typhoid fever nursing management

Typhoid fever otherwise known as enteric fever is an acute illness associated with fever caused by Salmonella typhi bacteria. Although the disease is curable it can cause death if left untreated.

The most common spread of Typhoid Fever

The Fecal-Oral route is the most common way of spreading typhoid fever. This method takes place when food or drinking water is contaminated with feces from a person infected with the disease. This happens when a person infected does not wash his/her hands well after using the bathroom. A former patient of the disease is also able to carry the bacteria in his/her intestinal tract or gallbladder even after recovery and spread the disease. Furthermore, flying insects that feed in feces can spread the bacteria in unhygienic places such as public areas.

Outbreak

The most recent outbreak of Typhoid Fever in the US was reported in 2010  in California Nevada. Where in 7 patients were hospitalized due to contaminated tropical fruit products positive for bacteria that causes typhoid.

In the Philippines recent outbreak declared in Tuburan Cebu City after recording 924 cases of typhoid and three deaths. The Department of Health presumed that the resident’s contaminated water was the source of the disease.

Sign and Symptoms

  • Fever as high 40 C° (104 F°)
  • Headache
  • Stomach pain
  • Weakness
  • Diarrhea or constipation
  • Loss of appetite and severe weight loss
  • Rash with flat rose-colored spots

Incubation Period

Average of 2 weeks usual range  1 to 3 weeks

Laboratory Diagnosis of Typhoid Fever

Of the various test available, laboratory of typhoid fever is based on two methods isolation of the causative organism, Salmonella typhi from suitably obtained clinical specimens like blood, bone marrow aspirate, urine, and stools and detection of S.typhi antigens by Widal test.

An ideal diagnostic test should be sensitive, specific, and suitable for early diagnosis. It should be simple and inexpensive too because typhoid fever is endemic mainly in less developed countries. Most of the tests available do not specifically fulfill these criteria so before arriving at a diagnosis of the disease one has to rely on the clinical picture, as well as the course of the disease.

Treatment

The conventional therapy for uncomplicated cases of typhoid fever is as follows:
Chloramphenicol 3-4 gm per day PO in 4 divided doses for 14 days or
Co-Trimoxazole forte or double -strength tab twice a day PO for 14 days or
Amoxicillin 4-6 gm per day PO in 3 divided doses for 14 days

Nursing Management

Health Teaching

  • Teach members of the family how to report all symptoms to the attending physician especially when the patient is being cared for at home
  • Teach, guide and supervise members of the family on nursing techniques which will contribute to the patient’s recovery
  • Interpret to family nature of disease and the need for practicing preventive and control measures.

Management

  • Demonstrate to the family how to give bedside care such as a tepid sponge, feeding changing of bed linen, use of bedpan and mouth care
  • Any bleeding from the rectum, blood in stools sudden acute abdominal pain restlessness, falling of temperature should be reported at once to the physician or the patient should be brought at once to the hospital.
  • Take vital signs and teach patient family members on how to take and record the same.

References:

  • Public Health Nursing in the Philippines  10 edition
  • Typhoid fever, its cause, transmission and prevention by S.N. Khosla

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