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

In the United States about 400 cases occur each year, and 75% of these are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year.

Typhoid fever can be prevented and can usually be treated with antibiotics. If you are planning to travel outside the United States, you should know about typhoid fever and what steps you can take to protect yourself.

Patients Profile Name: Shiela Acero Age: 29 years old Sex: Female Status: MArried Religion: Roman Catholic Home address: House Redeemer, Butuan City

History of Illness Two days prior to admission patient had been experiencing fever associated with body malaise and frontoparietal headache. She just took Paracetamol.

One day prior to admission patient had notice a rashes on her back and along to the extremities and so she decided to be admitted and have a proper management of her condition.

Reason for admission Patient was admitted at November 4,2007,Sunday a7 9:15am and was accompanied by family members, she was ambulatory. With chief complaints of fever, headache and body malaise. She was seen and examined by Dra. Daisy Galbo and advised to have a laboratory test and examinations to properly confirm the cause of her illness.

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

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

How is typhoid fever spread?
Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers , recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in their feces (stool). You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding S. Typhi or if sewage contaminated with S. Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage. Once S. Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

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

How can you avoid typhoid fever?
Two basic actions can protect you from typhoid fever: 1. Avoid risky foods and drinks. 2. Get vaccinated against typhoid fever. It may surprise you, but watching what you eat and drink when you travel is as important as being vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers' diarrhea, cholera, dysentery, and hepatitis A.

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

Diagnostic test:

 Blood Count Blood Count
Wbc Hemoglobin Hematocrit

2,600 12.8 38.8

Normal level (female)
5,000 - 10,000/uL 11.00 – 16.0 g/dL 38 – 47%

Increased Normal normal

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

 Urinalysis Color Transparency Ph Specific Gravity
Yellow Slightly Hazy 6.0 1.010

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

Generic Name Brand Name Classification Action Indication Adverse Effects Teaching

Cetirizine hydrochloride Zyrtec Antihistamines Long acting non-sedating antihistamines Chronic urticaria Fatigue, dizziness, headache  Tell patient to drink coffee or tea to reduce drowsiness if not contraindicated.  Ice chips may relieve dry mouth

Generic Name Brand Name Classification Action Indication Adverse Effects Teaching

Ceftriaxone sodium Rocephin Cephalosporins Inhibits cell wall synthesis, usually bactericidal Infections Fever, headache, rash Tell patient toreport discomfort on IV insertion

Nursing Care Plan: Typhoid Fever Problem: Knowledge Deficient on regarding to the mode of transmission. Diagnosis: Knowledge Deficient related to lack of information to the disease secondary to statement of misconception. Diagnosis Subjective: Patient verbalized of “ I don’t know where I get the disease, basta dili man pud ko hilig mag kaon sa gawas” Objective: She was avoiding to ask question upon Interaction or unknowledgeable when ask about her condition. Goal 1. After initial interaction patient will be able to know the disease process of her condition. Intervention Independent Actions: She will be guided by asking questions on the history of her condition PTA. Pictures regarding Typhoid Fever will be used to make it more informative and easy to understand. Implementation Evaluation Goal Met: Patient was able to verbalized understanding of her condition and the disease process itself and its proper preventative measures.

1. She will be encourage • to say something or talk about what she knew of her condition. • Important to assess her level of 2. She will be understanding. able to • 2. She will be explained verbalize and discussed all she understanding needed to know of her of her condition and how did condition, after she possibly acquire it. initial • Important to clarify interaction. her mind and be more informed about its mode of transmission. • 3. Discuss and demonstrate to her the proper preventative

She will be encourage to have a return demonstration and

measures of the disease like correct hand washing and handling of foods. • Necessary so that she will be able to have a base knowledge of the proper prevention and self management. 4. Significant others will be informed about the disease and its proper prevention. • Important to prevent possible reoccurrence of the disease and provide a safe and proper care to their affected family members. Dependent Actions: She will be advised to take medications as prescribed by the physician.

a discussion to properly assess her learning on proper hand washing and handling of food.

Significant others will also be allowed to have a demonstration regarding on the correct hand washing and preparation of food.

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