I.

INTRODUCTION

This study was carried out on a patient with typhoid fever. Through this study,the
student nurse will be able to acquire knowledge,skills,and attitude in caring for a patient
with typhoid fever. The nurse expect to know the necessary nursing interventions
needed appropriate for the patient’s condition and factors that may lead to possible
complications of the patient’s current condition.
The student nurse chose this study to discuss the background of the patient and
provide data and information about the care or interventions needed for a patient with
typhoid fever . This study will be useful for every nursing student,nurses and physician’s
medical education,both during training and on a continuing basis.
Common causes of transmission are flying insects most specifically flies feeding on
feces that may occasionally transfer the bacteria through poor hygiene habits and public
sanitation conditions. A person may become an asymptomatic carrier of typhoid
fever,suffering no symptoms but capable of infecting others.Typhoid does not affect
animals and therefore transmission is only from human to human. Typhoid can only
spread in environment where human feces or urine are able to come into contact with
food or drinking water.
II. OBJECTIVES

Student nurse-centered

General Objectives:
At the end of 5 days holistic nursing care, the student nurse will be able to gain more
knowledge,skills, and attitude in managing a patient with Typhoid fever.

Specific Objectives:
After 8 hours of student nurse-patient and significant others interaction, the student
nurse will be able to:
1. Make nursing assessment of the patient to be able to come up with an appropriate
plan of care
2. Explain the pathophysiology of Typhoid fever
3. Identify the causes of Typhoid fever
4. Recognize the possible symptoms of Typhoid fever as manifested by the patient
5. Develop an individualized plan considering client characteristics or the situation and
setting a specific,measurable,attainable,realistics and time bounded plan that reflect the
onset ,date of problem identified
6. List ways on preventing Typhoid fever
7. Site the importance of prevention,medication compliance and positive attitude to
early healing
8. Render appropriately nursing care to the patient to promote welness and optimum
level of functioning
9. Medicate properly and accurately the prescribed medications and to be able to
identify its action and drug information
10. Endorse proper health behaviors in relevance to her care and age through
protections against Typhoid fever.
Patient-Centered

General Objectives:
At the end of 5 days holistic nursing care, the patient and significant others will be able
to gain more knowledge,skills, and attitude in managing a patient with Typhoid fever.

1. Show interest and trust to the student nurse during interaction

2. Give information about the condition
3. State the health problems caused by the current condition
4. Identify the risk factors of Typhoid fever
5. Recognize own symptoms of Typhoid fever
6. Learn and understand why laboratory examination are being done
7. Know and understand the treatments of Typhoid fever
8. Demonstrate proper management with the signs and symptoms manifested
9. Show proper diet and exercise and stress its importance in promoting health and
preventing further complications
10. Display proper hygiene techniques and stress its importance in promoting health
and preventing further complications
III. NURSING ASSESSMENT

1. Personal History

1.1 Patient’s Profile

Name: Rama,Trinidad,Odac
Age: 62
Sex: Female
Civil Status: Married
Religion:Roman Catholic
Date of Admission: May 12,2023
Complaint: Epigastric pain
Diagnosis: Typhoid fever
Surgeon: Dr. Abegail Q. Chu
Medications:
Pre-operatived Medications
 Cefixime
 Omeprazole
 Amlodipine
 Losartan
 Carvedilol
 Metronidazole
 Paracetamol
 Rebamipide
 Ceftriaxone
1.2 Family and Individual Information, Social and Health History

Mrs. Rama is an 62-years-old, married woman, a Roman Catholic , and a Filipino.

She has 2 Children , and all are already working. She doesn’t have any bad habits and
follows a regular schedule of monthly check-ups. Prior to her admission, the patient
experienced an onset of watery stools greater than 10 episodes associated with fever.
Patient came in for admission for further management. This lead to epigastric pain. The
patient doesn’t have any other serious illness except that she is hypertensive but as per
her, she adheres to her medications and monthly check up.

1.3 Levels of Growth and Development in Middle-Aged Adults(40 to 65 years old)

1.3.1 Normal Development at Particular Stage

Physical Development
Both men and women experience decreasing hormones reduction during the middle
years. The term Menopause so-called changed of life in women. When menstruation
said to have occurred when a woman has not had a menstrual for 12 months. The
menopause usually occurs sometimes in ages 40-55. The average is about 47 years.
Common symptoms to a decline in estrogen, are hot flashes,chilliness, a tendency of the
breasts to become smaller and less dense , and a decrease in metabolic rate that may
lead to weight gain. Insomnia and headaches may also occur. Psychologically, the
menopause can be an anxiety,producing time,especially if the ability to bear children is
an integral part of the woman’s self-concept. For other women, menopause may
produce few symptoms,physically or psychologically.

Psychosocial Development
Middle aged adults received little attention. Havighurst(1972) outlined nine tasks for this
group . Erikson(1963) viewed the developmental choice of the middle-aged adult as
generatively versus stagnation. Generative middle-aged persons are able to feel a sense
of comfort in their lifestyle and receive gratification from charitable endeavors. He
wrote that people who are unable to expand their interest at this time and who do not
assume the responsibility of middle aged suffer a sense of boredoms and
impoverishment, that is stagnation.

Cognitive Development
Middle-aged adults cognitive and intellectual abilities change very little. Cognitive
processes include reaction time,memory ,perception,learning,problem solving and
creativity. Reaction time during the middle years stays much the same or diminishes
during the latter part of the middle years. Memory and problem solving are maintained
through middle-adulthood. Learning continues and can be enhanced by increased
motivation at this time in life.

Moral Development
According to Kohlberg , the adult can move beyond the conventional level to the
postconventional level. Kohlberg believed that extensive experience of personal moral
choice and responsibility is required before people can reach the postconventional level.
Kohlberg found that few of his subjects achieved the highest level of moral reasoning .
To move from stage 4 to stage 5. The session demonstrated a significant improvement
in the moral awareness ,processing and compensatory action that improved an
individual’s decision making processes.

Spiritual Developmental
At this stage, the individual can view”truth”from a member of viewpoints.Fowler’s fifth
stage corresponds to Kohlberg’s fifth stage of moral development. Fowler believes that
only some individuals after the age of 30 years reach this stage. In middle age, people
tend to be less dogmatic about religious belief’s, and religion often offers more comfort
to the middle -aged person than it did previously. People in this group often rely on
spiritual beliefs to help them deal with illness,death, and tragedy.
1.3.2 The Ill Person at Particular Stage of Patient
At the biological level, aging results from the impact of the accumulation of a wide
variety of molecular and cellular damage over time. This leads to a gradual decrease in
physical and mental capacity, a growing risk of disease and ultimately, death. But these
changes are neither linear nor consistent, and they are only loosely associated with a
person’s age in years. Lifestyle patterns in combinations with aging , family history and
developmental stressors are often related to health problems that do rise.
Developmental stressors such as menopause, the impending retirement, and situational
stressors such as divorce,unemployment, and death of a spouse, can increased of
depression in middle-aged adults.
Middle-aged adults usually take care health needs and are interested in
maintaining health and the acceleration of the aging process
2. Diagnostic Results
Name: Rama, Trinidad , Odac Age: 62 years old
Diagnosis: Typhoid fever Sex: Female
Physician: Dr. Abegail Q. Chu

DIAGNOSTIC IMAGING
Ultrasound of the Whole Abdomen

Impression:
-Normal size liver with moderate hepatic
-Small renal cortical cyst,left
- Normal sonographic evaluation of the abdominal aorta
-Unremarkable study of the right lower quadrant
-Intrahepatic and common bile ducts are well distended urinary bladder
-Normal size and anteverted uterus
-Intact and hyperechoic endometrial
-No fluid in the posterior Cul de Sac
3. Present Health Profile of Functional Health Patterns

3.1 Health Perception/ Health Management Pattern

Prior to Admission: Mrs. Rama, The patient make sure she does not miss her
maintenance medications. She does not take over the counter drugs or any herbal drugs
and follows religiously the orders of the doctors.
During Hospitalization: The patient is accept and follows with the orders of the doctor.
Takes medications on time.
3.2 Nutritional /Metabolic Pattern
Prior to Admission: The patient is not picky when it comes to her diet. She prefers
fish ,vegetables ,and over meat and oily foods. She eats 3 meals per day. She would
rather choose drinks water.
During Hospitalization: The patient is on a soft diet as tolerated. No known allergies
3.3 Elimination/Urinary Pattern
Prior to Admission: Mrs. Rama, defecates greater than 10 episodes of watery stools and
have not encountered problems in urinary elimination prior to admission.
During Hospitalization: freely have her Defecation (Yellow-green and watery)
3.4 Activity/ Exercise
Prior to admission: Mrs. Rama is an active middle-aged who spends her most of the
time of routinely doing households chores .
During Hospitalization: Now the patient's movements seemed weak . she keeps lying
down and sometimes, she sits up on his bed.
3.5 Cognitive / Perceptual Pattern
Prior to admission: Mrs. Rama, still functions and thinks her age. She still doing her
routine activity.
During Hospitalization: Patient is responsively to external stimuli. She is oriented from
people around her.
3.6 Rest/Sleep Pattern
Prior to Admission: Patient’s sleep is disturbed due to abdominal pain and feeling of hot
as it have a fever.
During Hospitalizations: She never had problems with sleep as she could take time relax.
3.7 Self-Perception-Self-Concept Pattern
Prior to Admission: The patient manages health by seeking medical assistance together
with her son.
During Hospitalization: The patient thinks that she really needs attention from his son
because she is not feeling very well.
3.8 Role Relationship Pattern
Prior to Admission: Patient at home is sometimes lively and somehow she is being shy
to talk for others , as verbalized by the patient
During Admission: The patient have fully assisted with her significant other
3.9 Sexuality/ Reproductive Pattern
Prior to Admission: Patient is married and a mother of 2 children and has not performed
any breast self-examination in the past years.
During Hospitalization: The patient does not have any problems affecting her sexuality
3.10 Coping Stress Tolerance Pattern
Prior to Admission: The patient’s lives with her husband and children who is her coping
mechanism every time she doesn’t feel well.
During Hospitalization: As per coping mechanism to the new place she is able to
consume more hours to sleep than her sleeping hours at home.
3.11 Value-Belief Pattern
Prior to Admission: The patient is a Roman Catholic . As verbalized by the significant
others. Prayer always Practice by the patient and that Practices continues to bring at
home .
During Admission: Patient has no religious restrictions in care given by health care
providers. Hospital procedures does not interfere with the spiritual practices of the
patient.
4.Pathophysiology and Rationale
4.1 Anatomy and Physiology of the Organ/Systems affected

The Digestive Process

The start of the process - the mouth:
 The digestive process begins in the mouth. Food is partly broken down by the process
of chewing and by the chemical action of salivary enzymes (these enzymes are produced
by the salivary glands and break down starches into smaller molecules).
On the way to the stomach: the esophagus
 After being chewed and swallowed, the food enters the esophagus. The esophagus is
along tube that runs from the mouth to the stomach. It uses rhythmic, wave-
like muscles movements (called peristalsis) to force food from the throat into the
stomach. This muscle movement gives us the ability to eat or drink even when we're
upside-down.
In the stomach
 The stomach is a large, sack-like organ that churns the food and bathes it in
a very strong acid (gastric acid). Food in the stomach that is partly digested
and mixed with stomach acids is called chyme.
In the small intestine
 A ft e r b e i n g i n t h e s t o m a c h , f o o d e n t e r s t h e d u o d e n u m , t h e fi r s t
p a r t o f t h e s m a l l i n t e s ti n e . I t t h e n e n t e r s t h e j e j u n u m a n d t h e n t h e
i l e u m ( t h e fi n a l p a r t o f t h e s m a l l i n t e s ti n e ). In the small intestine, bile
(produced in the liver and stored in the gall bladder),pancreatic enzymes, and other
digestive enzymes produced by the inner wall of the small intestine help in the
breakdown of food.
In the large intestine
Aft er passing through the small intesti ne, food passes into the large
intesti ne.In the large intesti nes,some of the water and electrolytes(chemical
like sodium) are removed from the food. Many microbes(bacteria like
Bacteroides,Lactobacillus acidophilus,Escheria Coli and Klebssiella) in the
large intesti ne help in the digesti on process . The first part of the large intestine is
called the cecum (the appendix is connected to the cecum). Food then travels upward in
the ascending colon. The food travels across the abdomen in the transverse colon,
goes back down the other side of the body in the descending colon, and then
through the sigmoid colon.

The end of the process

Solid waste is then stored in the rectum until it is excreted via the anus.
Digestive System Glossary:Anus
- the opening at the end of the digestive system from which feces (waste) exits the
body.
Appendix
– a small sac located on the cecum.
Ascending colon
- the part of the large intestine that run upwards; it is located after the cecum.
Bile
- a digestive chemical that is produced in the liver, stored in the gall bladder, and
secreted into the small intestine.
Cecum
- the first part of the large intestine; the appendix is connected to the cecum.
Chyme
- food in the stomach that is partly digested and mixed with stomach acids.Chyme goes
on to the small intestine for further digestion.
Descending colon
- the part of the large intestine that run downwards after the transverse colon and
before the sigmoid colon.
Duodenum
- the first part of the small intestine; it is C-shaped and runs from the stomach to
the jejunum.
4.2 Schematic Diagram of the Pathophysiology of the condition
PATHOPHYSIOLOGY OF TYPHOID FEVER

Predisposing Factors: Precipitating Fcators:

 Age: 62 years  Contaminated foods
 Sex: Female  Unsanitary food preparations
 Genes  Unsanitary environment

Ingestion of food or fluids contaminated by Salmonella Typhi

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)

Bacteria will then injects toxins known as the effector proteins into the
intestinal cells 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.

The bacteria induced macrophage apoptosis,breaking out into the

bloodstream and cause systemic infection. The bacteria induced
macrophage apoptosis,breaking out into the bloodstream and cause
systemic infection

TYPHOID FEVER

Signs:
-non bloody diarrhea Symptoms:
-slow progressive fever -Body malaise
-decreased appetite -Abdominal pain
-transient skin rash (rose spots) -Headache
-profuse sweating -Cough
-leukopenia -Weakness
-positive widal test
 Medical Mnagement:
 Administration of Analgesics Nursing Management:
 Administration of Antipyretics  Perform Tepid sponge bath
 Administration of Antibiotics
(Ceftriaxone)

4.3 Disease Process and its Effects on Different Organs/Systems

Typhoid fever is a bacteremia in which the organism gains access to the blood
stream through the bowel,principally through the infected preyers patches of lymphoid
tissue in the lower portion of the ileum. The first week these patches are swollen: the
second week they form sloughs ,which are often bile colored; the third week the sloughs
separates and leaves an ulcerative surface, which then starts to heal by granulation
Since the organism reaches all parts of the body through the bloodstream, almost
all organs at time may show pathologic changes being those due to toxemia and high
fever. Commonly,however, the heart,liver,spleen,muscle and mesenteric lymph glands
may be either red or swollen,or else broken down into messy masses. The muscles are
flabby granular. The urine may be milky in appearance with the peculiar
opalescence,which is due to the presence in it of millions of typhoid bacilli.
The causative organism invades the bloodstream by way of lymphatic tissues and
is carried to all parts of the body. Early symptoms may vary,may be vague with
headaches,anorexia and malaise. As the disease progresses,there are joints
paints,abdominal discomfort ,vomiting and usually constipation although they may be
diarrhea. Cough and bronchitis occur in about 50% of the cases.During the first week,the
body temperature rise in step ladder pattern until it reaches about 104. Wherein
remains until near the end of the 3 rd week,after which it falls by lysis. The temperature is
irregular,with 2 remissions in the morning.(Source: Smeltzer and Bare,2004)
4.4 Between Clinical and Classical Signs and Symptoms of the Disease
Classical Symptoms Clinical Rationale
Symptoms
 Fever(Intermittent) Temperatures the body temperature alternates at
Fluctuates from 38.8- regular intervals between periods or
39.7C to 36.5C subnormal.
Source: Lemone&Burke,Medical
Surgical Nursing, Chapter 24,page
639
 Body Malaise Patients keeps of Illness can deplete a person’s
lying in bed and energy to such degree that it
seldom moves becomes difficult for the person to
around. Doing deal with day-to-day life
sometimes to change Soure: Lemone&Burke,Medical
her position into Surgical Nursing, Chapter 24,page
sitting place. 639
 Abdominal Pain Abdominal pain of Abdominal spasm is induced to limit
6/10 pain mucosal injury adding in stimulation
scale,guarding of increased peristalsis.Perforation
behavior , facial and destruction of mucosal lining of
grimace the intestinal wall can lead to
persistent inflammation
Source: Monahan,Medical surgical
Nursing , Chapter 30,page 1708
 Diarrhea Consumes greater Tissue damage and inflammation
than 10 episodes due causes loss of absorption due to
to watery stools damaged villi causing an increase in
water,electrolytes,mucus,blood ,and
 serum to be pulled into the
intestines from the immature crypt
cells
Source:Lemone&Burke,Medical
Surgical Nursing, Chapter 24,page
639

IV. NURSING INTERVENTIONS

1. CARE OF CLIENT WITH TYPHOID FEVER
 Patient must be isolated until atleast 3 negative stool cultures, 24 hours apart and
has been secured.
 All stool ,urine, and vomitus must be disinfected
 All stools must be examined for evidenced or presence of blood
 Examined for bladder distention and retention of urine
 Vitals signs monitoring
 Paracetamol drug should be administered for fever
 Abdominal distentions should be guarded against,since it may lead to perforations
of intestinal ulcers.