typhoid fever nursing, medical, surgical managements

1. Typhoid Fever
NURSING MANAGEMENT
IDEAL
Possible Nursing Diagnoses
 Deficient fluid volume
 Imbalanced nutrition: Less than body requirements
 Diarrhea
 Acute pain
 Risk for infection
 Hyperthermia
 Activity intolerance
Key Outcomes
The patient will:
 Regain and maintain fluid and electrolyte balance.
 Experience no further weight loss.
 Maintain normal elimination pattern.
 Report adequate pain relief with analgesia or other measures.
 Experience no further signs or symptoms of infection.
 Remain afebrile.
 Demonstrate skill in conserving energy while carrying out daily activities to tolerance level.
Nursing Interventions
 Follow contact precautions. Wash your hands thoroughly before and after any contact with the patient.
 Wear gloves and a gown when disposing of stool or fecally contaminated objects.
 Continue contact precautions until three consecutive stool cultures are negative:
o The first one 48 hours after antibiotic treatment ends, followed by two more at 24-hour intervals.
 Observe the patient closely for signs of bowel perforation:
o sudden pain in the lower right abdomen and rebound tenderness
o one or more rectal bleeding episodes
o sudden decreasing temperature or blood pressure
1

2. o orthostatic hypotension
o increasing pulse rate
 During acute infection, promote rest, take safety precautions (because the patient may become delirious), and assign him a room close to the nurses' station so that you
can check on him often.
 Use a room deodorizer to minimize odor from diarrhea.
 Record intake and output.
 Maintain adequate I.V. fluid and electrolyte therapy as ordered.
 When the patient can tolerate oral feedings, encourage high-calorie fluids, such as milk shakes.
 Watch for constipation.
 Provide good skin and mouth care.
 Turn the patient frequently and perform mild passive exercises, as indicated.
 Apply mild heat to relieve abdominal cramps.
 Don't administer antipyretics, which mask fever and may lead to hypothermia.
 Instead, promote heat loss by applying tepid, wet towels (don't use alcohol or ice) to the patient's groin and axillae or by wiping wet towels down his arms and legs.
 Report salmonella cases to public health officials.
Patient Teaching
 Explain the causes of salmonella infection.
 Show the patient how to wash his hands by:
o wetting them under running water
o lathering with soap and scrubbing
o rinsing under running water with his fingers pointing down
o and drying with a clean towel or paper towel.
 Tell the patient to wash his hands after using the bathroom and before eating.
 Tell him to cook foods thoroughly (especially eggs and chicken) and to refrigerate them at once.
 Teach him how to avoid cross-contaminating foods by
o cleaning preparation surfaces with hot, soapy water and drying them thoroughly after use;
o cleaning surfaces between foods when preparing more than one food;
o and washing his hands before and after handling each food.
 Tell the patient with a positive stool culture to avoid handling food and to use a separate bathroom or clean the bathroom after each use.
 Tell the patient to report dehydration, bleeding, or recurrence of signs of salmonella infection.
 Advise the patient's close contacts to obtain a medical examination and treatment if cultures are positive.
 Urge those at high risk for contracting typhoid fever (laboratory workers and travelers) to be vaccinated.
Prevention and Control:(DOH)
 Boil water for drinking. (Upon reaching boiling point, extend boiling for two or more minutes)
 Do water chlorination
 Cook food well and always use food cover to prevent flies and other insects from contaminating them.

3.  Wash thoroughly all vegetables and fruits especially those that are eaten raw.
 Avoid eating street vended foods.
 Wash hands with soap and water after using the toilet and before eating.
 Keep surrounding clean to prevent breeding of flies.
Nursing Considerations
 Relapses occur in 5% to 10% of untreated cases and may be more common after antibiotic therapy.
 Educate public
o control flies
o avoid raw shellfish
o thoroughly rinse raw fruits and vegetables
 Typhoid is communicable as long as the infective organism is in the feces or urine, which may persist for months or, in 2%-5% of cases, permanently.
References:
Department of Health. Philippine Health Advisories. National Disease Prevention and Control and National Center for Health Promotion. p. 57. Manila, Philippines, 2005.
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Nettina, S.M., Mills, E.J., Lippincott Manual of Nursing Practice, 8 Ed. United States of America: Lippincott, Williams & Wilkins, 2006.
th
McCann, J.A., et al. Diseases: A Nursing Process Approach to Excellent Care, 4 Ed. United States of America: Lippincott Williams and Wilkins, 2006.
th
Smeltzer, C.S., Bare, B.G., Hinkle, J.L., Cheever, K.H., Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 11 Ed. United States of America: Lippincott Williams and
Wilkins, 2008.
rd
Sommers, M.S., Johnson, S., Beery, T., Diseases and Disorders: A Nursing Therapeutics Manual 3 Ed. Philadelphia: F.A. Davis Company, 2007.

4. MEDICAL MANAGEMENT
IDEAL
Diagnostic Tests
 Culture of urine or stool - positive for S. typhi during second week
 Culture of blood - positive for S. typhi during first week
 Bone marrow culture
 The presence of S. typhi in stools 1 or more years after treatment indicates that the patient is a carrier (about 3% of patients).
 Widal's test, an agglutination reaction against somatic and flagellar antigens, may suggest typhoid fever with a fourfold increase in titer.
o Drug use or liver disease also can increase these titers and invalidate test results.
 Other supportive laboratory values may include:
o transient leukocytosis during the first week of typhoidal salmonellosis
o leukopenia during the third week
o leukocytosis in local infection.
Treatment
 I.V. fluids and electrolytes.
 Bed rest.
 Avoid antispasmodics, laxatives, and salicylates.
Drug Therapy
 The type of antimicrobial agent chosen to treat typhoid fever depends on organism sensitivity.
 Antimicrobial Agents
o Ampicillin
o Amoxicillin
o Cefotaxime
o Ceftriaxone
o Chloramphenicol
o Ciprofloxacin
o Co-trimoxazole
o Fluoroquinolone
 Camphorated opium tincture, kaolin and pectin mixtures, diphenoxylate, codeine, or small doses of morphine can relieve diarrhea and control cramps for patients who
remain active.

5. Prevention
 Immunization is advised for travelers to areas of high endemicity.
References:
th
Nettina, S.M., Mills, E.J., Lippincott Manual of Nursing Practice, 8 Ed. United States of America: Lippincott, Williams & Wilkins, 2006.
th
McCann, J.A., et al. Diseases: A Nursing Process Approach to Excellent Care, 4 Ed. United States of America: Lippincott Williams and Wilkins, 2006.
Smeltzer, C.S., Bare, B.G., Hinkle, J.L., Cheever, K.H., Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 11th Ed. United States of America: Lippincott Williams
and Wilkins, 2008.
SURGICAL MANAGEMENT
IDEAL
 Surgical Drainage
o may be required for localized abscesses