Sabtu, 14 Mei 2011
NURSING CHILDREN WITH typhus abdominalis
A. DEFINITIONS
Thypus abdominalis is a common acute infectious diseases of the digestive tract.Symptoms normally generated is a high fever for more than 1 week, disorders of the digestive tract, and impaired consciousness (Faculty of medicine, 1985).
Typhoid fever caused by Salmonella typhi bacteria with the shoots 6-14 days. While abdominal typhus is an acute infectious disease in the small intestine is usually milder and showed the same clinical manifestations with acute enteritis.
B. Epidemiology
Abdominal typhus disease commonly known as typhoid disease. However, in the medicine called tyfoid fever.
In Indonesia, the estimated incidence of this disease is 300-810 cases per 100,000 population / year. Highest incidence was found in children. Adults often experience a mild infection and heal itself and become resistant. The incidence of patients aged 12 years and older is 70 - 80%, patients aged between 12 and 30 years is 10-20%, patients between 30-40 years is 50-10%, and only 50-10% over 40 years.
C. Etiology
Penyabab this disease is Salmonella typhi, Salmonella the typhii A, and Salmonella paratyphiiB. Gram-negative bacilli, moving with the vibrating hair, not berspora, has 3 kinds of antigen O antigen, H antigen, and antigen VI. In the patient serum contained a substance (aglutinin) to the three kinds of the antigen.
Germs grow in aerobic and facultative anaerobic atmosphere at a temperature of 15-41 ° C (optimum 37 ° C) and growth pH 6-8.
D. SIGNS AND SYMPTOMS
The average incubation period is 2 weeks of symptoms: rapid fatigue, malaise, anorexia, headache, discomfort in the stomach, and pain throughout the body. Fever gradually rises during the first week. Fever occurs mainly in the afternoon and evening (febrile remitten). At weeks 2 and 3 continuous high fever (febrile continuously) and then decreased gradually.
Gastrointestinal disturbances, dry mouth and cracked, dirty tongue-and-white webbed edges hiperemis, abdominal bloating and maybe a little tenderness, relative bradycardia, increased pulse rate does not match the increase in body temperature (Junadi, 1982).
E. Pathophysiology
Infection enter through contaminated food and beverages, infection occurs in the digestive tract. Basil in the small intestine through the lymph vessels into the blood circulation to the organs especially the liver and spleen so enlarged and are accompanied by pain. Basil went back into the blood (bacteremia) and spread throughout the body, especially into the small intestine lymphoid glands à cause ulcers in the intestinal mucosa is elliptical. Ulcers can cause bleeding and intestinal perforation. If conditions remain well preserved body, will form antibodies or antibody.In these circumstances, typhoid germs will die and the patient gradually recovered.
G. EXAMINATION SUPPORT
To diagnose abdominal typhus disease needs to be examination of the laboratory:
1. Peripheral blood
- There is a picture of leukopenia
- And relative lymphocytosis
- Ameosinofila at the beginning of illness
- May have mild anemia and thrombocytopenia
examination results are useful to help determine the disease quickly.
2. Examination Widal
Positive examination in case of agglutination reaction. If the titer of more than 1 / 80, 1 / 160, etc., the smaller the titration showed semaki severe illness.
3. Blood for culture (culture of bile)
H. MANAGEMENT
1. Treatment
a. Chloramphenicol
b. Co-trimoxazole
c. In the event of jaundice and hepatomegaly: besides kloramfenikkol, treated with ampicillin 100 mg / kg / day for 14 days were divided into 4 doses.
2. Treatment
a. Patients treated with the aim of isolation, observation and treatment. Clients must remain lying down until at least 7 days free of fever or 14 days to prevent complications of intestinal bleeding or intestinal perforation.
b. In clients with decreased consciousness, needed perubahan2 lying position to avoid hypostatic pneumonia and decubitus complications.
3. Diet
a. At first, clients are given porridge and gruel coarse filter to avoid the complications of intestinal bleeding and intestinal perforation.
b. The results showed that early solid feeding rice, side dishes low cellulose (abstinence vegetables with coarse fibers) can be given safely to the client.
I. COMPLICATIONS
1. In the small intestine:
Ø intestinal bleeding. Only a few are found if the stool examination with benzidin. If bleeding a lot, there was melena, can be accompanied by abdominal pain.
Ø intestinal perforation. Arises usually in the third week or later and occur at the distal ileum.
Ø peritonitis. Usually accompanies perforation. Found acute abdominal symptoms are severe abdominal pain, abdominal wall tension and tenderness.
2. Outside the gut
Occurred because of localization of inflammation due to sepsis (bacteria), namely meningitis, kolesistisis, enselovati, etc..
J. Prognosis
Generally the prognosis of typhus abdominalis in children is good, provided the client faster treatment. Mortality in the treated client is 6%. The prognosis is not good when there is a severe clinical picture such as:
Ø High fever (hipertireksia) or febrile continue
Ø Awareness is decreased
Ø There are serious complications such as dehydration and acidosis, perforation.
K. PREVENTION
§ By knowing how the spread of disease, it can be controlled.
§ Applying dasar2 hygiene and public health, namely detection and isolation of the source of infection. It should be noted environmental hygiene factors.
§ Disposal of garbage and chlorination of drinking water, protection of food and beverage supply, improvement of economy and improvement of healthy habits and reduce the fly population (reservoir).
§ Provide health education and health examination (examination of feces) regularly to the renderer good food on the food and restaurant industries.
§ Sterilization clothing, materials, and tools used by the client using the antiseptic.Washing hands with soap.
§ Detection of career done with blood tests and followed by examination of feces and urine are carried out repeatedly. Clients who made a positive career closer scrutiny is to provide information about personal hygiene.
L. NURSING
1. Assessment
a. Identity
b. The main complaint
Feeling of malaise, dizziness, headache, lethargy and lack of vibrant, decreased appetite (especially during the incubation period).
c. Data Focus
Eyes: conjunctiva anemis
Mouth: tongue typical (dirty white membrane, the tip and the edge of the redness), breath odor, dry lips and chapped.
Nose: occasional epistaxis
Abdomen: abdominal bloating (meteorismus), hepatomegaly, splenomegaly, tenderness.
Circulation: bradycardia, impaired consciousness
Skin: reddish spots on the back and extremities.
d. Examination Support
Laboratory:
SGOT § SGPT increased, leukopenia, leuukositosis relative in the acute phase, there may be anemia and thrombocytopenia.
§ asidal serological test (titer O, H)
§ germ cultures (blood, feces, urine, bile)
2. Nursing Diagnosis
a. Hipertermi b.d inflammatory process
Objectives:
· Client's body temperature returned to normal
· Clients can perform activities based on their ability
Intervention:
· Identify causes or factors that may cause hipertermi
· Observation of fluid in and out, calculate the water balance
· Leave a liquid as needed if no contraindications
· Leave a warm water compress
· Encourage clients to reduce excessive activity when body temperature rises
· Collaboration: giving antipyretics, antibiotics, supporting = the results of laboratory examination.
Evaluation:
· Client's body temperature returned to normal
· Frequency breathing returned to normal
· Skin client does not palpable heat
· Clients can move
b. Changes in nutrition: less than body requirements inadequate intake bd
Objectives:
· Client nutritional intake adequate
§ Increasing the client's appetite
Intervention:
· Assess the client's diet
· Observation nausea and vomiting
· Identify trigger nausea, vomiting, and abdominal pain
· Kaji food likes and dislikes client
· Sajikaan food in a warm and attractive kedaan
· Leave a semi-Fowler position during meals
· Help clients to eat, note the input of food.
Evaluation:
· Clients say no nausea and vomiting
· Appetite increases
c. Acute pain injuries b.d biological agents
Objectives:
· Pain reduced client
· Clients feel comfortable
Intervention:
· Assess pain characteristics and pain scale
· Assess the factors that can lower / raise the pain
· Teach and help the client make the relaxation and distraction
· Leave a comfortable position
· Create a peaceful environment
Evaluation
· Clients say reduced abdominal pain
· The client said it felt comfortable.
M. BIBLIOGRAPHY
Ngastiyah. 1997. Child Care Hospital. EGC: Jakarta.
Centre for Health Manpower Education. 1992. Foster Child Health in the Context of the Family. Department of Health: Jakarta.
Wahidiyat, Iskandar. 1985. Lecture Book of Pediatrics 2. Child Health Section FKUI: Jakarta.
NIC & NOC
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