CASE STUDY ON

TYPHOID FEVER
PEDIATRIC NURSING HISTORY
1.Demographic data
Name of the child – Dhairya Patel
Age of the child - 7 years
Gender - Male
Religion - Hindu
Diagnosis - Typhoid fever
Address - Arera Colony, Bhopal
Date of admission-
2. Chief complaints-
Vomiting- 1 days
Fever with chill- 3 days
Headache- 2 days
Body ache- 2 days
3. Family history-
Family composition:
Name of the Family Relationship Age Gender Education occupation Health
Member with patient (yrs) status

Badri Prasad patel Grand Father 65 Male 11th Farmer Good

Santi baipatel Grand Mother 60 Female 10 th House wife Good

Rakesh Kumar patel Father 34 Male 12 th Private job Good

Manotammapatel Mother 32 Female 12th Private job good

Dairyapatel Herself 7 Male 2nd

c) Family income in rupees per month - Rs.20000 /month.

d) Per Capita Income- = 20000/5
= 4000 /member.
e) Religion – dhairya belongs to a Hindu family.
f) Environmental History – Three family members are living in apakka house containing four
room. proper ventilation. They use gas for cooking. They drink corporation water.
4. Birth History
a) Prenatal history – dhairyais a non-consanguineous child. Age of the mother during pregnancy
was 23 years. There is no history of infectious disease like TORCH during prenatal period.
There was no exposure to radiations during prenatal period. Patient’s mother did not take any
teratogenic medicine during her prenatal period. She had taken only iron and folic acid tablets
during pregnancy Injection TT was given during her prenatal period.
b) Natal history – After the completion of 9 month the baby was delivered in hospital with
cesarean section delivery. Birth weight of the child was about 3 kg.
c) Postnatal/Neonatal history – Child cried immediately after birth. There is no history of
asphyxia/cyanosis/birth injury/eye during post- natal period.
5. Immunization history:
S. No. Age Vaccine Route Remarks Given/
Not Given

1. At birth BCG ID

OPV zero Oral

Hepatitis B- 1 IM

2 6 week OPV-1 Oral

DPT-1 IM

Hepatitis B-1 IM

HIB- 1 lM

3 10 week OPV-2 Oral

DPT-2 IM

Hepatitis-2 IM

HIB-2 lM

4 14 week OPV-3 Oral

DPT-3 IM

Hepatitis-3 IM

HIB- 3 lM
 5 9 month Measles-1 Subcutaneous

Vitamin A Oral

6 16- 24 OPV-4 Oral

week
DPT booster 1 dose IM

HIB booster IM

Measles-2 Subcutaneous

7. 5-6 year DPT booster-2 dose IM

6. Diet history- Breast-feeding was done till 6 months. Additional food was started after 6 months.
Weaning food items included mashed potatoes mashed banana, dalia, khichdi etc. Presently
patient is taking cereals, vegetables, daal/pulses, fruits etc. He is non-vegetarian.
7. Elimination pattern- Bowel movements are regular. He did not have problems of diarrhea and
constipation. Bowel and bladder control is attained.
8. Developmental history:
S.No Milestones Normal age of Child’s age of
attaining Milestones attaining Milestones

1) Head holding 2 months .5 months

2) Social Smile 3 months 3 months

3) Sitting independently 6 months 7 months

4)
Crawling 9 months 10 months

5)
Standing 12 months 11 months
6)
Speaks ma-ma 12 months 11 months
7)
Walking starts with support 12 months 12-13 months
8)
Teething 7 months 7 months
9)
Walks independently without 13-18 months 15 months
any support
 10) Drinking well from small glass 24 months 24 months

11) Toilet trained in day-time 24 months 2-3 years

12) Bowel and bladder control 3-5 years 4 years

9. Past Medical history- my patient has no any medical history.

10. Present Medical history –Client was admitted to medical with the chief complaints of
vomiting, fever, weakness and headache which was started 3 days before the admission.He was
diagnosed with typhoid fever
PHYSICAL EXAMINATION- HEAD TO TOE ASSESSMENT
General appearance –
Body build-
Activity-He is active.
Look- The child is irritable and anxious because of complains like abdominal distention and
swelling.
Consciousness-He is well oriented to time, place and person.

Anthropometric measurements-

S.NO. Measurement Child measurement Expected Measurement

1 Height

2 Weight

3 Head circumference

4 Chest circumference

Vital sign-

S.No. Vital Signs Child’s Values Normal value

1 Temperature
2 Pulse
3 Respiration
4 Blood pressure
Integument – No bad odor was there. Skin was pink in color. Skin texture is smooth and skin turger
is good. Edema and lesions were not found over any body part. Skin is warm to touch.
Nails – Nails are yellowish in color. Shape is normal. Nails are hard, not brittle. Nails are clean and
cut properly.
Hair – Hair are equally distributed. Color of hair is black and texture is good. Scalp is clean.
Head and Neck – Skull size is normal and it is symmetrical. Neck stiffness was not found. Lymph
nodes are normal in size.
Ears – Position and placement of ears is normal. Hearing capacity is also normal.
Eyes - There is no ptosis or drooping of eyelids, eyebrows are also normal. No discoloration of
sclera is found. Pupils are equal, round, reacting to light and accommodating to light is normally.
Visual equity is 20/20.
Nose – Size and shape is normal. Foul smell was absent. Nasal flaring and frost bite are not found.
No abnormal nasal discharge was found.
Mouth & lips – Lips are pink in color. Mouth and lips are symmetrical. Buccal mucosa and tongue
are normal. Number of teeth is 24, having no dental caries. Tonsils and voice are normal.
Thorax & lungs – Lungs and thorax are symmetrical. Depth and regularity of respiration is also
normal. No abnormal sounds were heard on percussion and auscultation.
Heart – Shape and size are normal. Heart is symmetrical. S1 and S2 sounds heard on auscultation,
no abnormal sounds were heard.
Abdomen –Peristaltic waves are visible on inspection. Liver is palpable. On palpation abdominal
pain was present. Bowel sounds are normal.
Umbilicus – Discharge and bad odor were not found from umbilicus.
Groin – Hernia was not present.
Genitalia –There was no abnormal discharge.
Anal region – Fissures/prolapsed and anomalies are not found.
Breasts – Normal in shape and size.
Spine – Spine curvatures are normal. Abnormalities like discoloration, hair growth and dimple are
not found.
Extremities – Gait is normal. Creases in palm and muscle strength are normal. Pitting edema was
not found over extremities. Child felt pain during movements.
Final impression-
He is slightly irritable and anxious. Anthropometric measurements are within normal range. Mild fever is
present on the day of physical examination. Head, neck, ears, eyes, nose, mouth, lips and all other body parts
are normal. Heart and lung sounds are also normal. Child is fully conscious.
 TYPHOID FEVER
INTRODUCTION-
Typhoid fever, also known simply as typhoid, is a bacterial infection due to Salmonella typhi that
causes symptoms. which may vary from mild to severe and usually begin six to thirty days after
exposure. Often there is a gradual onset of a high fever over several days. Typhoid fever is a type of
enteric fever along with paratyphoid fever.

DEFINITION-
Typhoid fever is an acute illness associated with fever caused by the Salmonella typhi bacteria. It can
also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness.

MODE OF TRANSMISSION-
 Contaminated food
 Unboiled milk and vegetables or water.
 House flies play a significant role by carrying bacilli from urine or stool of an infected person
or active sufferer or carrier to food and products.

INCIDENCE- peak incidence of typhoid occurs in summer and rainy season, when fly population
shows enumerousincreses. It is common in infants and young children.

INCUBATION PERIOD- 10- 14 days with extremes of 5 and 40 days.

PATHOLOGY-

After ingestion of infected food

There is initial proliferation of the organism in the lymphoid tissue of intestine

Swelling of the peyer patches

Followed by invasion of the food stream

Ulceration of ileum results from shedding of intestinal lymphoid tissue

Enlargement of mesenteric lymphnodes

Focal necrosis of liver, splenomegaly, myocarditis muscle degeneration and respiratory infection

Causes and spreading of the disease-

In general-
 The disease is produced by gram-negative bacteria called as Salmonellae Typhi. The bacterium is
present in contaminated food and water.
 Children with acute illness can contaminate the surrounding water supply through the stool that
contains bacteria and in s same way, contamination of water supply can, in turn, spoil the food
supply. Outside and unhygienic food may contain bacteria. Stale food, cold food and decayed
food are main transporters for the disease to spread.
 In some cases, the children remain the carriers even after getting full treatment. The bacteria
multiply in the gallbladder, bile ducts, or liver and then get into the intestines or bowels. The
bacteria causing typhoid can survive for weeks in any water or the sewage that is dried. These
chronic carriers can have no symptoms and yet can be the sources of new outbreak of typhoid
fever for quite a long time.

In patient-
 Out side unhygienic food to eat.
 Contaminated water.

CLINICAL FEATURES-
In general-
 Rapid raise of temperature
 Extreme malaise
 Anorexia
 Headache
 Vomiting
 Abdominal pain and distention
 Diarrhoea
 A rash is said to appear about 5th day on the front and the back of the trunk
 Bacillary dysentry, respiratory infection
 Anemia
 Dry cough
 Weakness and fatigue.
In patient-
 Rapid raise of temperature
 Vomiting
 Headache
 Weakness
 Fatigue
 Anorexia

DIAGNOSTIC EVALUATION-
In general-

 History collection
 Physical examination
 Blood and bone marrow culture for salmonella typhi
 Widal test, antibody titer test
 Urine and stool culture
 ELISA and coagulatin
In patient-
1. Widal test
2. Urine analysis report
Tests Results

Colour Pale yellow

Volume 20 ml

Appearance Clear

Specific gravity 1.010

Reaction Acidic

Albumin Absent

Sugar Absent

Bile salt Absent

Bile pigment Absent

3. Heametology report-
Investigation Patient value Normal value

Hb 12.8 12.0-16.0 gm%

TLC 8400 4000-11000/cumm

ESR 20 5-15 mm
 Polymarph 67 40-60%

Lymphocyte 255 20-40%

Eosinophil 05 01-06%

Monocyte 03 02-8%

MANAGEMENT-
Pharmacological management-
 Chloramphenicol- 10-14 days
 Amoxicillin, ampicillin, cotrimoxazole and furazoledine, multiple drugs resistant strains.
 Fluroquinolene like ciprofloxacin or a third generation cephalosporin like ceftriaxone,
cefoperazone or cefatoxime with combination of aminoglycoside like gentamycin, amikacin or
vetramycin.
 Administration of oflaxacin, cefixime and ceftibutamine
 Oral cefixime
 Administration of steroids
 Blood transfusions
 Antipyretics agents
 High dose ampicillin

Non pharmacological management-.

 Light fluid and semisolid diet is advisable during the first few days.
 Vitamin and hemantic supplements
 Clean water supply
 Proper sewage disposal and control of flies.
 Education of the public
 careful disposal of the excreta, bedrest and good care, attention to maintenance of adequate fluid
and dietary intake.

Nursing management-

1. Maintain the temperature within normal limits

 Review knowledge of the client and family about hyperthermia.
 Observations of temperature, pulse, blood pressure, respiration.
 Give drink enough
 Provision of anti-pyrexia
 Parenteral fluids (IV) is adequate

2. Improve nutrition and fluid

 Assess the nutritional status of children.

 Allow the child to eat foods that can be tolerated,
 Plan to improve the nutritional quality at the child's appetite increases.
 Give the food is accompanied by a nutritional supplement to improve the quality of nutritional
intake.
 Advised the parents to provide food with a small portion technique, but often.
 Measure weight every day at the same time, and with the same scale.
 Maintaining a child's oral hygiene.
 Explain the importance of adequate intake of nutrients for healing diseases.
 Collaboration for parenteral feeding through feeding through oral if you do not meet the
nutritional needs of children

3. Prevent the lack of fluid volume

 Observation of vital signs (body temperature) at least every 4 hours

 Monitor the increasing signs of dehydration: inelastic turgor, sunken fontanel, decreased urine
production, mucosal memberan dry, chapped lips
 Observe and record the weight at the same time and with the same scale.
 Monitor the provision of intravenous fluids per hour.
 Reduce the loss of fluid that is not visible (Insensible Water Loss / IWL) to give a cold compress
or a tepid sponge.
 Give antibiotics as a program
ASSESSMENT
The nurse collects a detailed history and conducts a through physical examination to reveal the
following problems the client faces:
• Elevated body temperature.
• Dry skin and mucous membrane.
• Less intake of food.
• Anxiety among the parents.
• Increased perspiration
• Frequent questioning by parents about care of child.