FINAL BURN CD-TYPHOID FEVA

8/14/2019 FINAL BURN CD-TYPHOID FEVA

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I. Introduction

Typhoid fever was not well understood in the ancient world, probably because its

symptoms are not primarily diarrheal, but rather systemic and non-specific. It was only inthe mid-19th century that physicians began to distinguish it from typhus and malaria.

Typhoid or enteric fever is an ancient disease, which has afflicted mankind since human

populations grew large enough to contaminate their water and food supplies. Practicality

has always been an attribute of the typical Filipino. It is a trait that has been embedded

into the very fabric of our lives as we bid to make the best out of what we have. We

exploit and utilize our resources to the maximum possible extent in an effort to limit

whatever goes to waste as a result of our actions. Kyle is one example of a very practical

person. Everyday before going to school in his hometown of Malugong Tboli, South

Cotabato, he chooses to make the nearby river useful and chooses to bathe in it rather

than use the water that his father had fetched from the community reservoir.

Unfortunately for him, other practical persons (and even animals) also exhibit

practicality by using the river as a site for disposing bodily waste, turning the natural

body of water into a medium for spread of infection and disease.

One week prior to admission, Kyle began to have persistent fever then after few

days he started to vomit everything that he eats. Initially, they thought that it was caused

by mosquito bite. Unbeknownst to him and his family, Kevin had contracted an infection

from his daily swimming sessions in the river. He was taken to the Davao Medical Center

on November 24, 2007 when he was no longer able to tolerate the symptoms especially

the vomiting episodes. After undergoing laboratory tests and diagnostic exams, Kevin

was diagnosed of having Typhoid fever.

In the United States alone, about 400 cases of typhoid fever occur each year, and

70% of these are acquired while traveling internationally. Typhoid fever is still commonin the developing world, where it affects about 12.5 million persons each year. In the

Philippines, the Department of Health estimated that in the year 2002 alone, there were

13,661 cases of typhoid and paratyphoid fever in the country, of which 990 were reported

from Region11. Typhoid is now regarded as a disease of history by many people living in

developed countries. However, WHO estimates that globally there are still more than 17

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million typhoid cases annually and that these infections areassociated with about 600 000

deaths.

Our group was able to handle the case of Kyle when we were assigned for duty at

the Pediatric Ward of the Davao Medical Center on November 9, 2007. After we were

given consent by his parents, we decided to take Kevins case as a subject for study in

order to expand our knowledge regarding his disease and be able to collect additional

data that we deem necessary for us to progress in our quest to become effective nurses in

the future.

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II. OBJECTIVES

-During our four weeks of exposure in the clinical area, from November 15-

December 1, 2007, the group will be able to achieve the following:

General Objectives:

1. To be able to choose a case study for our case presentation.

2. To have a case study related to our concepts in lecture regarding

communicable diseases and oxygenation.

3. To be able to apply our learnings from our lectures to our case study.4. To learn further regarding on our concepts in lecture.

Specific Objectives:

1. To gather enough and credible data for our case study and be

able to prevent it.

2. To be able to establish rapport to our patient and his family in

order to gain their cooperation for the interview and therapeutic

processes.

3. To be able to know our patients Family background and Health

history in order to trace past and present health condition.

4. To be able to assess our patients developmental stages in life

into three theories namely: Havighurts, Freud, Erikson, or

Piaget.

5. To be able to define Typhoid fever along with the patients

complete diagnosis in at least three sources from any medical

surgical textbooks.

6. To be able to assess our patient physically and cephalocaudally.

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III. PATIENTS DATAPatients code name: Kyle

Age: 8 years old Nationality: Filipino

Civil status: Single

Occupation: Student

Ward: Pedia

Room: IMCU

Bed no. : 4

Religion: Roman Catholic

Educal attainment: grade 1

Date of admission: November 24, 2007

V/S on admission:

T: 39. 8 C CR: 145 bpm

RR: 34 cpm BP: 90/70 mmhg

Chief Complaints: Fever

Admitting diagnosis: Enteric Fever t/c Typhoid fever

Final diagnosis: Thyphoid fever r/o intestinal perforation

Source of information: Patients Chart

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IV. HEALTH HISTORY

Family Health history

There is no history of any diseases in the family of Kyles Mother, the Gaway clan.

However, in the paternal line, a history of Heart diseases and Hypertension is present.

Marilou, his fathers eldest sibling and Robert Nelson, the fifth of the six siblings has

hypertension and heart disease while Anabelle, the second sibling and Gladys, the

youngest among has hypertension. Meanwhile, Wilfredo, Kyles father did not acquire

any from the two disease nor have any disease.

Effects and expectations of the illness to self and famil y

Of course, the first effect of Kyle being ill is that both of his parents and as well as

his lola and younger sibling, of which he is the eldest, they worry so much of Kyle. The

effect was emotional. His father became so worried and problematic. He said that he

cant sleep very well because he is too concerned for his child. Also, there was a big

effect on financial, the family needs to spend a lot of money for the medications which is

so expensive but they are so thankful that there is the Lingap which helped them in

their hospital finances. Her mother is also worried that she would always call from Jeda

for Kyle. Also Kyles brothers misses him so much and so is he that he will always cry

and wants to see his siblings who are in South Cotabato. Kyle is a grade 1 student from

Malugong Elementary school. There was a big effect on his studies because he has been

absent for about 3 weeks but with the permission from his teacher because Kyle is a very

diligent student. Also, because of the sickness Kyle sufferes both mental, physiological

and emotional. He wasnt able to do his usual routines at home like playing with his

playmates, watching TV and swimming in the pool when he was still not sick. These are

very important for a child of 8 years old.

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The Family expects a lot that Kyle would recover from the illness and that he

would go back to his old strength and go to school and do his usual routines. The Family

expects that they will become more careful in their diets or in the food hygiene in order to

prevent having the disease because hospitalization is expensive.

Past Health History

a. History of past illness

Kyle havent had any kind of diseases or illnesses since he was a

baby until this year. The only illnesses that he will have are just mild fever,

coughs and colds but nothing more severe.

b. History of present illness

Kyles lifestyle is so active. Before going to school, he takes a bathin the Malugong River which is near their house. Then, as a child, he loves to eat

junk foods like Mr. chips and drink sodas. He has a good academic performance

in school. As what his father says he would sometimes be the leader in some

schoolworks. When he arrives from school he plays with his playmates from the

neighborhood. If not playing outside and not swimming in the river with friends

and especially if its weekend he watches cartoons from morning till evening. His

usual diet are vegetables but eats slowly and his favorite foods are pork sausage,

salted foods and okras. He always skips breakfast especially during schooldays

because he wokes up late in the morning so there are no time for it and then he

usually have a dinner heavier than his lunch.

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On the month of November Kyle got sick. He had a fever for eight

day. Usually the fevers are high and is lowered by taking paracetamol which

offered a temporary relief then followed by loss of appetite. There are no medical

consultation made. There was an onset of soft and watery stools for five days but

still no consultation done and no meds given. The patient had anorexia and will

vomit everything that he will swallow along with his fever and diarrhea and this

prompted his father to consult medical help at Davao Medical Center.

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V. DEVELOPMENTAL DATA

Moral Development Theory (Lawrence Kohlberg)

Moral development, a complex process not fulkly understood, involves learning

what ought to be and what ought to be done. It is more than imprinting that parents rule

and virtues or values of children. The term moral means relating to right and wrong.

The terms Morality, Moral behavior, and Moral Development nedd to be distinguished

from each other. Morality refers to the requirements necessary for people to live in a

societry; Moral behavior is the way a person perceives those requirements and responds

to them; Moral development is the pattern of change in moral behavior with age.

At the meantime, the children lives with their lola at Malugong and their Father

lives their temporarily. Kyle, as a child perceives punishment as the sign that he dis

something wrong or what hes doing is wrong. He avoids punishment and consequences

which are either set by his father or authorities and so he does things that he thinks are

right by which he cant be punished. He follows what his Lola, mother and Father wants

him to do as having good grades at school and being a good and unbully child. Also, Hedoes what he wants to do or what interest him which tells that what his doing is actually

right(at his own view of what is right). Like he goes to swimming in the river, play with

playmates and watch TV a lot. This is his routine and what he likes to do and also his

father doesnt prohibit him from doing so.

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Psychosocial Development (Erik Erikson)

This theory refers to the development of personality. Personality is a complex that

is difficult to define. It can be considered as the outward (interpersonal) expression of theinner(intrapersonal) self. It compasses a persons temperament, feeling, character traits,

independence, self-esteem, self-concept, behavior, ability to interact with others and

ability to adapt to life changes.

The patient is an eight-years old child. He belongs in the stage of Industry vs.

Inferiority. Industry here refers to purposeful or meaningful activity. It's the development

of competence and skills, and a confidence to use a 'method', and is a crucial aspect of

school years experience. Erikson described this stage as a sort of 'entrance to life'. A child

who experiences the satisfaction of achievement - of anything positive - will move

towards successful negotiation of this crisis stage. A child who experiences failure at

school tasks and work, or worse still who is denied the opportunity to discover and

develop their own capabilities and strengths and unique potential, quite naturally is prone

to feeling inferior and useless. Engaging with others and using tools or technology are

also important aspects of this stage. It is like a rehearsal for being productive and being

valued at work in later life. Inferiority is feeling useless; unable to contribute, unable tocooperate or work in a team to create something, with the low self-esteem that

accompanies such feelings

Kyle is a productive student at school and an active child in the village. He has a

lot of friends and plays with them after school or on weekend when it does not interrupt

in his school works. He enjoys playing and swimming with his friends. He doesnt miss

his schooldays and he doesnt want to be absent in school. After playing and watching TV

during schooldays, he would now study his lessons for school. Kyle knows when to do

things and has his method of doing it by setting his priorities and what needs to be

attended first and whats more important. He is confident in his self as evidenced by

being a good leader at school. He also have a positive comments from his teachers.

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Cognitive Theory (Jean Piaget)

This theory refers to the manner in which people learn to think, reason,

and use language. It involves a persons intelligence, perceptual ability, and ability to process information. Cognitive development represents a progression of mental abilities

from illogical to logical thinking, from simple to complex problem solving, and from

understanding concrete iseas to understand abstract concepts.

Our Patient, Kyle is on Concrete Stage. During this stage, accommodation

increases. The child develops an ability to think abstractly and to make rational

judgements about concrete or observable phenomena, which in the past he needed to

manipulate physically to understand. In teaching this child, giving him the opportunity to

ask questions and to explain things back to you allows him to mentally manipulate

information.

Our patient is a grade 1 student from Malugong Elementary highschool in

South Cotabato. His favorite subjects are Math and Filipino. He likes to read short stories

like Fables and Filipino folklores.

He is practical. He thinks for what is important and what could he done.He follows his therapeutic regime i.e. NPO in which after knowing, he does not insists on

eating or drinking because it was the instruction. He knows how to reason and answers

question concretely and coherently. He follows our instructions or what we tells him to

do like, when he was lying on bed, we asked him to sit in order for us to auscultate his

lungs eventhough he has body malaise. We also observed that he knows how to reason

for things while were conversing with him.

As what we observed, Kyle is a smart boy. He knows what he should do

and what to say and reasons. At his age, He could comprehend his present condition and

follows instructions given to him by the medical staffs.

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DEFINITION OF COMPLETE DIAGNOSIS

Typhoid Fever r/o Intestinal Perforation

Typhoid Fever

Typhoid fever is a bacterial infection of the intestinal tract and occasionally the

bloodstream. It is an uncommon disease with only 30-50 cases occurring in New York

each year. Most of the cases are acquired during foreign travel to underdeveloped

countries. The germ that causes typhoid is a unique human strain of Salmonella calledSalmonella typhi . Outbreaks are rare

Source:

http://www.health.state.ny.us/diseases/communicable/typhoid_fever/fact_sheet.htm

An acute illness associated with fever caused by the Salmonellae Typhi bacteria. The

bacteria is deposited in water or food by a human carrier, and is then spread to other

people in the area. The incidence of the illness in the United States has markedly

decreased since the early 1900's. This improvement is the result of improved

environmental sanitation. Mexico and South America are the most common areas for

U.S. citizens to contract typhoid fever. India, Pakistan and Egypt are also known high risk

areas for developing this disease.

Source: http://www.medicinenet.com/typhoid_fever/article.htm

Typhoid fever is a potentially life-threatening illness that is caused by the bacteria

Salmonella typhi (S. typhi) . Persons with typhoid fever carry the bacteria in their bloodstream

and intestinal tract and can spread the infection directly to other people by contaminating

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http://www.health.state.ny.us/diseases/communicable/typhoid_fever/fact_sheet.htmhttp://www.medicinenet.com/typhoid_fever/article.htmhttp://www.health.state.ny.us/diseases/communicable/typhoid_fever/fact_sheet.htmhttp://www.medicinenet.com/typhoid_fever/article.htm


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This surgical emergency involves rupture of the wall of the intestine . intestinal

perforation results in severe abdominal pain intensified by movement . Later symptoms

include fever and chills.

Source: http://www.medhelp.org/HealthTopics/H.html

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http://www.bio-medicine.org/Medicine-Dictionary/emergency/http://www.bio-medicine.org/Medicine-Dictionary/rupture/http://www.bio-medicine.org/Medicine-Dictionary/intestine/http://www.bio-medicine.org/Medicine-Dictionary/abdominal_pain/http://www.bio-medicine.org/Medicine-Dictionary/movement/http://www.bio-medicine.org/Medicine-Dictionary/fever/http://www.bio-medicine.org/Medicine-Dictionary/chills/http://www.medhelp.org/HealthTopics/H.htmlhttp://www.bio-medicine.org/Medicine-Dictionary/emergency/http://www.bio-medicine.org/Medicine-Dictionary/rupture/http://www.bio-medicine.org/Medicine-Dictionary/intestine/http://www.bio-medicine.org/Medicine-Dictionary/abdominal_pain/http://www.bio-medicine.org/Medicine-Dictionary/movement/http://www.bio-medicine.org/Medicine-Dictionary/fever/http://www.bio-medicine.org/Medicine-Dictionary/chills/http://www.medhelp.org/HealthTopics/H.html


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VII. PHYSICAL ASSESSMENT

1. Vital signs

BP: 110/90 (sitting)

TEMP: 39. 7 C

RR: 42 bpm (shallow and fast)

PR: 112 bpm

2. General Survey

Weight remains the same since admission, 17 kg. The head

circumference is . He appears to have signs of distress, pain and anxietyand talks limitedly. He is conscious, alert, coherent and oriented. He is

ectomorphic, well developed and looks according to age. He is poorly

nourished as evidenced by very thin body structure, dry skin and reported

that he only eats a little and his usual diet is vegetables but his favorite is

pork sausage and salted foods. However at the onset of his symptoms, he

started to loss his appetite. His emotional state is that he appears to be

worried, restless and has grimaced face and also cries due to

homesickness.

3. Skin

Texture of skin is smooth and is hot to touch. Turgor is good. Scars

and allergies are noted on both lower legs. Pitting edema is noted on

both arms and feet. Pallor is present on palms and soles of feet.

4. Head

Configuration of the head is normocephalic with fontanels

closed and no masses or lesions are present. Facial movements are

symmetrical. Hair is evenly distributed and scalp is clean.

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5. Eyes

Lids are symmetrical but swelling. Edema is evident on

both periorbital regions but more severe on the right side. No lesions.

Conjunctiva is pale in color and sclera is anicteric but light red in color.

Visual acuity is glossy normal and peripheral vision is intact and full.

6. Ears

Has normoset of external pinnae and are symmetrical.

Hearing is symmetrical with cerumen on the external canal but without

discharges and foul smell.

7. Nose

Septum is midline. No discharges, no lesions and masses. Both

are patent.

8. Mouth

Lips are cracked and dry with presence of bleeding lesions.

Mucosa and gums are pale in color and tongue is at midline and intact speech.

Cavities are present on molars and premolars on both upper and lower teeth.

9. Pharynx

Uvula is at midline with mucusa pinkish in color. Tonsils are

not inflamed.

10. Neck

Trachea is at midline. No tenderness at cervical lymph nodes

upon palpation and thyroid is not enlarged.

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11. Chest and Lungs

Breathing is irregular and is having shallow and fast breathing

with use of accessory muscles. Lung expansion is symmetrical with no adventitious

lung sounds upon auscultation.

12. Heart

Palpitation is present. Bleeding tendencies for lesions on lips and

gastrointestinal tract. There is a presence of a heart sound upon palpation.

13. Breast and axillae

Both breast are equal in shape and symmetrical. Surface is smooth and

no dimpling, edema or retractions. No masses and tenderness.

14. Abdomen

By inspection, there are presence of visible veins but no lesions and

scars. Abdomen is globular in configuration with absent bowel sounds upon

auscultation. Tenderness is evident during palpation with presence of guarding

behavior. Abdominal pain is felt on the left hypochondriac region.

15. Back and extremities

Peripheral pulses are symmetrical. nail beds pale in color. ROM full

and symmetrical and muscle tone is equally strong and symmetrical muscle size with

coordinated gait.

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VIII. ANATOMY PHYSIOLOGY

The human digestive system is a complex series of organs and glands that processes food.

In order to use the food we eat, our body has to break the food down into smaller

molecules that it can process; it also has to excrete waste.

Most of the digestive organs (like the stomach and intestines) are tube-like and contain

the food as it makes its way through the body. The digestive system is essentially a long,

twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver

and pancreas) that produce or store digestive chemicals.

TheDigestiveProcess :

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 a long tube that runs from the mouth to the

stomach. It uses rhythmic, wave-like muscle 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.

Human Digestive System

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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 - After being in the stomach, food enters the duodenum, the first

part of the small intestine. It then enters the jejunum and then the ileum (the final part of

the small intestine). 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 - After passing through the small intestine, food passes into the

large intestine. In the large intestine, some of the water and electrolytes (chemicals like

sodium) are removed from the food. Many microbes (bacteria like Bacteroides ,

Lactobacillus acidophilus , Escherichia coli , and Klebsiella ) in the large intestine help in

the digestion 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 viathe 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.

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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.

epiglottis - the flap at the back of the tongue that keeps chewed food from going down

the windpipe to the lungs . When you swallow, the epiglottis automatically closes. When

you breathe, the epiglottis opens so that air can go in and out of the windpipe.

esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle

movements (called peristalsis) to force food from the throat into the stomach.

gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile

(a digestive chemical which is produced in the liver) into the small intestine.

ileum - the last part of the small intestine before the large intestine begins.

jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum

and the ileum.

liver - a large organ located above and in front of the stomach. It filters toxins from the

blood, and makes bile (which breaks down fats) and some blood proteins.

mouth - the first part of the digestive system, where food enters the body. Chewing and

salivary enzymes in the mouth are the beginning of the digestive process (breaking down

the food).

pancreas - an enzyme-producing gland located below the stomach and above the

intestines. Enzymes from the pancreas help in the digestion of carbohydrates, fats and

proteins in the small intestine.

peristalsis - rhythmic muscle movements that force food in the esophagus from the throat

into the stomach. Peristalsis is involuntary - you cannot control it. It is also what allows

you to eat and drink while upside-down.

rectum - the lower part of the large intestine, where feces are stored before they are

excreted.

salivary glands - glands located in the mouth that produce saliva. Saliva contains

enzymes that break down carbohydrates (starch) into smaller molecules.

sigmoid colon - the part of the large intestine between the descending colon and the

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rectum.

stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical

and mechanical digestion takes place in the stomach. When food enters the stomach, it is

churned in a bath of acids and enzymes.

transverse colon - the part of the large intestine that runs horizontally across the

abdomen.

Functions of the Digestive System

The digestive system includes the digestive tract and its

accessory organs, which process food into molecules that can

be absorbed and utilized by the cells of the body. Food is

broken down, bit by bit, until the molecules are small enough

to be absorbed and the waste products are eliminated. The

digestive tract, also called the alimentary canal or gastrointestinal (GI) tract, consists of a

long continuous tube that extends from the mouth to the anus. It includes the mouth,

pharynx, esophagus, stomach, small intestine, and large intestine. The tongue and teeth

are accessory structures located in the mouth. The salivary glands, liver, gallbladder, and pancreas are major accessory organs that have a role in digestion. These organs secrete

fluids into the digestive tract.

Food undergoes three types of processes in the body:

Digestion

Absorption

Elimination

Digestion and absorption occur in the digestive tract. After the nutrients are absorbed,

they are available to all cells in the body and are utilized by the body cells in metabolism.

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The digestive system prepares nutrients for utilization by body cells through six

activities, or functions.

Ingestion . The first activity of the digestive system is to take in food through the mouth.

This process, called ingestion, has to take place before anything else can happen.

Mechanical Digestion . The large pieces of food that are ingested have to be broken into

smaller particles that can be acted upon by various enzymes . This is mechanical

digestion, which begins in the mouth with chewing or mastication and continues with

churning and mixing actions in the stomach.

Chemical Digestion The complex

molecules of carbohydrates, proteins, and

fats are transformed by chemical digestion

into smaller molecules that can be absorbed

and utilized by the cells. Chemical

digestion, through a process called

hydrolysis, uses water and digestive

enzymes to break down the complex

molecules. Digestive enzymes speed up thehydrolysis process, which is otherwise very

slow.

Movements . After ingestion and mastication, the food particles move from the mouth

into the pharynx, then into the esophagus. This movement is deglutition, or swallowing.

Mixing movements occur in the stomach as a result of smooth muscle contraction. These

repetitive contractions usually occur in small segments of the digestive tract and mix the

food particles with enzymes and other fluids. The movements that propel the food

particles through the digestive tract are called peristalsis. These are rhythmic waves of

contractions that move the food particles through the various regions in which

mechanical and chemical digestion takes place.

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Absorption . The simple molecules that result from chemical digestion pass through cell

membranes of the lining in the small intestine into the blood or lymph capillaries. This

process is called absorption .

Elimination . The food molecules that cannot be digested or absorbed need to be

eliminated from the body. The removal of indigestible wastes through the anus, in the

form of feces, is defecation or elimination.

General Structure of the Digestive System

The long continuous tube that is the digestive tract is about 9 meters in length. It opens to

the outside at both ends, through the mouth at one end and through the anus at the other.

Although there are variations in each region, the basic structure of the wall is the same

throughout the entire length of the tube.

The wall of the digestive tract has four layers or tunics:

Mucosa

Submucosa

Muscular layer

Serous layer or serosa

The mucosa, or mucous membrane layer, is the innermost tunic of the wall. It lines the

lumen of the digestive tract. The mucosa consists of epithelium, an underlying loose

connective tissue layer called lamina propria , and a thin layer of smooth muscle called

the muscularis mucosa. In certain regions, the mucosa develops folds that increase the

surface area. Certain cells in the mucosa secrete mucus, digestive enzymes, and

hormones. Ducts from other glands pass through the mucosa to the lumen. In the mouth

and anus, where thickness for protection against abrasion is needed, the epithelium is

stratified squamous tissue. The stomach and intestines have a thin simple columnar

epithelial layer for secretion and absorption.

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The submucosa is a thick layer of loose connective tissue that surrounds the mucosa. This

layer also contains blood vessels, lymphatic vessels, and nerves. Glands may be

embedded in this layer.

The smooth muscle responsible for movements of the digestive tract is arranged in two

layers, an inner circular layer and an outer longitudinal layer. The myenteric plexus is

between the two muscle layers.

Above the diaphragm , the outermost layer of the digestive tract is a connective tissue

called adventitia. Below the diaphragm, it is called serosa.

Organs of the Digestive System

At its simplest, the digestive system is a tube running from mouth to anus. Its chief goal

is to break down huge macromolecules (proteins, fats and starch), which cannot be

absorbed intact, into smaller molecules (amino acids, fatty acids and glucose) that can be

absorbed across the wall of the tube, and into the circulatory system for dissemination

throughout the body.

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Regions of the digestive system can be divided into two main parts: the alimentary tract

and accessory organs. The alimentary tract of the digestive system is composed of the

mouth, pharynx, esophagus, stomach, small and large intestines, rectum and anus.

Associated with the alimentary tract are the following accessory organs: salivary glands,

liver, gallbladder, and pancreas.

Mouth

he mouth, or oral cavity, is the first part of the digestive tract. It is

dapted to receive food by ingestion, break it into small particles

y mastication, and mix it with saliva. The lips, cheeks, and palate

orm the boundaries. The oral cavity contains the teeth and tongue

nd receives the secretions from the salivary glands.

Lips and Cheeks

The lips and cheeks help hold food in the mouth and keep it in place for chewing. They

are also used in the formation of words for speech. The lips contain numerous sensory

receptors that are useful for judging the temperature and texture of foods.

Palate

The palate is the roof of the oral cavity. It separates the oral cavity from the nasal cavity.

The anterior portion, the hard palate, is supported by bone. The posterior portion, the soft

palate, is skeletal muscle and connective tissue. Posteriorly, the soft palate ends in a

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projection called the uvula. During swallowing, the soft palate and uvula move upward to

direct food away from the nasal cavity and into the oropharynx.

Tongue

The tongue manipulates food in the mouth and is used in speech. The surface is covered

with papillae that provide friction and contain the taste buds.

Teeth

A complete set of deciduous (primary) teeth contains 20 teeth. There are 32 teeth in a

complete permanent (secondary) set. The shape of each tooth type corresponds to the way

it handles food.

Pharynx and Esophagus

Pharynx

The pharynx is a fibromuscular passageway that connects the nasal and oral cavities to

the larynx and esophagus. It serves both the respiratory and digestive systems as a

channel for air and food. The upper region, the nasopharynx, is posterior to the nasal

cavity. It contains the pharyngeal tonsils, or adenoids, functions as a passageway for air,

and has no function in the digestive system. The middle region posterior to the oral cavity

is the oropharynx. This is the first region food enters when it is swallowed. The opening

from the oral cavity into the oropharynx is called the fauces. Masses of lymphoid tissue,

the palatine tonsils, are near the fauces. The lower region, posterior to the larynx, is the

laryngopharynx, or hypopharynx. The laryngopharynx opens into both the esophagus and

the larynx.

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Food is forced into the pharynx by the tongue.

When food reaches the opening, sensory receptors

around the fauces respond and initiate an

involuntary swallowing reflex. This reflex action

has several parts. The uvula is elevated to prevent

food from entering the nasopharynx. The

epiglottis drops downward to prevent food from

entering the larynx and trachea in order to direct

the food into the esophagus. Peristaltic

movements propel the food from the pharynx into

the esophagus.

Esophagus

The esophagus is a collapsible muscular tube that serves as a passageway between the

pharynx and stomach. As it descends, it is posterior to the trachea and anterior to the

vertebral column. It passes through an opening in the diaphragm, called the esophageal

hiatus, and then empties into the stomach. The mucosa has glands that secrete mucus to

keep the lining moist and well lubricated to ease the passage of food. Upper and lower

esophageal sphincters control the movement of food into and out of the esophagus. Thelower esophageal sphincter is sometimes called the cardiac sphincter and resides at the

esophagogastric junction.

Stomach

The stomach, which receives food from the esophagus, is located in the upper left

quadrant of the abdomen. The stomach is divided into the fundic, cardiac, body, and

pyloric regions. The lesser and greater curvatures are on the right and left sides,

respectively, of the stomach.

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Gastric Secretions

The mucosal lining of the stomach is simple columnar epithelium with numerous tubular

gastric glands. The gastric glands open to the surface of the mucosa through tiny holes

called gastric pits. Four different types of cells make up the gastric glands:

Mucous cells

Parietal cells

Chief cells

Endocrine cells

The secretions of the exocrine gastric glands - composed of the mucous, parietal, and

chief cells - make up the gastric juice. The products of the endocrine cells are secreted

directly into the bloodstream and are not a part of the gastric juice. The endocrine cells

secrete the hormone gastrin, which functions in the regulation of gastric activity.

Regulation of Gastric Secretions

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The regulation of gastric secretion is accomplished through neural and hormonal

mechanisms. Gastric juice is produced all the time but the amount varies subject to the

regulatory factors. Regulation of gastric secretions may be divided into cephalic , gastric,

and intestinal phases. Thoughts and smells of food start the cephalic phase of gastric

secretion; the presence of food in the stomach initiates the gastric phase; and the presence

of acid chyme in the small intestine begins the intestinal phase.

Stomach Emptying

Relaxation of the pyloric sphincter allows chyme to pass from the stomach into the small

intestine. The rate of which this occurs depends on the nature of the chyme and the

receptivity of the small intestine.

Small and Large Intestine

Small Intestine

The small intestine extends from the pyloric sphincter to the ileocecal valve, where it

empties into the large intestine. The small intestine finishes the process of digestion,

absorbs the nutrients, and passes the residue on to the large intestine. The liver,

gallbladder, and pancreas are accessory organs of the digestive system that are closely

associated with the small intestine.

The small intestine is divided into the duodenum, jejunum, and ileum. The small intestine

follows the general structure of the digestive tract in that the wall has a mucosa withsimple columnar epithelium, submucosa, smooth muscle with inner circular and outer

longitudinal layers, and serosa. The absorptive surface area of the small intestine is

increased by plicae circulares , villi, and microvilli.

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Exocrine cells in the mucosa of the small intestine secrete mucus, peptidase, sucrase,

maltase, lactase, lipase, and enterokinase. Endocrine cells secrete cholecystokinin and

secretin.

The most important factor for regulating secretions in the small intestine is the presence

of chyme. This is largely a local reflex action in response to chemical and mechanical

irritation from the chyme and in response to distention of the intestinal wall. This is a

direct reflex action, thus the greater the amount of chyme, the greater the secretion.

Large Intestine

The large intestine is larger in diameter than the small intestine. It begins at the ileocecal

junction, where the ileum enters the large intestine, and ends at the anus. The large

intestine consists of the colon, rectum, and anal canal.

The wall of the large intestine has the same types of tissue that are found in other parts of

the digestive tract but there are some distinguishing characteristics. The mucosa has a

large number of goblet cells but does not have any villi. The longitudinal muscle layer,

although present, is incomplete. The longitudinal muscle is limited to three distinct bands,

called teniae coli, that run the entire length of the colon. Contraction of the teniae coli

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exerts pressure on the wall and creates a series of pouches, called haustra, along the

colon. Epiploic appendages, pieces of fat-filled connective tissue, are attached to the

outer surface of the colon.

Unlike the small intestine, the large intestine produces no digestive enzymes. Chemical

digestion is completed in the small intestine before the chyme reaches the large intestine.

Functions of the large intestine include the absorption of water and electrolytes and the

elimination of feces.

Rectum and Anus

The rectum continues from the signoid colon to the anal canal and has a thick muscular

layer. It follows the curvature of the sacrum and is firmly attached to it by connective

tissue. The rectum and ends about 5 cm below the tip of the coccyx, at the beginning of

the anal canal.

The last 2 to 3 cm of the digestive tract is the anal canal, which continues from the

rectum and opens to the outside at the anus. The mucosa of the rectum is folded to form

longitudinal anal columns. The smooth muscle layer is thick and forms the internal anal

sphincter at the superior end of the anal canal. This sphincter is under involuntary control.

There is an external anal sphincter at the inferior end of the anal canal. This sphincter is

composed of skeletal muscle and is under voluntary control.

Accessory Organs

The salivary glands, liver, gallbladder, and pancreas are not part of the digestive tract, but

they have a role in digestive activities and are considered accessory organs.

Salivary Glands

Three pairs of major salivary glands (parotid, submandibular, and sublingual glands) and

numerous smaller ones secrete saliva into the oral cavity, where it is mixed with food

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during mastication. Saliva contains water, mucus, and enzyme amylase . Functions of

saliva include the following:

o It has a cleansing action on the teeth.

o It moistens and lubricates food during mastication and swallowing.

o It dissolves certain molecules so that food can be tasted.

o It begins the chemical digestion of starches through the action of amylase,

which breaks down polysaccharides into disaccharides.

Liver

The liver is located primarily in the right hypochondriac and epigastric regions of the

abdomen, just beneath the diaphragm. It is the largest gland in the body. On the surface,

the liver is divided into two major lobes and two smaller lobes. The functional units of

the liver are lobules with sinusoids that carry blood from the periphery to the central vein

of the lobule.

The liver receives blood from two sources. Freshly oxygenated blood is brought to the

liver by the common hepatic artery, a branch of the celiac trunk from the abdominal

aorta. Blood that is rich in nutrients from the digestive tract is carried to the liver by the

hepatic portal vein.

The liver has a wide variety of functions and many of these are vital to life. Hepatocytes

perform most of the functions attributed to the liver, but the phagocytic Kupffer cells that

line the sinusoids are responsible for cleansing the blood.

Liver functions include the following:

secretion synthesis of bile salts

synthesis of plasma protein

storage

detoxification

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excretion

carbohyrate metabolism

lipid metabolism

protein metabolism

filtering

Gallbladder

The gallbladder is a pear-shaped sac that is attached to the visceral surface of the liver bythe cystic duct. The principal function of the gallbladder is to serve as a storage reservoir

for bile. Bile is a yellowish-green fluid produced by liver cells. The main components of

bile are water, bile salts, bile pigments, and cholesterol.

Bile salts act as emulsifying agents in the digestion and absorption of fats. Cholesterol

and bile pigments from the breakdown of hemoglobin are excreted from the body in the

bile.

Pancreas

The pancreas has both endocrine and exocrine functions. The endocrine portion consists

of the scattered islets of Langerhans , which secrete the hormones insulin and glucagon

into the blood. The exocrine portion is the major part of the gland. It consists of

pancreatic acinar cells that secrete digestive enzymes into tiny ducts interwoven between

the cells. Pancreatic enzymes include anylase, trypsin, peptidase, and lipase. Pancreatic

secretions are controlled by the hormones secretin and cholecystokinin.

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IX Etiology

Predisposing Factors:

factor actual rationaleGenes X Salmonella typhi is shed

only in human feces and istransmitted via the fecal-oral route of infection. It istherefore a non-hereditarydisease.

Age X There is no specific agegroup within which thedisease is most dangerous.However, traditionally theage range considered to beat greatest risk was 5-25years but typhoid fever canaffect any person from anyage group who ingests thesalmonella typhi bacteria.

Sex X Both sexes can acquiretyphoid fever through theingestion of contaminatedfood or water.

Socio-Economic Status The Family is not sofinancially well off.However, the mother isworking in Jeda as aDomestic Helper and thefather is unemployed. Thefamilys income is notsufficient to finance all their

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needs in order for the livingto be more comfortable andto buy all the medicinesneeded.

Precipitating Factors:

Environment The family at the momentlived at a village near aRiver where Kyle and his

siblings usually takes a bath.Also it is where thecarabaos are bathing and thefather also said that maybetheir neighbors defecatethere.Typhoid is common in poor andtropical areas of theworld where sanitation isinadequate and the water supply not effectively

purified.Source:www.ptolemy.ca.pdf Unsanitary food handling The Family does practice

good sanitation in handlingfoods. They dining table isalways left uncleanedespecially the 3 youngsibling are the only oneeating together. Also,Unwashed plates are alwaysleft in their lavatory until it

accumulates. Sometimesleft-over foods are also leftuncovered in the diningtable.

Ingestion of ContaminatedFoods.

Kyle is always swimmingthe contaminated river.There is a possibility that heingested water from the

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river even at minimumamount. S typhi istransmitted via the fecal-oral route. The infectiousdose is between 105 and

109. The dose is lower if the bacteria are given withsodium bicarbonate,suggesting that a proportionof the ingested bacteria aredestroyed by the acidenvironment in the stomach.

Source: www.ptolemy.ca

Unsanitary preparation of

food

The father said that there are

a lot of food flies, rats andcockroaches in their kitchenthat must have contaminatedthe prepared food.

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X. Symptomatology

symptoms actual rationale

1. Fever Because of the presence of

Salmonella typhi on his blood thethe body releases pyrogeneswhich are abnormal proteins. The

body increases temperature toincrease oxygen uptake whichresults to increased respiratoryrate and renders WBC moreaggressive against bacteria andthis increases there phagocyticactivity. Endotoxins released bythe gram-negative bacteria whichelicits a antigenic response thatresults to increased intemperature.

2. Burning Micturition X Not Present.

3. Gastroenteritis S.typhi, which is present withinhis stomach, elicits aninflammatory reaction as the bodytries to combat the infection.

4. Diarrhea Diarrhea is one of the bodysmethods of releasing infectious

bacteria before it gets a chance to proliferate.

5. Headache X Not Present.

6. Abdominal Pain Frequent contact of the stomachlining with the S.typhi bacteriaresults in constant inflammation,especially in areas of greatestmacrophage concentration, whichin turn causes tissue necrosis,hence, the abdominal pain.

7. Body Ache X Not Present.

8. Dry Cough Bacteria can reach the lungs ascontaminated blood enters the

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XI. Pathophysiology

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S.typhi is shed inhuman feces

Contamination of food

and water

Ingestion of contaminatedfood or water by humans

S.typhi tries to survive in acidicenvironment of the stomach

Remaining bacteria invadeepithelial cells in the intestine

Macrophages from Peyers patches engulf bacteria

S.typhi injects effector proteins into macrophage

Normal cellular activities arediverted

Bacteria survives andmultiplies within

macrophage

Macrophages carrying bacteria

accumulate in Peyers patches

Phagocytes undergo lyses and release bacteria into nearby lymphatic ducts

Constant exposure to bacteria

Inflammation

Necrosis

Bowel perforation

Intestinal bleeding

-Blood in vomitus-Abdominal pain-Gastroenteritis

Bacteria disseminate to regional lymphnodes

Bacteria passes through thoracicduct and enters the bloodstream

Primary Bacteremia(Asymptomatic)

40

Predisposing Factors:

o Geneso Ageo Sexo Socio-economic

Status

Precipitating Factors:

o Environmento Unsanitary Food

Handlingo Ingestion of

ContaminatedFood


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Changes brought about by sepsisaccumulate in the heart, brain, andkidneys

IF NOTTREATED: IF TREATED:

Infection spreads to other systems

-Endocarditis-Renal Failure-Brain Infxn

41

-Fever -Headache-Abdominal Pain

Overwhelmingsepsis

Circulatory Failure

DEATH!

Antibiotic Therapy

-Elimination/decrease in number of S.typhi

-Alleviation of signsand symptoms-Recovery fromcondition

Bacteria spread to other cells of reticuloendothelial system (including

spleen, liver, and gallbladder)

Bacterial growthwithin spleen and liver

-Splenomegaly-Hepatomegaly

Bacteria is shed into the bloodstream

Secondary Bacteremia


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XII. Doctors Order

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Date Order Rationale Remarks11/25/07 >Pls. admit to SVI, level 2, red2

>DAT except for DCF>Dxs:

CBC, platelet count

UA

Blood GS/CS Urine GS/CS

Typhidot IgM and IgB

>IVF: D5LR 1L to run @56cc/h

>Meds: Ranitidine 20mg/ IVTTq8h prn for abdominal pain,

>Chloramphenicol565mg/IVTT q8h

>VSq4h with BP monitoring,WOF unusualities: bleeding andhypotension, refer

>To assess the patient for infection, anemia and anydisorders.

>To assess for anyabnormalities within theurinary system as well as for systemic problems that maymanifest symptoms throughthe urinary tract.

>To detect Typhoid fever andany other salmonellainfection.

>To prevent patient fromdehydration and maintainadequate electrolyte and fluid

balance.

>To relief Patients abdominal pain.

>Use to treat infetctionspecifically salmonellaspecies.

>To monitor the patientscondition and monitor for anyunusualties in the patient such

bleeding and hypotension.

DONE

DONE

DONE

DONE

DONE

DONE

DONE

DONE

11/26/079:30am

9:45pm

>Still for UA, blood GS/CS,urine GS/CS>Cont. IVF @ SR >Cont. meds

>VSq4h

>I&OqS

>To monitor patientscondition and assess for anyabnormalities in the patientsVS.

> To determine if the kidneysfunction is now affected

because Typhoid fever iscomplicated by AcuteOliguric Renal Failure.

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XIII. Diagnostic and L abor atory Exams

Date Diagnostic Exam Rationale Normalvalue

Result Clini cal significance Nursingconsiderations

11/24/07 COMPLETE BLOODCOUNT

Hgb

Hct

RBC count

To evaluate blood loss,erythropoieticability,anemia, andresponse totherapy.

To evaluate blood loss,anemia, bloodreplacementtherapy, andfluid balance,and screensred blood cellstatus. Also toevaluatedehydration

andhypervolemia.

To evaluateanemia andother conditions

135-175

0.40-0.52

4.20-6.10

L71 g/L

L0.20

L2.78x10^6/uL

Increased: Congenital heart disease Hemoconcentration Congestive heart failure Chronic obstructive

pulmonary disease

DehydrationDecreased: Anemia Hemolysis Severe hemorrhage Cancer Kidney disease Chronic hemorrhage Nutritional deficiency Lymphoma Hemoglobinopathies

Increased: Congestive heart disease Hemoconcentration Severe dehydration Shock Severe diarrheaDecreased: Anemia Cirrhosis Hemolytic reaction Dietary deficiency Malnutrition Hemorrhage

Increased: Congenital heart disease Polycythemia

vera/hemoconcentration

The CBC requiresa sample of bloodcollected from avein. The nurse or

phlebotomistinserting the needshould clean theskin first. Thetourniquet should

be removed fromthe arm as soon asthe blood flows. Ia fingerstick isused to collect the

blood, care must btaken to wipe awathe first drop, andnot to squeeze thefinger excessivelyas this causes the

blood to be diluted by tissue fluid.

Many drugs affecthe results bycausing increasedor decreased RBCWBC, and/or

platelet productionMedications shou

be taken intoaccount wheninterpreting result

Discomfort or bruising may occu

at the puncture sitApplying pressureto the puncture situntil the bleedingstops helps toreduce bruising;warm packs relievdiscomfort. Some

people feel dizzy faint after blood

44
http://www.labtestsonline.org/understanding/conditions/anemia.htmlhttp://www.labtestsonline.org/understanding/conditions/bone_marrow_disorders.htmlhttp://www.labtestsonline.org/understanding/conditions/anemia.htmlhttp://www.labtestsonline.org/understanding/conditions/bone_marrow_disorders.htmlhttp://www.labtestsonline.org/understanding/conditions/anemia.htmlhttp://www.labtestsonline.org/understanding/conditions/anemia.htmlhttp://www.labtestsonline.org/understanding/conditions/bone_marrow_disorders.htmlhttp://www.labtestsonline.org/understanding/conditions/bone_marrow_disorders.htmlhttp://www.labtestsonline.org/understanding/conditions/bone_marrow_disorders.htmlhttp://www.labtestsonline.org/understanding/conditions/bone_marrow_disorders.htmlhttp://www.labtestsonline.org/understanding/conditions/bone_marrow_disorders.htmlhttp://www.labtestsonline.org/understanding/conditions/anemia.htmlhttp://www.labtestsonline.org/understanding/conditions/bone_marrow_disorders.html


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Lymphocytes

Monocytes

Eosinophils

20-35

2-10

1-6

29

7

L0

Measles Rubella Mononucleosis or

tularemia SLE Aplastic anemia

Increased: Viral infection including

TB, hepatitis, mumps pertussis, syphilis,rubella,mononucleosis,cytomegalovirus, or other viral illnesses,lymphocytic leukemia,ulcerative colitis

chronic infection or animmune disease

Decreased: defective lymphatic

circulation chronic debilitating

conditions such as CHF,renal failure, or advancedTB

Hodgkins disease or burns

Increased: TB Hepatitis

Malaria Rocky mountain spotted

fever SLE Monocytic leukemia Lymphomas Chronic ulcerative colitis

Decreased: Does not have clinical

significance related todisease; it may indicate

positive response to prednisone treatment.

Increased: Allergic response Serum sickness Parasitic infection

including hookworm,roundworm, amebiasis, or trichonosis.

Skin disorder

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Basophils

Platelet CountTo assist inthe diagnosisof bleedingdisorders

0-1

150-400

0

L125

Neoplastic disorder Ulcerative colitis Pernicious anemia Scarlet fever Autoimmune disease Splenectomy

Decreased: Cushings syndrome Trauma Burns Shock Surgery CHF Aplastic anemia Pernicious anemia

Increased: Chronic myelocytic

leukemia Polycythemia vera Hodgkins disease Ulcerative colitis Nephrosis Chronic hemolytic anemia

Decreased: Hyperthyroidism Pregnancy Stress response Anaphylactic reactions Steroid therapy

An abnormally low platelet level(thrombocytopenia) is acondition that may resultfrom increaseddestruction of platelets,decreased production, or increased usage of

platelets. In idiopathicthrombocytopenicpurpura (ITP), plateletsare destroyed atabnormally high rates.Another cause of a low

platelet count is anenlarged spleen.Hypersplenism ischaracterized by thecollection (sequestration)of platelets in the spleen.

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Disseminatedintravascular coagulation(DIC) is a condition inwhich blood clots occur within blood vessels in anumber of tissues.

Leukemia and aplasticanemia can result in a low platelet count because of decreased production of

platelets in the bonemarrow. All of thesediseases produce reduced

platelet counts.

Abnormally high plateletlevels (thrombocytosis)may indicate either a

benign reaction to aninfection, surgery, or certain medications; or adisease like polycythemiavera, in which the bonemarrow produces toomany platelets tooquickly.

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Date Diagnostic Exam Rationale Normalvalue

Result Clinical significance Nursingconsiderations

11/28/-7 Serology Typhidot

It is a dot ELISAkit which detects

IgM and IgGantibodies againstS. Typhi. It uses aspecific antigen onthe outer membrane of S.Typhi dotted onnitrocellulose stripsand for detectingthe resultingantigen antibodycomplex,

peroxidaseconjugated antihuman IgG andIgM and achromogenicsubstrate areemployed.

IgM

IgG

+

+

Positive control gives bluecolour dots,

- blood culture positive for salmonella agglutinating bodies, indicative of salmenonella infection

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XIV. Drug Study

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XV. Nursing Theories

Nightingales Environmental Theory

Florence Nightingale, often considered the first nurse theorist, defined nursingover 100 years ago as "the act of utilizing the environment of the patient to assist him in

his recovery". She linked health with five environmental factors: pure or fresh air , pure

water ,efficient drainage , cleanliness , light, especially direct sunlight. Nightingale's

environmental factors attain significance when one considers that sanitation conditions in

hospitals of the mid-1800s were extremely poor and that women working in the hospitals

were often unreliable, uneducated, and incompetent to care for the ill. In addition to those

factors, Nightingale also stressed the importance of keeping the client warm, maintaining

a noise-free environment, and attending to the client's diet in terms of assessing intake,

timeliness of the food, and its effect on the person. Nightingale set the stage for further

work in the development of nursing theories. Her general concepts about ventilation,

cleanliness, quiet, warmth, and diet remain integral parts of nursing and health care today.

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The case of our patient is Typhoid fever. The cause of Typhoid is Salmonella. The

mode of acquiring the bacteria and so as the disease itself is through fecal-oral mode of

transmission. The bacteria is easily transmitted especially to unsanitary places or objects.

In order to provide care for our patient, we need to eradicate its reservoir in order to

prevent the bacterias survival and stop or prevent its transmission and so as help the

affected clients recover from the infection and also protecting his family. We need to

promote and maintain a clean environment conducive for a healthy living and not for

bacteria. We need to provide clean water and foods. Proper food handling and washing

before and after every procedure done should be well observed and maintained and so as

for the patient and family. They should practice having a safe food and safe eating and

living environment. Also, we need to provide a well balanced diet for the patient in order

to hydrate and fulfill the metabolic demands. Good ventilation and comfort should also be promoted so that our patient will feel quite relaxed and have a happy and healthy

disposition. All in all, this sums up to promoting wellness.

Dorothy Johnson Behavioral System (JBS) Model

Johnson states that a nurse should use the behavioral system as their knowledge base, comparable to the biological system that physicians use as their base of knowledge.

The reason Johnson chose the behavioral system model is the idea that "all the patterned,

repetitive, purposeful ways of behaving that characterize each person's life make up an

organized and integrated whole, or a system". Johnson states that by categorizing

behaviors, they can be predicted and ordered. Johnson categorized all human behavior

into seven subsystems: Attachment, Achievement, Aggressive, Dependence, Sexual,

Ingestive, and Eliminative. Each subsystem is composed of a set of behavioral responses

or tendencies that share a common goal. These responses are developed through

experience and learning and are determined by numerous physical, biological,

psychological, and social factors. Four assumptions are made about the structure and

function of each subsystems. These four assumptions are the "structural elements"

common to each of the seven Subsystems. The first assumption is "from the form the

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Seventh, engaging in genuine teaching-learning experience that attends to the

patients health care needs.

Eight, creating healing environment at all levels, physical, social, emotional,

mental, spiritual, and consciousness. Thereby, wholeness, beauty, comfort, dignity, and

peace must be enhanced.

Ninth, assisting with basic needs, with an intentional caring consciousness,

administering human care essentials' and examples of needs maybe according to

Maslows hierarchy of needs.

Tenth, Opening and attending to spiritual-mysterious and existential dimensionsof one's own life-death, soul care for self and the one-being-cared-for and so in attending

to the patient we should be open-minded regarding the patients beliefs.

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XVI. Nursing Care Plans

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XVII. Health Teachings

1. Wash your hands. Frequent hand washing is the best way to control infection.

Wash your hands thoroughly with hot, soapy water, especially before eating or

preparing food and after using the toilet. Carry an alcohol-based hand rub for times

when water isn't available.

2. Avoid untreated water. Contaminated drinking water is a particular problem in

areas where typhoid is endemic. For that reason, drink only bottled water or canned

or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer

than still water is. Wipe the outside of all bottles and cans before you open them.

Ask for drinks without ice. Use bottled water to brush your teeth, and try not to

swallow water in the shower.

3. Avoid raw fruits and vegetables. Because raw produce may have been washed in

unsafe water, avoid fruits and vegetables that you can't peel, especially lettuce. To

be absolutely safe, you may want to avoid raw foods entirely.

4. Choose hot foods. Avoid food that's stored or served at room temperature.

Steaming hot foods are best. And although there's no guarantee that meals served at

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the finest restaurants are safe, it's best to avoid food from street vendors it's

more likely to be contaminated.

5. Get Vaccinated- Typhoid fever vaccine. one is injected in a single dose, and the

other is administered orally over a period of days. Neither is 100 percent effective,and both require repeat vaccinations.

6. Appropriate systems for human waste disposal must be available. S.typhi can

only be shed through human feces. It is therefore of utmost importance that human

waste be disposed in a most appropriate manner to avoid spread of bacteria.

To prevent infecting others

If you're recovering from typhoid or paratyphoid, these measures can help keep others

safe:

1. Wash your hands often. This is the single most important thing you can do to keep

from spreading the infection to others. Use plenty of hot, soapy water and scrub

thoroughly for at least 30 seconds, especially before eating and after using the

toilet.

2. Clean household items daily. Clean toilets, door handles, telephone receivers and

taps at least once a day with a household cleaner and paper towels or disposable

cloths.

3. Avoid handling food. Avoid preparing food for others until your doctor says you're

no longer contagious. If you work in the food service industry or a health care

facility, you won't be allowed to return to work until tests show that you're no

longer shedding typhoid bacteria.

4. Keep personal items separate. Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water. Heavily soiled items can be

soaked first in disinfectant.

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XVIII. DISCHARGE PLAN

Medication

*Cephalosporins (sef-a-loe-SPOR-ins) are used in the treatment of

infections caused by bacteria. They work by killing

bacteria or preventing their growth.

-Cephalosporins may be taken on a full or empty stomach. If

this medicine upsets your stomach, it may help to take it

with food.

* Ampicillin are used to reduce the development of drug-resistant bacteria

and maintain the effectiveness of Ampicillin and other antibacterial drugs, Ampicillin

should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.

*Ciprofloxacin is used to treat bacterial infections in many different parts of

the body. They work by killing bacteria or preventing their growth.

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Exercise

*Regular exercises aides in achieving and maintaining an optimum level of wellness and health. This may help in avoiding diseases and disorders.

Treatment/therapy

*Water therapy helps in recovery from the illness.

Hygiene

*S.typhi is shed in human feces. Advise the patient to maintain proper hygiene, especially after voiding to avoid spreading the disease.

*Advise the patient not to handle food or participate in food preparation.

*Educate significant others on importance of sanitary food preparation.

Outpatient

1. Water must be properly filtered and boiled before drinking if it is from an

unreliable source.

2. Food must be properly washed and then cooked3. One must not eat or drink in suspected unhygienic or unreliable places.

4. Express importance of compliance to prescribed mediations.

Diet

Diet: Rich in Carbohydrates, proteins and fats

1. Food must be simple and easy to digest, avoid all kinds of spices on food.

2. Food should be cooked well, but not overcooked as that would make it difficult todigest.

3. If diarrheas develop in typhoid increase fluid intake such as soups, curries, gravies

and fruit juice. Vitamin B and C foods must be consumed in order to compensate

for the losses of those vitamins.

4. Eggs and milks are suitable proteins that can be consumed during typhoid fever.

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5. Vegetables oils and milk products such as butter, cheese, cream and emulsified

fats can be consumed. Wheat, rice, potatoes and other foods that are high in

carbohydrates are advised

XIX. PrognosisCRITERIA POOR FAIR GOOD JUSTIFICATION

1.Onset of

illness

The progression of thypoid fever

includes an incubation period of 2-3

weeks, in which the first week isasymptomatic. This explains why the

client sought admission only when

symptoms began to appear and the

bacteria were already in systemic

circulation.2. Duration of

illness

As of the writing of this study, the

client has had the illness for almost 3

weeks. He began proper treatment 9

days after the appearance of symptoms,

which would suggest that the disease is

already in its second week of

progression. We rated this parameter

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fair because proper treatment was given

at just the right time, although the

patient could have sought professional

help sooner.3. Precipitating

factors

Health teachings were given to the

patient and his family regarding the

causes of the disease. The precipitating

factors of this case were highly

modifiable and so we gave this

parameter a good rating.4. Attitude and

willingness to

take medication

Kyle was very willing to take his

medications and he and his family were

observed to have complied with the

treatment regimen being given. As for

this reason, we rated this parameter as

good.5. Family

Support

Kyles family is very supportive as

provided whatever they could to help in

their sons recovery. They also listened

intently when health teachings were being given to prevent reoccurrence of

the disease.6. Age Tyhpoid fever does not affect a specific

age group. It can be acquired by anyone

who accidentally ingests the S.typhi

bacteria.7. Environment The familys house is situated near a

river wherein which carabaos bathe andother humans defecate. Kyle is fond of

swimming in the river which may cause

infection due to the contaminated water.

POOR: Onset of Illness, Environment

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FAIR: Duration of Illness, Age

GOOD: Precipitating Factors, Attitude & Willingness to Take Medication, Family

Support

Computation:

Number of categories rated POOR x1 + Number of categories rated FAIR x2 +

Number of categories GOOD x3 divided by TOTAL number of categories = score of

general prognosis.

= 2 + 2(2) + 3(3)

= 2 + 4 + 9

= 15/7

= 2.1 (Good)

Scoring for general Prognosis:

1 1.6 = POOR

1.7 2.3 = FAIR

2.4 3.0 = GOOD

General Prognosis:

Based on above criteria, our patient Kyle has a good prognosis.

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I. References

Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Geissler-Murr, Nursing

Care Plans Guidelines for Individualizing Nursing Care, 6 th Edition, Copyright

2002 F.A. Davis Company

Suzanne C. Smeltzer, Brenda G. Bare, Brunner and Suddharts Textbook of

Maedical-Surgical Nursing, 10 th Edition, Copyright by Lippincott William and

Wilkins, 2004

Barbara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder, Fundamentals of

Nursing, Concepts, Procxess and Practice, 7th

Edition, Philippine Edition

published by PEARSON EDUCATION SOUTH ASIA LTD., Copyright 2004

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Marrilynn E. Doenges, Mary Frances Moorhouse, Alice C. Geissler-Murr, Nurses

Pocket Guide, Diagnoses, Interventions and Rationales, 9 th Edition, Copyright

2004 by F.A. Davis Company

Sylvia A. Price, Lorraine M. Wilson, Pathophysiology, Clinical Concepts of

Disease Process, 4 th Edition, Copyright 1992 by Mosby-Year Book, Inc.

Wilson, Shannon, Stang, Prentice Hall, Nurses Drug Guide 2005, Copyright

2005 by Pearson Education, Inc., Upper Saddle River, NJ 07458

Amy M. Karch, 2003 Lippincotts Nursing Drug Guide, Copyright 2003 by

Lippincott Williams and Wilkins

Rick Daniek, Nursing fundamentals, Caring and Clinical Decision Making,

Thanson Asian Edition, Copyright 2004 by Delmar, a division of Thomsom

Learning, Copyright 2002 by F.A. Davis Company

Marilyn E. Doenges, Macy Frances Moorhouse, Nurses Pocket Guide: Nursing

Diagnoses with interventions, 3 rd Edition, Copyright 1991 by F.A. Davis

Company

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Edited by: William A. Sodeman, Pathologic Physiology Mechanisms of Disease,

Illustrated, 2 nd Edition, Copyright, 150, by W.B. Saunders Company

Internet Sources:

- http://www.metagenics.com/ADAM/41/024200.html

- http://en.wikipedia.org/wiki/Typhoid_fever

- http://www.ecureme.com/emyhealth/data/Enteric_Fever.asp
http://www.metagenics.com/ADAM/41/024200.htmlhttp://en.wikipedia.org/wiki/Typhoid_feverhttp://www.metagenics.com/ADAM/41/024200.htmlhttp://en.wikipedia.org/wiki/Typhoid_fever

FINAL BURN CD-TYPHOID FEVA

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