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A CASE STUDY ON A PATIENTWITH TYPHOID FEVER
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INTRODUCTIION
“{Poor health is not caused by something we
don’t have ; it’s caused by disturbing something
that you already have. Healthy is not something
that you to get, it’s something you have already
if you disturb it.” ~ean !rnish
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Health is an essential part of aperson, it is the fel !hi"h #i$es e$er%
in&i$i&al the ph%si"al &ri$e nee&e& to"on'er a &a%( Withot it no )an "ansr$i$e, a &e*"ien"% in health i)pairs thenor)al fn"tionin# of a person, it +e"o)es
a hin&ran"e( Health pertains to thepersons +o&% s%ste)s as a !hole, it is nota"hie$e& if e$en onl% one +o&% s%ste) isi)paire&, a #oo& heart !ith !ea ln# still
&oes not si#nal health, there shol& +ehar)on% an& +alan"e +et!een the s%ste)to a"hie$e lti)ate health(
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TYPHOID FEVERTyphoid fever, also known as a typhoid, is a commonworldwide illness, transmitted by the ingestion of
food or water contaminated with the feces of aninfected person, which contain the bacteriumsalmonella typhi. The bacteria then perforatethrough the intestinal wall and are phagocytosed bymacrophages. The organism is gram-negative shortbacillus that is motile due to its peritrichous agella.The bacterium grows best at 37`!""`# human bodytemperature. Typhoid fever remains a seriousdisease especially di$cult to treat in developingcountries. %almonella typhi, the bacteria causingtyphoid fever, have become resistant to several
antibiotics increasing the di$culty of treating thedisease.
"htt#$%%&nowledge'storage.com%medicine%()'medicine%*+'ty#hoid'fever
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http://knowledge-storage.com/medicine/37-medicine/109-typhoid-feverhttp://knowledge-storage.com/medicine/37-medicine/109-typhoid-fever
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&n order to provide an updated assesment of the burden oftyphoid fever in 'sia, the world health organi(ation
conducted a population-based surveillance in ) 'siancountries namely* china, &ndia, &ndonesia, +akistan and
ietnam. The age groups under surveillance were selected asthose udge by local o$cials to the most appropriate targets
for typhoid vaccination* )-/year olds in hinese site0 andschool-aged children and adolescents1)-2years4 in theietnamese site. The statistics revealed the following*
' total of 552 53) persons in the targeted age groups wereunder surveillance for one year, during which 62 75 feverepisodes lasting 3days were detected and 57) persons hadblood cultured-conrmed %.typhi. The over all incidence offever lasting 3days for the ve sites combined was 5". per
2/// persons-years, ranging from 26.5 to 25." for the sitesin china and +akistan, respectively. The incidence of typhoidrange from 2).3 cases per 2/// person-years among thoseage )-/ years in china to 5)2.7 cases per 2// /// person-years among 6 to 2) years olds in +akistan. 8verall, the
%.typhi isolation rate1prevalence4was63.2 per 2/// culturedfebrile episodes and ranged from )./1vietnamese site4 to
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The statisti"s re$eal that a si#ni*"anta)ont of people !ho ha$e t%phoi& fe$erare "hil&ren( Spe"i*"all% "hil&ren !ho areat their pre-s"hool a#e as !ell as s"hoola#e( This hi#hli#hts the i)portan"e ofpri)ar% pre$ention s"h as +etter
sanitation, i)pro$e& !ater s%ste)s an&$a""ines(
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In a latest st&%, NIH s"ientists&e$elope& a $a""ine "alle& Vi, )a&e of
a pol%sa""hari&e fro) the srfa"e ofsal)onella t%phi, the +a"teria that"ase t%phoi& fe$er( It is e.e"ti$e a<s+t not in %on# "hil&ren( Clini"al trials
ha$e sho!n that "he)i"all% +in&in# theVi to a protein to for) a "on/#ate$a""ine has i)pro$e& its e0"a"% to
"hil&ren( No! NIH s"ientists ha$e&e$elope& another $a""ine for t%phoi&fe$er- sin# pol%sa""hari&e fro) frit,no!n as pectin.
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'9'T8:; '9<+=;%&8>8?;
1ASTROINTESTINA2 TRACT
-is a )s"lar t+e line& +% a spe"ial la%er of"ells, "alle& epitheli)( The "ontents of thet+e are "onsi&ere& e3ternal to the +o&% an&are in "ontinit% !ith the otsi&e !orl& at the)oth an & the ans(
The !alls is &i$i&e& into for la%ers as follo!s4
5UCOSA- the inner)ost la%er of the &i#esti$etra"t has spe"iali6e& epithelial "ells spporte&+% an n&erl%in# tisse "alle& the lamina propia.
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ANATO5Y AND PHYSIO2O1Y
SU75UCOSA
-srron&s the )s"laris )"osa an&
"onsists of fat, *+ros "onne"ti$etisse an& lar#er $essels an& ner$es(
5USCU2ARIS E8TERNA
-The s)ooth )s"le la%er has inner"ir"lar an& oter lon#it&inal la%ers of)s"le *+ers separate& +% the)%enteri" ple3s or Aer+a"h ple3s(
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ANATO5Y AND PHYSIO2O1Y
SEROSA9 5ESENTERY
-The oter la%er of the 1IT is for)e& +%
fat an& another la%er of epithelial "ells"alle& )esotheli)(
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INDIVIDUA2 CO5PONENTSOF THE 1I TRACT
ORA2 CAVITY
-is responsi+le for the intae of foo&( It is
line& +% a strati*e& s'a)os oral)"osa !ith eratin "o$erin# thoseareas s+/e"t to si#ni*"ant a+rasion,s"h as ton#e , har& palate
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INDIVIDUA2 CO5PONENTSOF THE 1I TRACT
SA2IVARY 12ANDS
-Three pairs of sali$ar% #lan&s
"o))ni"ate !ith the oral "a$it%( Ea"his a "o)ple3 #lan& !ith n)eros a"iniline& +% se"retor% epitheli)(
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INDIVIDUA2 CO5PONENTSOF THE 1I TRACT
PAROTIDS
-are lar#e, irre#lar shape& #lan&s
lo"ate& n&er the sin on the si&e ofthe fa"e( The% se"rete :;< of sali$a(
The% are sitate& +elo! the 6%#o)ati"ar"h an& "o$er part of the )an&i+le(
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INDIVIDUA2 CO5PONENTSOF THE 1I TRACT
SU75ANDI7U2AR
-se"rete =>< of the sali$a in the )oth(
The% are fon& in the ?oor of the)oth, in a #roo$e alon# the innersrfa"e of the )an&i+le(
SU72IN1UA2
-are the s)allest sali$ar% #lan&s, "o$ere&+% a thin la%er of tisse at the ?oor ofthe )oth( The% pro&"e ;< of sali$a(
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INDIVIDUA2 CO5PONENTSOF THE 1I TRACT
ESOPHA1US
-is a )s"lar t+e of appro3i)atel%
:;") in len#th an& :") in &ia)eter( Ite3ten&s to the phar%n3 to the sto)a"hafter passin# an openin# in the&iaphra#)(
STO5ACH
-is a @ shape& e3pan&e& +a#, lo"ate& /stleft of the )i&line +et!een the
esopha#s an& s)all intestine(
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INDIVIDUA2 CO5PONENTSOF THE 1I TRACT
S5A22 INTESTINE
-is "o)pose& of &o&en), /e/n) an&
ili)( It a$era#es appro3i)atel% ) inlen#th, e3ten&in# fro) the p%lori"sphin"ter of the sto)a"h to the ileo-"e"al $al$e separatin# the ile) fro)
the "e")
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INDIVIDUA2 CO5PONENTSOF THE 1I TRACT
2AR1E INTESTINE
-is a horse-shoe shape& an& e3ten&s aron& thes)all intestine lie a fra)e( It "ontains theappen&i3, "e"), as"en&in# an& si#)oi&"olon(
2IVER
-is a lar#e, re&&ish-+ro!n or#an sitate& in thepper 'a&rant of the a+&o)en( It srron&e&+% a stron# "apsle an& &i$i&e& into for lo+esna)el%, left, a&ate an& 'a&rate lo+es(
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INDIVIDUA2 CO5PONENTSOF THE 1I TRACT
1A22 72ADDER
-is a hollo!, pear shepe& or#an that sits in a
&epression on the posterior srfa"e of theli$erBs ri#ht lo+e( It "onsist of a fn&s,+o&% an& ne"(
PANCREAS
-is a lo+lar, pinish-#re% or#an that lies+ehin& the sto)a"h( Its hea&"o))ni"ates !ith the &o&en) an& itstail e3ten&s to the spleen(
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
1ENERA2 AD5ISSION INFOR5ATION4
9':@* R( C(
'&?&89* RO5AN CATHO2IC
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
=&@# 8:+>'&9T%* FEVER :8WEES
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
&T'> %&?9%*
TE5PERATURE4 >(GC
PU2SE RATE4 +p)
RESPIRATION4 :G"p)
NURSIN1 AD5ISSION AND HEA2TH
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#':&>; =&%T8A;
+'T@A9'> %& %&
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
B. ?@9@A'>&F@< @
7% O"to+er , :>:, R( C(Bs parents &e"i&e&to +rin# her in the hospital +e"ase of hi#hfe$er, s&&en a+&o)inal pain, hea&a"he an&+o&% !eaness( She !as &ia#nose& !itht%phoi& fe$er( In her sta% in the hospital, R(C(
ha& e3perien"e& &iarrhea( A""or&in# to her)other, she &efe"ates ;-= ti)es !ith :-G "psof soft-!ater% stool per episo&e( Drin# hersta% also, she )anifeste& "o#h an& "ol&s(
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
. +'%T :@
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
+=;%&'> '%%@%%:@9T
HEAD
skull is round in shape and hasnormal contour with no palpateddepressions
=air has ne strands, scalp is oilybut no masses palpated #acial features are symmetrical
with no noted abnormalities =air evenl distributed and skin is
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
With strai#ht, lon# an& +la" hair
No &an&r. !as o+ser$e& or an% a+nor)alsin #ro!th
EYES
Ppils are e'all% ron& an& rea"ti$e to li#ht
E%e+ro!s are s%))etri"all% ali#ne& E%elashes are short e$enl% &istri+te& an&
"rle& sli#htl% ot!ar&
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
No &is"har#es present
Cornea is transparent, s)ooth an&
shin% Details of the iris are $isi+le, &ar
+ro!n in "olor
S"lera appears !hite Sin aron& the e%e is inta"t
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
EARS
Ears are s%))etri"al an& ali#ne& !ith
the oter "anths of the e%e !ith nolesions note&
Color is sa)e as fa"ial sin
A+sen"e of &i0"lt% in hearin# No "er)en !as note& in +oth ears
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
NOSE
Nose has no &is"har#e, no lesions, not o""l&e& an&patent air!a%
Nose not ten&er, !ithot )asses or an%&ispla"e)ent of +one an& "artila#e note& ponpalpation
Color is sa)e as fa"ial sin
Nor)al si6e for the fa"e A+sen"e of &i0"lt% in no ?arin# on +oth nostrils !as
o+ser$e&
A+le to +reath "learl% an& i&entif% )il& aro)aspresent
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
THROAT AND 5OUTH
Throat an& )oth ha$e no sores an&
s!ellin# or in?a))ation Teeth are "o)plete in n)+er,
%ello!ish an& sli#htl% shin%
Dental "arries !ere o+ser$e& o$er herfront teethBs ena)el an& !hitishpla'e !ere note& o$er the )olars
7""al )"osa- )oist, s)ooth an&
li#ht pin in "olor
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
2ips are sli#htl% &r%, pin in "olor
No lesions in his lips an& )oth, !as
a+le to prse his lips, protr&e an&)o$e ton#e fro) si&e to si&e, p an&&o!n
1a# re?e3 !as eli"ite&
Palate appears paleJ soft palate iss)ooth an& li#ht pin, har& palate isli#hter pin !ith )ore irre#lar te3tre
U$la- positione& at the )i&line of the
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
Tonsils- pin in "olor, not in?a)e& ors!ollen
Pale #)sNEC
Ne" is "entere& an& ali#ne& !ith the
hea& A+le to )o$e the ne" !ithot )"h
e.ort fro) si&e to si&e, p an& &o!nan& e$en in rotation
No al a+le l ) h no&es
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
Th%roi& #lan& not $isi+le poninspe"tion an& as"en&s !hile
s!allo!in# Arteries an& $eins not &isten&e&
CHEST
S%))etri"al +reasts No lesions
No a+nor)al s!ellin# or presen"e of)asses
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
CARDIOVASCU2AR
A+sen"e of "hest pain an& )r)rs
Nor)al heart rh%th) an& re#lar rate
Veins are not $isi+l% &isten&e&
No presen"e of son&9+rit pon as"ltation
RESPIRATORY
Chest is s%))etri"4 anteroposterior totrans$erse &ia)eter ratio is one is 4:
Chest e3pansions are s%))etri"al
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
SIN
Sin is &r% an& has #oo& sin tr#or
E3hi+its a fair "o)ple3ion No )asses !ere o+ser$e& an&
palpate& all o$er his +o&%
K-L e&e)a K-L/an&i"e, K-L "%anosis
So)e +le)ishes on her lo!er
e3tre)ities
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
NAI2
Capillar% re*ll is less than : se"(
Untri))e& an& &irt% *n#ernails1ASTROINTESTINA2
Sin is fair
A+&o)en is soft an& ?at Non ten&er a+&o)en
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
E8TRE5ITIES
So)e +le)ishes !ere note& o$er the
patientBs le# No e&e)a note& on +oth pper an&
lo!er e3tre)ities, !ithot n)+nessan& tin#lin# sensation
1rossl% nor)al
K-L e&e)a, K-L "%anosis
1ENITOURINARY
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NURSIN1 AD5ISSION ANDHEA2TH ASSESS5ENT
NEURO2O1ICA2
7EHAVIORA2- the patient is silent +t
not "ons"ios an& "oherent ponintera"tion
5OTOR FUNCTIONIN1- slo!e&)o$e)ent of e3tre)ities(
REF2E8ES- Re?e3es !ere present s"has the +linin# re?e3(
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PATHOPHYSIO2O1Y
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2A7ORATORY STUDY>'B8A'T8A
;
%TG
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PRO72E5 2ISTIN1
G@% +A8B>@: A'9E +=;%&8>8?&'>'TG'> +8T@9T&'>
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'TG'> +8T@9T&'>
SU7@ECTIVE4
51A DUHANA ASE5ANA1A7A2I-7A2I IYAHI2ANAT DAW
ATAASDASUN1INAU7O PA1UID SITA(ASVER7A2IED
FEVER INEFFECTIVE RISFOR
THER5O-RE1U2ATIONR9T INVASIONKS( TYPHIL IN
THE 7ODY-1I TRACTAS EVID( 7Y
E2EVATED TE5P( >(GC