Philippine Christian University

Mary Johnston College of Nursing

415 Morga St., Tondo Manila

TYPHOID FEVER: ENTERIC FEVER

(Case Study)

Prepared by:
Ms. Macapugay, Sheela Mae
Ms. Moleta, Hazel Joyce

Submitted to:
Mrs. Rose Marie Lucas
Ms. Xara Dumapat

DEMOGRAPHIC DATA:
Name: Jarett Jethro Romero Galang
Age: 6 y/o
Gender: Male
Marital status: Single
Religion: Roman Catholic
Address: Don Bosco, Brgy. 117, Tondo Manila
Nationality: Filipino
Educational attainment: Grade 1 elementary (presently studying)

NURSING HISTORY:
Jarett Jethro Galang is 6 y/o, male born in residing in Tondo admitted for the 2nd
time in Mary Johnston Hospital on July 21,2011 due to fever for several days.
Interviewee: Patient and his mother
Chief Complaint: Fever
History of present Illness:
Present illness started 5days prior to admission, patient had fever documented at 38 C
with associate headache but still with good appetite
7 days prior to admission, patient still had low grade fever with rashes and persistence of
on and off fever.
Patterns of health:
Date of Admission: July 21, 2011
Time: 5:30 p.m
Attending Physician: Dr. Candelaria
Admitting Physician: Dr. Candelaria
Immunization:
BCG
DPT
OPV
Measles

x1 dose
x3 doses
x3 doses
x3 doses

Obstetrics history:
Born to a 24 y/o G5P5
Delivered full term via NSD
No complications

Family Health History:

(+) DM
-Mother side
(+) HPN
-Mother side
(+) Asthma -Mother side
Social History:
He lives with family in a well-lit, well ventilated house. Father is 25 service technician
while mother is 30 y/o housewife.
Six-year-old children play in groups, but when they are tired or under added stress, they
prefer one-to-one contact. He doesnt usually play outside their house instead he wants to play
with his siblings.
Growth and Development:
Psychosexual: Latency
Psychosocial: Industry vs. Inferiority
Cognitive: Concrete operational thought
Can understand that different nurses work different shifts
Moral: Preconvention level II stages 3 &4
Believes in heaven and hell
Type of play: Competitive/Cooperation
Play continues to be rough at age 6 years; however, when children
discover reading as an enjoyable activity that opens the world, they can begin to
spend quiet time with books. He spend hours playing with laptop and cell phone
games, an activity that can either foster a healthy sense of competition or create
isolation from others.

Age-appropriate Toys: Games

Books
Jigsaw puzzle
Table games
Greatest fears:
Fear of replacement/displacement
Loss of privacy
Fear of death
Physical Development: Mature slowly but steadily.
Average annual weight gain is 3-5lb.; their increase in height is 1-2 inches
Gross Motor Development:
Smile- 2 mos.
Head contour- 4 mos.
Crawl-7 mos.
Stand- 11 mos.
Walk- 1y/o
Skipping ,jumping, tumbling and hopping is a new skill

Fine motor Development:

He can draw a person with good detail. He can print, although he may
routinely reverse letters. One of his biggest discoveries is that reading and writing
are fun. Reading and writing are activities that can help a child pass the hours of
illness.

DATE: July 24, 2011

GORDONS FUNCTIONAL HEALTH PATTERN

Health Perception:
- Eto kawawala lang ng lagnat niya kaninang hapon. As stated
- Umabot nga ng 39.9C. ang lagnat niya eh. As stated by the mother.
- Sabi nga ng doctor niya maaaring nahawa daw siya sa mga kasama niya sa
bahay kaya nagkalagnat siya
- Marami kasi kami sa bahay na nagkatrangkaso tapos siya na yung sumunod

Nutrition-Metabolic Pattern:
- Kumakain din naman siya ng mga gulay,okra,preo bihira lang ang mga dahon,
mahilig din siya sa isda at chicken as stated
- Bihira lang siya kumain ng mga baboy at karne.
- Nung dumating yung pinsan niya saka siya natutong kumain ng mga
titsirya.yung mga tigpipiso na titsirya
- Nung natuto na siyang kumain ng titsirya,lagi na siyang kumakain nun hanggang
nakahiliga na niya.
- Favorite food: carrots, chicken
- Dislikes: leafy vegetables

Sleep-Rest Pattern:
- Sapat naman yung pahinga niya nung nasa bahay pa kami pero nung pumunta
na dito sa hospital, din na siya nakaka 8 hours na tulog kasi panay kuha ng dugo
sa kanya

Elimination:
- Nung una medyo matigas-tigas pero nagging malambot na rin ng konti ngayong
araw yung dumi niya
- Medyo madilaw pa rin yung ihi niya

Activity-Exercise:
- Di siya gaano lumalabas ng bahay para makipaglaro, ,lalabas lang yan minsan
para magpaalam na iihi o bibili ng pagakain
- Nag-eexercise po kami sa school pag pumapasok po ako as stated by the
patient.

Loves to play games in laptop and cell phone.

Cognitive-Perceptual:
- Gusto na nga niyang pumasok sa school kasi maraming araw na rin siyang
absent
- Mahilig siyang bumasa at magsulat
- Kaya minsan dinadalhan ko siya ng papel at lapis para makapaglibang din siya

Sexual-Reproductive:
- Kahit sino naman kasama niya,babae o lalaki,wala siyang pinipili

Role-Relationship:
- Panglima siya sa mga anak ko, pang-apat siya na lalaki
- Ayaw niyang nakikita na nakikipag-away ako. Gagawin niya ang gusto niya wag
lang ako mapa-away

Coping-stress
- Nakakayanan naman niya yung pagtusok sa kanya ng injection.
- Ang tapang nga niya eh.hindi siya umiiyak pag tinuturukan,minsan tinititigan pa
niya yun

Self-Perception:
- sinabi niya sa akin na antagal tagl na daw niyang di pumapasok baka sabihin
daw sa kanya ng teacher niya na anga bobo bobo na niya kaya nag-request siya na
magadala ako ng papel at lapis

Value-Belief:
- Katoliko yung relihiyon namin

DATE: July 25, 2011

GORDONS FUNCTIONAL HEALTH PATTERN

Health Perception:
- Okay lang naman po ako
- Hayan baka pauwiin na kami bukas, mga bago mag-12 ng tanghali kasi okay
naman na siya eh, wala ng lagnat
- Nung binigyan siya ng gamut,medyo humilab yung tiyan niya

Nutritional-Metabolic:
- Ayun Magana naman na siyang kumain
- Naubos ko yung pagakain ko na may isda
- Bibigyan daw siya ng reseta n gvitamins ni dok, zinc ata yun tsaka iibahin yung
brand ng gatas niya
- Minsan di siya naghuhugas ng kamay bago kumain

Activity- Exercise:
- Ayan palakad-lakad siya dito sa loob ng room, di mapakali

Elimination:
- Dalawang beses siya nakatae, nung una medyo matigas pero yung pangalawa
medyo lumambot na
- wala po akong sakit na nararamdaman pag umiihi

Sleep-Rest:
- Nakakatulog naman siya ng maayos kaya lang pag may maingay,galaw siya ng
galaw
Sexual-Reproductive:
- Babae po madalas kong kalaro

Role-Relationship:
- Namimiss ko na po yung kuya ko tsaka yung mga kapatid ko.Namimisss ko po
yung paglalaro namin

Coping-stress:
- naglalaro po ako ng plants vs. zombies tska yung ibang laro sa laptop

Values-Belief:
- Nagsisismba kami lingo linggo.
- Itong si Jethro lang tsaka yung isa ang isinansama ko

Self-perception:
- Mahal ko po si mama..Gusto ko na ring bualik ng school

PHYSICAL ASSESSMENT
Skin

Hair

Nails

Eyes

Ears

Nose

Mouth

Neck

With good skin turgor, 2secs.

dry skin
No lesions on any part of the body
Presence of skin rashes all over the body before admission
Smooth to touch
With minimal amount of perspiration
Warm to touch
Evenly distributed thick hair
Felt itchiness for sometime
Black hair
Oily scalp
No infestation of lice
Slightly curved
With capillary refill of 2 secs.
Smooth, rounded, and clean
(-) sunken eyeball
(-) eye discharge
(-) redness, inflammation or lesions
Pale conjunctivae
No lesions
No drainage, nodules or redness
Small amount of dry cerumen
Symmetric to the outer canthus of the eye
Moist, pinkish mucosa
Free from lesions
Moist buccal mucosa
Dry and pale lips
With hiccups
No swelling of lymph nodes
Supple neck

Chest
Symmetrical chest expansion
RR-24bpm
Clear breath sounds
Breast
No discharge
Small, undimpled. Same color as the rest of the skin
Abdomen
Enlarged liver said by the doctor
Epigastric pain felt after receiving paracetamol
Rectal
(-) hemorrhoids
(-) diarrhea
Defecates from hard to soft brown stool
Genitalia
Voids 4-5 times a day
(-) Discharge
(-) swelling, redness
Bones-joints-muscles
Well flexed
(+) ROM

DIAGNOSTICS AND LABORATORIES

July 24, 2011
Hematocrit
Platelet

RESULT
0.34
452 X 10 g/L

NORMAL VALUES
0.42-0.48
150-400 X 10g/L

REMARKS
low
high

Interpretation:
Low hematocrit also called anemia indicates that he does not have a sufficient volume of
red blood cells. The most common cause of mild anemia in healthy people is a low level of iron,
which is essential for the production of red blood cells. Monthly blood loss in imbalanced diet,
and frequent blood extraction can contribute to low iron levels.
Nursing consideration:
To support the iron and hematocrit levels in his body, we must encourage to increase his intake
of high iron foods or supplements. Foods rich in iron include:

Red meat
Fish

Poultry

Liver

Iron-fortified cereals

Beans

Raisins

Prunes

Eating foods rich in vitamin C such as citrus fruits, broccoli and tomatoes helps our body absorb
the iron that we eat. Also, multiple vitamin tablets often include iron.
URINALYSIS

Color: yellow
Specific Gravity: 1.010
WBC: Innumerable
RBC: 10-15
Epithelial cells: Few

Bacteria: moderate
Character: Turbid
Protein: 1.og/L
Reaction:6.0
Sugar: (-)

Nursing Consideration:
Encourage to drink plenty of water. Drink at least 8 glasses per day.

COURSE IN THE WARD

July 25, 2011
8 am
8:15 am
8:30 am

11 am

11:30 am
12 pm
12:15pm
2 pm

asleep on prone position with #8 d5imb 500cc x100 @ level of 350cc @ left
metacarpal vein @ 50mcgtts/min. infusing well with soluset for CMC stand by
initial vital signs taken as: T-36.7oc, BP-90/70mmhg, PR-102bpm, RR-28bpm
consumed half of breakfast served; macaroni with chicken sandwich
present IVF decreased to 25cc/hr as ordered
okay lang naman po pakiramdam ko as stated by the patient
wala na siyang rashes at pangangati, din a ri siya nilalagnat as stated by the
mother
with slightly pale conjunctivae
with good skin turgor, 2secs.
with capillary refill of 2secs.
moist buccal mucosa
readiness to physical wellness r/t compliance to therapeutic regimen
am care done like tooth brushing and changing linen of bed
encouraged to continue increasing oral fluid intake to 1500ml
encouraged to continue drinking of milk as prescribed by the doctor
encouraged to change position frequently
provided diversional activities like reading books and writing
ate of red apple
consumed foods served for lunch;fish and sayote
visited by dr. candelaria
present IVF shifted to kvo as ordered
sleeping in crib
endorsed to NOD

July 26,2011
6:45 am
8 am

asleep on supine position with #8 D5IMB 500cc X KVO @ level of 150cc @

Left metacarpal vein, infusing well
initial
v/s
taken
as:
T-36oC,
BP-90/60mm

NCP PROBLEM NO.2

Assessment:
Objective
Asleep on side-lying position
With no.7 D5IMB 500cc x 10 @ the level of 300 cc @ left metacarpal vein intact and
infusing well
Temp at 39 C
PR-100 bpm;RR-24 bpm
Flushed, warm skin noted
Moist oral mucosa noted

HEALTH TEACHINGS

Health Perception and Management

- Taught the mother continuous tepid sponge bath because it can cause heat loss by
means of conduction
- Taught the patient to limit contact with the person who has illness
- Encourage the child to express and rate pain
Nutrition and Metabolic
- Instructed the client to avoid eating junkfoods and avoid drinking softdrinks
- Instructed the mother to pick and wash the foods carefully
- Instructed the mother to offer at least 2 glasses of milk everyday
- Encouraged the mother to offer the son nutritious food always

Elimination
- Encouraged the client to increase fluid intake to avoid concentrated urine and
constipation
- Advised the mother to clean their restroom because it can be the cause of the illness
of her son
- Instructed to wash genitalia after voiding and defecating
Activity and Exercise
- Provided diversional activities like reading books and writing
- Encouraged the client to socialize with other kids for him not to be isolated at home
Sleep and Rest
- Encouraged at least 8 hours of sleep to increase his immune system.
- Advise mother to establish clear rules for rest periods (reading or watching television
is all right; playing a game isnot,etc.)
- Advised mother to manipulate her house in terms of resting time
Cognitive
- Encouraged the child to study his lessons at school
- Provided age related mobility
- Encouraged writing and reading books
Self- perception
- Encouraged to be optimistic always
Sexuality and Reproductive
- Encouraged to socialize with same and opposite sex
Role and Relationship
- Advised mother to bring her other children in the hospital t avoid feeling of isolation
Coping Stress Tolerance
- Encouraged verbalization of feelings
- Encouraged to avoid always playing with the computer
Values and Beliefs
- Provided spiritual care by praying and providing Bible stories