our country. the bacteria then attacks the gastrointestinal system of a person. That is why preventive . a lot of Filipinos can·t afford to buy distilled drinking water and so. These practices are alarming and need to be addressed by healthcare providers. student-nurses.We. and intestines. saying that ´mas masarap pag marumiµ. Moreover. we still eat such foods. with permanent injury or death. they resort into drinking water directly from the faucet. we should act on this problem by increasing the knowledge of the public about typhoid fever. Because at any moment in a persons life the occurrence of one disease condition such as typhoid fever can threaten his or her very existence. Garcia. Nowadays. Coco Chanel G. brain. Filipinos are fond of eating street foods. Such practice is observed to most Filipinos and even to us. Typhoid Fever is a condition caused by salmonella typhi . Conditions like typhoid fever are very serious. The health of every person is very fragile. Even we know that it is very risky to eat foods from unknown source or even observing that the vendor is not hygienic. Through this case study I have realized the importance of maintaining and developing my health. encourage them to be aware of their food and boil their water. it is easily compromised and can easily deteriorate. because this could lead to serious complications effecting bones.

our body is a creation and gift from God. we are all responsible in taking care of our own bodies. we as responsible people should start living a healthy life so that we could all live a normal life free of complications and suffering and at the same time be productive members of society. who at a very young age without any form of prevention may experience typhoid fever. we cannot afford to compromise our health since this may lead to poor production and development in the society if most of its citizens have diseases and the cost or expenses on the part of the citizens would increase which would not benefit anyone.measures should be taken. The study has brought me into realization that we. nurses. should have the willingness to learn about the different disease-conditions we are to face in everyday of our lives. I have learned to face new challenges in life as I walk through the path towards triumph. Santiago. Another step that is of importance in the prevention of typhoid fever is information dissemination because I believe that knowledge is power and with this power we could achieve our ultimate goal of optimal state of health. In these times of hardship and economic depression. because simple preventive steps such as improving sanitation of food and water could go a long way in minimizing the occurrence of typhoid fever. and that triumph is to be of service to the . This would also prevent people from experiencing any more form of suffering brought about by conditions like typhoid fever especially for children. We are all stewards of Creation. So as to prevent the occurrence of disease specifically Typhoid fever and also to prevent people from undergoing the suffering and pain of developing such condition. Antonio Miguel O.

Being a nurse is not just a responsibility. I realized one thing. as I made a thorough assessment regarding the patient·s condition. Vitug.clients needing the best possible care in order to bring about optimum wellness with regards to their condition. it·s a vocation we have to value. . At first. I thought I couldn·t make it knowing that we have too little time to assess comprehensively and gather all the necessary data for our study all because I was more focused of what would be the outcome of my study and to make it satisfactory. and that is the purpose of the study which is to make us more skillful and develop an attitude of giving oneself and having the heart to love what you do so that we will be able to be effective nurses in the future. but. Shaneen Jenica M.

gov/ct/show/NCT http://knowledge-storage.com/medicine/37-medicine/109-typhoid-fever http://www. Murr Nurse·s Handbook of Health Assessment by Jane R. Weber Internet Sources: y y y y http://knowledge-storage.com/medicine/37-medicine/109-typhoid-fever .VIII.who. M. Moorhouse & A. Black & Jane Hokanson Hawk y y Nurse·s Pocket Guide by M.int/bulletin/volumes/86/4/06-039818/en/ http://clinicaltrials. Bibliography: Book Sources: y y Brunner & Suddarth·s Handbook of Laboratory and Diagnostic Tests Medical-Surgical Nursing: Clinical Management for Positive Outcomes Eight edition by Joyce M. Doenges.

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