Introduction Typhoid fever, also known as enteric fever, is a potentially fatal multi-systemic illness caused primarily by Salmonella typhi.

The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within one month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications. If you eat or drink something that is contaminated, the bacteria enter your body. They travel into your intestines, and then into your bloodstream, where they can get to your lymph nodes, gallbladder, liver, spleen, and other parts of your body. Symptoms usually develop 13 weeks after exposure, and may be mild or severe. They include high fever, malaise, headache, constipation or diarrhoea, rose-coloured spots on the chest, and enlarged spleen and liver. Healthy carrier state may follow acute illness. S typhi has been a major human pathogen for thousands of years, thriving in conditions of poor sanitation, crowding, and social chaos. It may have responsible for the Great Plague of Athens at the end of the Pelopennesian War.The nameS typhi is derived from the ancient Greek typhos, an ethereal smoke or cloud that was believed to cause disease and madness. In the advanced stages of typhoid fever, the patient's level of consciousness is truly clouded. Although antibiotics have markedly reduced the frequency of typhoid fever in the developed world, it remains endemic in developing countries. S typhi has no nonhuman vectors. A few people can become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease. The following are modes of transmission: Oral transmission via food or beverages handled by an individual who chronically sheds the bacteria through stool or, less commonly, urine; Hand-to-mouth transmission after using a contaminated toilet and neglecting hand hygiene; and Oral transmission via sewage-contaminated water or shellfish (especially in the developing world). An inoculum, a material injected into a person or animal to create resistance to a disease, as small as 100,000 organisms causes infection in more than 50% of healthy volunteers. Typhoid

fever can be treated with antibiotics. However, resistance to common antimicrobials is widespread. Healthy carriers should be excluded from handling food. Typhoid fever occurs worldwide, primarily in developing nations whose sanitary conditions are poor. Typhoid fever is endemic in Asia, Africa, Latin America, the Caribbean, and Oceania, but 80% of cases come from Bangladesh, China, India, Indonesia, Laos, Nepal, Pakistan, or Vietnam. Within those countries, typhoid fever is most common in underdeveloped areas. Typhoid fever infects roughly 21.6 million people (incidence of 3.6 per 1,000 population) and kills an estimated 200,000 people every year. In the United States, most cases of typhoid fever arise in international travelers. The average yearly incidence of typhoid fever per million travelers from 1999-2006 by county or region of departure is at an average of 2.2.

Rationale The BSN III-B RLE group 4 has chosen the case of Mr. J.D. among others for the following reasons: the group is interested in this first encounter with a case of Typhoid fever, and desires to learn about it; the case of the client is related to our recent knowledge in communicable diseases and is comprehensive enough at our level of understanding, having learned about medical, surgical, and nursing interventions for Typhoid fever and its relative medical condition(s).

Objectives of the Study The student nurses shall be able to: 1. Discover facts and figures related to, and associated with typhoid fever. 2. Identify and prioritize Nursing Problems 3. Recognize the extent of the condition of the client and understand the disease process. 4. Formulate a Care plan that is patient- specific, focusing on the clients priority problem as ranked.

History of Present Illness

This is a case of J.D., 23 years old, Filipino, Male, Single, Catholic. He is a resident of Lapu-Lapu City. He was admitted for the first time in Vicente Sotto memorial Medical Cente, with chief complaints of fever and melena. Two weeks prior to admission, onset of an undocumented intermittent fever associated with LBM three times with watery, non-bloody, yellowish stools, and vomiting of previously ingested food. Condition was bloated. He claimed to have taken Paracetamol for his fever. No consultation was done. Nine days prior to admission, client sought consultation and was admitted at a local hospital with the same condition and complaints. He was given Cefuroxime, Ranitidine, and Paracetamol for medications.This provided him no relief from bloating, diarrhea, and fever. Four days prior to admission, He opted to go Home Against Medical Advice from the hospital he was admitted in. His condition persisted at home. One day prior to admission, the onset of melena was noted. There was an occurrence of more than six episodes of bloody defecation with approximately cup in quantity per episode, as estimated by the client. Ten hours prior to admission, he was noted by his mother to be weak and generally pale, still febrile. This persistence of condition prompted consultation hence, this admission.