Typhoid Fever Nursing Diagnosis and Nursing Care Plan

Typhoid Fever Nursing Care Plans Diagnosis and Interventions

Typhoid Fever Nursing Care Plans Diagnosis and Interventions

Typhoid fever or enteric fever is a systemic illness that is potentially fatal due to a multisystemic infection. The bacteria are shed through an infected individual’s urine or feces passed on after drinking or eating contaminated food or drink then spread quickly into the bloodstream causing an infection.

The disease course may last a month or more and progress from gastrointestinal symptoms to nonspecific systemic illness that may lead to multiple complications.

Typhoid fever is a global health problem commonly affecting overcrowded and unhygienic areas directly associated with poor sanitation, sewage, and water systems.

Signs and Symptoms of Typhoid Fever

Typhoid fever can develop suddenly or very gradually causing the following symptoms lasting for weeks:

  • fluctuating high-grade fever as high as 104 degrees Fahrenheit
  • bradycardia
  • headache and generalized pain
  • rose spots or salmon-colored maculopapular lesions which resolve within 2-5 days
  • colicky right upper quadrant or diffuse abdominal pain and tenderness
  • nausea and vomiting
  • dry skin and sunken eyes due to dehydration
  • constipation
  • pea soup diarrhea or foul-smelling, watery stool
  • abdominal distention and soft splenomegaly
  • poor appetite and evident weight loss
  • lethargy with dry and pale skin
  • dry cough due to pneumonia
  • rhonchi or rattling lung sound at the base of the lungs
  • jaundice with pale stool and dark urine due to biliary involvement
  • neck rigidity due to meningitis
  • neurologic symptoms like apathy, confusion, insomnia, psychosis, and delirium

Causes of Typhoid Fever

Salmonella enterica serotype Typhi (S. Typhi) bacteria is the causative agent of typhoid fever, which are motile Enterobacteriaceae causing a variety of infections. It is commonly acquired through:

  • Contaminated food. People with typhoid fever can contaminate the surrounding water supply through stool, which contains a high concentration of bacteria that can survive for weeks in water or dried sewage.
  • Poor hygiene. The bacteria can also be spread through direct contact with someone infected who hasn’t washed carefully after using the comfort room. It is more prevalent in low-income countries with poor sanitation practices.
  • Migration or travel. Traveling to countries where typhoid fever is endemic such as India and Southeast Asia with temperate and tropical climates. Travelers tend to be less cautious with the sources of food and water returning to their countries with the infection.
  • Decreased stomach pH. Individuals with decreased stomach acidity from medications or other conditions can have typhoid fever. Stomach pH as low as 1.5 facilitates survival of S typhi bacteria causing an infection.
  • Typhoid carriers. After being infected with typhoid fever, about 3%-5% becomes long-term carriers of the bacteria and be the source of a new infection. These chronic carriers don’t have any symptoms but may still shed the bacteria in their feces and infect others.

Risk Factors to Typhoid Fever

Certain factors increase the risk of acquiring typhoid fever such as:

  • Age. Children are at the greatest risk of acquiring this disease even though they have milder symptoms than adults. Old-age adults are prone to dehydration and serious metastatic infections.
  • Low-income families. Families struggling financially tend to live in areas with poor sanitation without proper water and sewage systems. Low-income families may not be cautious about the sources of their food and tend to settle for low-cost food that can be brought from the streets.
  • Close contact. People who have recently been in contact with someone who is infected with typhoid fever can acquire the infection also. Carriers may pass the infection through direct contact by improper hand hygiene and disposal of human waste.
  • Clinical microbiologist. Professionals who work and handle Salmonella typhi bacteria are also at great risk of accidental spillage or contact with the bacteria.
  • Travelers. People who work in or travel to areas where typhoid fever is endemic are also at risk. They may also be unaware of the sources of food and engage in trying local foods in the area.

Complications of Typhoid Fever

Typhoid fever can be a very serious medical condition and should require adequate treatment to prevent complications such as:

  • Intestinal hemorrhage. These are the most serious complications which usually develop in the third week. Small or large bowels can have holes where contents may leak and cause an infection or sepsis.
  • Sepsis. Widespread dissemination of bacteria can cause septicemia and multiorgan failure. Usually, it starts with the ulceration and perforation in the bowels causing peritonitis and continuous systemic spread of infection.
  • Hepatitis. Intraabdominal infections lead to hepatic and splenic involvement.
  • Typhoid encephalopathy. Neurologic symptoms such as insomnia, psychosis, meningitis, myelitis, muscle rigidity, and focal neurologic deficits occur in 17% of patients with a 55% mortality rate.
  • Myocarditis and nephritis. These are the consequences of toxic phenomena from septicemia.
  • Bone and joint infections. This occurs more often in children affecting the long bones which can lead to septic arthritis.
  • Gallbladder cancer. Patients who are not adequately treated for typhoid will continue to excrete the bacteria and colonize the gallbladder resulting in cancer.

Diagnosis of Typhoid Fever

It is important to disclose all relevant information that may help in the diagnosis of typhoid fever, this includes:

  • Medical and travel history. A complete medical history including socioeconomic status, residence, lifestyle, and immunizations are taken. Recent exposure history and related activities can also be asked to determine the source of infection. Travel history to areas with an outbreak of typhoid endemic must also be disclosed.
  • Physical exam. Physical exam findings vary depending on the duration of exposure and symptoms.
  • Blood tests.
    • Blood culture. This is the most common test used with high efficacy when high-volume samples are taken.
    • Bone marrow culture. This is the gold standard for typhoid fever diagnosis with 90% efficacy, however, it is a highly invasive and expensive procedure.
    • Widal test. This test detects antibody titer and antigen cut-off levels. This test is not reliable due to common false-negative and positive results.
    • Typhidot. This test is based on the presence of specific IgM and IgG antibodies to identify recent and remote infections.
    • Tubex test. Contains two types of particles that allow the antibody to attach itself indicating a positive result.
    • Enzyme-Linked Immunosorbent Assay (ELISA). Identifies antibodies that may help identify carriers but rarely us for present acute illness.
    • Polymerase Chain Reaction (PCR) Assay. Provide DNA-based gene identification which is rarely used because of its cost.
  • Stool culture. This test is used in the second and third week of infection with several samples needed to yield a positive result.
  • Urine and duodenal content culture. Identify Salmonella typhi via string capsule.
  • Histologic findings. Infiltration of tissues by macrophages is the hallmark finding in typhoid fever.
  • Skin snip test. Biopsy from the rose spots or the maculopapular lesions in the body with prior antibiotic treatment.
  • CT scan and MRI. radiography may be warranted for patients with progressive symptoms and multi-organ involvement.

Treatment for Typhoid Fever

After confirming the diagnosis of typhoid fever, immediate treatment should be given to reduce the risk of complications.

  • Medications. Used to prevent infection and progression. Antibiotic therapy is the only effective way to treat typhoid fever. Adequate information about side effects, medication dosage, and administration should be given to prevent antibiotic resistance from long-term use.
    • Corticosteroid. This is usually given in severe cases to decrease the likelihood of mortality from complications like meningitis and the like.
    • Analgesics. Given for headaches and generalized pain.
    • Rehydration therapy. Prevents dehydration from prolonged fever and diarrhea. Intravenous fluids may be given for patients who cannot tolerate oral fluids due to nausea and vomiting and for the severely dehydrated patient.
  • Surgery. For chronic infections and complications, surgery can be done to prevent mortality. The gallbladder is the usual site of infection which is why cholecystectomy is done. Repairing of perforated intestines with drainage of peritoneum for torn bowels and peritonitis. Small bowel resection may be indicated for patients with multiple perforations.

Prevention for Typhoid Fever

These precautions can be done to reduce the risk and prevent acquiring typhoid fever.

  • Handwashing. This is a universal health precaution to reduce all types of infection. Proper hand washing techniques using soap and clean water should be done frequently, especially among children and those handling food to avoid contamination.
  • Vaccination. Typhoid fever vaccines are 50%-80% effective in preventing the disease and a booster shot is needed every two years to stay protected. For those traveling in typhoid endemic areas, the shot should be given two weeks before traveling.
  • Water sanitation. Use treated water for washing and preparing food. Boil any water that will be used for drinking, cooking, or making ice.
  • Cook all the food. Fully cook all food and avoid raw food. Do not eat street foods and fruits that cannot be peeled. Properly wash the vegetables and fruits before cooking and eating.

Nursing Diagnosis for Typhoid Fever

Typhoid Fever Nursing Care Plan 1

Hyperthermia

Nursing Diagnosis: Hyperthermia related to increased metabolic rate secondary to typhoid fever as evidenced by hot flushed skin, diaphoresis, and a high-grade fever at 41 degrees Celsius.

Desired Outcomes:

  • The patient will maintain a normal body temperature after 4 hours of nursing interventions.
  • The patient will be free from complications of typhoid fever.
Nursing Intervention for Typhoid FeverRationale
1. Assess and monitor the patient’s temperature and vital signs. Note for skin color, diaphoresis, the fever’s degree, and pattern of occurrence.Monitoring of temperature can also determine the pattern of occurrence of fever. Continuous high-grade fever is evident in patients with typhoid fever.
2. Assess the environment and institute comfort measures like providing a cooling blanket, and comfortable and thin loose-fitting clothes.Room temperature may also affect the patient’s body temperature. Clothes and blankets should also be adjusted to regulate the patient’s temperature.
3. Assist the patient in a tepid sponge bath. Place an ice pack on the patient’s neck, axillae, and groins.Reduce hyperthermia without causing chills and sudden drop in temperature.
4. Encourage the patient to increase fluid intake or give IV fluids if the patient cannot tolerate oral fluids.Adequate hydration helps the body in the regulation of temperature.
5. Administer antipyretic and antibiotics as ordered.Antipyretics must be given to control the temperature. Treating the cause is the most effective treatment to prevent another episode of hyperthermia.
6. Monitor electrolyte and laboratory levels.Electrolyte levels may be affected during excessive diaphoresis, dehydration, and increased metabolic rate. Low sodium levels can cause mental changes and other complications.
7. Give emotional support and educate the patient about the disease process and treatment plan.The patient may become restless due to continuous hyperthermia and the lack of information about typhoid fever. Involving the patient in the treatment plan increases compliance.

Typhoid Fever Nursing Care Plan 2

Acute Pain

Nursing Diagnosis: Acute Pain related to inflammation of small bowels secondary to typhoid fever as evidenced by reports of diffused colicky pain and abdominal tenderness.

Desired Outcomes:

  • The patient will verbalize relief from pain after 2 days of nursing interventions.
  • The patient will display decreased abdominal tenderness and distention.
Nursing Intervention for Typhoid FeverRationale
1. Assess the patient’s characteristics and level of pain using a numeric rating scale (NRS) every hour. Observe for verbal and nonverbal cues and aggravating or relieving factors associated.A numeric rating scale is the most reliable assessment for pain. Pain assessment every hour can help determine the effectiveness of the treatment or progression of symptoms. Restlessness or irritability can be nonverbal cues suggesting the severity of the pain.
2. Assess the abdomen using the four basic components of assessment; inspection, palpation, percussion, and auscultation.This helps determine the exact location of affectation and internal organs involve.
3. Document and monitor the patient’s vital signs.Pain can affect the patient’s heart rate and blood pressure further increases the metabolic rate.
4. Encourage the patient to flex the knees to assume the position of comfort.This position reduces abdominal tension and strain, enhancing feelings of control.
5. Assist the patient in repositioning and encourage relaxation and diversional activities.Alleviate the patient’s pain while being active. Relaxation techniques promote comfort and reduce abdominal tension.
6. Administer analgesics and antibiotics as ordered.Reduce the pain and provides comfort. Inflammation of the bowels is caused by typhoid fever which can only be treated with proper antibiotic administration.
7. Ensure adequate nutrition and hydration by alternative measures such as parenteral nutrition and IV fluids.Patients with typhoid fever may not tolerate food and drinks due to pain or vomiting. Adequate nutrition is necessary to reduce the risk of an ulceration that may have to cause inflammation of the bowels.

Typhoid Fever Nursing Care Plan 3

Risk for Fluid Volume Deficit

Nursing Diagnosis: Risk for Fluid Volume Deficit related to diarrhea secondary to typhoid fever.

Desired Outcomes:

  • The patient will maintain normovolemia.
Nursing Intervention for Typhoid FeverRationale
1. Assess and monitor vital signs frequently.Provides information about decreasing circulating blood volume through hypotension and tachycardia.
2. Assess the patient’s skin turgor and mucous membrane for signs of dehydration.Dehydration can also be evident on the patient’s skin and mucous membranes.
3. Check the patient’s laboratory values and mental status.Laboratory values and electrolyte imbalances from dehydration may also affect the patient’s sensorium which is also a complication of typhoid fever.
4. Educate the patient about monitoring his/her intake and output.This will serve as a basis for the nurse if the patient is taking adequate fluid to prevent dehydration.
5. Encourage the patient to increase oral fluid intake or IV fluids may be given if oral fluid is contraindicated.Oral fluid intake is the most effective way to prevent dehydration. Patients with typhoid fever may suffer from vomiting and are not able to tolerate oral fluids which is why IV fluids are necessary.
6. Administer antipyretics or antidiarrheals as ordered.Patients with typhoid fever lose a lot of fluids from diarrhea. Fever can increase fluid loss from diaphoresis so it should be treated with medications as well.
7. Educate the patient about maintaining proper nutrition and hydration.Patient education increases compliance with diet and fluid regimen.
8. Educate the patient about the cause of fluid volume deficit in patients with typhoid fever and instruct them to watch out for signs of dehydration.The patient needs to understand and be involved with his/her care. Determining early signs of dehydration prevents complications and emergency care.

Typhoid Fever Nursing Care Plan 4

 Imbalanced Nutrition: Less Than the Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: Less Than the Body Requirements related to vomiting secondary to typhoid fever as evidenced by inadequate food intake and sudden weight loss.

Desired Outcomes:

  • The patient will be able to tolerate oral intake and the absence of nausea and vomiting.
  • The patient will be able to demonstrate increased nutritional intake as evidenced by increasing body weight.
Nursing Intervention for Typhoid FeverRationale
1. Document and monitor the patient’s vomiting episodes. Note the characteristics, amount, and frequency of the vomitus.This will help the nurse determine and measure the amount of fluid loss.
2. Assess and monitor the patient’s weight every morning.This will accurately measure the changes and response of the patient to the treatment plan.
3. Provide the patient with an emesis basin within reach.Keeping it accessible will reduce the risk of accidents from traveling to the bathroom. Also, a way to take note of the vomitus and measure the amount.
4. Give ice chips, cold water, or ginger products. Do not give a meal within 2 hours after vomiting.These products relieve nausea and vomiting and aid in hydration. Letting the stomach rest before introducing food may help prevent another episode of vomiting.
5. Educate the patient about alternative diets such as eating small frequent meals or a bland diet. Options for alternative feeding such as parenteral nutrition should also be explained.Alternative diets may help maintain nutritional status. Parenteral feeding should be instituted for patients who cannot tolerate oral intake.
6. Administer antiemetics as ordered. Give IV fluids as indicated.Help patients with continuous vomiting episodes. IV fluids should be given to prevent dehydration from vomiting.
7. Assist the patient in an upright position while eating and stay upright for 2 hours after a meal.This keeps the food from going up the throat and induces vomiting. This also allows the food to be digested first in the stomach.
8. Monitor laboratory and electrolyte levels.Vomiting can result in electrolyte imbalances and blood volume changes.
9. Refer to a dietician.Help the patient in planning adequate and nutritious food intake to regain normal body weight.

Typhoid Fever Nursing Care Plan 5

 Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to body malaise secondary to typhoid fever as evidenced by reports of weakness and discomfort.

Desired Outcomes:

  • The patient will be able to gain a sense of control over his/her body through a gradual increase in activity.
  • The patient will be able to return to normal daily activities.
Nursing Intervention for Typhoid FeverRationale
1. Assess the patient’s tolerance to activity.This will help the nurse develop a plan of activities that is attainable for the patient depending on his/her tolerance and capabilities.
2. Assess the patient’s condition which causes the activity intolerance.Treating the underlying condition will provide immediate progress to the patient’s activity intolerance.
3. Document and monitor the patient’s vital signs when active and while at rest.Sudden vital signs changes may also cause activity intolerance like orthostatic hypotension or bradycardia.
4. Assess patients’ nutritional and hydration status.The patient’s weakness can be caused by inadequate nutritional intake and dehydration.
5. Assist the patient in passive range of motion while on the bed then gradually increase to active range of motion.Activities should be planned based on the patient’s tolerance level. A sudden increase in activities may cause exhaustion and non-compliance.
6. Encourage frequent position changes while on bed and padding of bony prominences.Decrease the risk of skin breakdown from prolonged bed rest and inactivity.
7. Administer supplemental oxygen and analgesic as ordered.Patient’s can be reluctant in doing activities due to shortness of breath and giving oxygen helps maintain adequate saturation levels. Patient’s in pain may also have decreased activity and analgesics should be given in case of pain.
8. Educate the patient and significant others about assistive devices.Assistive devices may help to increase tolerance to activities and proper use of the assistive device should be reiterated to decrease the risk of accidents.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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