A. Definition
Typhoid is an acute
infectious intestinal disease caused by the bacteria salmonella and salmonella
thypi the thypi A, B, C. synonyms of this disease is Typhoid and paratyphoid
abdominalis, (Syaifullah Noer, 1998).
Abdominal typhus is an
acute infectious disease that usually affects the gastrointestinal tract with
symptoms of fever for more than 7 days, gastrointestinal disorders, impaired
consciousness, and more common in children aged 12-13 years (70% - 80%), at the
age of 30 - 40 years (10% -20%) and over the age of the child as much as 12-13 years
(5% -10%). (Mansjoer, Arif 1999).
Abdominal typhus is an
acute infectious disease that usually affects the gastrointestinal tract with
symptoms of fever of more than 1 week, digestive disorders and disorders of
consciousness (FKUI. 1999).
B. Etiology
a) Salmonella thyposa,
gram-negative bacillus that moves with the vibrating bristles, not bersepora
has at least three different antigens, namely:
• O antigen (somatic,
consisting darizat komplekliopolisakarida)
• H antigen (flagella)
• V1 antigen and hyaline
membrane proteins.
b) A Salmonella
parathypi
c) salmonella parathypi
B
d) Salmonella parathypi
C
e) Faces and urine of
patients thypus (Rahmad Juwono, 1996).
C. Pathophysiology
Transmission thypi
salmonella can be transmitted through a variety of ways, known as 5 F ie Food
(food), Fingers (fingers / nails), Fomitus (vomiting), Fly (fly), and through
the feces.
Stool and vomiting in
patients with typhoid germs can spread salmonella thypi to others. Germs can be
transmitted through the intermediary of flies, which fly will alight in food
that will be consumed by a healthy person. If people are paying less attention
to her hygiene such as washing hands and contaminated food thypi salmonella
bacteria enter the body through the mouth of a healthy person. Then the
bacteria into the stomach, some bacteria will be destroyed by stomach acid and
some into the distal small intestine and reaches limpoid network. Within this
network limpoid breed bacteria, and then enter the bloodstream and reach the
reticuloendothelial cells. Reticuloendothelial cells then release the bacteria
into the blood circulation and cause bacteremia, bacteria then enter the
spleen, small intestine and gall bladder.
Initially mistaken for
symptoms of fever and toxemia in typhoid caused by endotoxemia. But based on
experimental studies concluded that endotoxemia is not a major cause of typhoid
fever. Endotoxemia play a role in the pathogenesis of typhoid, as it helps the
local inflammatory process in the small intestine. Fever caused by salmonella
thypi and endotoxin stimulate synthesis and release by leukocyte pyrogen
substance in the inflamed tissue.
D. Clinical Symptoms
Future shoots 7-14
(average 3-30) days, during incubation was found prodromal symptoms (early
symptoms of growing disease / symptoms that are not typical):
• Feeling unwell
• Sluggish
• Headache
• Dizziness
• Diarrhea
• Anorexia
• Cough
• Sore muscles
(Mansjoer, Arif 1999).
Following other
clinical symptoms
1. FEVER
Fever lasts 3 weeks
• Week I: Fever
remittances, usually decreases in the morning and increased in the afternoon
and evening
• Sunday II: Fever
continues
• Sunday III: Fever
coming down gradually - gradually
2. DIGESTIVE DISORDERS
ON LINE
• The tongue is covered
with mucous dirty dirty brownish, reddish tips and edges, often accompanied by
tremor
• Liver and spleen
enlarged the pain on palpation
• There is
constipation, diarrhea
3. DISORDERS AWARENESS
• Awareness is apathy -
somnolence
• Other symptoms
"roseola" (red spots due to emboli result in skin capillaries)
(Rahmat Juwono, 1996).
E. Diagnostic
Examination
Laboratory tests
• Examination of
peripheral blood: match leukopenia, relative lymphocytosis, aneosinofilia,
thrombocytopenia, anemia
• Culture of bile:
typhii salmonella bacillus found in the blood of patients usually within the
first week of illness
• Widal examination -
If there is agglutination
- 1/200 Required
titer antibodies against antigeno are worth 4 times between the acute and
konvalesene leads or rise to typhoid fever (Rahmad Juwono, 1996).
F. Management
Consisting of three
parts, namely:
1) Care
- Bed rest until the absolute minimum of 7 days or more or less free of fever for 14 days.
- 2 hours to prevent pressure sores.
- Body position should be changed every
- Mobilization of appropriate conditions.
2) Diet
• Food is given in
stages in accordance with the state of the disease (initially air-soft-ordinary
food)
• Foods containing
plenty of fluids, TKTP.
• Food should
menagndung enough fluids, calories, and high in protein, it should not contain
a lot of fiber, does not stimulate or cause a lot of gas.
3) Drugs
• Antimicrobial
chloramphenicol
Tiamfenikol
Co-trimoxazole
(trimethoprim combination and Sulkametoksazol)
• Drug Symptomatik
antipyretic
Kartikosteroid,
given to patients who are toxic.
Supportive:
vitamins.
Soothing: given
to patients with symptoms neuroprikiatri (Rahmad Juwono, 1996).
G. Complication
Complications can be
divided into:
1. Intestinal
complications
intestinal
bleeding
bowel
perforation
paralytic ileus
2. Extra-intestinal
complications.
Cardiovascular:
peripheral circulatory failure (shock sepsis) myocarditis, thrombosis, and tromboflebitie.
Blood: hemolytic
anemia, tromboritopenia, hemolytic uremia syndrome
Lung: pneumonia,
empyema, pleurisy.
Liver and
gallbladder: hipertitis and cholecystitis.
Kidney:
glomerulonephritis, pyelonephritis, and perinefritis.
Bones: oeteomielitis,
periostitis, epondilitis, and arthritis.
Neuropsychiatric:
delirium, meningiemus, meningitie, polineuritie, peripheral, Guillan-Barre
syndrome, psychosis and catatonia syndrome.
In children with
paratyphoid fever, complications are rare. Complications often occur on the
state tokremia weight and general weakness, especially when patient care is
less than perfect (Rahmad Juwono, 1996).
H. Prevention
1. Efforts on the
environment:
a. Provision of
drinking water that meets
b. Disposal of human
waste (urinating and bowel movements) that hygiene
c. Eradication flies.
d. Supervision of
houses and food vendors.
2. Human effort.
a. Immunization
b. Health education in
the community: sanitary hygiene personal hygiene. (Mansjoer, Arif 1999).
NURSING MANAGEMENT
A. Assessment
1. Identity
In the identity
includes name, age, gender, address, education, no. Registration, marital
status, religion, occupation, height, weight, date of MR.
2. Main complaint
typhoid patients
usually complain of feeling sick and bloated stomach, decreased appetite, and
fever heat.
1. History of past
illness
Was previously typhoid
patients experienced pain, do not you ever, whether suffering from other
diseases.
2. Disease History Now
In general, the disease
in patients with typhoid fever, anorexia, nausea, vomiting, diarrhea, feeling
discomfort in the abdomen, pale (anemic), headache, dizziness, muscle aches,
typhoid tongue (gross), impaired consciousness such as somnolence to coma.
3. Family Health
History
Is the health of
families there who had suffered from typhoid or other illness.
4. Psychosocial History
Social psychology is
very influential at the psychological patients, with symptoms arise which go
into, whether a patient can receive on what he suffered.
5. Patterns of Health
Functions
1) Pattern pesepsi and
management of health
Changes in health
management that could cause health problems.
2) The pattern of
nutrition and metabolism
The presence of nausea
and vomiting, decreased appetite during illness, dirty tongue, and taste bitter
mealtime so it can affect nutritional status change.
3) The pattern of
activity and exercise
Patients will be
disrupted its activities due to physical weakness, and patients will have
limited mobility due to illness.
4) The pattern of sleep
and activity
Patient sleeping habits
will be disrupted due to increased body temperature, so that the patient feels
restless at bedtime.
5) The pattern of
elimination
Habits in waste BAK
reference point will occur when dehydrated because of the heat rises,
consumption of fluids that do not suit your needs.
6) The pattern of
reproductive and sexual
On reproductive and
sexual patterns in patients who have or are married will be changes.
7) The pattern of
perception and knowledge
Changes in health
conditions and lifestyle will affect the knowledge and ability to care for
themselves.
8) Pattern perception
and self-concept
In our modified if the
patient is not effective in overcoming illness.
9) The pattern of
response to stress
Stress arises when a
patient is not effective in overcoming illness.
10) Patterns of
relationship interpersonil
The existence of health
conditions affecting the interpersonal relationships and the role of additional
experience in their role during illness.
11) The pattern of
values and
beliefs
The emergence of
spiritual distress in the patient, then the patient will be anxious and fear of
death, and the habit of worship will be disrupted.
6. Physical examination
1) The general state
Usually in typhoid
patients experiencing weakness, heat, puccat, nausea, bad stomach, anorexia.
2) Head and neck
Bernjolan head no,
normal hair, normal eyelids, conjunctiva anemia, eye cowong, face edema not,
pale / dry lips, tongue foul, red edge and center, normal neck function symmetrical
pendengran, no enlargement of the thyroid gland.
3) Chest and abdomen
Normal chest,
symmetrical shape, irregular breathing patterns, tenderness found abdominal
area.
4) The respiratory
system
Is there normal
breathing, no extra noise, and there are no nostrils.
5) The cardiovascular
system
Usually in patients
with typoid found increased blood pressure but can be obtained tachiardi when
patients have elevated body temperature.
6) Integumentary System
Clean skin, decreased
skin turgor, pale, sweating, warm akral.
7) The system of
elimination
In patients typoid
sometimes diarrhea or constipation, urinary products patients can experience a
decrease (less than normal). N ½ -1 cc / kg / hr.
8) System
muskuloskolesal
Is there any
interference with the upper and lower extremities or no interference.
9) Endocrine System
Is there thyphoid in
patients with enlarged glands and tonsils toroid.
10) System persyarafan
Is it full or kesadarn
apathy, somnolence and coma, in patients with typhoid disease.
B. Nursing Diagnosis
1. The increase in body
temperature associated with Salmonella infection typhii
2. Impaired nutritional
needs less of a need related to anorexia
3. Activity intolerance
related to weakness / bedrest.
4. Disorders of fluid
balance (less than demand) associated with excessive secretion of fluid
(diarrhea / vomiting).
C. Intervention and
Implementation
1. The increase in body
temperature associated with salmonella infection typhsi
Objective: normal body
temperature / controlled.
Expected outcomes: The
patient reported an increase in body temperature
Seeking help to prevent
an increase in body temperature.
Improved skin turgor
Intervention:
Explain to the
client and family about the increase in body temperature
R / for clients and
families to know the cause of rising temperatures and help reduce the anxiety
that arises.
Encourage clients
to use light clothing and absorb sweat
R / to keep the client
feel comfortable, light clothing will help reduce evaporation body.
Limit visitors
R / for clients feel
calm and the air in the room was not hot.
TTV observations
every 4 hours once
R / vital signs is a
reference to determine the patient's general condition
2.5 liter / 24
hour Instruct patient to drink, drink
R / increased body temperature
resulting evaporation increases the body so it needs to be balanced with a lot
of fluid intake
Provide cold
compress
R / to help lower body
temperature
Collaboration
with physicians in the delivery of antibiotics and antipyretics tx
R / antibiotics to
reduce infection and antipyretic To reduce heat.
2. Impaired nutritional
needs less of a need related to anorexia
Goal: Patient is able
to maintain adequate nutrition needs
Criteria results: -
increased appetite
- Patients are able to
spend a portion of food in accordance with the given
Intervention
Explain to the
client and family about the benefits of food / nutrition.
R / to enhance the
client's knowledge about nutrition so the motivation to eat increases.
Weights clients
every 2 days.
R / to find out the
improvement and weight loss.
Give nutrition to
diet soft, does not contain a lot of fiber, not stimulate, or cause a lot of
gas and are served while still warm.
R / to increase the
intake of food because they are easy to swallow.
Give small
amounts of food and the frequency often.
R / to avoid nausea and
vomiting.
Collaboration
with physicians for the administration of antacids and parenteral nutrition.
R / antacids reduce
nausea and vomiting.
Parenteral nutrition is
needed, especially if oral nutritional needs very less.
3. Activity intolerance
related to weakness / bed rest
Objective: the patient
can perform activities of daily living (AKS) optimal.
Expected outcomes:
personal needs are met
Can do a move that will
benefit the body.
AKS comply with energy
saving techniques.
Intervention:
Motivate the
patient and my family to mobilize limited ability (missal. Leaning right, tilt
left).
R / that patients and
families know the importance of mobilization for patients bedrest.
Assess the
patient's ability to move (eating, drinking).
R / to find out the
weaknesses of the case.
Bring the patient
needs within reach.
R / to facilitate
patients in their daily activities.
Give mobilization
exercises gradually after fever is gone.
R / to avoid joint
stiffness and prevent pressure sores.
4. Disorders of fluid
balance (less than demand) associated with excess fluid (diarrhea / vomiting)
Goal: no fluid balance
disturbances
Expected outcomes:
increased skin turgor
The face does not look
pale
Intervention:
Provide an
explanation of the importance of fluid requirements in patients and families.
R / for ease of fluid
(water) in patients.
Observation entry
and discharge.
R / to find out the
fluid balance.
2.5 liters / 24
hours. Instruct patient to drink plenty
R / to meet fluid
needs.
Observation
smooth drip infusion.
R / to meet the needs
of fluid and prevent Odem.
Collaboration
with physicians for fluid therapy (oral / parenteral).
R / to meet the unmet
needs of fluids (parenteral).
D. Evaluation
From the results of
interventions that have been written, the evaluation is expected to:
Dx: increase in
body temperature associated with salmonella infection typhii
Evaluation: normal body
temperature (36 ° C) or controlled.
Dx: impaired
nutritional needs are less than the needs associated with anorexia.
Evaluation: The patient
is able to maintain adequate nutritional needs.
Dx: activity
intolerance related to weakness / bedrest
Evaluation: The patient
can perform activities of daily living (AKS) optimal.
Dx: disorders of
fluid balance (less than demand) associated with excessive secretion of fluid
(diarrhea / vomiting)
Evaluation: fluid needs
are met
REFERENCES
Dangoes Marilyn E.
1993. Nursing care plan. Edition 3. EGC, Jakarta.
Lynda Juall, 2000,
Nursing Diagnosis, EGC, Jakarta.
Mansjoer, Arif, 1999,
Capita Selekta Medicine, 3rd Edition, Media Aesculapis, Jakarta.
Rahmad Juwono, 1996,
Medicine. Edition 3, Faculty of Medicine, Jakarta.
Sjaifoellah Noer, 1998,
Patient Care Standards, Monica Ester, Jakarta.
