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Unciano Colleges Antipolo Inc.
Circumferencial road, Antipolo City
A case study of
In partial fulfillment of requirements in
NCM 101
Submitted by:
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I. TABLE OF CONTENTS
I. Table of contents 2
II. Acknowledgement 3
III. Introduction 4
IV. Background of the study 5
V. Objectives 6
VI. Patients Profile 7
VII. Nursing History 8-10
VIII. Pediatric Assessment 11-18
IX. Anatomy and Physiology 19-21
X. Pathophysiology 22-23
XI. Laboratory Results 24-26
XII. Drug Study 27-29
XIII. Nursing Care Plan 30-34
XIV. Evaluation 35-36
XV. Bibliography 37
XVI. Consent Form 38
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II. ACKNOWLEDGEMENT
We, the 3rd year Nursing students of, Section D Group 3 of Unciano Colleges
Antipolo, Inc. - Antipolo City would like to thank our clinical instructor , Mrs. Nhina
Sandeep S. De Rosas, RN, for the knowledge that she imparted to us during our duty in
Carlos Medical and Maternity Clinic. Her active supervision has been a guiding light
during the making of our case study.
We would also like to extend our gratitude to the management and staff ofCarlos
Medical and Maternity Clinic who accepted us wholeheartedly.
We wish to express our heartfelt gratitude to our client and his family for their
cooperation as we make our assessment and also for giving us information about his
health condition.
Much credit is also given to our dear parents and family for supporting us
emotionally and financially as we conduct this case study.
We also like to thank each other. This case study is a synergetic effort and would
not have been made possible without the cooperation and hard work of every member of
the group.
And above all, we would like to give thanks to ourGodAlmighty for giving us
the wisdom, strength and endurance in making our case study worthy and for giving us
the opportunity to realize the essence of nursing as a profession and as a vocation.
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III. INTRODUCTION
Nursing is a learned practice discipline with the ultimate goal of contributing as
individuals, collaborative with others and to the promotion of the clients optimum level
of functioning through health teachings and maximum delivery of case.
Mastering the skills and procedures of nursing practice is essential and is a must.
To survive in nursing practice, one must be able to utilize both hands as well as the head
to be well prepared in dealing with existing and potential problems of the client.
During our exposure in different hospitals we are able to render the proper
attitude towards our client, enhance the knowledge and practice the skills that we have
learned from Unciano Colleges Antipolo.
Our client B.A. is the subject in our case study. We have chosen him to be our
case presentation because our patient is cooperative and easy to talk to. The case
improved our attitudes, skills, and knowledge towards our patient and further gave us
insights on our chosen path. We chose this case to widen our knowledge in Anatomy and
Physiology of the Digestive System and the mechanism and action of Typhoid Fever,
and, to give our best to our clients.
This case study enhanced our knowledge and developed our skills in nursing
process, like assessing the client to come up with the Nursing Diagnosis, formulating
goals and performing interventions with regards to meet our goals.
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IV. BACGROUND OF THE STUDY
Typhoid fever, also known as enteric fever, Salmonella typhi or commonly justtyphoid, is an illness caused by the bacterium Salmonella enterica serovar typhi.Common worldwide, it is transmitted by the ingestion of food or water contaminated with
feces from an infected person. The bacteria then perforate through the intestinal wall and
are phagocytosed by macrophages. Salmonella typhi then alters its structure to resistdestruction and allow them to exist within the macrophage. This renders them resistant to
damage by PMN's, complement and the immune response. The organism is then spread
via the lymphatics while inside the macrophages. This gives them access to thereticuloendothelial system and then to the different organs throughout the body. The
organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella.
The bacteria grows best at 37 C/99 F human body temperature.
S. typhi bacteria are passed into the stool and urine of infected patients. They maycontinue to be present in the stool of asymptomatic carriers, who are persons who have
recovered from the symptoms of the disease but continue to carry the bacteria. This
carrier state occurs in about 3% of all individuals recovered from typhoid fever.
Typhoid fever is passed from person to person through poor hygiene, such as incompleteor no hand washing after using the toilet. Persons who are carriers of the disease and who
handle food can be the source of epidemic spread of typhoid. One such individual gave
her name to the expression "Typhoid Mary," a name given to someone whom othersavoid.
EPIDEMIOLOGY:
With an estimated 16-33 million cases of annually resulting in 500,000 to 600,000deaths in endemic areas, the World Health Organization identifies typhoid as a serious
public health problem. Its incidence is highest in children and young adults between 5
and 19 years old.
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http://en.wikipedia.org/wiki/Bacteriumhttp://en.wikipedia.org/wiki/Salmonella_typhihttp://en.wikipedia.org/wiki/Salmonella_typhihttp://en.wikipedia.org/wiki/Salmonella_typhihttp://en.wikipedia.org/wiki/Feceshttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Macrophageshttp://en.wikipedia.org/wiki/Granulocytehttp://en.wikipedia.org/wiki/Reticuloendothelial_systemhttp://en.wikipedia.org/wiki/Gram-negative_bacteriahttp://en.wikipedia.org/wiki/Flagellumhttp://en.wikipedia.org/wiki/Celsiushttp://en.wikipedia.org/wiki/Fahrenheithttp://www.healthline.com/adamcontent/typhoid-feverhttp://en.wikipedia.org/wiki/Bacteriumhttp://en.wikipedia.org/wiki/Salmonella_typhihttp://en.wikipedia.org/wiki/Feceshttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Macrophageshttp://en.wikipedia.org/wiki/Granulocytehttp://en.wikipedia.org/wiki/Reticuloendothelial_systemhttp://en.wikipedia.org/wiki/Gram-negative_bacteriahttp://en.wikipedia.org/wiki/Flagellumhttp://en.wikipedia.org/wiki/Celsiushttp://en.wikipedia.org/wiki/Fahrenheithttp://www.healthline.com/adamcontent/typhoid-fever8/9/2019 Cardy Age Umc
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V. OBJECTIVES
A. General Objectives
Within 32 hours of exposure Carlos Medical and Maternity Clinic, we, the 3rd
year Nursing students, section D group 3 of Unciano Colleges Antipolo, aim to convey
our empathy to our patients in the ward and learn and have knowledge trough our skills
that we do all throughout our rotation in providing holistic care to all our patients in the
ward.
B. Specific Objectives
To be able to establish nurse patient relationship that would build rapport for the
effective and informative interactions with the patient and the significant others.
To be able to assess health problem and condition using the Pediatric Assessment.
To be review the Anatomy and Physiology of the Digestive System and the
pathophysiology of Typhoid Fever.
To be able to gather necessary data and identify needs in order to formulate
specific nursing care plans.
To be able to formulate the care for the nursing care plan.
To be able to impart health teachings relevant to his condition.
To be able to evaluate the effectiveness of our nursing interventions.
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VI. PATIENTS PROFILE
Case Number : 29614
Patients Name : S.G
Address : Antipolo City
Date of Birth : June 28, 2006
Age : 3years old
Sex : Female
Status : Single
Religion : Roman Catholic
Chief Complaint : LBM
Final Diagnosis : AGE
Time and Date of Admission : April 25, 2010 / 3:00 pm
Admitted by : Dr. Fabros
Ward : Private Room 315
Date of Assessment : April 26, 2010
Time of Assessment : 5:00 pm
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VII. NURSING HISTORY
Chief Complaint: Nagtatae ang anak ko, as verbalized by the mother of the patient.
History of Present Illness
According to her mother, 2 days prior to admission, April 24, 2010, she noticed
that her daughter S.G defecated more often. From her usual 2 times a day, S.G defecated
about 4-5 times. But she just ignored it and has not taken any actions
April 25, 2010 at around 1:00pm her mother noticed that S.G is warm to touch.
She then gave her Tempra 125mg. 5ml for one time. But the fever did not cease. She then
decided to bring her to the nearest hospital, Unciano Medical Hospital
On arriving at the hospital she was taken to the emergency room. Her vital
signs were taken and recorded at;
Pulse rate - 97 bpm
Respiratory Rate - 23 cpm
Temperature - 38.1oC
She was given Paracetamol 125mg 5ml STAT for her fever. The doctor on duty
examined her and ordered for admission. She was given Intravenous fluid of D50.3NaCl
L X 75cc/hr at 470cc level inserted at her right metacarpal vein. The doctor ordered the
following medications; Diazepam 5 mg 0.5 ml TIV PRN for active seizures,
Met6ronidazole125/9mL q 80, and Tempra 2.5 ml PO q 4o. The attending physician, Dr.
Fabros made request for Hematology, fecalysis and urinalysis.
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At about 3:00 pm she was brought to Private room 315 with the diagnosis of
Acute Gastroenteritis.
History of Past Illness
According to her mother, our client has not been hospitalized 5 years ago. But
only experienced common cough and colds and took OTC medicines such as
Carbocisteine and Paracetamol to relief illness.
Heredo familial History
According to her mother she cannot recall that there is notable disease in the
family.
Socio Economic Status
Her mother is as Pharmacist at mercury Drug Corporation for 7 years in Antipolo.
She will take charge for her daughters hospital bills and other expenses. She did not
mention the occupation of her husband and their salary as well.
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Immunization:
Vaccine No. of Shots 1st/2nd/3rd Dose
BCG 1 1st Month
DPT 3 2nd/3rd/4th Month
OPV 3 2nd/3rd/4th Month
Hepatitis B 3 2nd/3rd/4th Month
Measles 1 9th Month
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VIII. PEDIATRIC ASSESSMENT
A. Physical Growth and Development
Weight: 13 kg
Normal Value: 13-18 kg
Remarks: within appropriate range
Height: 97 cm
Normal Value: 87-104 cm
Remarks: within appropriate range
Our client, S.G looks kempt. She has round face and body build. Her body is
symmetrical. Her look is appropriate to her age.
During our assessment S.G is smiling to us and does the activities I asked her to
do but she does not respond to all our questions because of being shy.
B. Motor Development
i. Gross Motor Adaptive
According to her mother SG can go upstairs on her own. She loves to play Barbie
dolls with her cousin. We asked SG to perform activities to test her gross motor skills. I
asked her to sit and walk on will. While lying she turns from side to side. She can stand
erect. She was able to walk, sit and stand when we asked her to.
During our assessment SG is sometimes moving bed from one place to the other
to get her toys. We also saw her playing with her mother her favorite Barbie doll.
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ii. Fine Motor Adoptive
According to her mother SG can eat on her own. Her mother also observed that
SG loves to draw. Her mother said that SG always looks for pen and paper where she can
write and draw. She can also wear her clothes by herself.
C. Language and Learning
During our assessment, we observed that SG can already express her feelings and
demands. She responds to our questions when she feels like to answer. Like when she
first answered our question that what is her favorite food, she quickly responded by
saying adobo at sinigang. She can speak and understand using tagalong words. She is
able to communicate her wants and rejections by saying gusto ko ng at ayaw.
According to the studies she should have been speaking at most 2000 words. Her words
are not clearly stated but we are still able to understand what she is trying to say.
We asked her to answer 1+1 she just smiled to us and didnt answer.
D. Playing
SG loves to play at home together with her friends and her cousin. She loves to
play like Barbie Doll. She also loves to play bahay-bahayan. She also loves to show her
friends her favorite Doll. At her stage she is currently on the bridge of the parallel play of
toddlerhood and the competitive play of the pre-schooler. Her plays are more of
competitive as she loves to play with others wanting to be the center of the play.
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E. Nutritional Assessment
We asked her mother about SGs appetite. According to her mother SG eats a lot
before hospitalization. She really likes to eat adobo and sinigang. She especially likes
sabaw for her food. She also loves to eat fruit but not very likely to vegetables.
According to her mother she likes to samalamig from the store beside their
house. She also likes to eat junkfoods, stick-O and candies. She also likes to eat fish-ball
that passess trough their house during the afternoon. According to her mother she uses
the fish-ball as reward to encourage SG to sleep.
During our assessment when she ate her merienda, she ate on her own using
spoon but we havent seen that her hands were washed.
On observing, the color of her buccal mucosa is pinkish. Her tongue and gums is
also pink. She doesnt want us to observe her teeth but we have seen it and observed that
it is color white and has no tooth decay observed. Her lips are observably dry.
During her infancy, according to her mother, SG is bottle fed starting from birth
up to 2 years old. Her mother uses 1:1 formula a scoop of milk to 1 ounce of water.
She has IVF of D50.3NaCl L X 75cc/hr at 470cc level inserted at her right
metacarpal vein.
_______________________________________________________________________
_
F. Stages of Growth and Development
i. Developmental (Robert Havighurst)
According to this developmental theory, learning is basic to life and that people
continue to learn throughout life. A certain task arises at a certain time of life of an
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individual, successes achievement of which leads to happiness and to success with later
tasks, while failure leads to unhappiness in the individual and difficulty with later task.
These are the tasks that CR was able to perform with regards to Havighursts Age
period and Developmental Task
Learned to walk
Learned to take solid foods
Learned to talk
Learned to control the elimination of body wastes but he is not yet fully toilet
trained.
Learned to distinguish right and wrong
ii. Psychosexual (Sigmund Freud)
According to this theory, the personality develops in five overlapping stages from
birth to adulthood. If the individual does not achieve a satisfactory progression at each
stage, the personality becomes fixated at that stage.
According to Sigmund Freuds CR is on Anal stage where his center of pleasure
is his anus and bladder. He is already trained of toileting. He informs his mother when
he feels like voiding or defecating.
iii. Psychosocial (Erik Erikson)
This theory envisions life as a sequence of levels of achievements. Each stage
signals a task that must be achieved. The resolution of the task can be complete, partial or
unsuccessful. The greater the task achievement, the healthier the personality of the
person; failure to achieve a task influences the persons ability to achieve the next task.
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According to Erik Eriksons Stages of Development CR is under Early Childhood
stage and his central task is Autonomy vs. Shame and Doubt. He shows indicators
positive resolution as he is able to cooperate and to express himself. He has control over
himself of what he wants and what he does not want.
He also is showing partial resolution on late childhood stage where his central
task is Initiative versus Guilt. According to his mother, he loves to do things on his own.
iv. Cognitive (Jean Piaget)
This theory refers to the manner in which people learn to think, reason, and use of
language. It involves a persons intelligence, perceptual ability, and ability to process
information. According to this theory, cognitive development is an orderly, sequential
process in which a variety of new experiences must exist before intellectual abilities can
develop.
According to Piagets Phase of Cognitive Development, he is under
Preconceptual Phase. He tells us story of how he plays with his friends and how are they
amazed of his robot toy. He often expresses his wants. He also likes to tell story that he is
a superhero and he will fly and defeat bad guys.
v. Moral (Lawrence Kohlberg)
According to this theory, moral development progresses through three levels and
six stages. Levels and stages are not always linked to a certain development stages,
because some people progresses to a higher level of moral development than others.
According to Kohlbergs Stages of Moral Development CR is under Punishment
and Obedient Orientation Stage. According to his mother he obeys commands when he is
told to be punished of disobedience.
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G. Vital Signs
i. Body Temperature
During our assessment his temperature is 36.1oC using a digital thermometer on
his right axilla for 1 minute.
ii. Respiratory Status
His respiratory rate is 26 cpm. We observed that his respiration is rapid and deep.
We auscultated his chest using a stethoscope and asked him to inhale and exhale deeply
and softly. Soft intensity, low pitch and gentle sound were heard.
iii. Circulatory Status
The radial pulse rate of CR is 116 bpm. Each beat is strong and can be felt easily.
We got his apical pulse and recorded 120 bpm. His pulse deficit is 4bpm.
We used the blanch test to test his Capillary Refill Time. We applied pressure on
the patients right finger of his right hand and released it. His fingertips returned to its
usual color after 2 seconds, the result was normal. We also did the same to his left arm
finger and his lower extremities and obtained the same result.
H. Elimination Pattern
i. Bowel
Before hospitalization, according to his mother CR usually defecates 2 times a
day. With the stool usually soft, brown and foul odor.
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Three days before hospitalization, CR defecated 4-5 times a day. According to his
mother the stool is yellowish in color, watery and foul in odor.
We have auscultated a hyperactive bowel sound. The sound is loud and frequent
at about every 3 seconds. There are 20 sounds per minute in each of the four quadrants.
ii. Bladder
Before hospitalization he voids about 6-7 times a day. His mother told us that it is
approximately 90-100ml per voiding. 7 X 100 = 700 ml/day.
During hospitalization, according to his mother, CR urinates about 7-9 times.
Each urination is 70 ml. X 9 = 630 ml/day.
According to his mother, CR has urinated 3 times until our assessment at 11:00
am. Each urination is about 70 ml.
Approximation is used using the empty vessels of IV fluids.
I. Reproductive Assessment
According to his mother, CR is not yet circumcised. We are not able to assess his
penis because CR is shy and does not allow us to. But we saw him void and his penile
length is approximately 2 inches long.
According to his mother, his penis is smooth and proportioned, and his testes are
normal.
J. State of Skin and Appendages
i. Skin: His skin is brown and intact. There is not presence of lesions observed.
His skin is dry, and he has fair skin turgor.
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ii. Hair: His hair is black, soft and well-trimmed. The strands of his hair is thin/
He has intact scalp. There are no signs of infections or infestations seen. He has evenly
distributed hair.
iii. Nails: CRs nails have a convex curvature. His nails are noticeably long and
there is presence of dirt on finger and toe nails. The epidermis around the nails is intact.
K. State of Rest and Comfort
According to his mother, CR usually sleeps at about 1:00 3:00 pm during
daytime and 8:00pm 6:00am during the night.
During hospitalization, according to his mother, CR sleeps at about 8:00pm. His
sleep is usually disturbed because of his medications but he manages to sleep again with
ease.
He is usually, reporting to his mother pain in the abdomen. We asked him where
he usually feels the pain he pointed on the right upper quadrant of his abdomen.
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IX. ANATOMY AND PHYSIOLOGY
The Digestive System
1. Ingestion is the process of taking food into the mouth.
2. Secretion is the liberation of water, acid buffers and enzymes into the lumen of
GI tract. Within the walls of GI tract are cells that secrete a total of about 9 liters
per day of these substances in the lumen of GI tract.
3. Mixing and Propulsion is the churning and passage of food through the GI tract.
It is usually brought about by the alternate contraction and relaxation of smoothmuscle in the walls of GI tract.
4. Digestion is the mechanical and chemical breakdown of food.
5. Absorption is the passage of food from the GI tract into the blood and lymph.
6. Defecation is the elimination of indigestible substances from the GI tract to the
anus.
Important Facts of Small Intestine
1. This is where the major events of digestion and absorption occur.
2. It begins at the pyloric sphincter of the stomach, coils through the central andinferior parts of the abdominal cavity and eventually opens into the large
intestine.
3. It averages 21/2cm in diameter and the length is about 3meters or 10 feet in a
living person and about 6 meters or 21 ft in a cadaver due to loss of smooth
muscle tone after death.
4. It is divided into three segments: the duodenum, jejunum and ileum.
5. The ileocical sphincter connects the ileum to the large intestine.
6. There are many projections called circular folds or plicae circulars that
enhance absorption by increasing surface area and causing the chyme to spiralas it passes through the small intestine
7. The wall of the small intestine is composed of the same four coats that makeup the GI tract
8. The mucosa forms a series of fingerlike villi that give the intestinal mucosa a
velvetly appearance.
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The Important Facts About Large Intestine
1. Its overall functions are completion of absorption, manufacture of certainvitamins, formation of feces and expulsion of feces from the body
2. It is about 1 m long and 6 cm in diameter that extends from the ileum
to the anus, and is attached to the posterior abdominal wall by itsmesocolon.
3. Structurally the large intgestine is divided into four principal regions, the
cecum, colon, rectum and the anal canal.
4. The wall of the large intestine differs from that of the small intestine sincethere are no villi or permanent circular folds are found in the mucosa
5. The mucosa is consist of simple columnar epithelium, lamina propria andmuscularis mucosae
6. The submucosa is similar to that found in the rest of the GI tract
7. The muscularis is consist of an external layer of longitudinal muscles and
an internal layer of circular muscles
8. There are epicloic appendages, which are small pouches of visceral
peritoneum filled with fats.
PHYSIOLOGY OF DIGESTION IN THE SMALL INTESTINES
1. The first step occurs trough segmentation where major movement of the smallintestine occurs.
(1) It begins with the circular muscle fibers in the small intestines contract, anaction that constricts the intestines into segments.
(2)Next, the muscle fibers that encircle the middle of each segment contract
that further divides the segments into smaller segments.
(3) Finally, the muscle fibers that contract first will relax and each smaller
segment unite to form a large segment.
These segment occur 12-16 times a minute, pushing the chime back and forth.
2) The second process is called Peristalsis that propels the chyme onward trough the
intestinal tract to be absorbed.
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ABSORPTION AND FECES FORMATION IN THE LARGE INTESTINE
1. By the time the chyme has remained in the large intestine 3-10 hours and then
become solid or semisolid as a result of water absorption and feces will beformed.
2. Feces are consisting of water, inorganic salts, and sloughed-off epithelial cellsfrom the mucosa of GI tract, bacteria and undigested parts of food.
Peyers Patches is an oval masses of lymphoid tissue on the mucous membrane
lining the small intestine.
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X. PATHOPHYSIOLOGY OF TYPHOID FEVER
The pathophysiology of typhoid fever is a complex process which proceeds
through several stages. The disease begins with an asymptomatic incubation period of 7-
14 days, during which bacteria invade macrophages and spread throughout the
reticuloendothelial system. The first week of symptomatic disease is characterized by
progressive elevation of the temperature followed by bacteremia. The second week
begins with the development of rose spots, abdominal pain and splenomegaly. The third
week is marked by a more intense intestinal inflammatory response particularly in the
Peyers patches with associated necrosis which can result in perforation and hemorrhage.
These clinical stages are associated with complex cellular events just now being
understood.
Invading organisms pass through the intestinal epithelial cells and come into
contact with phagocytic cells in the Peyers patches of the intestinal wall. However the
macrophages do not kill the bacteria. Thence, bacterial replication is primarily
intracellular. Salmonella avoids encapsulation in lysosomes by diverting normal cellular
mechanisms. Bacteria inject effector proteins into the cells of the innate immune system
(macrophages and natural killer cells) though a type III protein secretion system (TTSS)
which stimulate both pro and anti-inflammatory responses.
Over the asymptomatic incubation period of 7-14 days the bacteria proliferate and spread
through the blood stream to other cells in the reticuloendothelial system in the liver,
spleen, bone marrow and gall bladder. As replication inside phagocytic cells continues,
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bacteria are shed into the blood stream in sustained but low concentrations and the
clinical syndrome of fever, headache and abdominal pain begins. The gallbladder is felt
to be a significant site for ongoing exposure of intestinal epithelial cells to the pathogen.
The inflammatory response to this process of repeated exposure is felt to give rise to the
necrosis which is a prominent feature of the disease. This occurs in areas of greatest
macrophage concentration such as the Peyers patches and explains why intestinal
bleeding and perforation are the most frequent complications. Elsewhere typhoid nodules,
foci of macrophages and lymphocytes proliferate. As the infection progresses the typical
changes of sepsis accumulate in the heart, brain and kidneys. If not interrupted this
process may lead to circulatory failure and death from overwhelming sepsis.
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XII. Laboratory Results
Hematology Date: September 1, 2009
Parameters Result Reference Significance
WBC 7.0X109 5.0-10.0 X 106 u/l Primarily protects the body
against infection and tissueintegrity.
Neutrophils 0.72 0.45-0.73 Phagocytosis (ingestion anddigestion of bacteria and
particles)
Lymphocytes 0.27 0.2-0.4 Integral component of immune
system
Monocytes 0.01 0.02-0.08 Enters tissue as macrophage;
highly phagocytic, especiallyagainst fungus; immune
surveillance
RBC 4.55X1012 4.0-6.0X1012 Carries Hemoglobin to provide
oxygen to tissues; average life
span
Hemoglobin 130gm/dL 13-18gm/dL Iron-containing protein of
RBCs; delivers oxygen totissues
Hematocrit 0.39 0.42-0.52 Percentage of total bloodvolume consisting of RBCs
Acela G. Tantiongco, MD
Pathologist
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Fecalysis Date: July 10, 2009
Parameters Result Reference Significance
Apearance Brown Brown Normal
Consistency Soft formed Soft Normal
PUS Negative Negative Normal
No ova and/or parasite seen
Serology
Ig M Positive
Ig G Positive
Acela G. Tantiongco, MD
Pathologist
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URINALYSIS July 7, 2009
TEST RESULT NORMAL VALUES SIGNIFICANCE
Color Yellow Yellow Normal
Transparency Clear Clear NormalPH (reaction) Neutral Acidic A pH below 7 indicates acidity
and a pH in excess of 7
indicates alkalinity
Specific Gravity 1.020 1.015-1.025 Normal
Glucose (-1) Negative Normal
Protein (albumin) (-1) Negative Nrmal
Acela G. Tantiongco, MD
Pathologist
XIII. DRUG STUDY
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DRUGNAME
CLASSIFICATION &
INDICATION
ACTION ADVERSEREACTION
NURSING RESPONSIBILITY
DIAZEPAM
5 mg 0.5 mlTIV PRNFor active
siezure
C:
benzodiazepine
I: Statusepelepticus,severe recurrentseizures
A benzodiazepine
that probablypotentiates theeffects of GABA,depresses the CNSand suppresses thespread of seizureactivity
No adverse reaction
seen on the patient.
Possible adversereaction:
Drowsiness,dysarthria, slurredspeech, fatigue,headache andinsomnia.
>Warn the patients SO to
avoid activities that requirealertness and goodcoordination until effects ofdrugs are known.>Warn patient not toabruptly stop drug becausewithdrawal symptoms mayoccur.
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DRUGNAME
CLASSIFICATION &
INDICATION
ACTION ADVERSEREACTION
NURSING RESPONSIBILITY
Ceftriaxone
Sodium1 gm, TIV od
(-) ANST
C: Third generationcephalosporin
I: Acute Bacterialinfection
Inhibits cell wallsynthesis, promoting
osmotic instability; usually
bactericidal
No adverse reactionnoted in the patient
Possible adversereactions:
Fever, headache,dizziness, chills.
If large doses are given. Therapyis prolonged, or patient is at highrisk, monitor patient for signs f super
infection
Tell patients SO to reportadverse reaction promptly.
Tell patients SO to notifyprescriber about loose stool or
diarrhea.
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DRUGNAME
CLASSIFICATION &
INDICATION
ACTION ADVERSEREACTION
NURSING RESPONSIBILITY
Tempra
2.5 ml, 125 mg
q 4o PO
C:
Paraaminophenol
I: Mild pain or fever
Thought toproduce analgesia by
blocking pain impulses
by inhibiting synthesisof prostaglandin in theCNS or of other
substances that
synthesizes painreceptors to stimulation.
The drug may relievefever trough central
action in the
hypothalamic heat-regulating center.
Adverse reaction:
No adverse reaction
noted in the patient
Possible adverse
reaction:
Hemolytic anemia,
jaundice, hypoglycemia,rash
May decrease glucose andhemoglobin levels and hematocrit.
Warn patients SO that highdoses or unsupervised long termuse can cause liver damage.
Contraindicated with patientshypersensitive to drug.
XIII. NURSING CARE PLAN
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CUES / DATA NURSING
DIAGNOSIS
GOALS OF
CARE
NURSING INTERVENTIONS EVALUATION
Subjective:
masakit ang tiyan nganak ko as verbalized
by the mother of the
patient
Objective:
Expressive
behavior such asmoaning, crying
and irritability
Distraction behavior such as
pacing and
repetitiveactivities
Facial grimace
Facial pain scale
of
Acute pain
related to biological injuring
agents specifically
infections as
evidenced byexpressive anddestruction
behavior and facial
grimace and facialpain scale of
Within 1
hour of nursinginterventions the
client will
demonstrate
behavior that showsalleviation pain.
Independent
Provided Comfort measuressuch as back rubbing and
change in position
> To provide non-
pharmacologic painmanagement.
Encouraged divisional
activities such as toys, plays
and others.> To divert attention from
pain.
Re-check for the vital signs.
> Usually altered in acute
pain
Dependent
Administered analgesics as
indicated to maximal dosage
as needed (Tempra)> to maintain acceptable level of
pain.
After 1 hour of
nursing interventionsthe client has
demonstrated behavior
that shows alleviation
pain.
Goal met.
CUES / DATA NURSING
DIAGNOSIS
GOALS OF
CARE
NURSING INTERVENTIONS EVALUATION
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Subjective:
madaming beses nasiyang dumudumi as
verbalized by the mother
of the patient
Objective:
Decrease urineoutput
Dry lips
Dry skin
Weakness
Isotonic fluid
volume deficitrelated to active
fluid volume lost
specificallydiarrhea.
Within 30
minutes of nursingintervention the
clients mother will
verbalizeunderstanding of
causative factorsand purpose of
individual
therapeuticinterventions and
medications.
Independent
Kept fluids within clientreached and encouraged the
SO to increase the fluid intakeof the client.
Discussed the effects of
humidity and ambient airtemperature.
Reduced beddings clothes,
provide TSB> Reduced metabolic rate
Encouraged to change position frequently.
>To promote comfort and
safety
Encouraged the mother to
provide frequent oral care
>to prevent injury fromdryness
Discussed factors related tooccurrence of dehydration
After 30
minutes of nursingintervention the
clients mother has
verbalizedunderstanding of
causative factors and purpose of individual
therapeutic
interventions andmedications.
Goal met.
CUES / DATA NURSING GOALS OF NURSING INTERVENTIONS EVALUATION
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DIAGNOSIS CARE
Subjective:
Binibigyan ko siya ng
fishball para makatulogsiya sa hapon as
verbalized by the mother
of the patient
Objective:
Verbalization of
wrong actions.
Inadequateperformance
Deficientknowledge
regarding lifestylerelated to
unfamiliarity with
information.
Within 30minutes of nursing
intervention theclients SO will
verbalize
understanding of
conditions andindividual riskfactors.
Independent
Provided information relevant
to situation
Provided positive
reinforcements. Avoid
negative reinforcements.
Provided information for
clients SO
>Reinforces learning
process
Begin with information the
client already knows and
move to what the client doesnot know, progressing from
simple to complex.
>Limits sense of
overwhelmed.
Provided information about
additional learning resources.>May assist in further
learning/promote learning
at own pace.
After 30minutes of nursing
intervention theclients SO has
verbalized
understanding of
conditions andindividual risk factors.
Goal met.
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CUES / DATA NURSING
DIAGNOSIS
GOALS OF CARE NURSING INTERVENTIONS EVALUATION
Subjective:
Paano kaya nakukuhang anak ko ang sakit
niya? as verbalized by
the mother of the patient
Readiness for
enhanceknowledge on
health.
Within 30
minutes of nursingintervention the
clients SO will
verbalize
understanding ofinformation gain.
Independent
Verified clients SO level ofknowledge about specific
topic.>Provides opportunity to
assure accuracy andcompleteness of knowledge
base for future learning.
Determinedmotivation/expectations for
learning.
>Provides insight useful in
developing goals and
identifying information
needs.
Assisted clients SO to
identify learning goals.>Helps to frame or focus
content to be learned and
provides measure to
evaluate learning process.
Identified/provided
information in valid formats
appropriate to clients
After 30
minutes of nursingintervention the
clients SO has
verbalized
understanding ofinformation gain.
Goal met.
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learning style.
CUES / DATA NURSING
DIAGNOSIS
GOALS OF CARE NURSING INTERVENTIONS EVALUATION
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Objective:
Salmonella
Typhi infection
Risk for infection
related toinsufficient
knowledge to
avoid exposure topathogens.
Within 30
minutes of nursingintervention the
clients SO will
verbalizeunderstanding of
individualcausative/risk
factors.
Independent
Note risk factors for occurrence of infection.
Health Teachings:
Ensuring proper
environmental sanitation Hygienic sewage
disposal systems in a
community as well as
proper personal hygieneare the most important
factors in preventingtyphoid fever.
Proper handling and
cooking of foodsspecially on meats
Avoid the foods that arenot properly cooked
Safe source of water
After 30
minutes of nursingintervention the
clients SO has
verbalizeunderstanding of
individualcausative/risk factors.
Goal met.
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XIV. EVALUATION
A. General Objectives
After 32 hours of exposure Carlos Medical and Maternity Clinic, we, the 3rd year
Nursing students, section D group 3 of Unciano Colleges Antipolo, was able to convey
our empathy to our patients in the ward and learned and had knowledge trough our skills
that we do all throughout our rotation in providing holistic care to all our patients in the
ward.
B. Specific Objectives
We were able to establish nurse patient relationship that would build rapport for
the effective and informative interactions with the patient and the significant
others.
We were able to assess health problem and condition using the Pediatric
Assessment.
We were able to review the Anatomy and Physiology of the Digestive System and
the pathophysiology of Typhoid Fever.
We were able to gather necessary data and identify needs in order to formulate
specific nursing care plans.
We were able to formulate the care for the nursing care plan.
We were to impart health teachings relevant to his condition.
We were able to evaluate the effectiveness of our nursing interventions.
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Health Teaching
Ensuring proper environmental sanitation
Hygienic sewage disposal systems in a community as well as proper personal
hygiene are the most important factors in preventing typhoid fever.
Proper handling and cooking of foods specially on meats
Avoid the foods that are not properly cooked
Safe source of water
Discharge Plan
Advised patient to follow medication regimen properly.
Advised the patient to take adequate rest
Prognosis
Our patient chance is recovery is high. During our rotation in Carlos Medical and
Maternity Clinic, our client CR was able to recover and got home on September 4, 2009.
He is expected to resume his ADLs as soon as he had enough of rest. The mother is
advised to watch out for possible re-infection of salmonella typhi virus and to be carefull
of possible seizures.
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XV. BIBLIOGRAPHY
1. Marieb, Elaine RN; Essentials of Human Anatomy and Physiology 6th Edition
2005
2. Kozier, Barbara RN et al;Fundamentals of Nursing7th Edition2004
3. Smeltzer Suzanne EdD, RN, FAAN et al; Textbook of Medical-Surgical Nursing
11th Edition 2008
4. Doenges, Marilyn RN, BSN, MA;Nurses Pocket Guide 9th Edition 2004
5. Palma, Gregory Navarro; G&A Notes 2nd
Edition2009
6. Divinagracia, Carmelita;PDDs Nursing Drug Guide 2nd Edition 2008
7. Wiley, John; The Bantam Medical Dictionary 5th Edition 2004
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