Typhoid Fever case presentation lecture.pptx

Typhoid Fever

1. Ghayathi hospital Case presentation Typhoid Fever Prepared By:  RN Hani Abu Dieh  Male Ward

2. Objectives

3. Introduction Mr. X , 29 years old male, Bangladeshis, presents to the emergency department complaining of fever with general fatigue . Patient came recently from his county Bangladesh on 18/01/2022. Date of admission  - 30/01/2022 

4. Present medical History The patient presents with low grade fever , vomiting , diarrhea and abdominal pain , symptoms started 3 days ago denies cough, denies rhinorrhea and denies sore throat.  Review of Systems Constitutional symptoms:  Fever , weakness , fatigue .  ENT symptoms:  No sore throat, no nasal congestion.  Respiratory symptoms:  No cough, no hemoptysis.  Cardiovascular symptoms:  No chest pain, no palpitations.  Gastrointestinal symptoms:  Abdominal pain , moderate, diffuse, nausea , vomiting , diarrhea .  Genitourinary symptoms:  No discharge,  Musculoskeletal symptoms:  Muscle pain . Neurologic symptoms:  Headache .

5. Past medical History

6. Personal & Family History

7. Definition Typhoid fever , also known as  enteric fever , is a potentially fatal multisystemic illness caused primarily caused by Salmonella thypi , a Gram negative-bacterium . A very similar but often less severe disease is caused by Salmonella paratyphi A.

8. Definition Typhoid fever has a wide variety of presentations that range from an overwhelming multisystemic illness to relatively minor cases of diarrhea with low-grade fever. Untreated typhoid fever may progress to delirium , obtundation , intestinal hemorrhage , bowel perforation , and death within 1 month of onset .

9. Salmonella typhi can only attack humans. So, the infection always comes from another human, either an ill person or a healthy carrier of the bacterium.

10. How does the bacteria cause disease ?

11. Definition Confirmed enteric fever : Fever ≥38°C for at least three days, with a laboratory-confirmed positive culture (blood, bone marrow, bowel fluid) of S. typhi. Probable enteric fever: Fever ≥38°C for at least three days, with a positive serodiagnosis or antigen detection test but without S. typhi isolation.

12. Etiology Book Picture Present in patient Contaminated food (poor water sanitation and poor waste disposal techniques) ??? Poor hygiene ??? Decreased  stomach  pH ( Typhoidal salmonella can survive a stomach pH as low as 1.5, decrease stomach acidity and faciltate S typhi infection) ??? Migration ( developing countries, rural to urban areas) Recently came from his county Bangladesh on 18/01/2022 

13. Signs and Symptoms Book Picture Present in patient Fever 38.3 Gastrointestinal symptoms Abdominal pain, Diarrhea, Nausea,  loss of appetite , Vomiting Headache Headache Fatigue, malaise Fatigue, malaise confusion, delirium, psychosis, convulsion delirium Rose spots nil Abdominal distention ( soft splenomegaly) nil

14. Diagnostic measures Book Picture Present in patient Blood tests (CBC, U+E, PT/APPT, blood gas, LFT ) Na: 125 K: 3.4 Mg: 0.6 phos: 0.7 Crea : 2.3 AST:130 ALT: 145 C.re: 56 WBC: 10.5 Culture s of blood, urine, sputum Blood Cx (02/02/2022): + Ve Salmonella Typhi Stood Cx (03/02/2022): S. typhi , present Radiological investigations like chest x-ray, CT, ultrasound, MRI. X-ray, CT and ultrasound (abdomen) ( Thickening of the ileum ) Covid-19 PCR - Ve ECG daily

15. Treatment Book Picture Present in patient Antibiotics ( broad-spectrum antibiotics should be started immediately) Ceftriaxone 1g I.V q12hrs (7 DAYS) Ciprofloxacin 500mg P.O BID (5 DAYS) Doxycycline 100mg P.O BID (7 DAYS) Metronidazole 500mg I.V q8hrs Antipyretics, pain manegement Paracetamol 1g I.V Q8hrs Fluids and Electrolytes Replacement RL with K coverage continues infusion Mg sulfate 2g I.V Antiemetics Metoclopramide 10mg I.V PRN Corticosteroids nil Blood products nil Diet high-calorie high-Protein diet, (clear, soft, Antidiarrheal) Surgical care nil

16. Complications Book Picture Present in patient typhoid intestinal perforation (TIP) nil gastrointestinal hemorrhage nil hepatitis nil cholecystitis nil encephalopathy nil myocarditis nil shock nil

17. Nursing management Book Picture Present in patient contact and standard precautions to prevent the spread of infection contact and standard precautions   Monitor V/S, LOC, GCS Close observation (on monitor bed) Monitor blood levels as per order Daily Blood sample Intake and output monitoring Strict Intake and output monitoring Monitor the status of hydration (moisture of mucous membranes, skin turgor, adequate pulse, blood pressure orthostatic) Encourage increase in fluid intake and Improve nutritional intake Provide assistance for ADLs Provide assistance to meet their daily needs Prevention steps to avoid typhoid fever (Teaching) Hand Washing, proper personal hygiene Avoid drinking untreated water Avoid raw fruits and vegetables. Vaccination

18. Nursing Care Plan

19. Acute pain   related to inflammation of the small intestine. 1) Assess the level of pain, location, duration, intensity and characteristics of pain. 2) Review the factors that increase pain and decrease pain. 3) Give warm compresses on the area of pain. 4) Collaborate with other medical team in the delivery of analgesics. Nursing Diagnosis and Interventions

20. Activity intolerance  related to mandatory bed rest. Provide assistance to meet their daily needs such as food, drink, change clothes 2) Involve the family in the fulfillment of ADL. Participation family is very important to facilitate the nursing process and prevent further complications. 3) Explain the purpose of bed rest to prevent complications and speed up the healing process.

21. Imbalanced Nutrition, Less Than Body Requirements related to less intake due to nausea, vomiting, anorexia, or diarrhea due to excessive output. 1) Monitor the amount of nutrients and calories. 2) Monitor the weight loss. 3) Monitor the environment during the meal. 4) Monitor nausea and vomiting. 5) Involve the family in the client's nutritional needs. 6) Instruct the patient to enhance the protein and vitamins. 7 ) Collaboration with a nutritionist to determine the amount of calories and nutrients it needs patients.

22. Risk for  fluid volume deficit  related to the intake is less, nausea, vomiting / excessive spending, diarrhea, body heat. 1) Monitor the status of hydration (moisture of mucous membranes, skin turgor, adequate pulse, blood pressure orthostatic) if needed. 2) Monitor vital signs 3) Monitor the input of food / liquid and count daily calorie intake. 4 ) Collaborate with other medical team for IV fluid administration.

23. Knowledge Deficit: conditions of disease, treatment and prognosis needs related to lack of information or inadequate information. 1) Assess the extent of knowledge of the client's family about his illness. 2) Give health education about the disease and treatment of clients. 3) Give the family an opportunity to ask if there is not yet understood.

24. Prognosis 10/02/2022 : Patient stable condition, hemodynamic stable, afebrile, no complain of GI symptoms, last blood sample result within normal baseline as doctor order discharged on oral antibiotics for follow up after one week.

25. Reference nanda-nursinginterventions.blogspot.com Nurselabs.com Healthline.com

26. Thank you MW