DIAGNOSTIC INVESTIGATION AND NURSING MANAGEMENT

By | July 11, 2021

DIAGNOSTIC INVESTIGATION

 

Blood for culture reveals Salmonella Typhi in different specimens and different weeks.                       

  1st week in blood

2nd week in stool

  3rd week in urine

Haematologic abnormalities and antibodies titers reveal typhoid fever

Widal test measures titers of antibodies formed against typhoid bacilli

Leucocytosis

History, signs, and symptoms

 

 

MEDICAL/SURGICAL/NURSING MANAGEMENT

MEDICAL TREATMENT

 

This focuses on the eradication of causative agents and the prevention of complications.

Medical treatments given are;

Chloramphenicol 50mg/ kg daily in divided doses for 6 hours for 14 days.

Ciprofloxacin 500mg b.d orally × 14 days.

Blood transfusions to manage anemia.

Intravenous infusions to manage dehydration.

Analgesic to control pain.

Antipyretic to control pyrexia.

 

 

SURGICAL TREATMENT

 

The main focus is to repair the perforation by simple closure or resection and anastomosis. Laparotomy was done.

 

 

NURSING MANAGEMENT

 

REASSURANCE: Reassurance of client to relieve anxiety and agitation. This is done to gain her co-operation in the implementation of procedures.

 

POSITION: When the patient is conscious, the nurse must position him or her in bed according to the severity of the condition but in most cases, the patient is allowed to assume a position he or she feels most comfortable. The patient, who has undergone Laparotomy, is nursed in a recumbent position to ease breathing and prevent falling back of the tongue

DIAGNOSTIC INVESTIGATION AND NURSING MANAGEMENT

REST AND SLEEP: This is ensured for the client to conserve energy, promote relaxation, reduce stress, and aid in speedy recovery. This can be ensured by the nurse providing a firm and a comfortable bed, which is free from creases and regulating the number of visitors. Also minimizing noise, providing adequate ventilation to facilitate relaxation, and if the patient is in pain, serve prescribed analgesics to relieve pain.

 

ISOLATION: The client is admitted for some days before surgery to allow time for thorough investigation and preparation of the patient so that any deficiencies in the patient’s blood chemistry or the general condition are corrected before the operation.                

 

 Client with such a condition is barrier-nursed to prevent cross-infection to the health care members and another client. This can be ensured by nursing her in an isolated room or on the general ward with a screen around her bed. Gloves, gowns, goggles, and boots should be worn when coming into contact with the client’s urine, feces, sputum or vomitus, and vaginal discharge.

Frequent hand washing, which is the cheapest way to prevent cross-infection, should be adopted. All body secretions from clients should be decontaminated before washing. The client should be given a separate cup, spoon, plate, vomiting bowl, bedpan, and urinal. All these should be decontaminated before each use. Her leftover food should be thrown away and decontaminated. All instruments and equipment used on the patient should be properly disinfected and sterilized to prevent cross-infection.

 

NUTRITION: Prescribed parenteral nutrition served. This continued with oral foods as the patient’s condition improves. The food should be a balanced diet rich in vitamins to fight infections, proteins to repair worn-out tissues and to facilitate healing, carbohydrates for energy, and mineral salts for electrolytes.

 

ELIMINATION: Prompt provision of bedpan and urinal to prevent the client from soiling herself. Monitor fluid intake and output chart. Decontaminate stool and urine in 1:10 para zona for ten (10) minutes before disposal.

 

OBSERVATIONS: Quarterly, half-hourly, two hourly, and four hourly, vital signs are checked and recorded as the client’s condition improves. Observe contents, frequency, consistency, color, foreign body in urine and faeces, and any abnormalities in them. Again, observe breathing patterns, the rate, rhythm, and depth. Also observe for side effects and complications of drugs, the orientation of patient to time, place, and person to prevent anxiety.  Weigh patients daily depending on the condition to access the level of fluid retention and output. The intravenous infusion in situ is monitored to observe the drop rate, tissue infiltration, fluid overload, and swelling at the infusion site. Observe for possible complications, especially after surgery, for example, in the case of Laparotomy, which may include intestinal hemorrhage, intra-abdominal abscess, and pneumonia.

 

PERSONAL HYGIENE: Based on the client’s condition, a bed bath or assisted bed bath, may be given at least twice a day. The nurse must pay particular attention to the umbilicus and the skin fold areas to remove dirt, improve circulation, to promote sleep. The skin, nails, and mouth are cared for to promote health and prevent infection. Dirty bed linen is changed regularly to prevent bedsores and promote comfort. The nurse must make sure that the patient is always neat and well-groomed in bed.

 

EXERCISE: Exercise must begin as soon as the client regains full consciousness, these include deep breathing, coughing exercise, and mobilization thus turning the client from side to side, sitting up in bed, and at the edge of the bed. Limb exercise, which includes an active and passive range of motion exercise of the joints and massaging if the limbs are encouraged. Ambulating exercise is started 12-24 hours after surgery, depending on the client’s condition. This is to improve circulation and prevent constipation as well as joint stiffness and bed sores.

 

 

HEALTH EDUCATION: the client is educated on the predisposing factors of the disease condition, signs and symptoms, and the preventive measures related to the disease. Advice is given on the need to use soap to wash hands before and after meals and visiting the toilet. Also, fruits and vegetables should be washed thoroughly with water before consumption. Education is given on personal hygiene; skin, body cleanliness, nails, mouth, and cloth care. Environmental hygiene should be established in the endemic areas. Protection and purification of water must be enforced. Food handlers are also educated to maintain proper handwashing, personal, food, and environmental hygiene. The client is also educated on the desired effect and side effects of drugs and the importance of completion of drugs. The client is informed of follow-ups until she is declared fit.

 

CHEMOTHERAPY: Serve prescribed drugs such as antibiotics to fight infections, analgesics to combat pain, intravenous fluids to prevent hypovolaemia and dehydration, check out for any allergic reaction, desired effects, adverse effects, and complications of drugs.

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