NURSING CARE IN CHILDREN WITH typhoid

A. BASIC CONCEPTS

1. Definition

Typhoid is an infectious disease caused by acute systemic salmonella infection

thypi. These organisms enter through food and drink contaminated by the faeces
and urine of people infected with the bacteria salmonella. (Bruner and Sudart,
1994).

Typhoid is an acute infectious intestinal disease caused by the bacteria

salmonella thypi (Arief Maeyer, 1999).

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, 1996).

Typhoid is an infectious disease in the small intestine, also called the typhoid
paratyphoid fever, enteric fever, typhoid and typhus abdominalis (. Seoparman,
1996).

Typhoid is a disease of the intestine that cause systemic symptoms caused by

salmonella typhosa, Salmonella type ABC transmission occurs pecal, orally
through contaminated food and drink (Mansoer Orief.M. 1999).

From some sense can be summarized as follows diatasis, Typhoid is an infectious

intestinal disease caused by salmonella type A. B and C can be transmitted
through oral, fecal, contaminated food and drink.
2. Etiology

Etiology is salmonella typhi typhoid. Salmonella typhi A. The B and C. There are
two sources of salmonella typhi infections that patients with typhoid fever and
patients with the carrier. Carrier is a person who recovered from typhoid fever

and salmonella typhi continues mengekresi in feces and urine for more than 1
year.

3. Pathophysiology

Transmission thypi salmonella can be transmitted through a variety of ways,

known as the Food 5F (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.

4. Clinical Manifestations

Future shoots typhoid 10-14 days

a. Sunday I

usually fever gradually rises, especially late afternoon and evening. With
complaints and symptoms of fever, muscle aches, headache, anorexia and
nausea, cough, epitaksis, obstipasi / diarrhea, bad feeling in the stomach.

b. Sunday II

in the second week of the obvious symptoms can include fever, bradycardia,
typical tongue (white, dirty, edges hyperemia), hepatomegaly, meteorismus, loss
of consciousness.

5. Complication

a. Intestinal complications

1) intestinal bleeding

2) Perporasi intestine

3) Ilius paralytic

b. Extra intestinal complications

1) Cardiovascular Complications: circulatory failure (shock sepsis), myocarditis,

thrombosis, tromboplebitis.

2) Complications of Blood: hemolytic anemia, trobositopenia, and syndroma

hemolytic uremia.

3) pulmonary complications: pneumonia, empyema, and pleuritis.

4) Complications of the liver and gall bladder: hepatitis, cholecystitis.

5) Complications of kidney: glomerular nephritis, pyelonepritis and perinepritis.

6) Complications of bone: osteomyolitis, osteoporosis, spondylitis and arthritis.

7) neuropsychiatric complications: delirium, meningiusmus, meningitis,

peripheral polineuritis, Guillain syndrome sidroma bare and catatonia.
6. Management
a. Treatment.

1) Client rested 7 days until the bone fever or 14 days to prevent the
complications of intestinal bleeding.

2) mobilization gradually when there is no heat, according to the recovery of

platelets when bleeding complications.
b. Diet.

1) an appropriate diet, adequate calories and high in protein.

2) In patients with acute slurry can be filtered.

3) Once given free of fever for 2 days abrasive slurry and rice team.

4. Proceed with regular rice after the patient free from fever for 7 days.
c. Drugs.

1) Klorampenikol

2) Tiampenikol

3) Kotrimoxazol

4) Amoxilin and ampicillin

7. Prevention

How do the prevention of typhoid fever is washing hands after toilet and
especially before eating or preparing food, avoid drinking raw milk (which has
not dipsteurisasi), avoid drinking contaminated water, boiled water to boiling and
avoid spicy

8. Investigations

Investigations on the client with typhoid is laboratory, which consists of:

a. Examination of leukocyte

In some literature states that there is typhoid fever and leukopenia leukopenia
limposistosis relative but the reality is not often encountered. In most cases of
typhoid fever, the number of leukocytes in peripheral blood preparations are in
normal limits sometimes there are leukocytes although no complications or
secondary infection. Therefore, examination of the number of leukocytes is not
useful for diagnosis of typhoid fever.

b. Examination SGOT AND SGPT

SGOT and SGPT in typhoid fever is often increased but returned to normal after
recovery of typhoid.

c. Blood cultures

When blood cultures positive it indicates typhoid fever, but if negative blood
cultures do not rule out the possibility of typhoid fever. This is because the
results of blood cultures depends on several factors:

1) Engineering Laboratory examination

The results of the laboratory examination is different from other laboratories, it is

caused by differences in culture techniques and media used. Time is a good
blood sample at the time of high fever which lasts during bacteremia.

2) When the examination during the course of disease.

Blood cultures positive for salmonella thypi especially in the first week and
decreased in the following weeks. At the time of recurrence can be a positive
blood culture again.

3) Vaccination in the past

Vaccination against typhoid fever in the past can cause clients antibodies in the
blood, these antibodies may suppress bacteremia so negative blood cultures.

4) Treatment with anti-microbial drugs.

When the client before the blood culture was get anti microbial bacteria growth
in culture medium inhibited and culture results may be negative.

d. Widal test

Widal Test is an agglutination reaction between antigens and antibodies

(aglutinin). Aglutinin specific to thypi salmonella present in the serum clients
with typhoid are also found in people who have divaksinasikan. The antigen used
in the test is a suspension widal salmonella that has been turned off and
processed in the laboratory. The purpose of the test was to determine widal

aglutinin presence in the serum of clients suspected of suffering from typhoid.

Due to infection by salmonella thypi, clients make antibodies or aglutinin namely:

1) Aglutinin O, which made for O antigen stimulation (derived from the body of
germs).

2) Aglutinin H, which is due to stimulation of antigen H (derived from bacteria

flagellum).

3) Aglutinin Vi, which is due to stimulation of Vi antigen (derived from hoops

germs)

Of the three only aglutinin aglutinin O and H are determined titernya for
diagnosis, the greater the higher titernya client suffered typhoid.

Factors - factors that influence test widal:

a. Factors related to the client:

1. General condition: poor nutrition can inhibit the formation of antibodies.

2. During examination during the course of the disease: new aglutinin found in
the blood after 1 week sick clients and peaked at week 5 or 6.

3. Disease - specific diseases: there are some diseases that can accompany
typhoid fever which can not give rise to antibodies such as agamaglobulinemia,
leukemia and advanced carcinoma.

4. Early treatment with antibiotics: early treatment with anti-microbial to inhibit

the formation of antibodies.

5. Immunosuppressive drugs or corticosteroids: these drugs can inhibit the

formation of antibodies because of suppression of the reticuloendothelial system.

6. Vaccination with kotipa or TIPA: a person vaccinated with kotipa or TIPA,

aglutinin O and H titers can be increased. Aglutinin O usually disappear after 6
months to 1 year, while the H aglutinin titer decreased slowly for 1 or 2 years.
Therefore aglutinin H titers in people who have been vaccinated have less
diagnostic value.

7. Infection clients with clinical / subclinical by salmonella earlier: This situation

can support widal positive test results, although with a low titer results.

8. Reaction anamnesa: situation where there is an increase in titer against

salmonella thypi aglutinin due to infectious diseases typhoid fever is not a
person who had contracted salmonella in the past.

b. Technical Factors

1. Agglutination cross: some species can contain salmonella O and H antigens of

the same, so the agglutination reaction in one species can cause agglutination
reaction in other species.

2. Antigen suspension concentration: the concentration will affect the test results
widal.

3. Salmonella strains used for antigen suspension: no studies found power

Agglutination antigen suspension of local salmonella strain better than the
suspension of another strain.

9. Growth and development in children aged 6-12 years

Growth is a process of increasing the size of the various organs of the physical
problems associated with the change in number, large, size or dimensions of the
cell level. Weight gain of 2-4 kg / year and the children have started developing
female secondary sex traits.

The development focuses on aspects of the differentiation of form and function,

including social and emotional changes.
a. Gross motor

1) Skip the rope

2) Badminton

3) Hit

4) gross motor skills and cognitive under control by gradually increasing rhythm
and flexibility.
b. Fine motor

1) Demonstrate balance and eye-hand coordination

2) It enhances the ability of sewing, model making and playing musical

instruments.
c. Cognitive

1) Can be focusing on more and one aspect and situation

2) Can be considered a number of alternatives in problem solving

3) Can buy and keep track of how the sequence of events since early

4) Can understand the concept of past, present and future

d. Language

1) Understand the most abstract words

2) Using all parts of speech including adjectives, adverbs, conjunctions and

prepositions

3) Using language as a medium of exchange verbal

4) Can use compound sentences and combined

10. Impact of hospitalization

Hospitalization or illness and being treated in hospital for children and families
will lead to stress and did not feel safe. The amount and effect of stress depends
on the perception of children and families against the damage the disease and
treatment.

Causes of stress include children;

a. Psychosocial

Separated from their parents, other family members, friends and the changing
role

b. Physiological

Lack of sleep, feelings of pain, immobility and does not control myself

c. Foreign environment

Daily habits change

d. Chemical drug delivery

The reaction of the child while being treated at the hospital school age (6-12
years)

a. Worried about parting with school and peers

b. Can express their feelings and be able to tolerate the pain

c. Always wanted to know the cause of action

d. Seek independent and productive

The reaction of the parents

a. Anxiety and fear due to the seriousness of the disease, procedure, treatment
and its impact on a child's future

b. Frustration due to lack of information on procedures and treatment and do not

familiernya regulations Hospitals
B. NURSING CARE

1. Assessment

Precipitation and Predisposing Factors

Factors precipitation of typhoid fever is caused by food contaminated by

salmonella salmonella typhoid and paratyphoid A, B and C are transmitted

through food, fingers, flies and feces, and vomit compounded when clients do
not eat regularly. Factors predisposisinya are drinking contaminated water,
eating food that is not clean and spicy, do not wash their hands before and after
eating, from wc and prepare food.
2. Nursing Diagnosis

Diagnoses that may appear on the client typhoid are:

a. Resti volume of fluid and electrolyte imbalance bd hyperthermia and vomiting.

b. Resti impaired nutrition: less than body requirements bd inadequate intake.

c. Hipertermi b.d thypi salmonella infection process.

d. The inability to meet daily needs related to physical weakness.

e. Lack of knowledge about the disease related to lack of information or

inadequate information.

3. Plan

Based on theoretical nursing diagnoses, nursing in the formulation of planning

clients with typhoid, are as follows:
Diagnosis. 1

Resti imbalance disorders of fluid and electrolyte volume, less than the needs
associated with hyperthermia and vomiting.

Destination

Fluid volume imbalance does not occur

Expected outcomes

Mucous membranes moist lips, vital signs (BP, S, N and RR) in the normal range,
signs of dehydration no

Intervention

Assess for signs of dehydration such as dry mouth mucosa, inelastic skin turgor
and increased body temperature, monitor fluid intake and output in 24 hours,
measure the BB every day on time and at the same time, record or report things
like nausea, vomiting, pain and hull distortion. Encourage clients to drink plenty
of approximately 2000-2500 cc per day, collaboration in laboratory tests (Hb, Ht,
K, Na, Cl) and collaboration with doctors in addition to via parenteral fluids as
indicated.
Diagnosis. 2

High risk of nutrition: less than body requirements related to inadequate intake

Destination

Risk nutrition less than body requirements not happen

Expected outcomes

Appetite increased, indicating a stable body weight / ideal, value bowel /

intestinal peristalsis normal (6-12 times per minute) normal laboratory values,
conjunctiva and mucous membranes pale lips.

Intervention

Assess the client's nutritional patterns, assess eating likes and dislikes on the
client, advise bed rest / activity restrictions during the acute phase, weights
every day. Encourage clients to eat little but often, record or report things like
nausea, vomiting, stomach pain and distention, collaboration with a nutritionist
for dietary administration, collaboration in laboratory tests such as hemoglobin,
hematocrit and albumin and collaboration with physicians in the delivery of antiemetics such as (ranitidine).
Diagnosis 3

Hyperthermia associated with salmonella infection process thypi

Destination

Hipertermi resolved

Expected outcomes

Temperature, pulse and respiration within normal limits free of frost and no
complications related to the problem of typhoid.

Intervention

Observation of body temperature clients, encourage families to limit the

activities of the client, give compress with cold water (water) on axila area, groin,
temporal when heat, encourage families to put on clothing that can absorb sweat
like cotton, collaboration with doctors in anti-pyretic.
Diagnosis 4

Inability to meet their daily needs related to physical weakness

Destination

Daily needs are met

Expected outcomes

Able to perform the activity, move and showed an increase in muscle strength.

Intervention

Provide quiet environment by limiting visitors, assist clients daily needs such as
bathing, bowel and bladder, help clients mobilization gradually, bring stuff to the
table is always in need of the client, and collaboration with doctors in vitamins as
indicated.
Diagnosis 5

Resti secondary infections associated with invasive measures

Destination

Infection does not occur

Expected outcomes

Free of erythema, swelling, signs of infection and free of purulent secretions /

drainage and febrile.

Intervention

Observation vital signs (S, N, RR and RR). Observation smooth drip infusion,
monitor for signs of infection and in accordance with the conditions antiseptic
bandage infusion, and collaboration with the physician in the delivery of
antibiotics as indicated.

Diagnosis 6

Lack of knowledge about diseases related to lack of information or inadequate

information

Destination

Increase family knowledge

Expected outcomes

Demonstrate an understanding of the disease, through lifestyle changes and

participate in treatment.

Intervention

Assess the extent of knowledge of the client's family about her illness, give
health education about the disease and treatment of clients, give keluaga
opportunity to ask if there is not yet understood, give positive reinforcement if
the client responded appropriately, select a variety of learning strategies such as
engineering lectures, question and answer and demonstrations and ask what is
not known clients, involve the family in any action taken on the client

4. Evaluation

Based on the implementation will be undertaken, the evaluation is expected to

clients with digestive system disorders typhoid are: stable vital signs, fluid needs
are met, nutritional needs are met, there is no hyperthermia, clients can meet
their daily needs independently, the infection does not occurred and keluaga
clients understand about the disease.
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COLLECTION OF HEALTH CARE NURSING

NURSING CARE TO BABY WITH RDS

DEFINITION

Is a respiratory disorder that often occurs in premature infants with signs

takipnue (> 60 x / min), chest retractions, cyanosis in room air, which persist or
worsen at 48-96 hours of life with the x-ray thoracic specific. Clinical signs in
accordance with the size of the baby, severe illness, presence of infection and
the presence or absence of blood shunting through the PDA (Stark 1986).

Pathophysiology

RDS occurs at a very progressive atelectasis, due to the lack of a substance

called surfactant. Surfactants are the active substances produced by airway
epithelial cells called type II cells pnemosit. This substance is taking shape at 2224 weeks of pregnancy and reaches max at week 35. This substance is
composed of phospholipids (75%) and protein (10%). The role of surfactant is
degrading alveolar surface tension so it does not happen to collapse and be able
to withstand the functional residual air at the end remainder expirasi. Lung
collapse will cause disruption of ventilation to hypoxia, CO2 retention and
acidosis.

Hypoxia will lead to:

1. Decreased tissue oxygenation> anaerobic metabolism with lactic acid

accumulation of organic acids> metabolic acidosis.
2. Damage to capillary endothelial and alveolar epithelial duct> transudation
into the alveoli> formed fibrin> fibrin and necrotic epithelial tissue> hyaline
membrane layer.

Acidosis and atelectasis will cause disruption of the hea, keparum decreased
blood flow and lead to the formation of surfactant resistance, which leads to
atelectasis.

Cell type II is very sensitive and is reduced in infants with asphyxia in the
perinatal period, and a maturity driven by the presence of intrauterine stress
such as hypertension, IUGR and multiple pregnancies.

CLINICAL

RDS may occur in premature infants weighing <1000>

Signs of respiratory distress include:

Dispnue / hipernue

Cyanosis

suprasternal retraction / epigastric / intercostals

Grunting expirasi

Obtained other symptoms such as:

bradycardia

Hypotension

Cardiomegaly

edema especially in areas dorsal hands or feet

hypothermia

Decreased muscle tone

Radiology picture: patches of diffuse infiltrates retikulogranular be accompanied

by bronkogram water.

Nursing Diagnosis

1. Bd ineffective breathing pattern by accumulation of mucus in the airway.

2. Impaired tissue perfusion bd lack of oxygenation keotak
3. Bd fluid volume deficit increased metabolism
4. Less nutritional needs of bd inadequate intake
5. The risk of infection of the umbilical cord bd invasion of pathogens into the
body
6. Anxiety parent bd parent lack of knowledge about the condition of the baby.

NURSING CARE PLAN

THE BABY WITH RDS

No.

Nursing Diagnosis

Destination

Plan

1.

Ineffective breathing pattern b.d secret accumulation

Effective breathing patterns Criteria results:

RR 30-60 x / mnt

Cyanosis (-)

Shortness of (-)

Ronchi (-)

Whezing (-)

Observation breathing pattern

Observation frequency of breath sounds

Place the hyperextended head position.

 Observe for cyanosis.

Perform suction.

Monitor carefully the results of blood gas.

Give O2 according to the program.

Set the ventilation room where client care.

Observation baby responds to the ventilator and O2 therapy.

Collaborate with other medical personnel.

Impaired tissue perfusion bd lack of oxygenation keotak

Impaired tissue perfusion overcame Criteria results:

RR 30-60 x / mnt.

Nadi 120-140 x / mnt.

Temperature 36.5 to 37 C

 Cyanosis (-)

extremities warm

Observation frequency and heart sounds.

Observe for cyanosis.

Give oxygen as needed

Assess the baby's consciousness

Observation TTV

Collaboration with physicians for the provision of therapy.

3.

Risk of Nutritional Disorders less of a need bd inadequate intake

Nutritional needs are satisfied

Expected outcomes:

 No BB decline> 15%.

Vomiting (-)

Babies can drink well

Observation intake and output.

Observation sucking and swallowing reflexes baby.

Assess the presence of cyanosis when the baby is drinking.

Install NGT when needed

Give baby's nutritional needs.

BB Weigh every day.

Collaboration with physicians for the provision of therapy.

Collaboration with the team for giving diit infant nutrition

4.

Parents Anxiety bd lack of knowledge about the condition of the baby.

Anxiety decreased after nursing actions.

Expected outcomes:

Parents who do understand the purpose of the medication therapy.

Parents seemed calm.

Parents participate in treatment.

Tell me about the baby's condition.

Collaboration with physicians to provide explanations about the disease and

the measures to be taken related to infant illness.

Involve parents in baby care.

Provide mental support.

Provide reinforcement for understanding parents.

5.

The risk of umbilical cord infection bd invasion of pathogenic bacteria.

 umbilical cord infection does not occur.

Criteria results:

Temperature 36-37 C

umbilical cord dry and odorless.

There is no sign of infection in the umbilical cord.

Perform aseptic and antiseptic techniques when cutting the umbilical cord.

Keep the cord and surrounding areas.

Bathe your baby with clean and warm water.

Observation of bleeding on the cord.

Wash the umbilical cord immediately with soap and dry when the umbilical cord
is dirty or exposed to feces.

Observation baby's temperature.

6.

Bd fluid volume deficit increased metabolism.

The volume of fluid being met after nursing actions.

Expected outcomes:

Temperature 36-37 C

Nadi 120-140 x / mnt