A Case Study on a Patient With Typhoid

8/9/2019 A Case Study on a Patient With Typhoid

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A CASE STUDY ON A PATIENTWITH TYPHOID FEVER


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INTRODUCTIION

“{Poor health is not caused by something we

don’t have ; it’s caused by disturbing something

that you already have. Healthy is not something

that you to get, it’s something you have already

if you disturb it.” ~ean !rnish


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Health is an essential part of aperson, it is the fel !hi"h #i$es e$er%

in&i$i&al the ph%si"al &ri$e nee&e& to"on'er a &a%( Withot it no )an "ansr$i$e, a &e*"ien"% in health i)pairs thenor)al fn"tionin# of a person, it +e"o)es

a hin&ran"e( Health pertains to thepersons +o&% s%ste)s as a !hole, it is nota"hie$e& if e$en onl% one +o&% s%ste) isi)paire&, a #oo& heart !ith !ea ln# still

&oes not si#nal health, there shol& +ehar)on% an& +alan"e +et!een the s%ste)to a"hie$e lti)ate health(


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TYPHOID FEVERTyphoid fever, also known as a typhoid, is a commonworldwide illness, transmitted by the ingestion of

food or water contaminated with the feces of aninfected person, which contain the bacteriumsalmonella typhi. The bacteria then perforatethrough the intestinal wall and are phagocytosed bymacrophages. The organism is gram-negative shortbacillus that is motile due to its peritrichous agella.The bacterium grows best at 37`!""`# human bodytemperature. Typhoid fever remains a seriousdisease especially di$cult to treat in developingcountries. %almonella typhi, the bacteria causingtyphoid fever, have become resistant to several

antibiotics increasing the di$culty of treating thedisease.

"htt#$%%&nowledge'storage.com%medicine%()'medicine%*+'ty#hoid'fever

-

http://knowledge-storage.com/medicine/37-medicine/109-typhoid-feverhttp://knowledge-storage.com/medicine/37-medicine/109-typhoid-fever


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&n order to provide an updated assesment of the burden oftyphoid fever in 'sia, the world health organi(ation

conducted a population-based surveillance in ) 'siancountries namely* china, &ndia, &ndonesia, +akistan and

ietnam. The age groups under surveillance were selected asthose udge by local o$cials to the most appropriate targets

for typhoid vaccination* )-/year olds in hinese site0 andschool-aged children and adolescents1)-2years4 in theietnamese site. The statistics revealed the following*

' total of 552 53) persons in the targeted age groups wereunder surveillance for one year, during which 62 75 feverepisodes lasting 3days were detected and 57) persons hadblood cultured-conrmed %.typhi. The over all incidence offever lasting 3days for the ve sites combined was 5". per

2/// persons-years, ranging from 26.5 to 25." for the sitesin china and +akistan, respectively. The incidence of typhoidrange from 2).3 cases per 2/// person-years among thoseage )-/ years in china to 5)2.7 cases per 2// /// person-years among 6 to 2) years olds in +akistan. 8verall, the

%.typhi isolation rate1prevalence4was63.2 per 2/// culturedfebrile episodes and ranged from )./1vietnamese site4 to


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The statisti"s re$eal that a si#ni*"anta)ont of people !ho ha$e t%phoi& fe$erare "hil&ren( Spe"i*"all% "hil&ren !ho areat their pre-s"hool a#e as !ell as s"hoola#e( This hi#hli#hts the i)portan"e ofpri)ar% pre$ention s"h as +etter

sanitation, i)pro$e& !ater s%ste)s an&$a""ines(


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In a latest st&%, NIH s"ientists&e$elope& a $a""ine "alle& Vi, )a&e of

a pol%sa""hari&e fro) the srfa"e ofsal)onella t%phi, the +a"teria that"ase t%phoi& fe$er( It is e.e"ti$e a&lts+t not in %on# "hil&ren( Clini"al trials

ha$e sho!n that "he)i"all% +in&in# theVi to a protein to for) a "on/#ate$a""ine has i)pro$e& its e0"a"% to

"hil&ren( No! NIH s"ientists ha$e&e$elope& another $a""ine for t%phoi&fe$er- sin# pol%sa""hari&e fro) frit,no!n as pectin.


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'9'T8:; '9<+=;%&8>8?;

1ASTROINTESTINA2 TRACT

-is a )s"lar t+e line& +% a spe"ial la%er of"ells, "alle& epitheli)( The "ontents of thet+e are "onsi&ere& e3ternal to the +o&% an&are in "ontinit% !ith the otsi&e !orl& at the)oth an & the ans(

The !alls is &i$i&e& into for la%ers as follo!s4

5UCOSA- the inner)ost la%er of the &i#esti$etra"t has spe"iali6e& epithelial "ells spporte&+% an n&erl%in# tisse "alle& the lamina propia.


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ANATO5Y AND PHYSIO2O1Y

SU75UCOSA

-srron&s the )s"laris )"osa an&

"onsists of fat, *+ros "onne"ti$etisse an& lar#er $essels an& ner$es(

5USCU2ARIS E8TERNA

-The s)ooth )s"le la%er has inner"ir"lar an& oter lon#it&inal la%ers of)s"le *+ers separate& +% the)%enteri" ple3s or Aer+a"h ple3s(


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ANATO5Y AND PHYSIO2O1Y

SEROSA9 5ESENTERY

-The oter la%er of the 1IT is for)e& +%

fat an& another la%er of epithelial "ells"alle& )esotheli)(


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INDIVIDUA2 CO5PONENTSOF THE 1I TRACT

ORA2 CAVITY

-is responsi+le for the intae of foo&( It is

line& +% a strati*e& s'a)os oral)"osa !ith eratin "o$erin# thoseareas s+/e"t to si#ni*"ant a+rasion,s"h as ton#e , har& palate


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SA2IVARY 12ANDS

-Three pairs of sali$ar% #lan&s

"o))ni"ate !ith the oral "a$it%( Ea"his a "o)ple3 #lan& !ith n)eros a"iniline& +% se"retor% epitheli)(


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PAROTIDS

-are lar#e, irre#lar shape& #lan&s

lo"ate& n&er the sin on the si&e ofthe fa"e( The% se"rete :;< of sali$a(

The% are sitate& +elo! the 6%#o)ati"ar"h an& "o$er part of the )an&i+le(


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SU75ANDI7U2AR

-se"rete =>< of the sali$a in the )oth(

The% are fon& in the ?oor of the)oth, in a #roo$e alon# the innersrfa"e of the )an&i+le(

SU72IN1UA2

-are the s)allest sali$ar% #lan&s, "o$ere&+% a thin la%er of tisse at the ?oor ofthe )oth( The% pro&"e ;< of sali$a(


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ESOPHA1US

-is a )s"lar t+e of appro3i)atel%

:;") in len#th an& :") in &ia)eter( Ite3ten&s to the phar%n3 to the sto)a"hafter passin# an openin# in the&iaphra#)(

STO5ACH

-is a @ shape& e3pan&e& +a#, lo"ate& /stleft of the )i&line +et!een the

esopha#s an& s)all intestine(


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S5A22 INTESTINE

-is "o)pose& of &o&en), /e/n) an&

ili)( It a$era#es appro3i)atel% ) inlen#th, e3ten&in# fro) the p%lori"sphin"ter of the sto)a"h to the ileo-"e"al $al$e separatin# the ile) fro)

the "e")


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2AR1E INTESTINE

-is a horse-shoe shape& an& e3ten&s aron& thes)all intestine lie a fra)e( It "ontains theappen&i3, "e"), as"en&in# an& si#)oi&"olon(

2IVER

-is a lar#e, re&&ish-+ro!n or#an sitate& in thepper 'a&rant of the a+&o)en( It srron&e&+% a stron# "apsle an& &i$i&e& into for lo+esna)el%, left, a&ate an& 'a&rate lo+es(


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1A22 72ADDER

-is a hollo!, pear shepe& or#an that sits in a

&epression on the posterior srfa"e of theli$erBs ri#ht lo+e( It "onsist of a fn&s,+o&% an& ne"(

PANCREAS

-is a lo+lar, pinish-#re% or#an that lies+ehin& the sto)a"h( Its hea&"o))ni"ates !ith the &o&en) an& itstail e3ten&s to the spleen(


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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT

1ENERA2 AD5ISSION INFOR5ATION4

9':@* R( C(

'&?&89* RO5AN CATHO2IC


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=&@# 8:+>'&9T%* FEVER :8WEES


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&T'> %&?9%*

TE5PERATURE4 >(GC

PU2SE RATE4 +p)

RESPIRATION4 :G"p)

NURSIN1 AD5ISSION AND HEA2TH


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#':&>; =&%T8A;

+'T@A9'> %& %&


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B. ?@9@A'>&F@< @

7% O"to+er , :>:, R( C(Bs parents &e"i&e&to +rin# her in the hospital +e"ase of hi#hfe$er, s&&en a+&o)inal pain, hea&a"he an&+o&% !eaness( She !as &ia#nose& !itht%phoi& fe$er( In her sta% in the hospital, R(C(

ha& e3perien"e& &iarrhea( A""or&in# to her)other, she &efe"ates ;-= ti)es !ith :-G "psof soft-!ater% stool per episo&e( Drin# hersta% also, she )anifeste& "o#h an& "ol&s(


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. +'%T :@


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+=;%&'> '%%@%%:@9T

HEAD

skull is round in shape and hasnormal contour with no palpateddepressions

=air has ne strands, scalp is oilybut no masses palpated #acial features are symmetrical

with no noted abnormalities =air evenl distributed and skin is


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With strai#ht, lon# an& +la" hair

No &an&r. !as o+ser$e& or an% a+nor)alsin #ro!th

EYES

Ppils are e'all% ron& an& rea"ti$e to li#ht

E%e+ro!s are s%))etri"all% ali#ne& E%elashes are short e$enl% &istri+te& an&

"rle& sli#htl% ot!ar&


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No &is"har#es present

Cornea is transparent, s)ooth an&

shin% Details of the iris are $isi+le, &ar

+ro!n in "olor

S"lera appears !hite Sin aron& the e%e is inta"t


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EARS

Ears are s%))etri"al an& ali#ne& !ith

the oter "anths of the e%e !ith nolesions note&

Color is sa)e as fa"ial sin

A+sen"e of &i0"lt% in hearin# No "er)en !as note& in +oth ears


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NOSE

Nose has no &is"har#e, no lesions, not o""l&e& an&patent air!a%

Nose not ten&er, !ithot )asses or an%&ispla"e)ent of +one an& "artila#e note& ponpalpation

Color is sa)e as fa"ial sin

Nor)al si6e for the fa"e A+sen"e of &i0"lt% in no ?arin# on +oth nostrils !as

o+ser$e&

A+le to +reath "learl% an& i&entif% )il& aro)aspresent


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THROAT AND 5OUTH

Throat an& )oth ha$e no sores an&

s!ellin# or in?a))ation Teeth are "o)plete in n)+er,

%ello!ish an& sli#htl% shin%

Dental "arries !ere o+ser$e& o$er herfront teethBs ena)el an& !hitishpla'e !ere note& o$er the )olars

7""al )"osa- )oist, s)ooth an&

li#ht pin in "olor


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2ips are sli#htl% &r%, pin in "olor

No lesions in his lips an& )oth, !as

a+le to prse his lips, protr&e an&)o$e ton#e fro) si&e to si&e, p an&&o!n

1a# re?e3 !as eli"ite&

Palate appears paleJ soft palate iss)ooth an& li#ht pin, har& palate isli#hter pin !ith )ore irre#lar te3tre

U$la- positione& at the )i&line of the


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Tonsils- pin in "olor, not in?a)e& ors!ollen

Pale #)sNEC

Ne" is "entere& an& ali#ne& !ith the

hea& A+le to )o$e the ne" !ithot )"h

e.ort fro) si&e to si&e, p an& &o!nan& e$en in rotation

No al a+le l ) h no&es


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Th%roi& #lan& not $isi+le poninspe"tion an& as"en&s !hile

s!allo!in# Arteries an& $eins not &isten&e&

CHEST

S%))etri"al +reasts No lesions

No a+nor)al s!ellin# or presen"e of)asses


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CARDIOVASCU2AR

A+sen"e of "hest pain an& )r)rs

Nor)al heart rh%th) an& re#lar rate

Veins are not $isi+l% &isten&e&

No presen"e of son&9+rit pon as"ltation

RESPIRATORY

Chest is s%))etri"4 anteroposterior totrans$erse &ia)eter ratio is one is 4:

Chest e3pansions are s%))etri"al


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SIN

Sin is &r% an& has #oo& sin tr#or

E3hi+its a fair "o)ple3ion No )asses !ere o+ser$e& an&

palpate& all o$er his +o&%

K-L e&e)a K-L/an&i"e, K-L "%anosis

So)e +le)ishes on her lo!er

e3tre)ities


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NAI2

Capillar% re*ll is less than : se"(

Untri))e& an& &irt% *n#ernails1ASTROINTESTINA2

Sin is fair

A+&o)en is soft an& ?at Non ten&er a+&o)en


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E8TRE5ITIES

So)e +le)ishes !ere note& o$er the

patientBs le# No e&e)a note& on +oth pper an&

lo!er e3tre)ities, !ithot n)+nessan& tin#lin# sensation

1rossl% nor)al

K-L e&e)a, K-L "%anosis

1ENITOURINARY


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NEURO2O1ICA2

7EHAVIORA2- the patient is silent +t

not "ons"ios an& "oherent ponintera"tion

5OTOR FUNCTIONIN1- slo!e&)o$e)ent of e3tre)ities(

REF2E8ES- Re?e3es !ere present s"has the +linin# re?e3(


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PATHOPHYSIO2O1Y


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2A7ORATORY STUDY>'B8A'T8A

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FEVER INEFFECTIVE RISFOR

THER5O-RE1U2ATIONR9T INVASIONKS( TYPHIL IN

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Documents

A Case Study on a Patient With Typhoid