> Nursing Reviewer > Disease Affecting The Gastrointestinal System – Typhoid Fever

Disease Affecting The Gastrointestinal System – Typhoid Fever

AKA: Enteric Fever
Causative agent: Salmonella typhosa
Incubation period: Usually between 7 – 14 days
Period of communicability: For as long as the bacteria are in the stools
Mode of transmission:
– By food and water contaminated by stools and urine of patinets or carriers.  The vehicles are the 5 F’s: Feces, Food, Flies, Fomites, Fingers


Diagnostic/Laboratory exams:
a.  Blood culture: during the prodromal stage
– Widal test to determine the antigen left by the microorganism
> Antigen O (presently infected)
> Antigen H (has been exposed before or has received toxin)
> Typhoid (Typhidot)
b. Urine culture
c. Stool culture

Signs and Symptoms:
1.  Prodromal stage (3-4 days)
– Dull headache, malaise
– Chills; fever; body aches
– Vomiting or diarrhea
2.  Fastigeal/pyrexial stage (second week)
–  Exanthema: rose spots (4-5 peculiar rose-colored macules or maculopapules seen on the 7th to the 12th day on the abdomen and chest in adults or on the face in infants)
– Ladder-like fever
– Enlarged spleen
– Typhoid psychosis
> Coma-vigil look (pupils dilate and patient appears to have blank stares or staring without seeing)
> Difficulty putting out the tongue
> Carphologia (involuntary and aimless picking of linen)
> Subsultus tendinum (involuntary twitching of the tendon of the wrists)
> Constant tendency to slip down toward the foot of the bed
3. Deferenscence stage (3rd week)
– Intestinal hemorrhage – microorganism produces ulcers in the intestine
– Intestinal perforation – spillage of fecal materials in the peritoneum, causing peritonitis
> persistence of fever
> abdominal pain, distention and rigidity
– Cough and hypostatic congestion of the lungs; pneumonia
– Leukopenia
4.  Lysis/Convalescence stage
Although signs and symptoms subside, patient should still be observed for relapses which could be fatal

Management
Prevention
– Immunization, CDT (Cholera, Dysentery, Typhoid)
> Given 1M at the deltoid
> children; 0.25ml; Adults: 0.5 ml
> 6 months immunity
– Vivotif
> Capsule form
> Given 1 hour before meal every other day for 3 doses
> 3 years immunity
Control
– Proper handwashing; clean environment
– Boil drinking water
– Avoid street foods and improperly washed or improperly cooked food
Treatment
– Medical care
> The drug of choice is Chloromycetin
– Nursing care
> Regulation of the diet
> Prevention of dehydration
> hygiene and comfort

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