Typhoid fever is a bacterial disease, caused by Salmonella typhi.

It is transmitted through the

ingestion of food or drink contaminated by the faeces or urine of infected people.
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.
Typhoid fever can be treated with antibiotics. However, resistance to common antimicrobials is
widespread. Healthy carriers should be excluded from handling food.

Nursing Care Plan for Typhoid Fever : Nursing Diagnosis and Interventions
1. Activity intolerance related to mandatory bed rest.
Intervention:
1) Provide assistance to meet their daily needs such as food, drink, change clothes and watch oral
hygiene, hair, genetalia, and nails.
Rationale: To provide assistance to the client to avoid the onset of complications associated with the
movement who violate program bedrest.
2) Involve the family in the fulfillment of ADL.
Rationale: Participation family is very important to facilitate the nursing process and prevent further
complications.
3) Explain the purpose of bed rest to prevent complications and speed up the healing process.
Rationale: Rest decrease intestinal mobility also decreases the rate of metabolism and infection.

2. Risk for fluid volume deficit related to the intake is less, nausea, vomiting / excessive spending,
diarrhea, body heat.
Intervention:
1) Monitor the status of hydration (moisture of mucous membranes, skin turgor, adequate pulse, blood
pressure orthostatic) if needed.
Rationale: Changes in hydration status, mucous membranes, skin turgor describe the severity of
dehydration.
2) Monitor vital signs
Rationale: Changes in vital signs to describe the general state of the client.
3) Monitor the input of food / liquid and count daily calorie intake.
Rationale: Provides guidelines to replace fluids.
4) Encourage the family to help patients eat.
Rationale: Family as the driving fluid needs of clients.
5) Collaborate with other medical team for IV fluid administration.
Rationale: Giving IV fluids to meet fluid needs.

3. Imbalanced Nutrition, Less Than Body Requirements

related to less intake due to nausea, vomiting, anorexia, or diarrhea due to excessive output.
Intervention:
1) Monitor the amount of nutrients and calories.
Rationale: Knowing the cause of the less intake so as to determine appropriate and effective
intervention.
2) Monitor the weight loss.
Rational: Cleanliness nutrients can be known through increased weight 500 g / week.
3) Monitor the environment during the meal.
Rationale: A comfortable environment can reduce stress and more conducive to eating.
4) Monitor nausea and vomiting.
Rationale: Nausea and vomiting affect nutrition.

5) Involve the family in the client's nutritional needs.

Rationale: Increasing the role of the family in nutrition to accelerate the healing process.
6) Instruct the patient to enhance the protein and vitamin C.
Rationale: Protein and vitamin C to meet nutritional needs.
7) Provide food selected.
Rational: To assist in fulfilling the nutritional needs.
8) Collaboration with a nutritionist to determine the amount of calories and nutrients it needs patients.
Rationale: Helps in the healing process.

4. Acute pain related to inflammation of the small intestine.

Intervention:
1) Assess the level of pain, location, duration, intensity and characteristics of pain.
Rationale: Changes in the characteristics of the pain may indicate the spread of diseases /
complications occur.
2) Review the factors that increase pain and decrease pain.
Rational: It can pinpoint the factors that trigger or aggravate (such as stress, food intolerance) or
identify the occurrence of complications, as well as help in making the diagnosis and therapeutic
needs.
3) Give warm compresses on the area of pain.
Rationale: For the pain disappeared.
4) Collaborate with other medical team in the delivery of analgesics.
Rational: Analgesic can help reduce pain.

5. Knowledge Deficit: conditions of disease, treatment and prognosis needs related to lack of
information or inadequate information.
Intervention:
1) Assess the extent of knowledge of the client's family about his illness.
Rationale: Knowing the mother's knowledge about the disease typhoid fever.
2) Give health education about the disease and treatment of clients.
Rationale: In order for the client's mother found out about the disease typhoid fever, causes, signs
and symptoms, as well as the care and treatment of typhoid fever.
3) Give the family an opportunity to ask if there is not yet understood.
Rationale: In order to understand more about the family disease.

Typhoid Fever
Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic 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.
Pathophysiology
All pathogenic Salmonella species are engulfed by phagocytic cells, which then pass them
through the mucosa and present them to the macrophages in the lamina propria. Nontyphoidal
salmonellae are phagocytized throughout the distal ilium and colon. With toll-like receptor
(TLR)5 and TLR-4/MD2/CD-14 complex, macrophages recognize pathogen-associated
molecular patterns (PAMPs) such as flagella and lipopolysaccharides. Macrophages and
intestinal epithelial cells then attract T cells and neutrophils with interleukin 8 (IL-8), causing
inflammation and suppressing the infection.
In contrast to the nontyphoidal salmonellae, S typhi enters the host's system primarily
through the distal ilium. S typhi has specialized fimbriae that adhere to the epithelium over
clusters of lymphoid tissue in the ilium (Peyer patches), the main relay point for macrophages
traveling from the gut into the lymphatic system. S typhi has a Vi capsular antigen that masks
PAMPs, avoiding neutrophil-based inflammation. The bacteria then induce their host
macrophages to attract more macrophages.
It co-opts the macrophages' cellular machinery for their own reproduction as it is carried
through the mesenteric lymph nodes to the thoracic duct and the lymphatics and then through
to the reticuloendothelial tissues of the liver, spleen, bone marrow, and lymph nodes. Once
there, the S typhi bacteria pause and continue to multiply until some critical density is
reached. Afterward, the bacteria induce macrophage apoptosis, breaking out into the
bloodstream to invade the rest of the body.
The gallbladder is then infected via either bacteremia or direct extension of S typhi infected
bile. The result is that the organism re-enters the gastrointestinal tract in the bile and reinfects
Peyer patches. Bacteria that do not reinfect the host are typically shed in the stool and are
then available to infect other hosts.

Life cycle of Salmonella typhi.

Signs and Symptoms

Typhoid fever is characterized by a slowly progressive fever as high as 40 C (104 F),
profuse sweating, gastroenteritis, and nonbloody diarrhea. Less commonly, a rash of flat,
rose-colored spots may appear.
Classically, the course of untreated typhoid fever is divided into four individual stages, each
lasting approximately one week. In the first week, there is a slowly rising temperature with
relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a
quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the
number of circulating white blood cells, with eosinopenia and relative lymphocytosis, a
positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The
classic Widal test is negative in the first week.
In the second week of the infection, the patient lies prostrate with high fever in plateau
around 40 C (104 F) and bradycardia (sphygmothermic dissociation), classically with a
dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This
delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower
chest and abdomen in around a third of patients. There are rhonchi in lung bases. The
abdomen is distended and painful in the right lower quadrant where borborygmi can be heard.
Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell,
comparable to pea soup. However, constipation is also frequent. The spleen and liver are
enlarged (hepatosplenomegaly) and tender, and there is elevation of liver transaminases. The
Widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are
sometimes still positive at this stage. (The major symptom of this fever is the fever usually
rises in the afternoon up to the first and second week.)

In the third week of typhoid fever, a number of complications can occur :

Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very
serious but is usually not fatal.
Intestinal perforation in the distal ileum: this is a very serious complication and is
frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse
peritonitis sets in.

Encephalitis
Metastatic abscesses, cholecystitis, endocarditis and osteitis
The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and
the patient is delirious (typhoid state). By the end of third week the fever has started reducing
this (defervescence). This carries on into the fourth and final week.
NCP - Nursing Care Plan for Typhoid Fever

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Assessment
Health History Now
Why patients enter the hospital and what the major complaints of patients, so it can be
enforced priority nursing issues that may arise.
Previous Health History
Does the patient had been ill and treated with the same disease.
Family Health History
Does anyone in the family of patients, the sick like a patient.
Psychosocial History
Intrapersonal: the feeling felt client (anxious / sad)
Interpersonal: relationship with other people.
Patterns of health function
The pattern of nutrition and metabolism.
Usually the client is reduced appetite due to a disruption in the small intestine.
Rest and sleep patterns
During the pain patients feel unable to rest because the patient felt pain in her stomach,
nausea, vomiting, sometimes diarrhea.
Physical examination
Awareness and patient's general condition
Patient awareness of the need to study the unconscious - not conscious (composmentis coma) to assess the severity of the patient's disease prognosis.
Vital Signs and physical examination Head to foot
Blood pressure, pulse, respiration, temperature which is a measure of the general condition of
patient / patient's condition and includes examination from head to toe by using the principles
of inspection, auscultation, palpation, percussion), in addition to body weight were also aware
of any decline weight because of the increased nutritional deficiencies that occur, so it can be
calculated nutritional needs required.
Nursing Diagnosis
The increase in body temperature associated with the infection process of salmonella thypii
Intervention

Objectives : Normal body temperature

Intervention :
Observation of the client's body temperature
Rational: to know the changes in body temperature.

Encourage the family to put on clothing that can absorb sweat like cotton
Rational: to maintain body hygiene
Collaboration with physicians in the provision of anti piretik
Rational: to reduce the heat to the drug