NURSING CARE OF PATIENT WITH DISEASE

OF THE

Gastro Intestinal Tract

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 LESSON OUTLINE
 Typhoid Fever
 Cholera
 Dysentery
 Viral Hepatitis

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
Typhoid Fever
Infection of the lymphoid tissue (Peyer’s Patches) of
the SI
 Synonym: Enteric fever
 Caused by Salmonella typhosa

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 Mode of Transmission: Fecal-oral route ingestion of
contaminated food, milk and water
 Incubation period: 1-3 weeks
 Mean- 10-20 days
 Period of Communicability- variable( as long as the
patient is excreting the microorganism)

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 Source of Infection: 7 F’s
 Feces
 Finger
 Food
 Flies
 Fomites
 Fields/Floors
 Fluids/Water
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 Typhoid Fever
Manifestation: 4 stages
1. Prodromal Stage- microorganism travel in
bloodstream
-Fever, dull headache, abdominal pain, nausea
and vomiting, diarrhea or constipation.

2. Fastidial/Pyrexial Stage- organism has

reached Peyer’s patches

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3 Clinical Features of Typhoid
 Presence of Rose Spots (abdomen
and chest)- only symptom specific to typhoid
(Pathognomonic, present in 25% of cases)
Blanching pink macular spots 2-3
mm over trunk
2. Ladderlike fever
3. Splenomegaly

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Rose spot sign

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 Typhoid Fever
3. Defervescence Stage
a. Intestinal Hemorrhages-melena,
hematochezia
- Avoid dark-colored foods
b. Intestinal Perforation- peritonitis
- Sudden, severe, abdominal pain,
persistence of fever, rigid abdomen

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Peyer’s patch

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 Typhoid Fever
4. Lysis/Convalescence- s/s will subside
- patient should be watched because patient may
develop relapses
Dx.
a. Blood culture- done during prodromal stage
(1st week)
b. Widal Test – antibody test
- Becomes positive on the 2nd week
c. Typhidot- ELISA kit that detects IgM and IgG
antibodies. Becomes positive after 2-3 days of
infection
d. Stool culture – done on the 2nd week

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 Typhoid Fever
Tx
Antibiotic: Chloramphenicol 100mg/kg in 4
doses for 14 days
(side effect is bone marrow depression)
Ceftriaxone, cefixime, ciprofloxacin
Nursing Care:
1. Maintenance of fluid and electrolyte imbalance
- Proper regulation of IVF
- Adequate fluids
- Assess for the sign of dehydration
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 Typhoid Fever
2. Maintenance of nutrition
- High calorie, low residue diet
- Do not give milk which can lead to increase
acidity and diarrhea
3. Isolation of patients
Preventive:
 CDT Immunization
adults: 0.5 cc IM deltoid
children: <10 years old 0.25cc IM deltoid
*6 months immunity

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 Typhoid Fever
Vivotif- in capsule form
- 3 doses: 1 hour before meal q other
day
- 3 years immunity
 Protect / Purify water supplies
 Proper excreta disposal
 Hand washing
 Proper preparation and handling of food
 Avoid eating fresh and uncooked vegetables and fruits in
endemic areas
 Do not put anything in your mouth

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 DYSENTERY
intestinal inflammation, primarily of the colon. It
can lead to mild or severe stomach cramps and
severe diarrhea with mucus or blood in the feces.
It usually results in diarrhea with blood

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 Dysentery

1. Bacillary Dysentery- Shigellosis

2. Violent Dysentery- Cholera
3. Amoebic Dysentery- Amoebiasis

MOT: Fecal oral route

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 Dysentery
Bacillary Violent Amoebic
Dysentery Dysentery Dysentery

Causative Shigella Vibrio Entamoeba

agent dysenteriae cholerae/ histolytica
comma
S. flexneri Biotypes 2 Stages:
S. boydi : Cyst and
S. sonnei El Tor trophozoites
Ogawa
Inaba
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 Cholera ( EL TOR)
 Organism survives well at ordinary
temperatures and multiplies well in
temperature 22-40 °C
 Usually found in brackish water

 Survived longer in refrigerated food

Pathognomonic sign- RICE WATER STOOL

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 Dysentery
Bacillary Dysentery Violent Dysentery Amoebic
Dysentery
+/- fever Massive or profuse +/- fever
+/- vomiting diarrhea, continuous +/- vomiting
Rice watery stool
Abdominal pain Abdominal pain
(colicky or cramping) Signs of severe
dehydration: sunken Diarrhea with
Diarrhea with eyeball, +skin fold tenesmus
tenesmus sign, wrinkling of alternated with
Mucoid stool fingertips (Washer- constipation
woman’s hand) Muco-purulent
Blood streaked if
severe Vomiting, Abdominal blood streaked stool
cramps May affect brain,
Rectal prolapse
Shock, acidosis, liver, lungs 28
hypokalemia
 Amoebic dysentery

Acute - can present as diarrhea (watery foul

smelling) with tenesmus, frequent, small and often
blood streaked stools.
Chronic- can present with gastrointestinal
symptoms plus fatigue, weight loss and occasional
fever, hepatomegaly
Extraintestinal- can occur if the parasite spreads to
other organs, most commonly the liver where it
causes amoebic liver abscess
Abcess may break through the lungs by coughing
“anchovy sauce” sputum
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Dx Dysentery
Stool Examination
Amoebiasis ( stool should be fresh within 30
minutes to one hour to find trophozoites)
Cholera – dark field microscopy of fresh stool
Rectal Swab – for cholera and shigellosis

Treatment:
Shigellosis: Co-trimoxazole, ciprofloxacin
Cholera: Co-trimoxazole, Tetracycline,
Ciprofloxacin
Amoeba: Metronidazole,
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 Dysentery
Preventive Measures:
CDT Vaccine (Cholera/Dysentery/Typhoid)
6 months immunity – given only on outbreaks.
Personal hygiene - handwashing
Environment sanitation – boiling of water, protect food from
flies

Nursing Care:
 Control of fever
 Maintenance of fluid and electrolyte balance
 Oral Rehydration Salt (ORS)
 NaCl, Sodium Bicarbonate, Potassium Chloride, Glucose
 Given in large amounts as tolerated and the amount of
intake and loss should be recorded

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 Rehydration with ORS
(Brunner)
 Mild dehydration- mild oral mucous
membranes and increased thirst-
 50ml/kg over a 4-hour interval
 Moderate dehydration- sunken eyes,loss of
skin turgor, increased thirst, dry oral mucous
membrane- 100ml/kg over a 4-hour interval
 Severe dehydration – IVF
 NURSING ALERT-Sports drinks do not
replace fluid losses correctly and should not
be used. 32
 Hepatitis
 Due to alcoholism, drug intoxications, parasite,
chemical arsenic, microorganisms – viral
(communicable)

1. Hepatitis A Syn: Infectious hepatitis, Catarrhal-

jaundice hepatitis
 Mode of Transmission: fecal-oral, oral-anal sex

 Incubation period: 2-7 weeks

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 Hepatitis A (infectious hepatitis)
 Most common
 MOT- Fecal oral route, water and food
borne
 Contaminated food, water
 Oral anal contact during sex
 Incubation Period- 15–50 days Average: 30
days
 S/s with or without symptoms, low grade
fever, nausea, fatigue, hepatomegaly
 Tx rest, ^ CHO diet
 (Acute no tendency to be chronic)

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 Hepatitis
3 Stages of Manifestations:
1. Pre-icteric - fever, RUQ pain, fatigability,
weight loss, anorexia, N/V , headache

2. Icteric- jaundice, itchiness/pruritis-bile

salts in skin, tea colored urine, stools-
clay-colored, hepatomegaly, tender liver

3. Post -Icteric stage- jaundice subsides

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 Hepatitis
2. Hepatitis B
 Syn: Serum Hepatitis, DNA Virus

 MOT: percutaneous, sexual contact,

mother to child (time at the birth)
 Population at risk: healthcare workers,
blood recipients, drug addicts, sex workers
 Incubation period: 6 weeks- 6 months

 (28-160 days)- average- 70-80 days

 Has tendency to go chronic, cirrhotic, CA

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 HEP B (serum hepatitis)
(Percutaneous, permucosal routes) contaminated
blood, Semen , vaginal secretions, saliva
s/s jaundice, hepatomegaly (12-14 cm vertically),
pale stools, lethargy, nausea, arthralgia
more than 90% develop antibodies and recover
spontaneously in 6 months.
10% of patients progress to a carrier state or
develop chronic hepatitis with persistent HBV
infection and hepatocellular injury.
 Medical Mx
 Tx – rest, nutrition, no alcohol
 alpha-interferon as the single modality of
therapy that offers the most promise. A regimen
of 3x weekly for 16 to 24 weeks result in
remission
 antiviral agents- lamivudine (Epivir) and
 Adefovir (Hepsera), oral nucleoside analogs,

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 HEP B Vaccine for pre –exposure
 POST EXPOSURE PROPHYLAXIS

Hep B immunoglobulin and vaccine ASAP to 72hrs

post exposure.
14 days after sexual exposure to non immune people
who have close contact with Hep B patient
(needle prick, sexual contact)
If mother has Hep B, her newborn should be given
Hep B vaccine and immune.with this treatment, less
than 10% of infants become infected with Hep B
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 Hepatitis C
Syn: Post-transfusion hepatitis, multiple drug
use, Transmission possible with sex with
infected partner;
MOT: percutaneous

Population at risk: Healthcare workers

Blood recipients
Drug addicts
Incubation period: 2 weeks- 6 months-

15–160 days- Average: 50 days

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 Hep C

Transfer from mother to baby

IV drug use, multiple blood transfusion

Tendency to go Chronic > CA

 Hep D
 IV drug use
 Transmission parenteral co infects with HVB
to replicate
 Hep E
 Water borne
 Fecal oral
 Resemble HVA
 No chronicity
 Hepatitis
Dx:
Liver function Test- determine extent of liver
damage
ALT/SGPT- Alanine Aminotransferase
Hepatitis Profile

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 Hepatitis
Tx:
Symptomatic and supportive
Antiviral: lamivudine- OD x 1 yr
Interferon – 3x a week for 6 months

Nursing Care:
1. CBR
2. Nutrition: inc. CHO in diet
Preventive:
1. Immunization
2. Universal precaution

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 Management
H- HAND WASHING
E- EAT LOW FAT , HIGH CARB

P- PERSONAL HYGIENE NO SHARING

A- ACTIVITY CONSERVATION- REST

T- TOXIC PRODUCTS AVOIDANCE- ALCOHOL,

ASPIRIN, SEDATIVES, ACETAMINOPHEN
I- INDIVIDUAL BATHROOM

T- TESTING RESULTS (ALT,AST,.

BILIRUBIN,AMMONIA)
I- INTERFERON/ IMMUNIZATION

S- SMALL FREQUENT MEALS

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